Database Search Research Articles

The effectiveness of non-invasive brain stimulation in treatment of major depressive disorder (MDD): a systematic review and transfer analysis.

This study aimed to analyze the transferability of non-invasive brain stimulation (NIBS) interventions in individuals with major depressive disorder (MDD) based on the FIELD model (Function, Implementation, Ecology, Level, and Duration), encompassing function, implement, ecology, level, and duration. A systematic search of electronic databases yielded a total of 21 eligible studies, comprising 12 transcranial direct current stimulation (tDCS) and 9 transcranial magnetic stimulation (TMS) trials, involving 1029 individuals with MDD. The meta-analysis of effect sizes revealed positive transfer effects across all domains of the FIELD model, suggesting that NIBS interventions have potential efficacy in improving various facets of MDD. The subgroup analysis highlighted that bilateral dlPFC stimulation exhibited the highest effect size for transferability, indicating greater transferability for rTMS, a higher dose of stimulation, and the integration of additional interventions. Additionally, the study discusses the implications of bilateral dorsolateral prefrontal cortex (dlPFC) stimulation and the integration of complementary therapies for optimizing treatment efficacy.

Disparities in Breast Cancer Treatment and Reconstruction Among Native Hawaiian and Pacific Islander Women: Systematic Review and Meta-Analysis.

Native Hawaiian and Pacific Islander (NHPI) women experience significant disparities in breast cancer treatment and outcomes, including lower rates of postmastectomy reconstruction, higher refusal rates of radiation therapy, and delays in surgical care. These disparities contribute to poorer survival and increased complications compared to other racial/ethnic groups. This systematic review and meta-analysis aim to quantify these disparities and assess their impact on breast cancer outcomes in NHPI women. A comprehensive search of PubMed, Scopus, and Embase databases was conducted to identify studies reporting on breast cancer surgery, reconstruction, radiation therapy refusal, and surgical delays for NHPI women. Thirteen studies, encompassing a total of 5 546 918 patients, were included, and meta-analyses were performed to pool odds ratios (OR) and hazard ratios (HR) for key outcomes using random-effects models. Heterogeneity was assessed using I² statistics. Thematic analysis was also conducted to explore cultural and structural factors influencing treatment disparities. NHPI women had significantly lower odds of receiving postmastectomy reconstruction compared to non-Hispanic White women (pooled OR = 2.02, 95% confidence interval [CI]: 1.96-2.08, I² = 99%). Delays in surgical care were more frequent, with NHPI women being 4.51 times more likely to experience delays (OR = 4.51, 95% CI: 3.82-5.32, I² = 99%). Radiation therapy refusal was notably higher, with a pooled hazard ratio of 3.28 (95% CI: 2.99-3.58, I² = 77%) indicating that NHPI women who refused radiation therapy had more than three times the risk of mortality compared to those who accepted it. Thematic analysis revealed that geographic isolation, limited access to specialized care, and cultural perceptions surrounding cancer treatments, including fear of radiation due to historical trauma, contributed significantly to treatment disparities. Native Hawaiian and Pacific Islander women face considerable barriers to receiving equitable breast cancer treatment and reconstruction, resulting in worse outcomes compared to other racial/ethnic groups. Efforts to address these disparities must focus on improving access to care, reducing treatment delays, and implementing culturally sensitive interventions. Targeted policies and healthcare system improvements, especially in geographically isolated areas, are critical to improving survival and treatment outcomes for NHPI women.

Dienogest versus gonadotropin-releasing hormone analogues for the clinical treatment of endometriosis: an updated meta-analysis

Endometriosis is a chronic gynecological condition where endometrial-like tissue grows outside the uterus, leading to persistent pelvic pain, dysmenorrhea, dyspareunia, and infertility. The objective of the systematic review was to examine the efficacy and safety of Dienogest, which is a synthetic, orally active 19-nortestosterone derivative, in the treatment of women with endometriosis compared to GnRH-a, which is commonly used to treat conditions like endometriosis. We conducted a search of PubMed, Google Scholar, and Cochrane Library databases from inception until August 2024 for clinical studies, using the following keywords: ("Dienogest") and ("gonadotropin-releasing hormone analogue" or GnRH Analogues OR GnRH agonist) and (Endometriosis). Relevant randomized control trials were identified. Pooled effect estimates were calculated using a random effect model. This meta-analysis included eight randomized controlled trials (RCTs) with 1,219 patients, 602 in the dienogest group and 617 in the GnRH analogue group. Both treatments were equally effective in controlling pain, dysmenorrhea, and dyspareunia, but dienogest offered advantages. Dienogest significantly reduced the recurrence rate (RR: 0.37, 95% CI [0.15, 0.91]; p=0.03) and hot flushes (RR: 0.24, 95% CI [0.10, 0.59]; p=0.002) and protected against bone mineral density (BMD) loss. However, it increased the risk of irregular vaginal bleeding (RR: 3.61, 95% CI [1.09, 11.97]; p=0.04). Other side effects, such as headache, vaginal dryness, spotting, and alopecia, were not statistically significant. It concluded that Dienogest has comparatively fewer side effects than GnRH analogue, making it a considerably safer option for treating endometriosis.

Risk factors associated with human echinococcosis: a systematic review and meta-analysis.

Echinococcosis is a widespread zoonotic disease caused by tapeworms of the Echinococcus genus, manifesting in mature or larval forms. Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are the primary types affecting humans, linked, respectively, to Echinococcus granulosus and Echinococcus multilocularis. This study is a systematic review and meta-analysis of the risk factors associated with CE and AE in humans. Relevant English publications were found through a thorough search of eligible databases. The inclusion criteria focused on cross-sectional and case-control studies investigating risk factors for human echinococcosis. Collected data included author, country, study design, demographics, sample size, literacy, occupation, drinking water source, dog ownership, and hand hygiene. A total of 1,594 studies were found in the initial search, with only 36 papers (involving 1,207,436 cases) meeting the inclusion criteria. Most of the study population (99.35%) showed no echinococcosis infection, while 0.65% were infected. Of the infected cases, 77.92% had CE, while 22.08% had AE. Among 629,996 (52.18%) females, 4,830 (0.76%) were infected, compared to 2,968 (0.52%) infections among 565,872 (46.86%) males (p < 0.001). Rural areas, low education levels, agricultural/livestock workers, dog owners, water sources, and poor hand hygiene were all significantly associated with the infection (p < 0.05). Echinococcosis remains a global health concern, particularly among rural residents, those with lower education, agricultural workers, and dog owners. Targeted public health measures, including improved hygiene practices and access to clean water, are essential to reducing its impact.

Efficacy and safety of resmetirom for the treatment of nonalcoholic steatohepatitis: a GRADE assessed systematic review and meta-analysis.

There are no Food and Drug Administration (FDA)-approved treatment options for nonalcoholic steatohepatitis (NASH) which is a prevailing disease that leads to fibrosis, cirrhosis, or hepatocellular carcinoma. Hence, this systematic review and meta-analysis aims to determine the efficacy and safety of resmetirom, the first FDA-approved drug, for the treatment of NASH. A Grading of Recommendations, Assessment, Development, and Evaluation assessed systematic search of Cochrane Library, MEDLINE, Scopus, and Google Scholar database was conducted from inception till 31 March 2024. Meta-analyses were carried out in accordance with the PRISMA statement. Heterogeneity was determined to be significant if found above 50%. This meta-analysis encompasses three randomized clinical trials, including a total of 2231 patients. The findings show resmetirom's significant efficacy in several key outcomes, including improvement in fibrosis risk ratios, 1.67 [95% confidence intervals (CI), 1.26-2.20], reductions in liver fat content (95% CI, -39.58 to -23.5), and enhanced liver fibrosis score (95% CI, -0.37 to -0.13) along with improved levels of liver enzymes. Resmetirom was found to be associated with nausea and diarrhea. This is the first systematic review and meta-analysis to determine the safety and efficacy of resmetirom which showed significant positive results in fibrosis improvement, liver fat content, lipid profiles, and liver enzymes in comparison to placebo. Moreover, moderate side effects, such as diarrhea and nausea, were seen in few patients indicating a satisfactory safety profile.

Overview of evidence-based research on acupuncture for stroke treatment using magnetic resonance imaging technology.

Stroke is a neurological condition characterized by high rates of disability and mortality. Magnetic resonance imaging (MRI) is widely used to examine the mechanisms of acupuncture in stroke treatment. This review provides neuroimaging evidence for the efficacy of acupuncture in treating stroke using MRI. We conducted a comprehensive search of databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Data, Chinese BioMedical Literature Database (CBM), and Chonqing VIP (CQVIP), from inception to April 2024. Relevant neuroimaging studies on acupuncture for stroke were included, and the research findings were presented through charts and textual analyses. A total of 158 studies were included, and the overall methodological quality of the included studies was moderate to high. The results were divided into three categories: basic characteristics, clinical characteristics, and quality assessment of the included literature. We elucidated the neural mechanisms underlying the effects of acupuncture on stroke; however, the evidence remains preliminary. There is a need for large-scale, well-designed, multimodal neuroimaging trials. This review represents the first active use of an evidence map to systematically review and illustrate the current state of neuroimaging research on the acupuncture treatment of stroke, thereby providing a valuable reference for future research.

RBP-Tar – a searchable database for experimental RBP binding sites

Background RNA-binding proteins (RBPs) play a critical role in regulating gene expression by binding to specific sites on RNA molecules. Identifying these binding sites is crucial for understanding the many functions of RBPs in cellular function, development and disease. Current experimental methods for identifying RBP binding sites, such as ultra-violet (UV) crosslinking and immunoprecipitation (CLIP), and especially the enhanced CLIP (eCLIP) protocol, were developed to identify authentic RBP binding sites experimentally. Methods To make this data more accessible to the scientific community, we have developed RBP-Tar (https://ncbr.muni.cz/RBP-Tar ), a web server and database that utilises eCLIP data for 167 RBPs mapped on the human genome. The web server allows researchers to easily search and retrieve binding site information by genomic location and RBP name. Use case Researchers can produce lists of all known RBP binding sites on a gene of interest, or produce lists of binding sites for one RBP on different genomic loci. Conclusions Our future goal is to continue to populate the web server with additional experimental datasets from CLIP experiments as they become available and processed, making it an increasingly valuable resource for the scientific community.

Factors influencing patient satisfaction in home care services: A systematic review

Background Home care services are an extension of hospital services provided by hospital staff. The hospital must conduct evaluation, coordination, and education for home care patients to ensure proper care and expedite their recovery. This service also introduces a new concept to the community, as it can help save on costs and equipment. The purpose of this study has been added to the background, namely to determine what factors can influence patient satisfaction with home care services from previously published literature. A systematic review examined the factors influencing patient satisfaction using home care services by following the PRISMA guidelines. PROSPERO submitted and approved the study protocol with the following numbers: CRD42023482315. Researchers have searched articles through the ScienceDirect, Scopus, and Google Scholar databases. The researcher chose the three databases that are open access providers. Including Scopus and ScienceDirect are article search databases that can be accessed directly in the electronic resources of the University of Indonesia Library. The 10-year time span is considered as a source of literature that is still relevant to be used as a reference in evaluating home care service satisfaction. Result Two hundred eighty-eight articles were selected, but 10 met the inclusion criteria. It was found that factors influenced patient satisfaction with home care services and two things that did not affect them: financial aspects and working time. Conclusion Fifteen aspects influence patient satisfaction and two aspects that do not influence patient satisfaction. It is expected that the results of this literature review can be used as a reference for hospitals that provide home care services to pay attention to aspects that can affect satisfaction. The author realizes that the varying methods in the articles reviewed are deficiencies in the results of this study.

Therapeutic Potential of Solenopsis invicta Venom: A Scoping Review of Its Bioactive Molecules, Biological Aspects, and Health Applications

Solenopsis invicta, a South American ant species from the Formicidae family (subfamily Myrmicinae), has recently established a stable settlement in Europe, raising public health concerns due to its venomous stings. The venom of S. invicta is rich in bioactive molecules, particularly piperidine alkaloids such as solenopsin A and peptides (Sol 1–4). These compounds have been implicated in various health applications, including antimicrobial, anti-inflammatory, and antitumour activities. While previous reviews have focused on the ecological and allergenic risks posed by S. invicta, this scoping review aims to evaluate the potential therapeutic uses of S. invicta venom by summarizing existing scientific evidence and providing a novel synthesis of recent research on its bioactive components. Furthermore, this study, by describing the unique biological aspects of S. invicta, provides an overview of its direct impact on public health, highlighting new findings on the venom’s role in inhibiting bacterial biofilm formation and modulating cancer growth pathways through gene regulation. A search of databases (PubMed, Scopus, Science Direct, and Cochrane Library) identified 12,340 articles, from which 11 studies met the eligibility criteria. These studies included seven microbiological investigations and four studies on tumour cell lines and animal models. The findings suggest that S. invicta venom could inhibit biofilm formation, combat fungal infections, and suppress tumour growth. However, further research, including clinical trials, is required to fully elucidate the safety and efficacy of these bioactive molecules in human medicine, for their potential use in drug discovery to counteract several diseases, including cancer.

Are Imaging Evaluations of Soft-Tissue Masses Before Referral to a Specialized Center Being Performed Properly? A Systematic Review

Background/Objectives: Since the initial approach towards the clinical presentation of soft-tissue masses is challenging for frontline physicians, some countries use clinical practice guidelines. Proper imaging work-up is crucial to differentiate between soft-tissue tumors. Recently, ultrasonography and magnetic resonance imaging (MRI) have been widely used. But there is some controversy about whether pre-referral evaluations are being conducted properly. Thus, this study aims to assess whether the ultrasonography investigation of soft-tissue masses prior to referral to the musculoskeletal tumor center is being performed adequately in terms of indications, diagnostic accuracy, and referral interval, and to evaluate whether the pre-referral MRI for soft-tissue masses is being conducted reasonably concerning indications, imaging protocol, reporting, diagnostic accuracy, and cost-effectiveness. Methods: The study protocol was registered. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We performed a database search of the MEDLINE, Embase, and Cochrane Library. Then, two authors reviewed the studies, and the third author resolved any disagreement between them. A total of nine studies were included. The Risk Of Bias In Non-Randomized Studies-of Interventions was applied. Relevant data were extracted by two authors. Results: This review showed that the way that the imaging investigations are performed in non-specialized centers before referral was generally considered inappropriate. Conclusions: Frontline physicians should regard the alarm symptom as an indication for advanced imaging evaluation. Education and certification may be required for ultrasonography. MRI should be performed and interpreted in a specialized center or by a specialist with relevant expertise. Guidance may help reduce inappropriate imaging.

Impact of Physical Activity on Digestive System Diseases

ABSTRACT Introduction: Digestive system diseases, including IBD, and GERD, are prevalent health concerns worldwide. Physical activity, widely acknowledged for its health benefits, has emerged as a promising area of research for its potential in mitigating symptoms and influencing risk factors associated with digestive system diseases. This study aims to critically assess existing evidence on the role of physical activity in the prevention, symptom management, and progression of prevalent digestive disorders. Materials and Methods: A systematic review of pertinent studies was conducted through comprehensive searches in databases including PubMed, NCBI and Google Scholar. The data were sourced from clinical and experimental studies, evaluated for methodological rigor, participant characteristics, and therapeutic outcomes. State of knowledge: The analysis demonstrated that physical activity can exert beneficial effects on digestive health through mechanisms such as enhanced gut motility, reduced inflammation, and increased microbiota diversity. Moderate-intensity aerobic exercise was associated with reduced risk and symptom improvement in patients with IBS and IBD, while high-intensity exercise showed variable effects, with potential symptom exacerbation in certain cases. Additionally, exercise correlated with a lower incidence of GERD, likely due to benefits in weight management. Despite these positive associations, inconsistencies in study design and exercise protocols underscore the need for standardized guidelines on physical activity tailored to specific digestive conditions. Conclusions: Physical activity appears to play a beneficial role in managing and potentially preventing certain digestive system diseases. While moderate exercise shows promise in symptom alleviation and risk reduction, further research is necessary to establish clear, condition-specific exercise recommendations.

Choice of primary healthcare providers among population in urban areas of low- and middle-income countries—a protocol for systematic review of literature

IntroductionStrengthening and reforming the urban primary healthcare (PHC) system is essential to efficiently deliver need-based healthcare services to the rapidly increasing urban poor population. Such reforms of PHC system need to emphasize the opinion of patients in co-designing services in order that delivery of services can be accessed effectively by the urban population in a timely and low-cost way. Hence, it is important to identify the preference of urban population while choosing healthcare providers. The aim of this proposed protocol is to summarize a planned systematic review of existing evidence on the attributes considered for choosing PHC providers in urban settings of low- and middle-income countries (LMICs), as classified by the World Bank.Methods and analysesAn inclusive literature search will be conducted in electronic databases including Pubmed/MEDLINE, Embase, Global Health, Cochrane Library, Web of Science, and Scopus. Databases will be searched from the earliest date of entry until March 30, 2024. Database search will be supplemented by manual search of citations, reference lists, and grey literature sources. Following the pre-set inclusion and exclusion criterion, two researchers will independently screen all the retrieved studies in Covidence. Any discrepancies will be resolved through a discussion between two researchers, and if disagreements persist, a third reviewer will be consulted. The methodological quality of included studies will be appraised using checklist for Conjoint Analysis studies and the Mixed Methods Appraisal Tool (MMAT). An Excel-based data extraction table will be developed, piloted, and refined during the review process. Preference attributes will be identified and analyzed according to their types. The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines.DiscussionThe identification of attributes, their influence on preference, and heterogeneity with socioeconomic characteristics of the population will help the policymakers and researchers to design targeted PHC interventions. Such evidence will be also useful to design choice experiment studies to quantify the preferred attributes of PHC providers in urban context of LMICs.Systematic review registrationPROSPERO CRD42023409720.

Analysis of the usefulness and benefits of ultrafiltration in cardiorenal syndrome: A systematic review.

Cardiac decompensation in cardiorenal syndrome (CRS) results in systemic congestion usually treated with diuretics. When despite high doses of diuretics, response is poor, ultrafiltration (UF) appears to be a useful and safe technique. The aim of the study was to analyse, by means of a systematic review, the efficacy and safety of UF versus conventional diuretic treatment. Search of the main databases (Pubmed, Embase and Cochrane Central Register of Controlled Trials) identifying comparative studies of UF versus diuretic therapy, from 2000 to the present. After screening the studies, 13 studies were analysed; 1100 patients (UF: 532, diuretic treatment: 568). Renal function: UF showed a trend to lower creatinine at discharge (SME=-0.68; 95% CI -1.50 to 0.13; I2=97%) with no difference in glomerular filtration rate (SME=0.05; 95% CI -0.17 to 0.27; I2=0%). Diuretic response: With UF, there was a trend towards greater weight loss (SME=1.82; 95% CI -0.79 to 4.42; I2=99.7%) and greater volume removed (SME=3.04; 95% CI -2.13 to 8.20; I2=99.8%). Morbidity and mortality: No difference in days of hospital stay (LogOR=-0.14; 95% CI -0.52 to 0.23; I2=66.9%) and mortality at 1month (LogOR=-0.04; 95% CI -0.34 to 0.44; I2=0%) but reduction in readmissions in patients with UF (LogOR=-0.60; 95% CI -0.94 to -0.26; I2=40.5%). In decompensated HF and CRS with inadequate diuretic response, UF versus diuretic intensification is an effective and safe option; it reduces readmissions with a tendency to decrease weight, creatinine levels and increase volume depletion without affecting mortality. Prospective randomised studies with a sufficient number of patients are needed to corroborate these results.

Pattern-Based Genome Mining Guides Discovery of the Antibiotic Indanopyrrole A from a Marine Streptomycete.

Terrestrial actinomycetes in the genus Streptomyces have long been recognized as prolific producers of small-molecule natural products, including many clinically important antibiotics and cytotoxic agents. Although Streptomyces can also be isolated from marine environments, their potential for natural product biosynthesis remains underexplored. The MAR4 clade of largely marine-derived Streptomyces has been a rich source of novel halogenated natural products of diverse structural classes. To further explore the biosynthetic potential of this group, we applied pattern-based genome mining, leading to the discovery of the first halogenated pyrroloketoindane natural products, indanopyrrole A (1) and B (2), and the bioinformatic linkage of these compounds to an orphan biosynthetic gene cluster (BCG) in 20 MAR4 genomes. Indanopyrrole A displays potent broad-spectrum antibiotic activity against clinically relevant pathogens. A comparison of the putative indanopyrrole BGC with that of the related compound indanomycin provides new insights into the terminal cyclization and offloading mechanisms in pyrroloketoindane biosynthesis. Broader searches of public databases reveal the rarity of this BGC while also highlighting opportunities for discovering additional compounds in this uncommon class.

Ethiopian residents’ knowledge and attitude towards blood donation and its associated factors: systematic review and meta-analysis

IntroductionDespite the existence of numerous blood donation centers globally, there remains a significant gap between the demand and supply of blood. In Ethiopia, replacement blood donation is more common than voluntary donation. The National Blood Bank of Ethiopia collects approximately 200,000 units of blood each year, while the daily requirement is 18,000 units. Donors’ knowledge and attitudes are vital for ensuring a steady blood supply. This systematic review and meta-analysis sought to evaluate the knowledge and attitudes of Ethiopian residents regarding blood donation and the factors influencing them.MethodsRelevant research articles were identified through searches of various databases. Data extraction and organization were performed using Microsoft Excel, and the data were then analyzed using STATA/MP 17.0. A weighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data. Heterogeneity was examined with the Galbraith plot and Cochrane I² statistics. To identify sources of heterogeneity, meta-regression, subgroup analysis, and sensitivity analysis were conducted. Publication bias was assessed using Egger’s test and managed with trim and fill analysis. The adjusted odds ratio was calculated to explore the relationship between knowledge and attitudes towards blood donation, with a significance threshold of p < 0.05.ResultsThe pooled prevalence of favorable attitudes towards blood donation was 65.95%. Moderators such as study year (p = 0.72), publication year (p = 0.877), and sample size (p = 0.291) were not significant, indicating they did not contribute to heterogeneity. Studies from Northern Ethiopia reported the highest prevalence of favorable attitudes at 69.95%, while research on healthcare workers also indicated a high proportion of favorable attitudes at 69.29%. There was a significant association between knowledge and attitudes towards blood donation (AOR = 2.03).ConclusionThe pooled prevalence of favorable attitudes towards blood donation was 65.95%, with the highest levels observed in Northern Ethiopia and among healthcare workers. A significant association between knowledge and positive attitudes towards blood donation was found. To enhance attitudes towards blood donation, increasing public awareness and education about the importance and safety of donating blood is crucial.

My ‘normal’ isn't your normal...What is maternal wellbeing? A scoping review

ProblemMany global health strategies are developed to optimise ‘maternal wellbeing’. However, what is meant by this term and therefore how it is interpreted and understood by different groups of people is currently poorly understood. BackgroundFor midwives to provide woman-centred care they must recognise the diverse understandings of what is considered ‘maternal wellbeing’ and be able to identify factors underpinning this. AimTo identify and synthesise the literature related to the meaning and understanding of the term ‘maternal wellbeing.’ MethodsA search of PubMed, CINAHL Ultimate, OVID and Emcare databases was conducted between 2015 and 2024 for studies related to maternal wellbeing. Data from fourteen studies were charted and thematically analysed. FindingsTwo overarching but interrelated themes were identified. One refers to the inner self, and the second to the woman's place in her social world. Theme 1, sense of self, comprises two sub-themes: finding a sense of self and sustaining a sense of self. Theme 2, the sense of place, comprises two sub-themes: sustaining place and making space in place. DiscussionDisconnects between the practice-oriented concept of wellbeing and wellbeing as perceived by women exist. Current maternal wellbeing assessment methods only measure the woman's sense of identity, and sense of self in their changed worlds. ConclusionClear articulation of maternal wellbeing is needed to operationalise health strategies, institutional policies, procedures and standards of care that support positive maternal and infant outcomes. Midwives are pivotal to promoting maternal wellbeing during transitions across the pregnancy, birth, and motherhood continuum.

Erector spinae plane block versus quadratus lumborum block for abdominal surgery: A systematic review and meta-analysis.

The erector spinae plane block (ESPB) and quadratus lumborum block (QLB) are two novel interfascial plane block techniques with possible analgesic effects for both incisional and visceral pain. However, the results of the intercomparison of the two techniques for analgesia after abdominal surgery remain controversial. A systematic literature search was performed on five databases for randomized controlled trials comparing the analgesic efficacy of ESPB and QLB in abdominal surgery. The primary outcome was the 24 h postoperative intravenous IV morphine-equivalent consumption. A meta-analysis was performed using a random-effects model, with subgroup analyses based on the types of surgery and approaches of QLB. The 24 h postoperative IV morphine-equivalent consumption was lower in patients receiving ESPB than in those receiving QLB (MD -2.307mg; 95% CI ‒4.577 to -0.038; p=0.046; and I2=96.5%), though the reduction did not reach clinically meaningful difference. Static and dynamic pain at different postoperative time points, the time to first rescue analgesia, and the incidence of PONV showed no significant difference between the two groups. However, the QLB group demonstrated a significantly prolonged time in performing the block compared to the ESPB group (MD -2.985min; 95% CI -4.608 to -1.363; p<0.001; and I2=97.5%). Based on the available evidence from a systematic search of databases, the single-shot ESPB exhibits similar analgesic effects as QLB in abdominal surgery. The incidence of PONV was similar between the two techniques, with no block-related complications identified though QLB might be a more technically challenging approach than ESPB.

The correlation of shift work and CLOCK, BMAL1, and PER1 gene polymorphisms with hypertension in healthcare workers: A cross-sectional study

This study aimed to investigate the polymorphisms of circadian clock genes and the association of shift work and gene polymorphisms with hypertension in healthcare workers. This study recruited 222 healthcare workers, of whom 76 had primary hypertension (Hyp group) and 146 served as controls (Control group). General information and working hours were collected through questionnaires. Next, the identification of specific single nucleotide polymorphism (SNP) loci related to the Circadian locomotor output cycles kaput (CLOCK), brain and muscle arnt-like 1 (BMAL1), and PER1 genes was conducted by literature and PDGene database search. Venous blood samples were then collected for DNA extraction, and polymerase chain reaction-restriction fragment length polymorphism techniques were used to analyze the genotyping and allele frequency of the SNP sites. Finally, multivariate logistic regression was employed to analyze the association between various risk factors and hypertension in healthcare workers. Compared to the control group, the Hyp group had significantly higher proportions of alcohol consumption and family history of hypertension, while the average sleep duration and average exercise time were significantly lower. Shift work analysis showed that the Hyp group had a significantly lower average number of evening shifts per month while a much higher average number of night shifts per month compared to the control group. The GG genotype at the CLOCK rs1801260 locus was associated with a lower risk of hypertension (OR = 0.446), and the TT genotype of the BMAL1 rs11022775 locus also showed a similar protective effect (OR = 0.426). However, the genotype distribution of the PER1 rs2735611 locus was not significantly associated with the risk of hypertension. Multivariate regression analysis revealed that a family history of hypertension and insufficient sleep were significantly associated with the risk of hypertension, and the average number of night shifts per month was positively correlated with the risk of hypertension. Specific polymorphisms in the CLOCK and BMAL1 genes may have a protective effect against hypertension in healthcare workers, while polymorphisms in the PER1 gene are not significantly associated with the risk of hypertension. Additionally, a family history of hypertension, insufficient sleep, and shift work patterns may be significant risk factors for hypertension.

Using the German National Medication Plan for Clinical Studies in Practice-Based Research Networks.

The German National Medication Plan (GNMP) can be a valuable and interoperable data source for clinical studies, due to its digital specification and mandatory provisioning for chronically ill patients. Digital transfer of a patients current GNMP from the Patient Data Management System (PDMS) into electronic case report forms would avoid error prone manual data capturing. It is also essential for studies in practice-based research networks (PBRN), where data capturing must have as little impact as possible on everyday practice. The following issues are currently preventing seamless digital integration: There is no standardized interoperable export of the GNMP from PDMS. In the current form, pharmaceutical catalogs are needed to decode the contained pharmaceutical registration numbers. As accessibility to the pharmaceutical catalogs is restricted, there is no generic access to the actual information needed for study data evaluation. In order to conduct studies, feasible workarounds for these issues had to be implemented in the standard operating procedures, tools and participating GP practices. To overcome the GNMP's current lack of digital interoperability, the proposed solution combines semi-automated data export from PDMS at the GP practice and manual database search at the study center with a semi-automated processing pipeline to balance workload between GP practices, study management and evaluation.

Evaluating safety and efficacy of plastic versus metal stenting in malignant hilar biliary obstruction: a systematic review and meta-analysis of randomized controlled trials.

Stenting malignant hilar biliary obstruction (MHBO) is challenging due to its complex structure, and it is less effective than blockages in the distal bile duct area. Plastic stents (PSs) and metal stents (MSs) are commonly used for stenting MHBO. This study aims to compare the outcomes of PSs and MSs in MHBO patients. We conducted a search of medical databases up to March 2024. Using a fixed-effect model, we analyzed the risk ratios (RRs) of the outcomes between the PS and MS groups. We calculated the RR for clinical and technical success, reinterventions, and adverse events, as well as the hazard ratio (HR) for survival and stent patency. This analysis includes five randomized controlled trials (RCTs) that met the inclusion criteria, comprising a total of 322 patients (156 in the PS group and 166 in the MS group). Significant differences (P < .05) in favor of the MS group were found in the reinterventions (RR 1.80, 95% CI 1.07-3.04), and stent patency (HR 0.54, 95% CI 0.32-0.90). There were no significant differences (P > 0.05) between the PS and MS groups regarding technical success (RR 1.01, 95% CI 0.94-1.09), clinical success (RR 0.86, 95% CI 0.69-1.07), overall survival (HR 0.71, 95% CI 0.47-1.05), stent migration (RR 0.69, 95% CI 0.08-6.02), stent occlusion (RR1.32, 95% CI 0.97-1.81), and adverse events (RR 0.80, 95% CI 0.53-1.20). Both PS and MS are effective for managing MHBO, while MS offers greater efficacy in increased stent patency and lower reintervention rates. Key message What is already known on this topic Metal stents (MSs) and plastic stents (PSs) are used for palliative treatment of malignant hilar biliary obstruction (MHBO). MSs significantly reduced the need for reinterventions compared to PSs in patients with MHBO. What this study adds There were no significant differences between MSs and PSs in terms of technical success, clinical success, overall survival, stent migration, stent occlusion, or adverse events. How this study might affect research, practice, or policy The study's findings may prompt researchers to design more targeted studies to further investigate these specific outcomes in MHBO patients. The results encourage endoscopists to consider patient-specific factors, such as life expectancy and preference for minimizing recurrent procedures, when choosing between MSs and PSs for MHBO.