Observational Studies Research Articles

Gut microbiota changes associated with frailty in older adults: A systematic review of observational studies

BACKGROUND Frailty is a complex aging-related syndrome characterized by a cumulative loss of physiological reserve and increased vulnerability to adverse clinical outcomes, including falls, disability, incapacity and death. While an increasing number of studies suggest that the gut microbiota may play a key role in the pathophysiology of frailty, direct evaluation of the association between gut microbiome alterations and frailty in older adults remains limited. AIM To gain insight into gut dysbiosis in frail older adults. METHODS Seven electronic databases (China National Knowledge Infrastructure, VIP, SinoMed, Wanfang, PubMed, Web of Science and EMBASE) were searched for articles published before October 31, 2023 to identify observational studies that compared the microbiomes of older adults with and without frailty. The diversity and composition of the gut microbiota were the main outcomes used to analyze the associations of changes in the gut microbiota with frailty in older adults. The quality of the included studies was assessed via the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality. RESULTS Eleven observational studies with 912 older adults were included in this review. Consistent results revealed a significant difference in the gut microbiota composition between frail and non-frail older adults, with a significant decrease in α diversity and a significant increase in β diversity in frail older adults. The pooled results revealed that at the phylum level, four microbiota (Actinobacteria , Proteobacteria , Verrucomicrobia and Synergistetes ) were significantly enriched, and two microbiota (Firmicutes and Fusobacteria ) were significantly depleted in frail older adults. At the family level, the results consistently revealed that the abundances of 6 families, most of which belong to the Actinobacteria or Proteobacteria phylum, were greater in frail than in non-frail older adults. At the genus or species level, consistent results from more than two studies revealed that the abundances of the genera Prevotella , Faecalibacterium, and Roseburia were significantly lower in frail older adults; individual studies revealed that the abundances of some genera or species (e.g. , Megamonas , Blautia , and Megasphaera ) were significantly lower, whereas those of other genera or species (e.g. , Bifidobacterium , Oscillospira , Ruminococcus and Pyramidobacter ) were significantly greater in frail older adults. CONCLUSION This systematic review suggests that changes in the gut microbiota are associated with frailty in older adults, which is commonly reflected by a reduction in beneficial species and an increase in pathogenic species. However, further studies are needed to confirm these findings.

From Virtual Patients to AI-Powered Training: The Evolution of Medical Simulation

Simulation is a learning technique or tool that allows medical professionals to have dynamic training for diagnosing and treating clinical-surgical pathologies. It can also be employed on the patient as a distraction to reduce pain and anxiety using virtual reality. The objective of this research was to determine the usefulness of medical simulation and its current advances, for which a bibliographic search was carried out of 58 medical articles obtained from databases such as PubMed, ScienceDirect, Mendeley, Latindex, published in the last 5 years that included observational studies, randomized studies, systematic reviews and meta-analyses referring to the research topic. It is concluded that the advances of simulation in medicine and the vast majority of medical specialties recommend implementing this technique for teaching, diagnosis, and treatment. In addition, it can also be used through virtual reality, artificial intelligence, and mixed reality to reduce stress in patients, being an advance in development; however, it was found that there are areas where the help of expert evaluators is indispensable, in topics such as resuscitation and physical rehabilitation where simulation did not surpass conventional treatment. Keywords: Patient simulation; Training Simulation; Faculties of Medicine; Coroner; Medical Specialties.

Bidirectional associations among gallstone disease, non-alcoholic fatty liver disease, kidney stone disease

BACKGROUND A body of evidence has suggested bidirectional relationships among gallstone disease (GSD), non-alcoholic fatty liver disease (NAFLD), and kidney stone disease (KSD). However, the results are inconsistent, and studies on this topic in China are relatively few. Our goal is to explore the bidirectional associations among these three diseases through a multicenter study, systematic review, and meta-analysis. AIM To explore the bidirectional associations among these three diseases through a multicenter study, systematic review, and meta-analysis. The results may help to investigate the etiology of these diseases and shed light on the individualized prevention of these three diseases. METHODS Subjects who participated in physical examinations in Beijing, Tianjin, Chongqing in China were recruited. Multivariable logistic regression was employed to explore the bidirectional relationships among GSD, KSD, and NAFLD. Systematic review and meta-analysis were initiated to confirm the epidemiologic evidence from previous observational studies. Furthermore, trial sequential analysis (TSA) was conducted to evaluate whether the evidence was sufficient and conclusive. RESULTS Significant bidirectional associations were detected among the three diseases, independent of potential confounding factors. The pooled results of the systematic review and meta-analysis also corroborated the aforementioned results. The combined evidence from the multicenter study and meta-analysis was significant [pooled odds ratio (OR) = 1.42, 95%CI: 1.16-1.75, KSD → GSD; pooled OR = 1.48, 95%CI: 1.31-1.67, GSD → KSD; pooled OR = 1.31, 95%CI: 1.17-1.47, GSD → NAFLD; pooled OR = 1.37, 95%CI: 1.26-1.50, NAFLD → GSD; pooled OR = 1.28, 95%CI: 1.08-1.51, NAFLD → KSD; pooled OR = 1.21, 95%CI: 1.16-1.25, KSD → NAFLD]. TSA indicated that the evidence was sufficient and conclusive. CONCLUSION The present study presents relatively sufficient evidence for the positive bidirectional associations among GSD, KSD, and NAFLD. The results may provide clues for investigating the etiology of these three diseases and offer a guideline for identifying high-risk patients.

Comparison of visual outcomes between corneal topography-guided FS-LASIK and SMILE for myopia and myopic astigmatism: a network meta-analysis

Objective: To compare the postoperative visual outcomes of corneal topography-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia and myopic astigmatism. Methods: Embase and PubMed were searched for randomized controlled trials (RCTs), prospective comparative studies, observational studies and retrospective studies of patients with myopia and/or myopic astigmatism treated by corneal topography-guided FS-LASIK, the other FS-LASIKs or SMILE (inception to November 2023). The studies meeting the criteria were collected and underwent quality assessment according to the Jadad scale for RCTs and the Newcastle-Ottawa scale for non-randomized studies. RevMan4.3.0 was used for network meta-analysis. Results: A total of 17 studies were included for meta-analysis, including 7 RCT and 10 observational studies. For the percentage of surgical eyes with uncorrected distance visual acuity≥20/20 (≤3 months), there were no statistically significant differences among corneal topography-guided FS-LASIK, the other FS-LASIKs and SMILE. The surface under the cumulative ranking curve (SUCRA) ranking from best to worst was corneal topography-guided FS-LASIK (86.7%), the other FS-LASIKs (53.1%) and SMILE (10.2%). For the percentage of surgical eyes with postoperative manifest refraction spherical equivalent (MRSE) within ±0.50 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses disclosed the relative risk (RR) of corneal topography-guided FS-LASIK significantly increased by 14% (RR=1.14, 95%CI:0.78-1.59) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (90.4%), SMILE (31.7%) and the other FS-LASIKs (27.9%). For the percentage of surgical eyes with postoperative MRSE within± 1.00 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses showed the RR of corneal topography-guided FS-LASIK significantly increased by 15% (RR=1.15, 95%CI:0.93-1.61) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (94.5%), the other FS-LASIKs (53.9%) and SMILE (1.7%). For the percentage of surgical eyes with postoperative corrected distance visual acuity improved by 1 or more lines (combined follow-up measure timepoint), the main analyses showed no statistical difference between corneal topography-guided FS-LASIK and the other FS-LASIKs, while the RR of SMILE was slightly lower than that of the other FS-LASIKs (RR=0.86, 95%CI:0.65-1.14). The sensitivity analyses disclosed the RR of corneal topography-guided FS-LASIK significantly increased by 40% (RR=1.40, 95%CI:0.06-24.00) as compared to that of the other FS-LASIKs, while SMILE had a slightly lower RR as compared with the other FS-LASIKs (RR=0.77, 95%CI:0.17-2.74). The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (72.4%), the other FS-LASIKs (67.3%) and SMILE (10.3%). Conclusions: Compared with SMILE, FS-LASIK showed a similar postoperative visual acuity improvement. The corneal topography-guided FS-LASIK had better predictability with a higher rate of MRSE within ±0.50 D/1.00 D.

Transseptal Sheath Perfused with High Concentration Heparinized Saline for Reducing Sheath-associated Thrombus.

Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath-associated thrombus development risk was investigated. AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi-center observation study and a prospective single-center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300s was maintained by heparin infusion. TSS aspiration with negative suction and re-perfusion with high concentration heparinized saline (20u/mL) was performed for the remaining procedure before and after catheter withdrawal. A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24-48 h, and after 48 h post-procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath- nor catheter-associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies. For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath-associated thrombus for interventional procedures.

New insights into the use of dexamethasone-dexmedetomidine as perineural adjuvants in peripheral nerve and fascial blocks: an up-to-date narrative review.

The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants. The aim of this up-to-date review was to provide the newest insights on the two adjuvants dexamethasone and dexmedetomidine for regional anesthesia. The addition of perineural dexamethasone-dexmedetomidine combination has shown a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anesthesia compared to perineural single adjunct. This is consistent with clinical studies (trials, observational studies and reports) of a marked prolongation of the local anesthetic effect. Nevertheless, further studies are needed to ascertain the full potential of this technique and all possible associated risks.

Roles of BMI in mediating the causal effect of obstructive sleep apnea on psoriasis: a two-step mendelian randomization study.

Observational studies have reported an association between obstructive sleep apnea (OSA) and psoriasis. Nonetheless, the presence of a causal relationship within this observed association remains to be confirmed. Consequently, we utilized the Mendelian Randomization (MR) method to assess the causal effects between OSA on psoriasis.Single-nucleotide polymorphisms associated with OSA were extracted from the FinnGen study. statistics for psoriasis were obtained from the publicly available IEU GWAS database. Inverse-variance weighted (IVW) method was chosen as the primary analysis, combined with several sensitivity analyses to evaluate the robustness of results. The study design included two-sample MR and two-step MR.Our primary MR analysis revealed that genetically predicted OSA was positively linked to psoriasis (OR = 1.26, 95% confidence interval [CI]: 1.12-1.42, p < 0.001), while no significant causal relationships were observed between psoriasis and OSA (p > 0.05). The two-step MR suggests that BMI might act as a mediating factor in the effect of OSA on psoriasis, with a mediated portion estimated at 23%.Our findings provide support for a causal relationship between genetically predicted OSA and psoriasis. Furthermore, our results suggest that BMI may play a role in mediating the influence of OSA on psoriasis.

Kahook Dual Blade Goniotomy versus iStent Implantation Combined with Phacoemulsification: A Systematic Review and Meta-analysis.

In this meta-analysis, Kahook dual blade goniotomy achieved higher rates of surgical success compared to iStent/iStent inject implantation combined with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 6 compared to the Stent group. To compare the outcomes of phacoemulsification combined with either Kahook Dual Blade (KDB) goniotomy (phaco-KDB) or trabecular microbypass stent (iStent and iStent inject) implantation (phaco-Stent). A literature search was performed on PubMed, Embase, Web of Science, and Cochrane Library from inception to April 2024. Randomized clinical trials and observational studies that compared KDB goniotomy to the first or second generation iStent combined with phacoemulsification were included. The main outcomes measures were surgical success, mean change in intraocular pressure (IOP) and medication number, and complication rates. Mean differences (MD) and pooled odds ratios (OR) were used to analyze continuous and binary outcomes, respectively. Fourteen studies were included with a total of 1959 eyes (958 phaco-KDB, and 1000 phaco-Stent including 753 phaco-iStent and 207 phaco-iStent inject). The combined findings showed significantly higher rates of surgical success in the phaco-KDB group versus the phaco-Stent group (OR: 0.68; 95% CI:0.50 to 0.92; P=0.01; I2=40%), and greater IOP reduction in the phaco-KDB group versus the phaco-Stent group at month 6 (MD: 1.13mmHg; 95% CI: 0.43 to 1.83; P=0.002; I2=51%). By month 12, both groups demonstrated similar IOP reduction. Subgroup analysis at month 12 showed greater IOP reduction in the phaco-KDB group versus the phaco-iStent group (MD: 1.69mmHg; 95% CI:0.44 to 2.95; P=0.008; I2=74%). However, compared to the phaco-iStent inject group, there was no significant difference in IOP reduction (MD: -0.72mmHg; 95% CI: -3.69 to 2.24; P=0.63; I2=64%). Medication reduction and the incidence of adverse events were comparable between groups. KDB goniotomy may offer better surgical success compared to Stent implantation, when used in combination with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 12 compared to iStent. However, iStent inject showed similar IOP reduction to KDB.

Global and Regional Prevalence of Domestic Violence During the COVID-19 Pandemic and Its Determinants: Protocol for a Systematic Review and Meta-Analysis.

Domestic violence is one of the most significant global public health priorities. This social problem could be accelerated by global catastrophes such as the COVID-19 pandemic. The structural changes due to the imposition of health measures, combined with personal and social problems, may worsen the situation. This study aims to investigate the global and regional prevalence of domestic violence during the COVID-19 pandemic and its determinants. We will perform a comprehensive review of the literature in PubMed, PsycINFO, Embase, Cochrane COVID-19 Register, and Applied Social Sciences Index and Abstracts, up to July 2024. This review will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Observational studies will be considered eligible if they have a population-based design, report the number of cases or prevalence of domestic violence during the COVID-19 pandemic, and report potential determinants. Studies in languages other than English, those with unclear data, case reports, conference proceedings, reviews, and letters will be excluded. To assess the methodological quality, a standardized critical appraisal checklist for studies reporting prevalence data will be used. A robust Bayesian approach will be applied using the STATA software package (version 14; STATA Inc) and JASP 0.19.1 (GNU Affero General Public License [GNU AGPL]) software. The search and screening for the systematic literature review are anticipated to be finished in October 2024. Data extraction, quality appraisal, and subsequent data synthesis will begin in November 2024. The review is expected to be completed by April 2025, and the study results will be published in 2025. This systematic review and meta-analysis will address significant gaps in understanding the pandemic's impact on domestic violence, providing a comprehensive assessment of its prevalence and contributing factors. Despite some limitations, the study incorporates diverse data sources and vulnerable groups to offer a detailed and accurate picture. The findings will inform targeted interventions and policy responses to mitigate the impact of future global crises on domestic violence rates. PROSPERO CRD42022351634; https://tinyurl.com/yth37jkx. PRR1-10.2196/60963.

Association between waist-to-hip ratio and risk of myocardial infarction: a systematic evaluation and meta-analysis

BackgroundMyocardial infarction(MI) is one of the most serious health threats. Despite the increasing number of clinical methods used to predict the onset of MI, the prediction of MI is still unsatisfactory and necessitates new methods.ObjectiveTo systematically review observational studies from the past two decades on the association between waist-to-hip ratio (WHR) and MI risk.MethodsOriginal literature on the correlation between WHR and MI was searched in PubMed, Embase, Web of Science, Cochrane Library, Science Direct, CNKI, and Wanfang up to January 31, 2024. Two researchers independently screened, extracted data, and assessed quality using the Newcastle-Ottawa Scale (NOS) and Revman5.3. Meta-analysis with Stata 16.0 calculated the combined Odd ratio (OR) for WHR and MI risk. Heterogeneity was assessed with the I2 statistic to select the appropriate effects model. Subgroup analysis, meta-regression, sensitivity analysis, and funnel plots tested for heterogeneity and publication bias.ResultsA total of 22 observational studies were included, involving 709,093 participants. The meta-analysis showed that an elevated WHR was significantly associated with an increased risk of MI, with a pooled odds ratio (OR) of 1.98 [95% Confidence interval (CI): 1.75–2.24] and high heterogeneity (I2 = 91.5%, P &amp;lt; 0.0001). Subgroup analysis revealed a stronger association between WHR and MI in women (OR: 1.99, 95% CI: 1.43–2.77) compared to men (OR: 1.74, 95% CI: 1.36–2.22). Regional analysis indicated that the association between WHR and MI risk was highest in Asian populations (OR: 2.93 95% CI: 1.61–5.33), followed by American (OR: 1.73, 95% CI: 1.45–2.08) and European populations (OR: 2.19, 95% CI: 1.49–3.22). Sensitivity analysis demonstrated that the results remained stable after excluding one study.ConclusionIn the general adult population, a higher WHR is a potentially significant association for MI and has predictive value for MI.

Enhancing recovery and reducing inflammation: the impact of enhanced recovery after surgery recommendations on inflammatory markers in laparoscopic surgery—a scoping review

IntroductionThe relationship between the Enhanced Recovery After Surgery (ERAS) guidelines and inflammatory markers in laparoscopic surgery has garnered increasing attention. These recommendations are designed to minimize surgical stress and potentially improve recovery outcomes by modifying perioperative care.ObjectiveThis scoping review aims to evaluate the impact of ERAS recommendations on inflammatory markers in patients undergoing laparoscopic surgeries, identifying current research gaps and consolidating findings from existing studies.MethodsGuided by the Cochrane Handbook for Systematic Reviews and adhering to the PRISMA-ScR guidelines, this review analyzed studies from databases like PubMed, Scopus, and Cochrane Library. We included both randomized controlled trials and observational studies that assessed inflammatory markers such as C-reactive protein (CRP), white blood cells (WBC), and Interleukin-6 (IL-6) in laparoscopic surgery patients managed with ERAS recommendations.ResultsOut of 64 initial studies, 7 met the inclusion criteria, involving a total of 2,047 patients. Most of the studies focused on laparoscopic colorectal surgeries. Commonly assessed markers were CRP and WBC. The findings consistently showed that ERAS guideline could mitigate the inflammatory response, evidenced by reduced levels of CRP and IL-6, which correlated with fewer postoperative complications and expedited recovery.ConclusionERAS recommendations appear to beneficially modulate inflammatory responses in laparoscopic surgery, which suggests a potential for enhanced recovery outcomes. However, the evidence is currently limited by the small number of studies and inherent methodological biases. Further robust RCTs are required to strengthen the evidence base and refine these protocols for broader clinical application. Systematic Review Registrationhttps://osf.io/tj8mw/

The role of omega-3 fatty acids in acute pancreatitis.

Prior observational studies have reported the potential protective effect of omega-3 fatty acids on the prognosis of acute pancreatitis. However, the causal impact of omega-3 fatty acids on acute pancreatitis is unclear. We aimed to investigate further the association of omega-3 fatty acids with acute pancreatitis. We performed a meta-analysis and Mendelian randomization (MR) to explore the association between omega-3 fatty acids and the prognosis of acute pancreatitis from clinical observation and genetics perspectives, respectively. 9 randomized controlled trials were included in this study. The result meta-analysis showed that complementary therapy of omega-3 fatty acids significantly decreased mortality (RR: 0.30; 95% CI 0.14 to 0.65, P＜0.05) and infectious complications in acute pancreatitis (RR: 0.45; 95% CI 0.27 to 0.77, P＜0.05). Compared to the control groups, the hospital stays (MD: -1.02; 95% CI -1.85 to -0.20, P＜0.05) in acute pancreatitis patients with omega-3 fatty acids treatment were statistically reduced. However, the ICU stay (MD: -0.49; 95% CI -1.29 to -0.31, P＞0.05) between control groups and acute pancreatitis patients with omega-3 fatty acids treatment was insignificant. Utilizing genetic susceptibility analysis in the Mendelian randomization (MR) approach, the MR showed omega-3 fatty acids have a significant causal effect on the acute pancreatitis risk (OR, 0.887; 95% CI, 0.797-0.986, P = 0.027, fixed-effect; OR, 0.887; 95% CI, 0.792-0.993, P = 0.037, random-effect). Omega-3 fatty acids complementary therapy may improve the prognosis of acute pancreatitis. Furthermore, genetically predicted serum levels of omega-3 fatty acids can significantly lower acute pancreatitis risk.

Genetic Causal Association Between 15 Micronutrients and 12 Obstetric-Related Diseases: A Mendelian Randomization Study.

Micronutrients, namely vitamins and minerals, are associated with pregnancy outcomes. However, the effects reported in previous observational studies and randomized controlled trials have been inconsistent. Using publicly available genetic data, we conducted a two-sample MR analysis to estimate the causal association between 15 micronutrient levels and 12 obstetric-related diseases. Sensitivity analysis was performed to assess the robustness of the results, detect heterogeneity, and examine the potential existence of horizontal pleiotropy. Iron was protective against gestational diabetes mellitus (GDM) (OR = 0.597, 95% CI 0.438-0.814, P = 0.001), while zinc increased the risk of pregnancy hypertension (OR = 1.064, 95% CI 1.004-1.128, P = 0.035). Vitamin B6 was associated with increased risk of spontaneous abortion (OR = 1.222, 95% CI 1.001-1.490, P = 0.047), and vitamin D was linked to poor fetal growth (OR = 1.612, 95% CI 1.018-2.552, P = 0.041). Conversely, vitamin B12 showed protective effects against preterm birth (OR = 0.686, 95% CI 0.482-0.976, P = 0.036). Selenium and vitamin E were protective against polyhydramnios (OR = 0.828, 95% CI 0.698-0.981, P = 0.030; OR = 0.441, 95% CI 0.213-0.910, P = 0.026), whereas selenium increased the risk of premature rupture of membranes (OR = 1.083, 95% CI 1.007-1.164, P = 0.030).However, no causal links were found between the other micronutrients analyzed and obstetric-related diseases. Sensitivity analyses revealed no significant heterogeneity or pleiotropy. Our research has clarified the causal link between micronutrients and obstetric-related diseases, assisting clinicians in offering personalized guidance on the appropriate intake of micronutrients for women preparing for pregnancy and those who are pregnant. These findings are essential for screening and preventing pregnancy complications, and they also provide new insights and evidence for improving pregnancy outcomes through nutritional interventions.

Gut microbiota and breast cancer: systematic review and meta-analysis.

The gastrointestinal microbiota can modulate systemic estrogens, potentially influencing estrogen-induced breast neoplasia development. This study aimed to assess alterations in the gut microbiota in breast cancer patients. A search strategy was developed using the terms: "Microbiota," "Gastrointestinal Microbiome," "Breast Cancer," and synonyms. Ten observational studies were included. The total sample was 1730 women (929 cases and 801 controls). The meta-analysis of alpha diversity, assessed by the Shannon index, displayed that in the breast cancer group, the diversity of the gut microbiota was reduced compared to controls, with a standardized mean difference (SMD) of -0.34 (95% CI -0.59, -0.10, I2 = 68%, p = 0.007). Regarding the premenopausal population, there was a significant reduction in the breast cancer group (SMD -0.67, 95% CI -1.06, -0.28, I2 = 77%, p = 0.0009). In women with a body mass index (BMI) between overweight or obesity, no statistically significant difference was observed (SMD -0.20; 95% CI -0.51, 0.11; I2 52%, p = 0.20). However, in women with a BMI greater than or equal to 18.5 and less than 25.0, there was lower diversity in women with breast cancer compared to controls (SMD -0.49, 95% CI -0.94, -0.04; I2 78%, p = 0.03). The study found a significant difference in gut microbiota diversity between women with breast cancer and controls, supporting the growing evidence that the gut microbiota may play a role in mammary carcinogenesis.

Estimating Causal Effect of Two-Dose COVID-19 Vaccination on Hospitalization: A Propensity Score Matching Approach

Introduction: To estimate the effectiveness of two-dose COVID-19 vaccination in reducing hospitalization, accounting for complex confounding factors in observational studies. Methods: Researchers applied propensity score methods to adjust for confounding variables, comparing their performance to traditional covariate adjustment methods. Multiple Logistic Regression and Propensity Score Matching were employed to analyze the data, ensuring a balanced comparison between vaccinated and unvaccinated groups. Results: Both analytical methods demonstrated a significant reduction in the likelihood of hospitalization among vaccinated individuals. The adjusted odds ratios (OR) were 0.29 (95% CI: 0.26, 0.31) via logistic regression and 0.32 (95% CI: 0.30, 0.34) using propensity score matching. Conclusion: The study confirms the effectiveness of two-dose COVID-19 vaccination in decreasing hospitalization. It highlights the importance of using meticulous approaches like propensity score methods to assess real-world impacts in complex observational data settings

The sitting men: A systematic review of spare and working time exposure to sedentariness in relation to semen parameters.

Over the past few decades, several studies have found that semen quality parameters have steadily declined over time. Many hypotheses have been made to explain this finding, among which a sedentary lifestyle has been investigated. To synthesize the current evidence, we performed a systematic review of published papers reporting on the relationship between sedentary habits and semen parameters. Embase and PubMed were systematically searched for papers published in English up to May 2023. We included all full-text observational papers that reported the relationship between sedentariness and semen parameters. Article selection adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Sixteen observational studies were ultimately included, six in healthy men and ten in men from Fertility Clinics. They encompassed a total of 13,509 men, with 9877 being healthy men and 3632 presenting at Fertility Clinics for initial assessment. In terms of semen volume, no association emerged in the six studies involving healthy men: however, results in men referring to fertility clinics mainly showed no association, with one indicating a decline and one higher volume. Twelve studies did not report differences in sperm concentration, while one study in men from Fertility Clinics and two in healthy men observed a decline in this parameter with increasing time spent on TV watching or sedentary posture in spare time. Total sperm count was found to be similar across groups of inactivity, except for one study that showed a significant decrease when men from Fertility Clinics spent more time watching TV. No significant differences were reported in sperm motility across all studies, with only one study, among those addressing sperm morphology, indicating a lower percentage of normal forms in men watching TV more than 3h per day. Finally, three studies conducted in men referring to Fertility Clinics analyzed the sperm DNA fragmentation index. Two of these studies found a higher DNA fragmentation index in men spending more time per day in a sitting posture. This review suggests a weak association between time spent sitting during spare time and sperm concentration, but the findings are inconsistent, highlighting the need for further research.

Influence of The Anabolic Steroid Usage on The Physical Health: A Review

Introduction: Anabolic steroids are synthetic derivatives of testosterone commonly used to enhance athletic performance and physical appearance. Despite their popularity, their non-medical use is associated with significant health risks. This review aims to synthesize current knowledge on the impact of anabolic steroid use on physical health, emphasizing cardiovascular, hepatic, endocrine, and musculoskeletal systems, as well as broader systemic effects. Materials and Methods: A systematic literature review was conducted using peer-reviewed articles from databases such as PubMed, Scopus, and Google Scholar published between 2000 and 2023. Studies were selected based on relevance, with particular focus on human clinical trials, observational studies, and meta-analyses. Keywords included "anabolic steroids," "health effects," "cardiovascular risk," and "endocrine disruption." Results: Anabolic steroid use is linked to increased cardiovascular risks, liver dysfunction, endocrine disturbances, and musculoskeletal injuries. Key effects include hypertension, hepatotoxicity, testosterone suppression, infertility, and tendon injuries. Psychological impacts such as aggression and mood changes were also observed. Conclusions: Anabolic steroid use poses significant risks to multiple organ systems and overall health. Despite widespread awareness of these dangers, misuse persists, often driven by societal pressures and misinformation. Healthcare providers should prioritize prevention through education, early intervention, and support for individuals at risk. Future research should focus on long-term effects and effective strategies for harm reduction.

Hands-On Versus Hands-Off Treatment of Hip-Related Nonspecific Musculoskeletal Diseases: A Systematic Review

Background/Objectives: A manual approach combined with therapeutic exercise versus therapeutic exercise alone is a debated issue in the literature. The American College of Rheumatology guidelines “conditionally recommended against” manual therapy for the management of hip osteoarthritis. Manual therapy followed by exercise, instead, appears to lead to a faster return to sport than exercise alone for adductor groin pain. There is a need to understand which is the most effective treatment in the management of hip nonspecific musculoskeletal diseases. The aim of this systematic review is to determine which is the most effective treatment between manual therapy combined with therapeutic exercise and therapeutic exercise alone in subjects with hip nonspecific musculoskeletal diseases. Methods: This systematic review complies with the guidelines of the 2020 Prisma Statement. The databases consulted were Pubmed, Cinahl, and Web Of Science. The search was conducted from October 2004 to November 2023. The search string was developed following the PICO model. Free terms or synonyms (e.g., manual therapy, exercise therapy, hip disease, effectiveness) and Medical Subject Headings terms were combined with Boolean operators (AND, OR, NOT). The risk-of-bias assessment was conducted using Version 2 of the Cochrane risk-of-bias tool for randomized controlled trials and the Newcastle Ottawa Scale for observational studies. A qualitative analysis of the results was conducted through narrative synthesis of key concepts. When possible, quantitative analysis was conducted through statistical parameters. Results: Ten articles were analyzed. Results show no differences between the interventions analyzed. Preliminary evidence seems to favor the combined intervention for the outcomes of pain, ROM, and patient satisfaction, with other studies claiming an absence of differences. Only one study claims that therapeutic exercise alone is more effective for quality of life. Preliminary evidence seems to show that manual therapy does not seem to bring any benefit in addition to therapeutic exercise in mid- and long-term functionality, especially for hip osteoarthritis. Conclusions: There seems to be no difference in effectiveness between manual therapy combined with therapeutic exercise and therapeutic exercise alone in individuals with hip nonspecific musculoskeletal diseases.

Non-Invasive Ventilation in Acute Asthma Exacerbations: A Systematic Review.

Multiple clinical practice guidelines lack recommendations pertaining to non-invasive ventilation (NIV) in acute asthma exacerbations due to a paucity of evidence. However, the evidence syntheses for these guidelines were performed years ago and more recent randomized controlled trials (RCTs) and observational studies have been published. Update the evidence syntheses from previous guidelines to further clarify the effects of NIV in acute asthma exacerbations. A systematic search of Medline, Embase and the Cochrane Library was conducted, studies comparing NIV plus standard medical therapy to standard medical therapy alone in adults with acute asthma exacerbation were selected using a priori selection criteria, and relevant data were extracted. Weighted aggregation (meta-analysis) was performed to summarize effects, which were appraised using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Eight RCTs and five observational studies were selected. NIV was associated with a reduced intubation rate (RCTs RR 0.46, CI 0.16-1.29 and observational studies RR 0.55, CI 0.45-0.68), admission rate (RR 0.57, CI 0.34-0.98), and time to improvement in accessory muscle use (Mean difference -1.13 hours, CI -1.28 - -0.99). Additional outcomes favored NIV plus standard medical therapy but didn't reach statistical significance including dyspnea measures and spirometry measures. There were too few deaths to reliably assess mortality. The quality of evidence ranged from low to very low for all outcomes. All statistically significant outcomes favored NIV plus standard medical therapy over standard medical therapy alone in adults with acute asthma exacerbation. Our aggregate data suggests that intubation rate may be reduced with NIV plus SMT, though the overall quality of the evidence is low. If this is a true effect, it may be clinically important because intubation has been shown to correlate with mortality in multiple observational trials. Given these findings, patients with acute asthma exacerbations may benefit from a trial of NIV in addition to standard medical therapy.

Management of Acute Ischemic Stroke Following Transcatheter Aortic Valve Implantation: A Systematic Review and Multidisciplinary Treatment Recommendations

Background/Objectives: Acute ischemic stroke is an uncommon but potentially devastating complication of Transcatheter Aortic Valve Implantation (TAVI). Despite improvements in device technology and procedural techniques, stroke rates have remained stable, with cerebral embolic protection devices demonstrating only limited efficacy to date. Therefore, the management of acute ischemic stroke complicating TAVI (AISCT) remains a key priority. We conducted a systematic review of the management of AISCT and provided multidisciplinary consensus recommendations for optimal management. Methods: PubMed, Google Scholar, and Cochrane databases were searched from inception to October 2023. All the original studies focusing on the treatment of AISCT were included. Non-English language studies, review articles, and studies in pediatric populations were excluded. Consensus recommendations were made by a working group comprising experts in stroke medicine and structural interventional cardiology. Results: A total of 18 studies met the inclusion criteria, including 14 case reports/series and 4 observational studies. No clinical trials were identified. The included case reports and series suggest that tissue-type plasminogen activator (tPA) and mechanical thrombectomy (MT) might be effective strategies for managing AISCT. However, significant bleeding complications were reported in two out of the four patients receiving tPA. Four observational studies also suggest an association between tPA and/or MT and improved functional outcomes and survival compared to conservative management. Higher bleeding rates were reported following tPA. Observational data suggest that there is currently little real-world utilization of either reperfusion strategy. Conclusions: There is an absence of high-quality randomized data to guide clinical decision making in this important area. Observational data suggest reperfusion strategies are associated with improved clinical outcomes once important confounders such as stroke severity have been accounted for. While MT can be recommended as the standard of care in appropriately selected patients, significantly increased rates of bleeding with tPA following large-bore arterial access raise important safety concerns. We present simple clinical guidance for AISCT based on the limited available data. Close multidisciplinary work and patient-specific consideration of ischemic and bleeding risk is essential.