Standardized Mean Difference Research Articles

Evaluation of the efficacy and safety of acupuncture assisted treatment for atrial fibrillation: A systematic review and meta-analysis based on randomized controlled trials.

To systematically evaluate the efficacy and safety of acupuncture in the treatment of atrial fibrillation (AF). Eight databases were searched. The search time limit is from January 2000 to November 2023. All randomized controlled trials on acupuncture treatment of AF were included. After the literature screening, data extraction and quality evaluation were carried out independently according to the inclusion and exclusion criteria, and the included literature was analyzed by Meta using RevMan 5.4 software. A total of 15 research studies on randomized controlled trials were included, involving 1960 patients. The results of the meta-analysis showed that acupuncture therapy could increase the sinus cardioversion rate of patients with AF, and the difference was statistically significant (relative risk = 1.21, 25% confidence interval (CI) [1.11, 1.31], P < .001). The clinically effective rate of the acupuncture plus drug treatment group was higher than that of the drug treatment group (relative risk = 1.32, 95% CI [1.19, 1.46], P < .01). Acupuncture plus other conventional therapies treatment was more helpful in reducing the ventricular rate of patients with AF (mean difference = -7.89, 95% CI [-14.52, -1.26], P = .006). The cardioversion time of patients with AF treated with acupuncture plus conventional therapies was shorter than those treated with traditional therapies alone (standardized mean difference = -1.82, 95% CI [-3.28, -0.35], P = .01). No severe adverse reactions such as hemorrhage, hematoma, or local infection caused by acupuncture were reported in the study. The available evidence shows that acupuncture can effectively improve the total clinical effective rate and sinus rhythm recovery rate, shorten the recovery time of sinus rhythm, and reduce the ventricular rate, and there are no apparent adverse reactions. However, a limited number of studies may affect the generalizability of the findings. Future studies should include more extensive and diverse studies to enhance the power and generalizability of the findings.

Effectiveness of non-pharmacological interventions for pain reduction following chest tube removal: A systematic review and network meta-analysis

ObjectiveThis study aimed to determine the most effective non-pharmacological intervention for pain relief following chest tube removal in adult patients. MethodsWe performed a systematic review with network meta-analysis, searching electronic databases for randomized controlled trials up to January 20, 2024. Compared to control or placebo groups, the trials included adult patients receiving non-pharmacological interventions, such as cold therapy, relaxation exercises, music therapy, transcutaneous electrical nerve stimulation, or aromatherapy. Data analysis utilized a random-effects model, reporting standardized mean differences (SMD) with 95% confidence intervals (CI), and treatment ranking was determined through surface under the cumulative ranking analysis and forest plots. ResultsSixteen studies enrolling 1,342 patients were included, with moderate to high heterogeneity. Cold therapy and relaxation exercises effectively reduced pain after chest tube removal, with SMD of −1.84 (95 % CI: −2.81 to −0.87) and −2.04 (95 % CI: −3.43 to −0.65), respectively, from baseline to immediately post-removal. From baseline to ten to twenty minutes after removal, both therapies continued to show significant pain reduction, with SMD of −1.96 (95 % CI: −3.14 to −0.77) for cold therapy and −2.01 (95 % CI: −3.75 to −0.28) for relaxation exercises. Sensitivity analysis supported these findings, and cold therapy’s efficacy appeared unaffected by obesity. However, publication bias, possibly due to small study samples, was noted. ConclusionsCold therapy and relaxation exercises proved most effective for reducing pain immediately and up to ten to twenty minutes after chest tube removal. Given their cost-effectiveness, lack of side effects, and ease of use, we recommend relaxation exercises as a practical alternative to cold therapy. Nonetheless, further studies are needed to comprehensively assess non-pharmacological options for managing chest tube removal pain. Implications for clinical practiceIncorporate cold therapy and relaxation exercises into post-chest tube removal pain management to improve patient comfort and minimize reliance on pharmacological interventions.

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.

Circulating Fetuin-A concentrations in rheumatic diseases: asystematic review and meta-analysis.

Rheumatic diseases (RDs) include a broad group of disabling conditions with different phenotypes, from autoimmune to autoinflammatory, degenerative, metabolic or mixed manifestations. With the continuous efforts to identify therapeutic targets for new biologic drugs to treat overt clinical manifestations, research is also focusing on the discovery of new biomarkers to diagnose and manage early disease stages. In this context, we conducted a systematic review and meta-analysis of Fetuin-A (FtA), a glycoprotein synthesized by the liver that participates in several biological processes and has been proposed as a biomarker for several disorders, including rheumatoid arthritis. A systematic search in PubMed, Scopus and Web of Science, from inception to the 24th of August 2024, led to the identification of 13 manuscripts from 219 records; six additional studies were identified through reference hand-search, for a total of 19 studies. There was a significant decrease in FtA concentrations in RD patients (standardized mean difference, SMD = -.91; 95% CI -1.43 to -.39, p = .001), with no substantial contribution from any individual study nor publication bias. The effect size was significantly associated with erythrocyte sedimentation rate, various lipid fractions, geographical area of study conduction, study design and specific type of RD. In conclusion, our study identified significant reductions in FtA concentrations in RD patients versus healthy controls. These alterations were significantly associated with specific study and patient characteristics. Further research is required to identify the exact pathophysiological mechanisms underlying these alterations and the possible utility of measuring FtA for the diagnosis and management of RDs.

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

Aims To evaluate the efficacy and safety of tranexamic acid combined with rivaroxaban in prevention of clinical events in patients after TKA/THA through meta-analysis of randomized controlled trials. Materials and Methods Randomized Controlled Trials (RCTs) were retrieved from medical literature databases. Risk ratios (RR) Standard mean difference (SMD) and 95% confidence intervals (CI) were calculated to compare the primary and safety endpoints. Results In total, 21 articles (32 trial comparisons) were retrieved which contained 2909 patients. In general, 1718 patients (59.06%) were randomized to experimental group whereas 1191 patients (40.94%) were randomized to control group. The result showed that TXA combined with rivaroxaban significantly reduce TBL, BTV, BTR and the incidence of MB compared to the control group; there were no significant differences in NMB between experimental group and control group. Conclusion This meta-analysis reveals that TXA combined with rivaroxaban can significantly reduce TBL, BTV, the incidence of blood transfusion and the incidence of MB compared to the control group, which proved that its efficacy and safety are trustworthy.

Relationship between number of different lower-limb resistance exercises prescribed in a program and exercise outcomes in people with knee osteoarthritis: A systematic review with meta-regression.

Determine whether there is a relationship between the number of different lower-limb resistance exercises prescribed in a program and outcomes for people with knee osteoarthritis. Systematic review with meta-regression. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase up to 4th January 2024. We included randomised controlled trials that evaluated land-based resistance exercise for knee osteoarthritis compared with non-exercise interventions. We conducted meta-regressions between number of different exercises prescribed and standardised mean differences (SMD) for pain and function. Covariates (intervention duration, frequency per week, use of resistance exercise machine/s, and comparator type) were applied to attempt to reduce between-study heterogeneity. 44 trials (3,364 participants) were included. The number of resistance exercises ranged from 1-12 (mean 5.0; standard deviation 3.0). Meta-regression showed no relationship between the number of prescribed exercises and change in pain (slope coefficient: -0.04 SMD units [95% confidence interval (CI): -0.14 to 0.05) or self-reported function (-0.04 [-0.12 to 0.05]). There was substantial heterogeneity and evidence of publication bias. However, even after removing 31 trials that had overall unclear/high risk of bias, there was no change in relationships. There was no relationship between the number of different lower-limb resistance exercises prescribed in a program and change in knee pain or self-reported function. However, given that we were unable to account for all differences in program intensity, progression, and adherence, as well as the heterogeneity and overall low quality of included studies, our results should be interpreted with caution.

EFEITOS DOS EXERCÍCIOS DE PILATES NO EQUILÍBRIO ESTÁTICO E DINÂMICO DE IDOSOS: REVISÃO SISTEMÁTICA E META-ANÁLISE

During aging, some organic and functional deficits occur. The most effective intervention for its prevention is resistance exercise, but another possibility is Pilates. Despite the evidence of its influence on the elderly, its improvement in the dynamic and static balance of this population has not yet been fully elucidated. The objective was to verify the effects of Pilates exercises on static and dynamic postural balance in elderly people. The searches took place in the following databases: PubMed, EMBASE, CENTRAL, CINAHL, Web of Science, SPORTDiscus, LILACS and PEDro. The methodological quality was assessed by PEDro. Meta-analyses were performed using the standardized mean difference between groups. 35 studies were included in the review, of which 13 were considered of good quality, with a significant result (p&lt;0.05) of Pilates exercises in relation to the control group. Therefore, practicing Pilates exercises for the elderly is beneficial for dynamic and static balance.

Diagnostic significance of neutrophil-to-lymphocyte ratio in non-arteritic anterior ischemic optic neuropathy: a meta-analysis.

We aimed to determine the association of neutrophil-to-lymphocyte ratio (NLR) with non-arteritic anterior ischemic optic neuropathy (NAION). We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus and Web of Science were searched from the establishment of the database to May 5, 2022 to find the relevant studies. The quality of the included literature was evaluated with the Newcastle-Ottawa scale (NOS). The results are reflected in the form of standard mean difference (SMD) and 95% confidence interval (CI). Finally, six articles were included in our study. Compared with healthy controls, patients' NLR levels were significantly higher (SMD = 0.47; CI 95% = 0.30-0.65, p<0.001). The included studies were not statistically heterogeneous (I2 = 0.0%, p = 0.60); thus, the analysis used the fixed-effect model. The pooled sensitivity of NLR was 0.69 (95% CI 0.60-0.67), and the pooled specificity was 0.59 (95% CI 0.50-0.67). The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NLR were 1.71(95%CI 1.48-1.98), 0.50 (95%CI 0.41-0.62), and 3.38 (95%CI 2.57-4.44), respectively. Our findings suggest NLR to be a potential marker of NAION, while also implicating a role for inflammation in underlying pathophysiology.

Effectiveness of exercise-based rehabilitation on functionality and quality of life in breast cancer survivors undergoing chemo-radiotherapy: A systematic review and meta-analysis

Abstract Breast cancer survivors often face physical and psychological complications post-chemoradiotherapy, including fatigue, muscle weakness, pain, and reduced quality of life (QoL). This systematic review and meta-analysis, conducted according to PRISMA guidelines, aimed to evaluate the effectiveness of exercise-based rehabilitation in improving functionality and QoL in breast cancer survivors. Databases such as MEDLINE, PEDro, Cochrane Library, and CINAHL Complete were searched for studies published between January 2014 and August 2024. The methodological quality was assessed using the PEDro scale, and bias was evaluated with the Cochrane RoB 2.0 tool. Evidence certainty was determined via the GRADE framework. The intervention significantly reduced fatigue (standardized mean difference [SMD] = −0.50, 95% confidence interval [CI]: −0.60 to −0.40, P &lt; 0.00001). However, no significant effect was observed for aerobic capacity (VO2 max) (SMD = −0.06, 95% CI: −0.58–0.46; P = 0.83), though long-term interventions showed slight improvements. Muscle strength significantly increased (SMD = 1.02, 95% CI: 0.17–1.87, P = 0.02), with gains in both upper and lower limbs. Pain outcomes were mixed, with long-term interventions showing a small but significant reduction (SMD = −0.35, 95% CI: −0.69 to −0.02, P = 0.05). QoL significantly improved (SMD = 0.94, 95% CI: 0.42–1.46, P = 0.0004), with long-term interventions showing greater effects (SMD = 1.25, 95% CI: 0.34–2.15, P = 0.007). In conclusion, exercise-based rehabilitation reduces fatigue, improves muscle strength, and enhances QoL. Standardized protocols are needed to generalize benefits across broader populations. that these benefits can be generalized across broader populations. Further research should focus on developing tailored and standardized exercise regimens to maximize patient outcomes.

Clinical trial emulation in nephrology.

Trial emulation, also known as target trial emulation, has significantly advanced epidemiology and causal inference by providing a robust framework for deriving causal relationships from observational data. This approach aims to reduce biases and confounding factors inherent in observational studies, thereby improving the validity of causal inferences. By designing observational studies to mimic randomized controlled trials (RCTs) as closely as possible, researchers can better control for confounding and bias. Key components of trial emulation include defining a clear time-zero, simulating random assignment using techniques like propensity score matching and inverse probability treatment weighting, assessing group comparability by standardized mean differences and establishing a clear comparison strategy. The increasing availability of large-scale real-world databases, such as research cohorts, patient registries, and hospital records, has driven the popularity of target trial emulation. These data sources offer information on patient outcomes, treatment patterns, and disease progression in real-world settings. By applying the principles of target trial emulation to these rich data sources, researchers can design studies that provide robust causal inferences about the effects of interventions, informing clinical guidelines and regulatory decisions. Despite its advantages, trial emulation faces challenges like data quality, unmeasured confounding, and implementation complexity. Future directions include integrating trial emulation with machine learning techniques and developing methods to address unmeasured confounding. Overall, trial emulation represents a significant advancement in epidemiology, offering a valuable tool for deriving accurate and reliable causal inferences from observational data, ultimately improving public health outcomes.

Whether monitored anesthesia care is the optimal anesthetic strategy for transcatheter aortic valve implantation surgery? a meta-analysis and systematic review

ObjectivesTo explore whether monitored anesthesia care is more beneficial to the outcome of transcatheter aortic valve implantation.MethodsThe research methodology involved comprehensive searches across major databases, including the Cochrane Library, PubMed, Scopus, and Web of Science, covering the period from January 1, 2010, to March 1, 2024. The aim was to identify trials comparing different anesthetic methods for transcatheter aortic valve implantation. The primary outcomes assessed were mortality and length of hospital stay, while secondary outcomes included common complications such as bleeding, stroke, paravalvular leakage, renal failure, and others. Data synthesis was conducted using risk ratios or standardized mean differences, along with 95% confidence intervals. The study protocol was prospectively registered with PROSPERO (CRD42024507749).ResultsA total of 35 trials and 45,616 patients were included in this study. The results showed that monitored anesthesia care significantly reduced the patient's risk of death, shortened the patient's length of hospital stay, and also reduced the risk of common complications such as paravalvular leakage (RR, 0.80; 95% CI: 0.72 to 0.88; p < 0.00001; I2 = 0) and stroke (RR, 0.80; 95% CI: 0.65 to 0.99; p = 0.04; I2 = 0).ConclusionMonitored anesthesia care has an absolute advantage in patient survival and effectively shortens the length of hospitalization. In addition, it also reduces the risk of complications such as paravalvular leakage and stroke. Monitoring care under anesthesia plays a vital role during TAVI surgery, not only helping to ensure the smooth progress of the surgery and patient safety, but also promoting the patient's recovery and recovery.

Effects of saffron (Crocus sativus L.) supplementation on cardiometabolic Indices in diabetic and prediabetic overweight patients: a systematic review and meta-analysis of RCTs.

The incidence of diabetes mellitus (DM) is increasing worldwide, and there is growing interest in the potential use of natural compounds as an alternative treatment for managing DM. Several research studies have investigated the impact of saffron consumption on managing and improving metabolic profiles in patients with DM, and they have shown promising results. The study aims to systematically review and perform a meta-analysis to evaluate the potential effects of saffron and its extract on cardiometabolic indicators in diabetic and prediabetic overweight patients. We conducted a comprehensive systematic review and meta-analysis, searching PubMed, Scopus, Web of Science, Embase, and Google Scholar for all relevant studies published before April 20, 2024. We extracted weighted (WMD) or standardized (SMD) mean differences (before-after) and 95% confidence intervals (95%CI) of the outcomes and conducted meta-analyses using R. The study protocol was registered in PROSPERO (CRD42024538380). Out of the studies screened, 15 RCTs were selected for inclusion in the systematic review and meta-analysis. These studies collectively involved 869 participants, 438 in the intervention group and 431 in the control group. Notably, our results showed that saffron supplementation led to significant changes in FBS (MD: - 8.75mg/dL, 95% CI [- 14.75; - 2.76], P < 0.01), HbA1C (MD: - 0.34%, 95% CI [- 0.39; - 0.9], P < 0.01), TG (MD: - 13.28 mg/dL, 95% CI [- 22.82; - 3.75], P < 0.01), SBP (MD: - 5.33 mmHg, 95% CI [- 8.99-1.67], P = 0.04), DBP (MD: - 1.02 mmHg, 95% CI [- 3.91; 1.86], P = 0.03), AST (MD: - 1.32 IU/L, 95% CI [- 1.72, - 0.93], P < 0.01) levels in T2DM patients compared to placebo or no supplementation, indicating its potential as a therapeutic intervention. However, there was no significant effect on Insulin secretion (MD: - 0.15 µU/ml, 95% CI [- 2.1763; 1.8689], P = 0.88), HOMA (MD: - 0.35%, 95% CI [- 1.34;0.63], P = 0.48), TC (MD: - 4.86 mg/dL, 95% CI [- 9.81-0.09], P = 0.54), HDL (MD: 0.18 mg/dL, 95% CI [- 0.93; 1.29], P = 0.74), LDL (MD: - 1.77 mg/dL, 95% CI [- 5.99-2.45], P = 0.41), TNF-α (MD: - 0.34 pg/mL, 95% CI [- 0.99-0.30], P = 0.29), creatinine (MD: 2.83 mg/dL, 95% CI [2.29, 3.37], P = 0.31) and BUN (MD: - 0.44 mg/dL, 95% CI [- 1.43, 0.55], P = 0.38). Saffron may improve specific CMI indices in overweight patients with diabetes or prediabetes, including significant reductions in FBS, HbA1C, TG, SBP, and AST. However, it did not significantly affect HDL, TC, LDL, insulin secretion, HOMA, DBP, TNF-α, ALT, Cr, or BUN. Further research with more trials and extended follow-up periods is needed to confirm and expand these findings.

Protective Effect of 1,8-Cineole (Eucalyptol) on Respiratory System: A Systematic Review and Meta-analysis from Animal Studies

Background 1,8-Cineole is used in traditional folk medicine to treat various diseases. This study evaluates the protective effects of 1,8-cineole on the respiratory system by investigating its impact on inflammatory factors in animal studies. Materials and Methods We conducted searches in PubMed, Medline, Embase, Cochrane, and the Web of Science databases until December 2023. This study utilized Get Data Graph Digitizer 2.26, EndNote, and RevMan 5.4. The random effects model and standard mean difference (SMD) were applied for data analysis. Results The results showed tumor necrosis factor-alpha (TNF-α) (SMD: −8.19, 95% CI: −11.30 to −5.08, p &lt; 0.00001), interleukin (IL)-6 (SMD: −7.38, 95% CI: −10.61 to −4.15, p &lt; 0.00001), IL-1β (SMD: −19.18, 95% CI: −32.57 to −5.79, p = 0.005), NF-κB (SMD: −6.26, 95% CI: −7.88 to −4.65, p &lt; 0.00001), neutrophils (SMD: −8.16, 95% CI: −11.65 to −4.67, p &lt; 0.00001), and macrophages (SMD: −5.06, 95% CI: −8.06 to −2.05, p = 0.001). Conclusion The study suggests that 1,8-cineole significantly inhibits the expression of inflammatory factors, indicating its potential for further study and development.

Dynamic coronary roadmap in percutaneous coronary intervention: a systematic review and meta-analysis

BackgroundContrast-induced acute kidney injury (CI-AKI) is one of the complications of percutaneous coronary intervention (PCI) with high financial burden and poor outcomes. Dynamic coronary roadmap (DCR) is one of the augmentation tools that can provide a dynamic clear coronary mapping with the potential to reduce contrast use and CI-AKI incidence. Herein, we aim to systematically investigate the studies that have assessed the effect of DCR on PCI outcomes.MethodsFour online databases including PubMed, Scopus, Embase, and the Web of Science were systematically searched for relevant studies. Studies that compared the DCR group with the non-DCR group were included while the outcomes were AKI incidence, contrast volume, fluoroscopy time, dose area product, air kerma, intravascular ultrasonography (IVUS) use, and procedural success. Random-effect meta-analysis was conducted to calculate the standardized mean difference (SMD) or odds ratio (OR) and 95% confidence interval (CI) for comparison of DCR and non-DCR groups.ResultsA total of six studies were included in the final analysis comprised of 447 patients in the DCR group and 527 in the non-DCR group. The mean age was 68.7 ± 10.6 years while 78.9% of the DCR group and 75.6% of the non-DCR group were males. There was no difference between the groups in terms of the rates of hypertension, diabetes, hyperlipidemia, prior myocardial infarction (MI), prior coronary artery bypass grafting (CABG), and atrial fibrillation. Meta-analysis revealed that patients in the DCR group had a significantly lower rate of AKI (OR 0.50, 95% CI 0.27 to 0.93, p-value = 0.028), and contrast volume used (SMD -1.16, 95% CI -2.15 to -0.18, p-value = 0.021). However, there was no difference in fluoroscopy time (SMD -0.64, 95% CI -1.43 to 0.16, p-value = 0.116), air kerma (SMD -1.81, 95% CI -4.61 to 0.99, p-value = 0.206), IVUS use (OR 1.21, 95% CI 0.85 to 1.73, p-value = 0.285), and procedural success (OR 1.05, 95% CI 1.15 to 7.26, p-value = 0.957).ConclusionThese findings show that DCR use is associated with a lower rate of AKI and lower contrast use, compared to conventional PCI. This is of particular importance since many patients undergoing PCI have limited renal function and hence will benefit from the use of DCR. Further studies are needed to confirm these findings and to pave the way for the routine use of DCR in clinical settings.

Dendropanax morbifera Extracts for Cosmetic Applications: Systematic Review and Meta-Analysis

We have conducted a systematic review and meta-analysis to evaluate the cosmetic applications of Dendropanax morbifera extracts (DMEs). A total of 261 articles were screened; however, after eliminating inappropriate studies, only 16 individual studies were eligible. The comparative standardized mean difference (SMD) between the DME treatment and control groups was used to evaluate the cosmetic properties of DME, including its biocompatibility, whitening effects, and anti-inflammatory and antimicrobial properties. DME treatment exhibited positive results in controlling hyperpigmentation, including effective inhibition of the production of tyrosinase and melanin, with SMDs of 6.85 [4.27, 9.44] and 23.38 [12.94, 33.82], respectively. Moreover, the results confirmed the anti-inflammatory properties in terms of suppressing the expression of interleukin markers (ILs) (SMD = 5.22 [3.12, 7.33]) and reducing NO production (SMD = 6.92 [2.89, 10.96]). DME treatment also effectively inhibited bacteria growth, which causes skin disorders. According to the results, DMEs are shown to be highly biocompatibility, with excellent anti-hyperpigmentation, anti-inflammatory, and antimicrobial properties that contribute significantly to improving skin appearance. The findings provide strong evidence for further research into the in vivo effects of DMEs and their potential cosmetic applications, which could lead to clinical trials in the future.

Adjunctive Use of Gabapentinoids Increases Opioid Consumption Following 1- to 3-Level Anterior Lumbar Interbody Fusion with Posterior Fixation: A Propensity-Score Matched Analysis.

Retrospective cohort. To evaluate the impact of adjunctive gabapentinoid therapy on postoperative opioid consumption following 1-3 levels anterior lumbar interbody fusion (ALIF) with posterior fixation. Gabapentin and pregabalin are analogues of the inhibitory neurotransmitter Gamma-Aminobutyric Acid (GABA) and are frequently employed as adjuncts in multimodal anesthesia strategies for managing acute pain. However, the opioid-sparing effect of gabapentinoids in the context of spine surgery has yet to be consistently demonstrated. The PearlDiver Database was queried from 2010 to 2021 for patients who underwent primary 1-3 levels ALIF with posterior fixation. Patients with opioid or gabapentinoid use within 6 months prior to index surgery were excluded. Patients with both gabapentinoid and opioid treatment were propensity score-matched to patients with opioid-only treatment. The propensity score-matching resulted in two equal groups of 2,617 patients with and without adjunctive gabapentinoid treatment for pain management. Adjunctive use of gabapentinoids was associated with a modest 2.9% reduction in average Morphine Milligram Equivalent (MME) per day (Standardized Mean Difference (SMD) -1.33, 95% Confidence Interval (CI) [-2.657, -0.002], P=0.050). However, this was accompanied by a 37.1% increase in the total duration of opioid prescriptions (SMD 94.97, 95% CI [56.976, 132.967], P<0.001) and a 41.7% increase in total MME consumption per patient (SMD 4817.23, 95% CI [1864.410, 7770.044], P=0.001). Additionally, gabapentinoid use was associated with an increased risk of readmission due to pain (Relative Risk (RR) 1.10, 95% CI [1.002, 1.212], P=0.050) and the development of drug abuse (RR 1.37, 95% CI [1.016, 1.833], P=0.046). Despite the modest daily opioid-sparing effect observed, adjunctive gabapentinoid treatment appears to increase total opioid consumption due to prolonged opioid use and may compromise pain management in the context of ALIF with posterior fixation.

Is Naltrexone Effective and Safe for Treating Amphetamine-Type Stimulant Use Disorder? A Systematic Review and Meta-analysis.

We conducted a systematic review and meta-analysis (PROSPERO ID: CRD42023401796) of randomized placebo-controlled trials evaluating the effectiveness and safety of naltrexone as a standalone pharmacotherapy for amphetamine-type stimulant use disorder (ATSUD). We searched EMBASE, MEDLINE, EBM Reviews, PsycINFO, CINAHL, Google Scholar, and trial registries on April 11, 2023, and updated on September 24, 2024, to identify randomized placebo-controlled trials evaluating the effectiveness of naltrexone for the treatment of ATSUD. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed for reporting the study. Risk of bias and quality of evidence were assessed with the Cochrane Risk-of-bias Assessment tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Risk ratios (RRs) or Peto odds ratio were estimated for binary outcomes as appropriate. Standardized mean differences were calculated for continuous outcomes. Five studies (n = 419 participants) were eligible. We found no significant difference between naltrexone and placebo for amphetamine-type stimulant use (RR = 0.903, 95% confidence interval [CI] = 0.698 to 1.167, P = 0.44, I2 = 96.1%; 4 studies), study retention (RR = 1.055, 95% CI = 0.942 to 1.182, P = 0.35, I2 = 45.0%; 4 studies), end-of-treatment craving (standardized mean difference = 0.069, 95% CI = -0.272 to 0.410, P = 0.69, I2 = 0.0%; 2 studies), and serious adverse events (odds ratio = 1.086, 95% CI = 0.414 to 2.849, P = 0.87, I2 = 0.0%; 3 studies). The quality of evidence was low to very low. The available evidence does not support the use of standalone naltrexone to treat ATSUD. Significant research efforts must be put toward to identify effective pharmacotherapies to complement psychosocial interventions for ATSUD.

Is Acupuncture an Effective Treatment for Radiation-Induced Xerostomia of Patients with Head and Neck Cancer? A Systematic Review and Meta-Analysis.

Background: Radiation-induced xerostomia (RIX) stands out as one of the most severe side effects among patients with head and neck cancer (HNC). Given the varied conclusions in previous studies concerning the association between acupuncture, sham acupuncture, or acupuncture combined with standard oral care and therapeutic effects, our aim is to conduct a systematic review to assess the effectiveness and safety of acupuncture in managing RIX in patients with HNC. Methods: Six databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Chongqing VIP, and WanFang Database) were electronically searched, following the Cochrane manual and adhering to reported Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines, from their inception dates to July 1, 2024. Primary randomized clinical trials included in systematic reviews or meta-analyses were identified, with the Xerostomia Questionnaire and Xerostomia Inventory designated as the primary outcomes. Salivary flow rates (unstimulated or stimulated) were defined as secondary outcomes. Results: Eight clinical trials involving 1273 participants were analyzed, with six studies included in the meta-analysis. The results indicate that acupuncture demonstrated a significant improvement in patient-reported xerostomia scores (standardized mean difference [SMD] = -0.20, 95% confidence interval [95% CI] [-0.38, -0.02], I2 = 0%) in comparison to standard care, but did not significantly improve oral dryness symptoms compared with sham acupuncture (SMD = -0.06, 95% CI [-0.29, 0.16], I2 = 25.8%). The merged total showed negative result (SMD = -0.13, 95% CI [-0.27, 0.01], I2 = 8.2%). Additionally, there was no significant difference in stimulated salivary flow rate (SMD = -0.22, 95% CI [-0.58, 0.13], I2 = 0%) and unstimulated salivary flow rate (SMD = -0.19, 95% CI [-0.11, 0.72], I2 = 67.2%). In general, the acupuncture did not cause serious adverse effects. Conclusion: As far as current research is concerned, acupuncture treatment for RIX symptoms in patients with HNC still lacks strong and convincing evidence support. The more scientific research methods and more clinical trials are still needed.

The effect of probiotics on gestational diabetes mellitus: an umbrella meta-analysis

BackgroundPrior studies indicated the positive effects of probiotics on glycemic regulation in patients with gestational diabetes mellitus (GDM). Nonetheless, the results remain inconclusive. To address this, we conducted an umbrella meta-analysis to evaluate the impact of probiotics on glycemic indicators in GDM.MethodsA comprehensive search was conducted on the PubMed and Scopus databases to identify all relevant meta-analyses of randomized clinical trials published until July 2024. The outcomes included serum hemoglobin A1C (HbA1c), fasting blood insulin (FBI), fasting blood sugar (FBS), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), homeostatic model assessment of beta cell function (HOMA-B), C-peptide, and oral glucose tolerance test (OGTT). Standardized mean difference (SMD) was used to test the effects.ResultsIn total, 27 studies, comprising 33,378 participants, were included in the analysis. Probiotics resulted in a significant decrease in FBS (SMD: -0.39, 95% CI: -0.56 to -0.23), especially when administered for ≤ 7 weeks. Significant reductions were also observed in FBI (SMD: -1.99, 95% CI: -2.41 to -1.58), HOMA-IR (SMD: -0.61, 95% CI: -0.72 to -0.50), and HOMA-B (SMD: -24.58, 95% CI: -30.59 to -18.56). Moreover, supplementation with probiotics significantly improved QUICKI (SMD: 0.007, 95% CI: 0.004 to 0.01). There was significant evidence of heterogeneity and publication bias. No significant effects were observed on 1-h OGTT, 2-h OGTT, HbA1c, and C-peptide. No dose-specific effect was observed.ConclusionsSupplementation with probiotics could improve glycemic control in women with GDM. The effects of probiotics on HOMA-IR, HOMA-B, and fasting insulin were clinically important, while, their effect on FBS was not clinically important.

Effect of Coenzyme Q10 Supplementation on Lipid and Glycaemic Profiles: An Umbrella Review

Coenzyme Q10 (CoQ10) has been suggested as an adjunct therapy for endocrine and metabolic disorders. The aim of this study was to synthesise the evidence for the effect of CoQ10 supplementation on lipid and/or glycaemic alterations, including total cholesterol (TC), LDL- and HDL-cholesterol (LDL-C and HDL-C), lipoprotein a, fasting blood glucose (FBG), haemoglobin A1c (HbA1c), fasting insulin and Homeostatic Model Assessment of Insulin Resistance. A systematic search was conducted in Medline, Scopus, Web of Science and the Cochrane Library from their inception to July 2024. Meta-analyses that evaluated the effect of CoQ10 on the lipid or glycaemic profiles were included. Results were expressed as mean difference (MD) or standardised mean difference (SMD). CoQ10 showed an effect on the glycaemic profile, especially on FBG (MD from −11.21 to −5.2 mg/dL, SMD from −2.04 to −0.17) and on HbA1c (MD from −1.83 to −0.12%, SMD of −0.30). CoQ10 may also have an effect on the lipid profile, such as TC, triglycerides, HDL-C and even LDL-C, although the inconsistency of the results was somewhat higher. Supplementation with CoQ10 may be beneficial, especially in populations with diabetes mellitus or other endocrine and metabolic disorders. It could also have some effect on lipid parameters, which, together with the above, may reduce cardiovascular morbidity and mortality, although this is something that needs further research.