Standardized Mean Difference Research Articles

Perioperative administration of sub-anesthetic ketamine/esketamine for preventing postpartum depression symptoms: A trial sequential meta-analysis

Objective Postpartum depression (PPD) is a major mental health issue affecting 10%–15% of women globally. This meta-analysis synthesized updated evidence on sub-anesthetic ketamine/esketamine’s efficacy in preventing PPD. Methods Randomized controlled trials (RCTs) comparing ketamine/esketamine to a placebo for PPD prevention were searched without language restriction. Primary outcomes were PPD risk at 1- and 4–6-week postpartum. Secondary outcomes included the difference in depression scores and risk of adverse events. Trial sequential analysis (TSA) was conducted to validate the reliability. Results A meta-analysis of 22 RCTs (n = 3,463) showed that ketamine/esketamine significantly decreased PPD risk at 1- (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.3–0.57) and 4–6-week (RR, 0.47; 95%CI, 0.35–0.63) follow-ups. Consistently, participants receiving ketamine/esketamine had lower depression-related scores at 1- (standardized mean difference [SMD], −0.94; 95%CI, −1.26 to −0.62) and 4–6-week (SMD, −0.89; 95%CI, −1.25 to −0.53) follow-ups. Despite potential publication bias, TSA confirmed the evidence’s reliability. Subgroup analysis showed that ketamine/esketamine’s preventive effect on 1-week PPD was consistent, regardless of administration timing, type of agents, or total dosage (<0.5 vs. ≥0.5 mg/kg). For the 4–6-week period, PPD risk was favorably reduced only with postoperative administration or the use of esketamine, with the total dosage having no observed influence. Participants on ketamine/esketamine experienced more frequency of hallucinations (RR, 4.77; 95%CI, 1.39–16.44) and dizziness (RR, 1.36; 95%CI, 1.02–1.81). Conclusion Our findings advocate for the postoperative administration of low-dose ketamine/esketamine to avert PPD, which needed additional research for confirmation.

Preclinical evidence and possible mechanisms of cardioprotective effects of resveratrol in diabetic cardiomyopathy: a systematic review and meta-analysis

Abstract Introduction Diabetic cardiomyopathy (DCM) is a significant complication of diabetes, characterized primarily by the development of heart failure in individuals with diabetes. Numerous animal studies have indicated that resveratrol enhances cardiac function in diabetic cardiomyopathy; however, its reliability and underlying mechanism remain unclear. This study aims to assess the cardioprotective effects of resveratrol on DCM and explore its potential mechanism. Methods We searched PubMed, EMBASE, WOS, Cochrane Library, CNKI, CBM, Chinese VIP, and Wan Fang Database until March 31st, 2024, without language restrictions. Continuous outcome measures were analyzed using weighted mean difference or standardized mean difference, and heterogeneity was assessed with I2. The risk of bias in animal experiments was evaluated using the SYRCLE tool, and evidence reliability was determined with the GRADE tool. All data were analyzed using Review Manager 5.4.1 and Stata 17. This study has been registered on the PROSPERO (CRD42024523944). Results A total of 18 studies meeting the criteria were identified. The analysis revealed that the resveratrol intervention group exhibited significant improvements in LVEF (WMD = 17.88), LVFS (WMD = 8.77), HW/BW (SMD=-2.92), SOD (SMD = 4.53), and MDA (SMD=-5.07) compared to the control group. The GRADE grading assessment indicated moderate certainty for LVEF, HW/BW, and MDA, while certainty for other factors was considered low. Conclusion Our research suggests that resveratrol may protect cardiac function in DCM through anti-inflammatory and anti-oxidative stress effects. However, these findings are based on preclinical data, and further extensive trials are needed to confirm their effectiveness and safety before clinical application.

Effects of laser treatment on bond strength of epoxy resin and calcium silicate-based sealers: a systematic review and meta-analysis of in vitro studies.

This study aimed to systematically review the effect of laser treatment on the bond strength of epoxy resin-based and calcium silicate-based endodontic sealers to root dentine. The search encompassed four databases: PubMed/MEDLINE, EMBASE, Scopus, and ISI Web of Science. Inclusion criteria were limited to in vitro studies conducted on extracted human teeth evaluating bond strength in megapascals (MPa) of either epoxy resin-based or calcium silicate-based sealers, using the push-out test. Two independent reviewers appraised the methodological quality of the selected studies to assess the risk of bias. Meta-analysis was performed for different laser types, endodontic sealers, and control groups. Standard Mean Difference and 95% Confidence Interval values were calculated. 17 studies met the inclusion criteria for qualitative synthesis, and 15 for quantitative analysis. Meta-analyses revealed that certain lasers (Er,Cr:YSGG, Er:YAG) significantly increased bond strength for epoxy resin-based sealers when compared to negative controls (inert solutions), but did not show a significant advantage over EDTA agent. For calcium silicate-based sealers, laser treatment did not show significant enhancement in bond strength compared to either inert solutions or EDTA. The subgroup analysis suggested that erbium lasers, especially in the PIPS mode, potentially increase the bond strength of epoxy resin-based sealers. Laser treatment enhances the bond strength of epoxy resin-based sealers compared to inert solutions, but not more than EDTA. For calcium silicate-based sealers, laser treatment does not significantly improve bond strength over inert solutions or EDTA. Laser treatment increases the bond strength of epoxy resin-based sealers.

Vascular endothelial growth factor in inflammatory bowel disease: A systematic review and meta-analysis.

Vascular endothelial growth factor (VEGF) is linked to inflammation and angiogenesis, indicating a possible role in inflammatory bowel disease (IBD) and its main clinical manifestations, Crohn's disease (CD) and ulcerative colitis (UC). This systematic review and meta-analysis investigated studies assessing circulating VEGF concentrations in IBD patients and healthy controls, considering the effect of IBD type, sample type and geographical location. A systematic search identified 18 studies (28 group comparators) investigating 1741 IBD patients and 1291 controls. Data were extracted and analysed using standardized mean differences (SMD) with 95% confidence intervals (CI). VEGF concentrations were significantly higher in IBD patients (SMD = .71, 95% CI .38 to 1.04; p < .001). UC patients showed higher VEGF concentrations than CD patients. Serum samples indicated significant VEGF elevations, unlike plasma samples. Significant VEGF increases were observed in studies conducted in Western Europe and Asia, but not in Eastern Europe. No significant differences were found between active and inactive disease. VEGF concentrations are elevated in IBD patients, with variations by disease type, sample type and geography. However, VEGF is not a reliable marker of disease activity. Future research should standardize methods and explore regional influences to enhance VEGF's clinical utility as a biomarker of IBD.

A systematic review and meta-analysis of the effects of probiotics on bone outcomes in rodent models.

Emerging evidence demonstrates an opportunity for using probiotics to support bone health but findings in humans are limited. This systematic review investigated if probiotic supplementation improves bone mineral density and bone structure in rodent models compared to no supplementation. Studies (n = 71) examining the effect of oral consumption of any probiotic strain on bone mineral density or bone structure in rodents were included. Meta-analyses were conducted separately by study model (intact, ovariectomized) and bone site (femur, tibia, spine) to determine the probiotic effect (standardized mean difference, SMD) on volumetric bone mineral density (vBMD), bone volume fraction (BV/TV) and cortical thickness (Ct.Th). Reasons for heterogeneity were explored (probiotic genus, sex, type of rodent). In intact rodents, probiotics resulted in greater vBMD (SMD = 0.43, 95% CI [0.13, 0.74], I2 = 3%, P<.05) and higher BV/TV (SMD = 0.63, 95% CI [0.25, 1.02], I2 = 57%, P<.05) at the femur without changes in cortical bone structure. In ovariectomized models, probiotic supplementation resulted in greater vBMD (femur: SMD = 1.28, 95% CI [1.01, 1.55], I2 = 3%, P<.05; tibia: SMD = 1.29, 95% CI [0.52, 2.05], I2 = 67%, P<.05; and spine: SMD = 1.47, 95% CI [0.97, 1.97], I2 = 26%, P<.05) as well as higher BV/TV (femur: SMD = 1.16, 95% CI [0.80, 1.52], I2 = 56%, P<.05; tibia: SMD = 2.13; 95% CI [1.09, 3.17], I2 = 79%, P<.05; spine: SMD = 2.04, 95% CI [1.17, 2.90], I2 = 76%, P<.05) and Ct.Th at the tibia (SMD = 2.35; 95% CI [0.72, 3.97], I2 = 82%, P<.05) but not at the femur versus control. The syntheses support probiotics as a strategy to improve bone outcomes in rodent models.

Efficacy and safety of rituximab in patients with lupus nephritis: A systematic review and meta-analysis.

Our aim was to systematically evaluate the efficacy and safety of rituximab (RTX) in patients with lupus nephritis (LN). PubMed, Embase, China National Knowledge Infrastructure (CNKI), Cochrane Library, and Wanfang Databases were searched to collect literature on the efficacy and safety of RTX in patients with LN. Odds ratios (ORs), weighted mean differences (WMDs), and standardized mean differences (SMDs) were used to represent treatment efficacy and overall outcome. The outcomes included complete renal remission rate, proteinuria, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, serum creatinine, any adverse events and serious adverse events. We explored the heterogeneity with I2 and assessed publication bias with funnel plot and Egger's test. Nine studies involving 723 patients (254 in the RTX group and 469 in the control group) were included in our systematic review and meta-analysis. RTX resulted in a higher complete renal remission rate (OR: 2.62; 95% CI 1.43 - 4.79, p = 0.024, I2 = 54.7%) than the control group. It significantly decreased SLEDAI scores (WMD = -3.79, 95% CI: -5.78 to -1.8, p < 0.001, I2 = 94.7%) as well as proteinuria (WMD = -0.9, 95% CI: -1.6 to -0.2, p < 0.001, I2 = 97.6%). There were no significant differences in any adverse events and serious adverse events between the RTX group and control group. RTX was an effective therapeutic agent in patients with LN, and it did not increase the risk of adverse events compared to the control group.

Comparative Analysis of the Physical, Tactical, Emotional, and Mood Characteristics of Under-13 Soccer Players by Performance Level

Background and Objectives: Soccer is a sport characterized by various unpredictable situations in which physical abilities are associated with athletic performance. There are several capabilities that young soccer players must develop to adapt to the needs of the competition. This study analyzes the physical characteristics, tactical knowledge, emotional intelligence, and mood states of youth soccer players at different competitive levels. Materials and Methods: The sample consisted of 36 male soccer players with an average age of 12.65 ± 0.48 years, weight of 44.92 ± 7.49 kg, and height of 157.2 ± 0.08 cm. A cross-sectional correlational study design was selected. Inferential analysis was conducted via the RV coefficient to assess relationships between groups. Two-sample tests (Student’s t test or the Mann–Whitney U test) were used to assess the distribution of the samples. Standardized mean differences (i.e., Cohen’s d) were calculated as effect sizes. Results: For the yo-yo intermittent endurance test level 1, the Premier category showed higher speed (p = 0.01, d = 0.40) and superior estimated VO2max (p = 0.01, d = −0.91). The statistically significant variables included the hamstring strength exercise of the hamstrings for the angle of rupture (p = 0.04, d = −0.04, d = −0.72), the COD-Timer 5-0-5 for contact time—5-0-5 (ms) (p = 0.04, d = 0.69) and 10 m—5-0-5 (s) (p = 0.02, d = 0.79), tactical knowledge of in-game performance (p = 0.01, d = −1.19), support level (p = 0.01, d = −1.27), decision-making ability (p = 0.01, d = 0.59), melancholy (p = 0.01, d = 0.59), confusion (p = 0.01, d = 0.56), and emotional intelligence (p = 0.04, d = 0.77). The Premier category presented slightly higher averages than did category A. In the assessment of running-based anaerobic sprint test power (p &lt; 0.05, d = 0.83) and mood states (p &lt; 0.05, d = 0.59), players in category A presented higher results. Conclusions: The performance capacity of youth soccer players encompasses a multidimensional complexity that includes physical, tactical, emotional, and psychological aspects, which vary among players of the same age.

Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta-Analysis.

We wanted to determine if higher compliance with American College of Sports Medicine (ACSM) exercise prescription guidelines influences exercise outcomes in knee osteoarthritis (OA). We conducted a systematic review. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to January 4, 2024, for randomized controlled trials evaluating resistance and/or aerobic exercise for knee OA. Interventions were classified as higher compliance (meeting ≥60% of ACSM guideline recommendations for frequency, intensity, and duration) or lower compliance (meeting <60% of recommendations). Effects on pain and function were evaluated via meta-analysis, stratified by compliance. Twenty-five trials (3,290 participants) evaluated combined resistance and aerobic programs, with no differences in outcomes between those with higher and lower compliance (standardized mean difference [SMD] pain: -0.38 [95% confidence interval (CI) -0.59 to -0.17] vs -0.31 [95% CI -0.45 to -0.16], respectively; SMD function: -0.43 [95% CI -0.64 to -0.21] vs -0.36 [95% CI -0.58 to -0.14]). Sixty-six trials (5,231 participants) evaluated resistance exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.60 [95% CI -0.81 to -0.39] vs -0.93 [95% CI -1.27 to -0.59]; SMD function: -0.64 [95% CI -0.83 to -0.44] vs -0.85 [95% CI -1.20 to -0.49]). Twelve trials (958 participants) evaluated aerobic exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.79 [95% CI -1.20 to -0.38] vs -1.00 [95% CI -2.52 to 0.53]; SMD function: -0.83 [95% CI -1.27 to -0.38] vs -0.76 [95% CI -2.02 to 0.50]). Higher or lower compliance with ACSM exercise prescription guidelines did not influence exercise outcomes. Given there was substantial heterogeneity and many publications were at risk of bias, our results should be interpreted with caution.

Accelerated versus conventional corneal collagen cross-linking for keratoconus: A meta-analysis of randomized controlled trials.

To systematically compare the effectiveness of conventional corneal collagen cross-linking (CCXL) protocols and accelerated corneal collagen cross-linking (ACXL) protocols in cases with progressive keratoconus. The Cochrane library, EMBASE, MEDLINE, PubMed, and Web of Science databases were searched for randomized controlled trials (RCTs). Outcomes were clinical results and changes in corneal properties. Standardized mean differences (SMD) and 95% confidence interval (CI) were used to estimate the clinical consequences. All outcomes were distributed by different follow-up durations (6 months, 12 months, and > 12 months). We also compared maximum keratometry (Kmax) and best spectacle-corrected visual acuity (BCVA) in subgroups, which were categorized by the discrepant impregnation time period of riboflavin. We included 14 RCTs that met the eligibility criteria in this meta-analysis. At the last follow-up, CCXL was superior in postoperative change in demarcation line (SMD: -1.573; 95% CI: -2.897 to -0.248) and in Kmax (SMD:0.302; 95% CI: 0.071 to 0.533), whereas ACXL provided a significantly lower reduction in central corneal thickness (SMD: 0.498; 95% CI: 0.125 to 0.871). No differences in the changes in uncorrected visual acuity, BCVA, manifest refraction spherical equivalent, corneal biomechanical properties, and the endothelial cell density were found among both groups. CCXL was superior to ACXL in greater corneal flattening and deeper demarcation line, while ACXL seemed to cause less reduction in CCT and allow for earlier UDVA stability. To clearly define the comparative safety and clinical consequences of the different regimens of CXL, more RCTs are required.

Viscoelastic haemostatic assays to guide therapy in elective surgery: an updated systematic review and meta-analysis.

Patients undergoing major surgery frequently experience major uncontrolled bleeding. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of using viscoelastic haemostatic assays to manage peri-operative bleeding in elective surgery. We searched PubMed/MEDLINE and Embase databases for randomised controlled trials according to pre-determined criteria. The primary outcomes were blood product requirements; duration of stay in the operating theatre or ICU; and surgical reintervention rate. We included 20 randomised controlled trials. The overall risk of bias was low to moderate. Twelve studies used thromboelastography-based transfusion algorithms, while eight used thromboelastometry. Viscoelastic haemostatic assay-guided therapy was associated with a statistically significant reduction in transfusion of red blood cells (standardised mean difference (95%CI) 0.16 (-0.29 to 0.02)), platelets (standardised mean difference (95%CI) -0.33 (-0.56 to -0.10)) and fresh frozen plasma (standardised mean difference (95%CI) -0.64 (-1.01 to -0.28)). There was no evidence of an effect of viscoelastic haemostatic assay-guided therapy on surgical reintervention (relative risk (95%CI) 1.09 (0.70-1.69)). Viscoelastic haemostatic assay-guided therapy was associated with lower blood loss and shorter ICU duration of stay. There was no evidence of any effect on total duration of stay and all-cause mortality. Viscoelastic haemostatic assay-guided therapy may reduce peri-operative blood product transfusion requirements and blood loss during major elective surgery, with no discernible effect on patient-centred outcomes. The overall quality of evidence was modest.

The clinical efficacy of laser in the nonsurgical treatment of peri-implantitis: a systematic review and meta-analysis.

To systematically assess studies regarding the efficacy of lasers in the nonsurgical treatment of peri-implantitis. Electronic and manual searches were performed by two reviewers independently. Randomized controlled trials (RCTs) comparing lasers vs. mechanical debridement or air abrasive on primary outcome (probing depth (PD)) and secondary outcomes (bone loss, bleeding on probing (BOP), clinical attachment level (CAL) and plaque index (PI)) were included. Data extraction and quality assessment were conducted independently. Weighted mean difference (WMD) or standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for continuous outcomes. Publication bias, leave-one-out analysis and GRADE assessment were conducted. 13 eligible publications were included in the review and 12 in the meta-analysis. Solid-state lasers significantly improved in PD (WMD = -0.39, 95% CI (-0.70, -0.09), p = 0.01, moderate-certainty evidence), BOP (SMD =-0.76, 95% CI (-1.23, -0.28), p = 0.002, moderate-certainty evidence) and CAL (WMD =-0.19, 95% CI (-0.39, -0.00), p = 0.05, moderate-certainty evidence), but not in bone loss (WMD = 0.03, 95% CI (-0.13, 0.18), p = 0.74, low-certainty evidence) and PI (SMD =-0.19, 95% CI (-0.42, 0.04), p = 0.11, moderate-certainty evidence) compared with the control group. However, the diode lasers showed no clinical advantages. No publication bias was detected, and leave-one-out analysis confirmed the robustness of findings. In the nonsurgical treatment of peri-implantitis, solid-state lasers yielded positive influence in term of PD, BOP and CAL, while diode laser provided no beneficial effect. Future well-designed large RCTs are still needed, considering the limitations of included studies. This review aimed to guide clinicians in choosing the appropriate laser for peri-implantitis, enhancing treatment strategies and attaining better outcomes.

Metformin plus lifestyle interventions versus lifestyle interventions alone for the delay or prevention of type 2 diabetes in individuals with prediabetes: a meta-analysis of randomized controlled trials.

We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes. We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the "meta" package of RStudio software. We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes. Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.

Intravenous ketamine versus electroconvulsive therapy for major depressive disorder or bipolar depression: A meta-analysis of randomized controlled trials.

Intravenous (IV) ketamine has been evaluated alongside electroconvulsive therapy (ECT) in addressing major depressive disorder (MDD) or bipolar depression (BD), though the comparative outcomes remain inconclusive. This meta-analysis aimed to provide a systematic assessment of the efficacy, safety, and tolerability of IV ketamine relative to ECT for treating MDD or BD. Randomized controlled trials (RCTs) comparing IV ketamine and ECT in terms of efficacy, safety, and tolerability for MDD or BD were identified and reviewed. Three independent investigators extracted relevant data, which was synthesized using RevMan 5.3 software under a random effects model. Five RCTs encompassing 664 patients diagnosed with MDD or BD were analyzed. At 24 h post-initial treatment, IV ketamine demonstrated a statistically greater reduction in depressive symptoms compared to ECT (standardized mean difference (SMD) = -0.53; 95 % CI = -1.03 to -0.04; P = 0.04; I2 = 80 %). However, no significant differences were observed between groups in terms of the study-defined response (risk ratio (RR) = 1.49; 95 % CI = 0.08 to 28.42; P = 0.79; I2 = 0 %) at 24 h. Similarly, no notable differences were found for depressive symptom improvement (SMD = -0.48; 95 % CI = -2.41 to 1.45; P = 0.63; I2 = 99 %), the study-defined response (RR: 0.96, 95 % CI: 0.70 to 1.31; P = 0.79; I2 = 75 %) or remission (RR: 0.91, 95 % CI: 0.45 to 1.82; P = 0.78; I2 = 90 %) at the end-of-treatment visit. Among the three RCTs (60 %) comparing the neurocognitive outcomes of IV ketamine and ECT through varying test batteries, results were inconsistent. IV ketamine was associated with marked increases in dissociation, blurred vision, dizziness, and diplopia, while ECT led to a significant rise in muscle pain (all Ps < 0.05). Discontinuation rates due to any cause were comparable between both groups (P > 0.05). IV ketamine demonstrates a faster onset of antidepressant effects compared to ECT, despite both treatments yielding comparable outcomes at the end-of-treatment visit for patients with MDD or BD. However, large-scale RCTs are required to thoroughly evaluate the long-term efficacy and safety of IV ketamine relative to ECT in these populations.

Meta-Analysis: Evaluating Placebo Rates Across Outcomes in Eosinophilic Oesophagitis Randomised Controlled Trials.

High placebo responses have limited drug development in eosinophilic oesophagitis. The optimal configuration of trial outcomes is uncertain. To inform more efficient future trial designs, to characterise clinical, endoscopic and histologic placebo responses in eosinophilic oesophagitis randomised controlled trials (RCTs). We updated a Cochrane systematic review and meta-analysis, searching multiple databases to January 1, 2024, to identify placebo-controlled RCTs evaluating medical therapies for patients with eosinophilic oesophagitis. The primary outcome was the pooled proportion of study-defined clinical, endoscopic and histologic responders and remitters randomised to placebo, using an intention-to-treat approach and random-effects model. Sources of heterogeneity were explored using meta-regression. We included 25 RCTs. The pooled proportion of clinical response was 41.0% [95% CI: 29.7%-52.8%] with substantial heterogeneity (I2 = 74.9%). On meta-regression, older age and a higher probability of being randomised to placebo reduced the likelihood of clinical response to placebo. The pooled proportion of histologic remission defined as a peak eosinophil count [PEC] ≤ 6 eosinophils per high power field [HPF] or ≤ 1 eosinophil/HPF was 4.3% [95% CI: 2.6%-6.2%] (I2 = 23.6%) and 1.3% [95% CI: 0.5%-2.5%] (I2 = 0%), respectively. The standardised mean difference in the Eosinophilic Oesophagitis Endoscopic Reference Score to placebo was -0.25 [95% CI: -0.41, -0.10]. Over 40% of patients in eosinophilic oesophagitis trials respond clinically to placebo, and this is associated with trial design factors such as randomisation ratio and trial population. Objective endoscopic and histologic measures are associated with very low placebo responses.

Effect of Nutrition Education During Pregnancy on Iron-Folic Acid Supplementation Compliance and Anemia in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.

Stakeholders implement nutrition education to prevent and control anemia during pregnancy. Nutrition education during pregnancy can increase the consumption of iron-folic acid (IFA) supplements and encourage behavioral changes. However, there is no comprehensive meta-analysis to determine the effectiveness of this intervention. This review aimed to determine the effect of nutrition education on IFA supplementation (IFAS) compliance, hemoglobin level change, and prevalence of anemia in low- and middle-income countries. The systematic searches on Ovid Medline, Scopus, Embase (Elsevier), Web of Science, Health and Medical Collection (ProQuest), and Google Scholar were conducted until September 11, 2023. The updated searches were performed on November 16, 2023. In total, 12 436 records were imported to Covidence. Of these, 9109 records were screened by title and abstract. A total of 112 records were evaluated in full, and 53 articles were ultimately included based on eligibility. Fifty-three peer-reviewed research articles met the inclusion criteria, involving 13 475 pregnant women. Those who received nutrition education during pregnancy were 2.80 times more likely to comply with IFAS (odds ratio = 2.80; 95% CI: 2.04, 3.83; I2 = 66.20%). There was an average increase of 0.88 g/dL (Cohen's d = 0.88; 95% CI: 0.63, 1.13; I2 = 96.17%) in hemoglobin levels among women who received nutrition education. A meta-regression analysis revealed that 61.85% (adjusted R2 = 61.85%) of heterogeneity between standardized mean differences was explained by anemia status, intervention duration, and geographic region. Also, pregnant women in the nutrition education group had a 34% (relative risk = 0.66; 95% CI: 0.54, 0.80, I2 = 86.85%) lower risk of anemia compared with the control group. Nutrition education during pregnancy improves compliance with IFAS, increases hemoglobin levels, and reduces the risk of anemia. Therefore, it is crucial to enhance the existing nutrition education program to prevent and control anemia during pregnancy. PROSPERO registration no. CRD42023454241.

Comparative efficacy of endoscopic variceal ligation versus non-selective beta-blockers in primary prevention of gastroesophageal varix type 2: an IPTW-adjusted study.

Practice guidelines recommend non-selective beta-blockers (NSBB) and endoscopic variceal ligation (EVL) for primary prevention in cirrhosis patients with esophageal varices. However, there is no clear recommendation for primary prevention strategies for gastric varices, particularly GOV-2. Our objective is to investigate the incidence of initial bleeding and liver-related complications when NSBB and EVL are used for primary prevention in GOV-2. A retrospective analysis was conducted on data from patients with GOV-2 gastric varices. Patients were divided into the NSBB group or the EVL group. Differences in the incidence of initial bleeding within 1year, as well as the occurrence of complications such as hepatic encephalopathy and ascites, were compared between the two groups before and after adjustment for Inverse Probability of Treatment Weighting (IPTW). A Cox proportional hazards model was used to identify independent risk factors for the first bleeding event. There were 60 patients in the NSBB group and 66 patients in the EVL group. Before IPTW adjustment, there were differences between the two groups in sex, portal hypertensive gastropathy, esophageal variceal diameter, red signs, FIB-4, and MELD scores. After IPTW adjustment, these differences were balanced, with standardized mean differences (SMDs) within acceptable ranges. Kaplan-Meier survival analysis showed no difference in bleeding rates between the two groups before or after IPTW adjustment. After IPTW adjustment, Cox regression analysis identified esophageal variceal diameter (HR:5.59 (2.03-15.39), p < 0.001) and MELD score (HR:1.17 (1.01-1.23), p = 0.042) were independent risk factors for bleeding. NSBB treatment did not reduce the incidence of liver-related complications within one year compared to EVL. For primary prevention of bleeding in cirrhotic patients with GOV-2, EVL does not significantly reduce initial bleeding episodes or liver-related complications compared to NSBB.

Anti-Porphyromonas gingivalis Antibody Levels in Patients With Stroke and Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Atrial fibrillation (AF) and stroke are two highly related conditions, with periodontitis and periodontal pathogens, such as Porphyromonas gingivalis (Pg), appearing to be the most prominent common risk factors. In this study, we evaluated studies assessing Pg infection via serum/plasma anti-Pg antibodies in patients with AF and/or stroke. Online databases (PubMed, Scopus, Embase, and the Web of Science) were screened for studies showing the association between anti-Pg antibodies with stroke and/or AF. Relevant data were extracted, and a subsequent random-effects meta-analysis was performed to calculate the pooled odds ratio (OR) or standardized mean difference (SMD) and 95% confidence intervals (CIs) for Pg seropositivity or anti-Pg antibody levels in stroke patients compared to controls. Sixteen studies were included in the systematic review. Based on the meta-analysis performed, there was no significant difference in Pg IgA and IgG levels between patients with stroke and controls (IgA: SMD 0.11, 95% CI -0.02 to 0.25, p = 0.1; IgG: SMD -0.12, 95% CI -1.24 to 0.99, p = 0.83). Similarly, no difference was observed between these groups in terms of Pg IgA and IgG seropositivity (IgA: OR 1.63, 95% CI 1.06-2.50, p = 0.026; IgG: OR 2.30, 95% CI 1.39-3.78, p < 0.001). Subsequently, we reviewed the results of six articles investigating serum or plasma IgG antibodies against Pg in patients with AF. Our results revealed a strict association between Pg infection and AF, with AF patients exhibiting either higher anti-Pg antibody levels or a higher prevalence of positive serum Pg antibodies. Our study supports the clinical utility of Pg infection assessment in patients with periodontitis and those with AF and solicits more focused studies to corroborate its use in clinical settings to enhance overall outcomes, reduce the risk of complications like stroke, and help fine-tune personalized therapies.

Effectiveness of the Music Therapy in Dementia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Studies have not comprehensively examined key variables in music therapy (MT) interventions such as exposure time, session length, and frequency, particularly in relation to patients with dementia. This study investigated the effects of MT on cognitive function, depression, anxiety, behavior, and quality of life in individuals with dementia. Relevant articles published before April 23, 2023, were sourced from five databases, including PubMed, Web of Science, and Embase. Only randomized controlled trials (RCTs) comparing the effects of MT and standard care on the cognitive function, depression levels, anxiety levels, behaviors, and quality of life of individuals with dementia were included. The Reviewers independently extracted data and assessed the studies' methodological quality. Heterogeneity was quantifed using Q statistics from 2 tests and I2 statistics. Outcome analysis was conducted using a random-effects model, and the standardized mean difference (SMD), mean difference, and 95% confidence interval (CI) were calculated. A total of 23 RCTs were included. Compared with the control group, patients who received MT had higher cognitive function, lower levels of depression, and lower levels of anxiety. Meta-regression analysis revealed that the total MT period, total number of MT sessions, weekly MT frequency, MT exposure time, and length of each MT session were associated with an improvement in cognitive function. However, no significant difference was observed in behaviors or quality of life. MT yielded improved cognitive function in individuals with dementia if the intervention spans at least 12 weeks, has at least 16 sessions, and has at least 8 hours of therapy.

Does adjunctive phototherapy have better outcomes than adjunctive antibiotic therapy for the management of peri-implantitis?

Elsevier's Scopus, Web of Science and Pubmed through Medline identified 431 articles, which were reduced to 206 when duplicates were removed. 8 articles were screened, and 1 excluded after reading the full-text, leaving 7 studies. 6 of these were randomised controlled trials, and 1 a non-randomised controlled clinical trial. Studies selected were either blinded, double-blinded, split-mouth clinical studies, comparative or controlled clinical studies, or randomised controlled trials in humans. There were no limitations on year of publication or language of studies. Most studies had a control of mechanical debridement (MD) with adjuvant antibiotics; 1 was surgical therapy. The test group was MD with adjuvant phototherapy. Exclusions were in vitro reports, animal studies, treatment with sole laser therapy, treatment with no additional antimicrobial therapy alongside MD. Pre-prints, reviews, abstracts, opinion articles, editorials, case reports and case series were also excluded. Data were extracted electronically by a single author and a senior librarian from the 3 databases. Titles and abstracts of articles were screened by the author if they contained Medical Subject Headings either in free terms or with Boolean operators. Full text studies that met the inclusion criteria were included. Data were also searched manually in 6 journals. For missing or conflicting information, the author of the article was contacted for clarification. Data extracted were country of origin of article, study design, sample size, research groups, diagnostic criteria, frequency of intervention, follow-up visits, and outcome of parameters which included clinically: plaque index (PI), probing depth (PD), bleeding on probing (BOP) and radiographically: crestal bone loss (CBL). Additional data on lasers were also collected, although not all studies had complete data on this. RevMan was used for statistical analysis. Inconsistencies were evaluated using I2 value > 50% and Cochrane's Q test, with a P value < 0.05 considered. Standard Mean Differences (SMD) were calculated and Confidence Interval was set at 95%. A random effects model was used for each meta-analysis. PI had no statistical difference, with high heterogeneity. PD had no statistical difference, with no heterogeneity. BOP had a statistically significant difference and a high level of heterogeneity, favouring adjunctive phototherapy. MBL had statistically non-significant differences between control and test groups, and no heterogeneity. The findings from the systematic review differed from the meta-analysis, suggesting that application of adjuvant phototherapy was equally as effective as adjunctive antibiotic therapy in outcomes such as PI, PD, BOP and MBL. The meta-analysis found that implants treated with adjuvant phototherapy had superior outcomes in relation to BOP only.

Effects of Inspiratory Muscle Training in People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

This study aimed to investigate the effects of inspiratory muscle training (IMT) on inspiratory muscle strength, dyspnea, and quality of life (QOL) in COPD patients. A comprehensive search was undertaken on the Web of Science, Scopus, Embase, Cochrane, and PubMed databases, encompassing data published up to 31 March 2024. A meta-analysis was subsequently conducted to quantify the standardized mean difference (SMD) and 95% confidence interval (CI) for the effects of IMT in COPD patients. Sixteen studies met the inclusion criteria. IMT significantly improved inspiratory muscle strength (SMD, 0.86, p &lt; 0.00001), dyspnea (SMD = −0.50, p &lt; 0.00001), and QOL (SMD = 0.48, p = 0.0006). Subgroup analysis showed that &lt;60% maximal inspiratory muscle pressure (PImax) IMT (inspiratory muscle strength, SMD = 1.22, p = 0.005; dyspnea, SMD = −0.92, p &lt; 0.0001), IMT conducted for ≤20 min (inspiratory muscle strength, SMD = 0.97, p = 0.008; dyspnea, SMD = −0.63, p = 0.007; QOL, SMD = 1.66, p = 0.007), and IMT conducted &gt;3 times per week (inspiratory muscle strength, SMD = 1.06, p &lt; 0.00001; dyspnea, SMD = −0.54, p &lt; 0.00001; QOL, SMD = 0.48, p = 0.0009) had greater effects. This meta-analysis provides clinicians with evidence supporting the recommendation that COPD patients engage in IMT at &lt;60% PImax for more than 3 times per week, with each session lasting no more than 20 min, to improve inspiratory muscle strength, dyspnea, and QOL.