Standardized Mean Difference Research Articles

Efficacy of Myricetin Supplementation on Glucose and Lipid Metabolism: A Systematic Review and Meta-Analysis of In Vivo Mice Studies

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a disorder characterized by insulin resistance, hyperglycemia, and dyslipidemia. Myricetin, a flavonoid found in various plants, has shown potential anti-diabetic effects in murine studies. This meta-analysis aimed to evaluate the impact of myricetin supplementation on glucose metabolism and lipid profiles in mouse models of metabolic diseases. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD42084518999). Studies involving mice with metabolic disease models and exclusively using myricetin supplementation were checked across four databases (Embase, Scopus, PubMed, and WoS) until 23rd September 2024. The primary outcomes assessed were blood glucose (BG), insulin levels, triacylglycerol (TAG), total cholesterol (TC), HDL, and LDL. A random-effects model was applied to estimate standardized mean differences (SMD), and SYRCLE’s risk-of-bias tool for animal studies was used. Results: Twenty-one studies with 514 mice met the inclusion criteria. Myricetin supplementation significantly reduced BG (SMD = −1.45, CI: −1.91 to −0.99, p < 0.00001, I2 = 74%), insulin (SMD = −1.78, CI: −2.89 to −0.68, p = 0.002, I2 = 86%), TAG (SMD = −2.60, CI: −3.24 to −1.96, p < 0.00001, I2 = 81%), TC (SMD = −1.86, CI: −2.29 to −1.44, p < 0.00001, I2 = 62%), and LDL (SMD = −2.95, CI: −3.75 to −2.14, p < 0.00001, I2 = 74%). However, the effect on HDL was not statistically significant (SMD = 0.71, CI: −0.01 to 1.43, p = 0.05, I2 = 83%). Conclusions: Myricetin supplementation improved glucose metabolism and lipid profiles in mouse models, suggesting its potential as a therapeutic agent for managing T2DM. However, further research is needed to confirm these findings in human studies.

The Effectiveness of Ozone Infiltration on Patient-Reported Outcomes in Low Back Pain: A Systematic Review and Meta-Analysis

Background/Objective: The objective of this systematic review and meta-analysis was to evaluate the current evidence on the relative efficacy of ozone injections for improving patient-reported outcomes (PROMs). Methods: A literature search was conducted in four databases, and PROMs were analyzed. Odds ratios (ORs), mean differences, and standard mean differences with 95% confidence intervals (CI) were calculated. Meta-analysis was performed using Review Manager. Results: Nine studies (total number of participants = 1711) were included. Overall, the ODI (Oswestry Disability Index) showed favorable results for ozone (SMD −0.28, 95% CI −0.51 to −0.06). However, subgroup analysis by follow-up time found no significant differences at 2 weeks or 6 months but significant differences at 1 month. The VAS also favored ozone use overall (SMD −0.12, 95% CI −0.24 −0.01). Subgroup and sensitivity analyses revealed no significant differences between groups. There were also no significant differences in excellent outcomes (OR 0.95, 95% CI 0.54 to 1.67) or poor outcomes (OR 1.25, 95% CI 0.66 to 2.37). Conclusions: Ozone therapy has demonstrated limited benefits over the usual care for lower back pain. While a small advantage emerged for function at one month, the results were inconsistent, and no differences were seen in pain or clinical outcomes.

Neonatal care and developmental outcomes following preterm birth: A systematic review and meta-analysis.

Major amendments in neonatal care have been introduced in recent decades. It is important to understand whether these amendments improved the cognitive sequelae of preterm children. Through a large-scale meta-analysis, we explored the association between prematurity-related complications, neonatal care quality, and cognitive development from birth until 7 years. MEDLINE, APA PsycInfo, and EBSCO were searched. Peer-reviewed studies published between 1970 and 2022 using standardized tests were included. We evaluated differences between preterm and full-term children in focal developmental domains using random-effects meta-analyses. We analyzed data from 161 studies involving 39,799 children. Preterm birth was associated with inferior outcomes in global cognitive development (standardized mean difference = -0.57, 95% CI [-0.63, -0.52]), as well as in language/communication, visuospatial, and motor performance, reflecting mean decreases of approximately 7.3 to 9.3 developmental/intelligence quotients. Extreme prematurity, neonatal pulmonary morbidities, and older assessment age in very-to-extreme preterm cohorts were associated with worse outcomes. Contemporary neonatal medical and developmental care were associated with transient improvements in global cognitive development, evident until 2 to 3 years of age but not after. Blinding of examiners to participants' gestational background was associated with poorer outcomes in preterm cohorts, suggesting the possibility of a "compassion bias." The results suggest that preterm birth remains associated with poorer cognitive development in early childhood, especially following pulmonary diseases and very-to-extreme preterm delivery. Importantly, deficits become more pervasive with age, but only after births before 32 gestational weeks and not in moderate-to-late preterm cohorts. Care advancements show promising signs of promoting resiliency in the early years but need further refinements throughout childhood. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Meta-analysis of the efficacy of the erector spinae plane block after spinal fusion surgery.

To investigate the efficacy of erector spinal plane block (ESPB) after spinal fusion surgery in this study. The PubMed, Embase, Cochrane library, and Web of Science databases were searched with a search deadline of March 30, 2024, and Stata 15.0 was used to analyze the data from the included studies. Nine randomized controlled trials involving 663 patients were included. Meta-analysis showed that EPSB could reduce pain scores at 2h (standard mean difference (SMD) = -0.78, 95% CI [-1.38 to -0.19], GRADE: Moderate), 6 h (SMD = -0.81, 95% CI [-1.23 to -0.38], GRADE: Moderate), 12 h (SMD = -0.59, 95% CI [-1.05 to -0.13], GRADE: Moderate), 24 h (SMD = -0.54, 95% CI [-0.86 to -0.21], GRADE: Moderate), 48 h (SMD = -0.40, 95% CI [-0.75 to -0.05], GRADE: Moderate) after spinal fusion surgery, as well as the PCA (analgesia medication use) (SMD = -1.67, 95% CI [-2.67 to -0.67], GRADE: Moderate). However, EPSB had no effect on intraoperative blood loss (SMD = -0.28, 95% CI [-1.03 to 0.47], GRADE: Low) and length of hospital stay (SMD = -0.27, 95% CI [-0.60-0.06], GRADE: Low). Combined with the current findings, EPSB may reduce pain scores in spinal fusion surgery, possibly reducing the use of postoperative analgesics. However, due to the limitations of the study, we need more high-quality, multi-center, large sample randomized controlled trials to merge.

Cognitive and academic outcomes of large-for-gestational-age babies born at early term: A systematic review and meta-analysis.

Early induction of labor (37+0-38+6 gestational weeks) in large-for-gestational-age infants may reduce perinatal risks such as shoulder dystocia, but it may also increase the long-term risks of reduced cognitive abilities. This systematic review aimed to evaluate the cognitive and academic outcomes of large-for-gestational-age children born early term versus full term (combined or independent exposures). The protocol was registered in the PROSPERO database under the registration no. CRD42024528626. Five databases were searched from their inception until March 27, 2024, without language restrictions. Studies reporting childhood cognitive or academic outcomes after early term or large-for-gestational-age births were included. Two reviewers independently screened the selected studies. One reviewer extracted the data, and the other double-checked the data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. In addition to narrative synthesis, meta-analyses were conducted where possible. Of the 2505 identified articles, no study investigated early-term delivery in large-for-gestational-age babies. Seventy-six studies involving 11 460 016 children investigated the effects of either early-term delivery or large-for-gestational-age. Children born at 37 weeks of gestation (standard mean difference, -0.13; 95% confidence interval, -0.21 to -0.05), but not at 38 weeks (standard mean difference, -0.04; 95% confidence interval, -0.08 to 0.002), had lower cognitive scores than those born at 40 weeks. Large-for-gestational-age children had slightly higher cognitive scores than appropriate-for-gestational-age children (standard mean difference, 0.06; 95% confidence interval, 0.01-0.11). Similar results were obtained using the outcomes of either cognitive impairment or academic performance. No study has investigated the combined effect of early-term delivery on cognitive scores in large-for-gestational-age babies. Early-term delivery may have a very small detrimental effect on cognitive scores, whereas being large for gestational age may have a very small benefit. However, evidence from randomized controlled trials or observational studies is required.

Revisiting the markers interleukin-6 and glucagon-like peptide-1 for targeting low-grade inflammation in type 2 diabetes: a meta-analysis and our lab experience.

Type 2 diabetes (T2DM) manifests as pancreatic disorder as a consequence of low-grade systemic inflammation, attributed to upregulated levels of interleukin-6 (IL-6). This in turn is associated with a reduced incretin effect with lower circulatory GLP-1 levels. Therefore, its important to monitor the circulating IL-6 and GLP-1 levels for better management and outcomes in T2DM patients. Limited studies being available in literature on circulating concentrations of GLP-1 and IL-6 in T2DM patients, a meta-analysis was conducted by identifying 1558 studies from 3 databases. As per inclusion and exclusion criteria, the studies were screened for the 2-markers.Forest plots were drawn for standardized mean differences and median values were deduced from the datasets. In parallel, analysis was conducted to ascertain the expression levels of the markers by ELISA (n = 52 T2DM patients) in real time. The meta-analysis showed a significant (p < 0.01) standardized mean difference of 3.82 and 1.04 for IL-6 and GLP-1 respectively. The median values obtained from analysis for IL-6 were 26.50 pg/ml which were higher than the controls downregulated levels of GLP-1(8.77 pg/ml) were noted. The above findings are corroborated by the results of our experimental analysis with IL-6 concentrations at 11.603pg/ml and GLP-1 at 13.05pg/ml. The study highlights that systemic concentrations of IL-6 and GLP-1 correspond to a persistent low-grade inflammation and decreased incretin effect in T2DM patients which manifest as pancreatic β-cell dysfunction. The expression of the markers is inversely correlated and monitoring their levels is clinically important for targeting them through their potential antagonists thus reducing the risk of complications, thereby improving the quality of life of the patients.

Towards Standardized Assessment of Outcomes in Back Pain—Validation of Linking Studies Between Disease-Specific and Generic Patient-Reported Outcome Measures

Background: Comparing outcomes across different health measurement tools is essential where various patient-reported outcome measures (PROMs) are used. In spinal surgery, where recent studies show that over 30 different PROMs are applied, this need becomes even more pressing. Although several statistical transformations between the Oswestry Disability Index (ODI) and the PROMIS Profile 29 have been proposed, validation studies on conversion equations and cross-walk tables remain limited. In this study, we examined the agreement between observed ODI scores and those predicted from the PROMIS Profile 29 in a large sample of patients with low back pain, collected from routine clinical care. Methods: We compared the performance of regression and linking models at both the individual and group levels. Using Bland–Altman plots, we assessed the mean difference, 95% limits of agreement, root mean squared error (RMSE), and standardized mean differences (Cohen’s d) between predicted and observed ODI scores. Results: While group-level agreement was satisfactory, with negligible effect sizes, individual prediction accuracy was relatively poor. Additionally, regression models showed inconsistent performance across the ODI score range, though incorporating more domains marginally improved predictions. Conclusions: The equipercentile linking approach demonstrated stable agreement across all ODI scores, making it the preferred method. Future regression models should account for nonlinear relationships between PROMs to enhance prediction accuracy.

Non-exercise-based interventions to support healthy ageing in older adults: A systematic review and meta-analysis of randomised controlled trials.

Healthy ageing is a multidimensional construct, where various factors play a role in influencing wellbeing in older age. Many studies heavily emphasise the importance of physical activity, negating other aspects such as psychosocial or cognitive influences. This review aimed to evaluate the effectiveness of non-exercise-based interventions on the quality of life (QoL) and life satisfaction of community-dwelling, healthy older adults. A systematic review and meta-analysis of randomised controlled trials was conducted. Four electronic databases were searched from inception. Three independent reviewers screened the articles and appraised the risk of bias. Data relating to study characteristics, intervention and outcomes were extracted. The mean difference and standardised mean difference with 95% confidence intervals were synthesised to pool effect sizes. Outcomes that could not be included in the meta-analysis were synthesised narratively. Thirty-six articles from 35 randomised controlled trials, involving 6,127 older adults, were included. Most were multi-component interventions and involved supporting lifelong learning. Most participants were females (70.2%). Pooled analyses revealed small but statistically significant effects on overall QoL (SMD=0.26, CI: 0.00 to 0.53), and QoL subscales relating to mental health and psychological wellbeing (SMD=0.26, CI: 0.12-0.41) and environment (SMD=0.31, CI: 0.03-0.58). Effects on social health and functioning, and role functioning related to physical health were marginal. There were no improvements in other subscales. Results revealed non statistically significant improvements in life satisfaction. Multicomponent non-exercise-based interventions that support lifelong learning in older adults can support healthy ageing, particularly in improving overall QoL, and mental health, social health and environment QoL subscales.

Role of dormancy survival regulator and resuscitation-promoting factors antigens in differentiating between active and latent tuberculosis: a systematic review and meta-analysis

BackgroundDormancy survival regulator (DosR) and resuscitation-promoting factor (Rpf) antigens of Mycobacterium tuberculosis are activated during dormant phase of tuberculosis (TB). This study evaluates the differential immunogenicity potentials of DosR and Rpf antigens in individuals with latent tuberculosis infection (LTBI) and active TB patients.MethodsAfter a literature search in electronic databases, studies were selected by following precise eligibility criteria. Outcomes were synthesized systematically, and meta-analyses were performed to estimate standardized mean differences (SMDs) in interferon-gamma (IFNγ) levels, and IFNγ positive immune cells between individuals with LTBI and active TB patients.ResultsTwenty-six studies (1278 individuals with LTBI and 1189 active TB patients) were included. DosR antigens Rv0569 (Standardized mean difference; SMD 2.44 [95%CI: 1.21, 3.66]; p < 0.0001), Rv1733c (SMD 0.60 [95%CI: 0.14, 1.07]; p = 0.011), Rv1735c (SMD 1.16 [95%CI: 0.44, 1.88]; p = 0.002), Rv1737c (SMD 1.26 [95%CI: 0.59, 1.92]; p < 0.0001), Rv2029c (SMD 0.89 [95%CI: 0.35, 1.42]; p = 0.002), RV2626c (SMD 1.24 [95%CI: 0.45, 2.02); p = 0.002), and Rv2628 (SMD 0.65 [95%CI: 0.38, 0.91]; p < 0.0001) and Rpf antigens Rv0867c (SMD 1.33 [95%CI: 0.48, 2.18]; p = 0.002), Rv1009 (SMD 0.65 [95%CI: 0.05, 1.25]; p = 0.034), and Rv2450c (SMD 1.54 [95%CI: 0.92, 2.16]; p < 0.0001) elicited higher IFNγ levels in individuals with LTBI in comparison with active TB patients. IFNγ-positive immunoresponsive cells were significantly higher in individuals with LTBI than in active TB patients for antigens Rv1733c (SMD 1.02 [95%CI: 0.15, 1.88]; p = 0.021), Rv2029c (SMD 0.57 [95%CI: 0.05, 1.09]; p = 0.031), and Rv2628 [SMD 0.38 [95%CI: 0.15, 0.61]; p = 0.001).ConclusionDosR antigens Rv0569, Rv1733c, Rv1735c, Rv1737c, RV2626c, Rv2628, and Rv2029c, and Rpf antigens Rv0867c, Rv1009, and Rv2450c are found to elicit immune responses differently in individuals with LTBI and active TB patients.

The Effect of Music Distraction on Dental Anxiety During Invasive Dental Procedures in Children and Adults: A Meta-Analysis

Background: Dental anxiety and odontophobia are common issues, leading to challenges with oral hygiene and dental health. Music distraction offers an effective and side effect-free solution to alleviate pain and increase the acceptability of dental treatments. Our meta-analysis aimed to assess the efficacy of music distraction in reducing patient anxiety during invasive dental procedures in children and adults. Methods: The PubMed, Web of Science, and Embase databases were searched for clinically controlled trials, using the keywords “music” and “dental anxiety”. The main outcome measured was the anxiety score. A meta-analysis was conducted using a random-effects model to estimate the standardized mean differences (SMDs). The subgroup analyses were conducted based on age groups, music preferences, and music styles. The research protocol has been registered with PROSPERO (Registration ID: CRD42022357961). Results: A total of 24 controlled clinical trials involving 1830 participants met the inclusion criteria for the meta-analysis. Music distraction significantly reduced dental anxiety during invasive procedures under local anesthesia (SMD, −0.50; 95% CI, −0.80 to −0.21; p = 0.0009; I2 = 83%). Our subgroup analysis revealed that music distraction was more effective in adults (SMD, −0.51; p = 0.0007) than in children (SMD, −0.47; p = 0.13) in reducing dental anxiety. Regarding music selection, music chosen by the participant (SMD, −1.01; p = 0.008) demonstrated more anxiolytic effects than by the author (SMD, −0.24; p = 0.02). Regarding music styles, classical music (SMD, −0.69; p = 0.009) was associated with better anxiolytic effects in adults. Conclusions: Our meta-analysis supports the use of music to alleviate dental anxiety during invasive procedures. Listening to classical or customized music can serve as an effective adjunct to outpatient surgical care in dental clinics.

The association of plasma homocysteine levels with short-term mortality in sepsis patients: A meta-analysis.

The association between plasma homocysteine (Hcy) levels and short-term mortality in sepsis patients remains unclear. This meta-analysis aimed to clarify this potential relationship. Following PRISMA 2020 and Cochrane Handbook guidelines, we conducted a comprehensive literature search in the PubMed, Embase, and Web of Science databases up to June 24, 2024. We included cohort studies that assessed the association between plasma Hcy levels and all-cause mortality in adult sepsis patients. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model to account for potential heterogeneity. Nine cohort studies involving 771 sepsis patients were included. Overall, no significant difference in plasma Hcy levels was observed between survivors and non-survivors (SMD: -0.23, 95% CI: -0.84 to 0.37, P = 0.45), with substantial heterogeneity (I² = 86%). Subgroup analysis revealed lower plasma Hcy levels among survivors in Chinese patients (SMD: -1.56, 95% CI: -1.98 to -1.13, P < 0.001) but not in non-Asian patients. Plasma Hcy levels were not significantly associated with all-cause mortality (OR per 1-unit increment: 1.03, 95% CI: 0.95 to 1.11, P = 0.51), with notable heterogeneity (I² = 72%). However, a significant association was found in Chinese patients (OR: 1.09, 95% CI: 1.03 to 1.15, P = 0.003), but not in non-Asian patients. In conclusion, plasma Hcy levels were not generally associated with short-term mortality in sepsis patients. However, significant associations were observed in Chinese patients, suggesting potential ethnic differences that warrant further investigation.

Spinal hyperexcitability in patients with chronic musculoskeletal pain or headache as evidenced by alterations in the nociceptive withdrawal reflex: a systematic review and meta-analysis.

The nociceptive withdrawal reflex (NWR) is a spinal withdrawal reflex induced by painful stimulation. It is a measure of spinal hyperexcitability, which is believed to contribute to chronic musculoskeletal pain (MSKP) and headache. Previous syntheses of the evidence for alterations in the NWR in patients with chronic MSKP and headache needed a comprehensive update. This systematic review and meta-analysis was performed after the Preferred Items for Systematic reviews and Meta-Analyses guidelines. Studies examining NWR-related outcome measures in patients with chronic MSKP and headache compared to pain-free controls were identified through electronic database searches and included after screening against predefined eligibility criteria. Standardized mean differences or mean differences and 95% confidence intervals (CI) were calculated. Thirty-one studies were included in the systematic review and 25 in the meta-analysis. Moderate-quality evidence was found indicating lower NWR threshold (-3.68; 95% CI, -4.56 to -2.80; P < 0.001), larger NWR area (standardized mean difference = 0.69; 95% CI, 0.37-1.01; P < 0.001), and shorter NWR latency (mean difference = -13.68; 95% CI, -22.69, -4.67; P = 0.003) in patients compared to controls. These findings remained robust when performing meta-regressions based on subgroups (ie, headache, fibromyalgia, whiplash-associated disorder, and osteoarthritis). Low-quality evidence demonstrated facilitated temporal summation of NWR threshold (-2.48; 95% CI, -3.13 to -1.83; P < 0.001) in patients compared to controls. Spinal hyperexcitability as evidenced by lowered NWR threshold values and temporal summation of the NWR is present in patients with chronic MSKP and headache. No evidence was found for alterations in NWR duration and NWR magnitude. Future research is needed to address the gap in research on NWR-related outcome measures other than NWR threshold.

Endoscopic Sinus Surgery Significantly Reduces Eustachian Tube Dysfunction Symptoms in Patients with Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

(1) Background: Eustachian tube dysfunction (ETD) is a frequently observed clinical manifestation of chronic rhinosinusitis (CRS). This systematic review aimed to evaluate the function of the Eustachian tube following endoscopic sinus surgery (ESS) in adult CRS patients with confirmed preoperative ETD symptoms. (2) Methods: A systematic search of PubMed, Cochrane, Embase, and MEDLINE electronic databases was conducted. The review was performed following the PRISMA guidelines. Studies investigating concurrent ETD in CRS patients who underwent ESS were retrieved. The changes in ETD outcomes were measured by the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7). We employed a random-effects model to conduct the meta-analysis (3) Results: We included seven observational studies that involved a total of 436 CRS patients with concurrent ETD. The pooled results revealed a statistically significant reduction (Standardized mean difference = −1.24; 95% CI = −1.64 to −0.84) in ETDQ-7 scores among the CRS with ETD patient cohort at the 3-month postoperative follow-up. (4) Conclusions: ESS serves as an effective intervention for improving E-tube function in adult CRS patients with concurrent ETD. Future prospective randomized controlled trials that incorporate various outcome predictors should be conducted to explore potential clinical factors for greater ETD improvement and normalization after ESS.

The Effect of Self-Management on Patients with Chronic Diseases: A Systematic Review and Meta-Analysis

Background: Chronic diseases significantly impact global morbidity and mortality, affecting millions. Self-management interventions are crucial for improving patient health outcomes. This study explores the effects of self-management interventions on the quality of life (QOL), self-efficacy, depression, and anxiety of patients with chronic diseases. Methods: Relevant studies were searched from PubMed, EMBASE, and Web of Science. Two reviewers independently screened the literature, evaluated the risk of bias assessment, and extracted characteristics and outcomes among patients with chronic diseases. For each included study, we calculated the standardized mean difference (SMD) and 95% confidence interval (CI) of the main outcomes. When deemed feasible, the heterogeneity of the study was explored by meta-analysis and subgroup analysis. Results: Thirty-four studies involving a total of 7603 patients with chronic diseases were included. Self-management interventions significantly improved quality of life (Higher-better QOL and Lower-better QOL), self-efficacy, and reduced depression symptoms compared to usual care (95%CI 0.01 to 0.15, p = 0.03; 95%CI −0.49 to −0.08, p = 0.006; 95%CI 0.19 to 0.62, p &lt; 0.001; 95%CI −0.23 to −0.07, p &lt; 0.001). However, no significant effect was found for anxiety (95%CI −0.18 to 0.03, p = 0.18). In the heterogeneity analysis, Lower-better QOL and self-efficacy were all higher than 50% (I2 = 80%, 87%). After the subgroup analysis, the heterogeneity of Lower-better QOL and self-efficacy was less than 50% (I2 = 0%, 16.1%). Subgroup analyses revealed that studies with mean age greater than 60 years old and follow-up times greater than 6 months were more effective in improving patients’ Lower-better QOL (p = 0.03, p = 0.004), whereas follow-up times less than 6 months were better at reducing patients’ anxiety symptoms (p = 0.03). Conclusions: Self-management interventions are more effective than routine care in managing chronic diseases, significantly improving patients’ quality of life, self-efficacy, and reducing depressive symptoms, but they did not show significant improvements in anxiety symptoms. Overall, self-management interventions for chronic diseases can help patients adapt to the changes brought about by the disease and self-manage diseases to prevent disease progression.

Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis

Open total cranial vault reconstruction (CVR) is the common procedure in managing craniosynostosis, yet more techniques have been introduced as alternatives, namely endoscopic suturectomy (ES), endoscopy-assisted craniectomy (EC), spring-assisted surgery (SAS), strip craniectomy with helmet (SC), Pi craniectomy (PiC), Pi plasty (PiP), and Renier’s “H” technique (RH). The aim of this study was to compare the effectiveness of craniosynostosis surgeries in improving the cephalic index of the patients. Studies published until 7 March 2024 reporting CVR, ES, SAS, SC, RH, and PiP as definitive craniosynostosis management with the cephalic index as the outcome were included. Bayesian network meta-analysis and pair-wise meta-analysis were performed using a random-effects model based on standardized mean difference (SMD) and 95% confidence interval (CI). Nine studies published in 2008–2024 recruiting a total of 464 craniosynostosis patients (age: 18–61 months) were included in this meta-analysis. EC (SMD = 0.23 [95%CI: −5.47 to 5.63]; p = 0.935), PiP (SMD = −0.07 [95%CI: −9.27 to 8.79]; p = 0.988), ES (SMD = −0.59 [95%CI: −6.07 to 4.94]; p = 0.834), PiC (SMD = −1.16 [95%CI: −8.89 to 6.35]; p = 0.765), RH (SMD = −0.96 [95%CI: −6.62 to 4.53]; p = 0.736), SAS (SMD = −0.86 [95%CI: −8.25 to 6.18]; p = 0.815), and SC (SMD = −1.79 [95%CI: −9.05 to 5.28]; p = 0.624) were found to be as effective as CVR in improving the cephalic index. Network meta-analysis suggests that PiP is the most effective among these techniques (rank 1 probability = 0.273). According to the rank probabilities of our model the order of techniques from the most to the least effective is as follows: EC &gt; CVR &gt; PiP &gt; ES &gt; SAS &gt; RH &gt; PiC &gt; SC.

Effects of aerobic exercise on executive function among overweight and obese children: a systematic review and meta-analysis

ObjectiveOverweight and obesity are serious public health issues worldwide and significantly impair children’s executive function (EF). However, there is no consensus regarding the benefits of aerobic exercise, on the EF of overweight and obese children. This study systematically evaluated the intervention effects of aerobic exercise on EF and its subcomponents (inhibitory control, working memory, and cognitive flexibility) in overweight and obese children.MethodsWe searched six databases—PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, and China National Knowledge Infrastructure—until March 17, 2024 for randomized controlled trials examining the effects of aerobic exercise on the EF of overweight and obese children the Cochrane Risk of Bias Assessment Tool. Following heterogeneity testing, RevMan 5.4 and Stata 17.0 were used for meta-analysis and subgroup analysis of the three indicators. The standardized mean difference (SMD) and 95% confidence intervals (CI) were used as statistical measures for effect analysis with the SMD value as the effect size and a p-value of ≤0.05 indicating statistical significance.ResultsEighteen studies involving 1,260 participants were included. Aerobic exercise significantly improved overall EF (SMD = −0.50, 95% CI [−0.68, −0.32], p &amp;lt; 0.01) with a moderate to high positive effect on inhibitory control (SMD = −0.52, 95% CI [−0.72, −0.31], p &amp;lt; 0.01) and working memory (SMD = −0.63, 95% CI [−1.06, −0.20], p &amp;lt; 0.01) but not on cognitive flexibility (SMD = −0.32, 95% CI [−0.71, 0.07], p = 0.11). These results suggest that EF in overweight and obese children is influenced by factors such as exercise characteristics and body mass index (BMI). Subgroup analysis revealed a significant moderating effect of exercise type, exercise intensity, session time, and individual BMI on EF.ConclusionAerobic exercise selectively improved EF in overweight and obese children. Subgroup analysis indicated that cognitive engagement in ball game interventions of at least moderate intensity and a single session of 25–40 min are more beneficial for improving EF in overweight and obese children. Extremely obese children (BMI &amp;gt; 25 kg/m2) do not benefit from the intervention, highlighting the need for a specific focus on intervention outcomes in future studies.

PCSK9 inhibitors and coronary atherosclerotic plaque modification: a meta-analysis

Abstract Introduction Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as a promising class of medications, primarily recognized for their potent cholesterol-lowering effects. Beyond their established role in reducing low-density lipoprotein cholesterol levels, recent studies suggest a potential impact of PCSK9 inhibitors on the modification of coronary atherosclerotic plaques. Purpose The purpose of this meta-analysis is to comprehensively synthesize data from relevant clinical studies and trials that have investigated the effects of PCSK9 inhibitors on coronary atherosclerotic plaque characteristics. Methods We performed a literature search for studies assessing the evolution of coronary atherosclerotic plaques after treatment with a PCSK9 inhibitor compared to a control group. We excluded reviews, editorials, case reports/case series, and studies that did not use PCSK9 inhibitors or did not have a control group for comparison. The main outcomes of interest were the changes in percent atheroma volume (PAV), total atheroma volume (TAV), minimal fibrous cap thickness (FCT), lipid arch, as well as the number of patients with improved PAV at follow-up. Effect sizes are presented as standardized mean difference (SMD) or risk ratio (RR) with their corresponding 95% confidence intervals (CIs) and were pooled based on a random-effects model. Publication bias was assessed by funnel plot inspection and egger’s regression test. Results The literature search yielded 189 results. After application of the exclusion criteria, a total of 8 studies were selected for data extraction and inclusion in the meta-analysis. Concerning the intravascular ultrasound findings PCSK9 inhibitors induced greater reductions in PAV (SMD -2.70, 95% CI -5.24 to -0.15, p=0.04) (Figure 1) and TAV (SMD -2.46, 95% CI -4.68 to -0.23, p=0.03) (Figure 2), with a greater proportion of patients exhibiting an improvement in PAV (RR 1.30, 95% CI 1.20 to 1.41, p&amp;lt;0.01). Moving to optical coherence tomography parameters, patients treated with PCSK9 inhibitors had an increase in minimal FCT (SMD 2.09, 95% CI 0.12 to 4.07, p=0.04) and a lower lipid arch (SMD -0.64, 95% CI -0.97 to -0.32, p&amp;lt;0.01). Funnel plot inspection and egger’s regression test did not indicate the presence of publication bias. Conclusion This meta-analysis suggests that PCSK9 inhibitors use is associated with a favorable coronary atherosclerotic plaque remodeling.Figure 1Figure 2

Family-based sexual health intervention for adolescents; A systematic review and meta-analysis

Abstract Background Family-based interventions are important in promoting adolescent sexual health outcomes. However, the effectiveness of these interventions in promoting adolescent sexual and reproductive health (ASRH) in Lower and middle-income countries (LMIC) has not been empirically evaluated. This review aimed to summarise the effectiveness of family-based sexual and reproductive health interventions in promoting ASRH in LMIC. Methods We conducted a systematic search for studies published in English from 2000 to October 2023 using MEDLINE, PsyINFO, CINAHL, Web of Science, and EMBASE databases. Studies were included if they involved adolescents aged 10-19 years, included family members in a key intervention component, evaluated the effectiveness of the interventions using an experimental or quasi-experimental design, assessed ASRH outcomes reported by adolescents and were conducted in LMIC setting. Standardized mean difference (SMD) and 95% confidence intervals were computed and meta-analyses were conducted using random effect models. Results Ten articles involving 2,246 participants were included in the review. The studies were nostly conducted in Africa. Across studies, there was no significant impact of family-based interventions in improving adolescent sexual health knowledge (SMD=0.5, 95%CI: -1.98 to 2.98), attitudes (SMD= -0.05, 95%CI: -1.92 to 1.82), practices (SMD=0.53, 95%CI: -0.69 to 1.75), or sexual communication with their family (SMD= 0.14, 95%CI: -0.42 to 0.7). Although individual studies reported a mixed effect of family-based interventions in improving sexual health outcomes, the pooled results from the meta-analysis showed no significant impact of family-based interventions. Conclusions Our review did not find any significant impact of family-based interventions in improving ASRH in LMIC. We recommend interventions using innovative approaches and novel strategies to align with the socio-cultural and economic background of the study setting. Key messages • This study found no significant impact of family-based interventions in improving ASRH in LMIC. • Additional studies, particularly from Asia, using culturally relevant interventions is required in this area.

A meta-analysis of the efficacy and safety of exercise-based cardiac rehabilitation in patients with left ventricular assist devices

Abstract Background Left Ventricular Assist Devices (LVADs) and heart transplantation stand out as the two well-established and effective therapeutic approaches for managing patients with advanced heart failure. Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to improve functional capacity in patients with LVAD. Purpose We aim to assess the efficacy and safety of EBCR in patients with LVAD. Also, to compare high-intensity (HIT) versus moderate-intensity (MIT) EBCR regimens in patients with LVAD. Methods A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) studies obtained from PubMed, Embase Cochrane, Scopus, and WOS until January 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using standardized mean difference (SMD) with a 95% confidence interval (CI). Results Six RCTs with 160 patients were included. There was no significant difference between EBCR and standard care regarding peak VO2 change [SMD: 0.24 with 95% CI (-0.14, 0.62), P= 0.21] and six-minute walk distance (6-MWD) change [SMD: 0.28 with 95% CI (-0.11, 0.66), P= 0.16]. Also, there was no significant difference between HIT and MIT exercise regarding peak VO2 change [SMD: 0.20 with 95% CI (-0.41, 0.82), P= 0.52] and 6-MWD change [SMD: 0.07 with 95% CI (-0.54, 0.69), P= 0.81]. Moreover, EBCR was associated with a significant decrease in the incidence of any adverse events when compared to usual care with [RR: 0.80 with 95% CI (0.65, 0.99), P= 0.04], while there was no significant difference between HIT and MIT exercise regarding the incidence of any adverse events [RR: 0.38 with 95% CI (0.02, 9.22), P= 0.55]. Conclusion EBCR did not improve functional capacity in patients with LVAD, with no significant effect on peak VO2 or 6-MWD.

Intravascular lithotripsy in the management of underexpanded stents

Abstract Introduction Stent underexpansion significantly heightens the risk of major adverse cardiac events (MACE), and available treatment options for this condition remain limited. Intravascular Lithotripsy (IVL) technology disrupts superficial and deep calcium by using localized pulsative sonic pressure waves, emerges as a promising tool for underexpanded stents. Methods Following PRISMA guidelines, we systematically explored PubMed, SCOPUS, and Cochrane databases up to September 3, 2023, for studies evaluating IVL's safety and efficacy in treating underexpanded stents. We gathered angiographic (QCA) and intracoronary imaging (OCT or IVUS) data, examining the stent's minimal diameter stenosis (MDS), minimal lumen diameter (MLD), minimal stent area (MSA), and minimal lumen area (MLA) pre- and post-IVL application. Procedural success constituted the efficacy endpoint, while peri-procedural complications, in-hospital-30-days and long-term mortality, and MACE were safety endpoints Results This meta-analysis comprised 21 studies including 669 patients and 673 treated lesions in underexpanded stent. The mean age was 73.2 ± 2.1 years, with an overall IVL procedural success rate of 93% [(95% Confidence Interval (CI): 88%-96%, I2=29%), while the in-hospital-30-days and long-term mortality incidence were 1% (95% CI: 1%-3%, I2=0%) and 3% (95% CI: 2%-6%, I2=0), respectively. The 30-days target lesion revascularization (TLR) was approximately 6% (95% CI: 3%-12%, I2=50%). There was a significant increase in the MDS [Standardized Mean Difference (SMD): +50.52%, 95% CI: 39.4-61.6, I2=94%)] and in MSA (SMD: +3.52, 95% CI: 2.47 to -4.58, I2=83%) immediately after IVL application. It was observed a significant increase in MLD (SMD: +1.54, 95% CI: 1.09 to 1.98, I2=95%) and in the MLA (SMD: +3.64, 95% CI: 2.62-4.66, I2=5%). Major procedural and device related complications were 3% (95% CI: 1%-6%, I2=0%) and 1% (95% CI: 0%-2%, I2=85%) respectively. Notably low rates were observed for stent thrombosis (0%, 95% CI: 0%-2%, I2=0%), dissections (1%, 95% CI: 1%-4%, I2=0%), perforations (1%, 95% CI: 1%-3%, I2=0%) and no-reflow (0%, 95% CI: 0%-1%, I2=0%). Conclusions IVL demonstrates promise as a safe and effective strategy for underexpanded stent treatment, characterized by low rates of periprocedural complications. Future prospective studies are now warranted to compare IVL to other lesion preparation strategies.30day All-Cause Mortality after IVL use.Minimum Stent Diameter after IVL use.