Quality Of Studies Research Articles

Decision-making for children and adolescents: a scoping review of interventions increasing participation in decision-making.

To review and synthesize the literature on interventions to facilitate shared decision-making or to increase participation in decision-making in pediatrics focusing on interventions for children and adolescents. We systematically searched three electronic databases (September 2021, update in September 2022). We included studies that aimed to increase involvement of children and adolescents in medical or treatment decisions, regardless of study design and reported outcomes. Study quality was assessed using the MMAT. The synthesis strategy followed a narrative methodology. 21 studies met the inclusion criteria. Interventions aimed to increase participation by provision of information, encouraging active participation and collaboration. Didactic strategies included digital interactive applications (n = 12), treatment protocols and guiding questions (n = 12), questionnaires or quizzes about patients' condition or their knowledge (n = 8), visual aids (n = 4), and educational courses (n = 1). Findings indicate positive effects on some of the investigated outcomes. However, the heterogeneity of studies made it difficult to draw consistent conclusions about the effectiveness of interventions. Interventions used a variety of approaches to facilitate SDM and increase participation. The findings suggest that interventions have inconsistent effects across different outcome variables. The evidence was limited due to the methodological shortcomings of the included studies. To increase the participation of children and adolescents in decision-making, interventions targeting them are needed. Most intervention focus on the provision of information and encouragement for active participation. The results suggest high feasibility and, mostly, positive effects in participation, health-related knowledge, patient-HCP relationship, and adherence The study highlights that further high-quality studies using similar outcome parameters are needed to investigate the effects of interventions to facilitate participation in decision-making.

Small cyst size and lack of growth as negative predictors of malignant transformation in low-risk intraductal papillary mucinous neoplasms of the pancreas: A systematic review and meta-analysis.

For branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) without worrisome features (WFs) or high-risk stigmata (HRS), current guidelines recommend surveillance. However, these intraductal papillary mucinous neoplasm (IPMNs), especially the small and stable-sized ones, carry a low risk of malignant transformation. Our aim was to assess whether small cyst size and absence of rapid growth provide reassurance against the development of WFs/HRS and malignancy (high-grade dysplasia (HGD) or pancreatic cancer (PC)). PubMed/Medline, Embase, the Cochrane Library and the Web of Science Core Collection were systematically searched from inception to May 2023 to identify studies investigating surveillance outcomes of low-risk BD-IPMNs. Studies assessing baseline cyst size and/or growth in relation to WFs/HRS and/or HGD/PC were included. The Newcastle-Ottawa scale tool was used to assess study quality. Of the 1937 identified manuscripts, 21 studies were eligible for inclusion. The quality of these studies was considered reasonable. A negative association between cyst size and WFs/HRS development was found in 11 out of 13 relevant studies, but only one out of nine studies reported a negative association between size and malignancy. Regarding cyst growth, four out of six studies described a negative association with the development of WFs/HRS, and all six reported a negative association with malignancy. The pooled relative risk (RR) of developing WFs/HRS or malignancy for cysts ≤15mm was 0.37 (95% CI 0.25-0.57) and the RR of developing malignancy for cyst growth <2-2.5mm/year was 0.04 (95% CI 0.02-0.09)). This systematic review and meta-analysis shows that small and stable-sized low-risk BD-IPMNs are associated with a markedly low progression rate, with stable cyst size being the most reassuring feature. Because of substantial heterogeneity in definitions and reported outcome measures, prospective studies are needed to confirm that surveillance of small and stable sized cyst can be de-intensified or even discontinued.

8582 THE PREVALENCE OF POLYCYSTIC OVARY SYNDROME IN ADULT WOMEN: THE IMPACT OF GEOGRAPHIC REGION

Abstract Disclosure: M. Amiri: None. S. Hatoum: None. R.P. Buyalos: None. A. Sheidaei: None. R. Azziz: Consulting Fee; Self; Spruce Biosciences, May Health, Core Access Surgical Technologies, Acacia Bio, Fortress Biotech, and Rani Therapeutics. Stock Owner; Self; Martin Imaging. Background: Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age and is associated with various health complications. The reported prevalence of PCOS varies widely. However, variations in PCOS prevalence by geographic region are unclear. Objectives: This systematic review and meta-analysis aimed to compare PCOS prevalence in adults across World Health Organization (WHO) regions. Materials and methods: A search of PubMed and Embase was conducted for studies on PCOS prevalence in unselected populations published from inception to July 2023 using various diagnostic criteria. Studies were categorized according to: a) PCOS criteria (NIH 1990 [PCOS phenotypes A&amp;B], AE-PCOS 2006 [PCOS phenotypes A-C], Rotterdam 2003 [PCOS phenotypes A-D], and ‘other/self-reported’ criteria); b) subject assessment type (direct assessment, survey/indirect assessment, or mixed assessment); and c) study quality, assessed using the PCOS Epidemiology and Phenotype (PEP) quality assessment tool. Meta-analyses were performed using fixed-effects or random-effects models depending on the heterogeneity among the studies. Publication bias was assessed using the Egger’s regression test and funnel plots. Subgroup analyses were conducted based on PCOS criteria, assessment types, study quality, and WHO region. Results: Of 6,644 records, 50 studies with including a total of 70,146 adult women (age ≥18 years) were included. The overall pooled prevalence of PCOS was 9.7% (95% CI: 8.25, 11.38) with a pooled PCOS prevalence by criteria of NIH 7.7% (95% CI: 6, 9.83), Rotterdam 11.83% (95% CI: 9.15, 15.17), AE-PCOS 11.48% (95% CI: 7.5, 17.18), and other/self-report 10.05% (95% CI: 6.63, 14.96). High-quality studies reported lower prevalences for Rotterdam and NIH criteria than low-qualities (6.99% vs 10.07% for NIH and 11.07% vs 20.97% for Rotterdam), with all studies using AE-PCOS being high-quality and all studies using other/self-report criteria being low-quality. Among high-quality studies using direct/mixed assessments, PCOS prevalence by NIH was highest in Western Pacific Region (8.19%) and lowest in Europe (6.47%), whereas by Rotterdam, it was highest in Europe (21.30%) and lowest in Western Pacific Region (7.67%). We also observed that highest PCOS prevalence based on AE-PCOS criteria was in Europe (16.09%) and lowest in Western Pacific Region (7.43%). Publication bias was not significant (Egger’s coefficient = 1.2, 95% CI: -1.49, 3.9, p = 0.38), and funnel plot showed a nearly symmetrical distribution of studies around the estimated effect size. Conclusions: This meta-analysis revealed that the reported PCOS prevalence in adults varies widely by WHO geographic region. Study quality, assessment type and diagnostic criteria for PCOS impact the assessment, with low-quality studies overestimating PCOS prevalence. Presentation: 6/2/2024

8558 Prevalence of Polycystic Ovary Syndrome in Adolescent Girls by World Health Organization Region

Abstract Disclosure: S. Hatoum: None. M. Amiri: None. R.P. Buyalos: None. A. Sheidaei: None. R. Azziz: Consulting Fee; Self; Spruce Bioscience, May Health, Core Access Surgical Technologies, Acacia Bio, Fortress Biotech, Rani Therapeutics. Stock Owner; Self; Martin Imaging. Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. The use of several diagnostic criteria imposes a challenge for healthcare providers, especially in adolescents, whose PCOS symptoms may mimic normal pubertal changes. Objectives: This systematic review and meta-analysis aims to estimate the pooled prevalence of PCOS in adolescents using various diagnostic criteria in total and by WHO region. Methods: We systematically reviewed Pubmed and Embase through July 2023 to capture all studies performed in medically unbiased adolescent populations (age &amp;lt;18 years) reporting PCOS prevalence. Studies were categorized according to: a) PCOS criteria (NIH 1990 [PCOS phenotypes A&amp;B], AE-PCOS 2006 [PCOS phenotypes A-C], Rotterdam 2003 [PCOS phenotypes A-D], and ‘other/self-reported’ criteria); b) subject assessment type (direct assessment, survey/indirect assessment, or mixed assessment); and c) study quality, assessed using the PCOS Epidemiology and Phenotype (PEP) quality assessment tool. We performed a meta-analysis using fixed-effects or random-effects models depending on the heterogeneity among the studies. We conducted subgroup analyses based on PCOS criteria, assessment type, study quality, and WHO region. Results: 6,644 studies were initially retrieved, of which 11 were eligible for inclusion including a total of 10,516 adolescents, yielding 15 study groups according to the diagnostic criteria. Considering all studies, PCOS prevalence was 4.98% according to the NIH 1990, 8.80% according to Rotterdam 2003, 4.74% according to the AE-PCOS 2006, and 1.69% according to other criteria/self-report, with an overall pooled PCOS prevalence of 4.57%. All studies using NIH 1990, Rotterdam 2003, and AE-PCOS 2006 were of high quality, and those using other criteria/self-report were of low quality, thus subgroup analysis based on quality resulted in the same prevalences as above. When including only high-quality studies that used direct or mixed assessment, PCOS prevalence was highest in the Western Pacific Region (WPR) at 20.69% and lowest in the Eastern Mediterranean Region at 3.43% under Rotterdam 2003, while it was highest in the South-East Asia Region at 6.20% and lowest in the WPR at 3.94% under NIH 1990. Only one high-quality study using direct or mixed assessment was available under AE-PCOS 2006. Conclusion: This meta-analysis revealed that PCOS prevalence varies according to the PCOS criteria, assessment type, and WHO region. This variability should be addressed, ideally through unifying the diagnostic criteria and using meticulous methods in PCOS epidemiologic studies. The effect of study quality alone on PCOS prevalence could not be detected because of insufficient data, further reinforcing the need for undertaking PCOS prevalence studies in all populations and regions. Presentation: 6/2/2024

A systematic review of individual, social, and societal resilience factors in response to societal challenges and crises

Societal challenges put public mental health at risk and result in a growing interest in resilience as trajectories of good mental health during stressor exposure. Resilience factors represent multilevel psychosocial resources that increase the likelihood of resilient responses. This preregistered systematic review aims at summarizing evidence on the predictive value of individual, social and societal resilience factors for resilient responses to societal challenges and crises. Eligible studies examined the predictive value of resilience factors in stressor-exposed populations in high-income countries by means of multinomial regression models based on growth mixture modeling. Five databases were searched until August 2, 2023. Data synthesis employed a rating scheme to assess the incremental predictive value of resilience factors beyond sociodemographic variables and other resilience factors. An adapted version of the Newcastle-Ottawa Scale was used for risk of bias assessment. Fifty studies (sample sizes: 360–65,818 participants) with moderate study quality reported on various stressors (e.g., pandemics, natural disasters, terrorist attacks). Higher income, socioeconomic status and perceived social support, better emotion regulation and psychological flexibility were related to more resilient responses. The association between resilience factors and resilient responses was stronger in samples with younger mean age and a larger proportion of women. Most studies used non-representative convenience samples and effects were smaller when accounting for sociodemographic variables and other resilience factors. For many factors, findings were mixed, supporting the importance of the fit between resilience factors and situational demands. Research into social and societal resilience factors and multilevel resilience interventions is needed. Preregistration-ID: 10.17605/OSF.IO/GWJVA. Funding source: Robert Koch Institute (ID: LIR_2023_01).

The effectiveness of parenteral agents to mitigate relapses after severe acute migraine headache presentations: A systematic review and network analysis.

To compare the effectiveness of parenteral agents to reduce relapse in patients with acute migraine and identify factors that predict relapse. Following discharge from emergency settings, many patients with acute migraine will experience a relapse in pain; severe relapses may result in re-visits to emergency settings. A comprehensive literature search, updated to 2023, was conducted to identify randomized controlled trials assessing the effectiveness of parenteral agents on relapse outcomes in patients with acute migraine discharged from emergency settings. Two independent reviewers completed study selection, quality assessment, and data extraction. A traditional meta-analysis compared parenteral corticosteroids to placebo; a frequentist network analysis assessed direct and indirect comparisons. Results are reported as risk ratios (RRs) and 95% confidence intervals (CIs). The review protocol was registered with the International Prospective Register of Systematic Reviews (identifier: CRD42018099493). From 8949 citations, a total of 53 unique studies were included involving 6167 patients. Most studies had a high or unclear risk of bias. Corticosteroids significantly reduced relapses compared to placebo (RR 0.67, 95% CI 0.52-0.88; I2 = 0%). Patients receiving lidocaine (RR 0.10, 95% CI 0.01-0.82), sedatives/hypnotics (RR 0.33, 95% CI 0.14-0.75), ergot agents (RR 0.44, 95% CI 0.25-0.75), neuroleptics (RR 0.47, 95% CI 0.31-0.71), opioids (RR 0.58; 95% CI 0.35-0.94), or corticosteroids (RR 0.64, 95% CI 0.47-0.86) were significantly less likely to relapse. Lidocaine (RR 0.09, 95% CI 0.01-0.71), combination therapy (RR 0.12, 95% CI 0.02-0.74), or adding corticosteroids (RR 0.61, 95% CI 0.44-0.84) were more likely to reduce severe relapses. Longer duration of headache and residual pain at discharge were significantly associated with higher relapses. Corticosteroids remain the recommended first-line option to reduce relapse outcomes. Some parenteral agents typically provided for pain relief including ergot agents, neuroleptics, or combination therapy may effectively reduce relapse; however, opioids are not recommended due to safety concerns. Additional research is needed for some lesser studied, albeit promising, agents including lidocaine and propofol. Effective pain control in emergency settings prior to discharge and duration of headache may play a role in the success of such treatments and further investigations could provide further insight regarding how and why some parenteral agents are effective in mitigating relapse events.

Burden of neural tube defects in India: a systematic review and meta-analysis.

One of the most common and serious congenital defects is neural tube defect (NTD) in India. The data about the NTDs in India is lacking. The objective of this meta-analysis is to provide an estimate of NTDs in India with regional variations. This study was conducted by doing a literature search using PubMed (Medline) and Embase databases for studies published from their inception to 1 October 2023 by using relevant keywords. We have prepared our study protocol by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, and our study is registered in PROSPERO. Pooled prevalence was calculated by using the Der Simonian-Liard method and random effect model to find out the burden of NTD in India. Additionally, subgroup and sensitivity analyses were also performed. NHLBI (National Heart, Lung, and Blood Institute) tool was used for assessing the study quality. A total of 1129 articles were identified by using the predefined keywords in which 27 articles were selected which were fitting the selection criteria defined in our study. The prevalence of NTDs in our meta-analysis was found to be 9.46 per 1000 births with a 95% confidence interval of 8.01 to 10.91 per 1000 births with significant heterogeneity with I2 of 99.15%. Our study highlights the increasing trend of NTDs over the past decades, with significant regional variation in India. There is an urgent need for comprehensive prevention strategies such as advocacy and awareness, antenatal screening for NTDs, folic acid supplementation, and food fortification. Future research is required for identification and implementation for a target-based approach for region specific.

Minimum information for reporting on the TEER (trans-epithelial/endothelial electrical resistance) assay (MIRTA).

Standard information reporting helps to ensure that assay conditions and data are consistently reported and to facilitate inter-laboratory comparisons. Here, we present recommendations on minimum information for reporting on the TEER (trans-epithelial/endothelial electrical resistance) assay (MIRTA). The TEER assay is extensively used to evaluate the health of an epithelial/endothelial cell culture model and as an indicator of the potential toxicity of a test substance. This publication is the result of an international collaboration─called the RespTox (Respiratory Toxicity) Collaborative─through which twelve laboratories shared their protocols for assessing the barrier function of respiratory epithelial cells using the TEER assay following exposure to substances. The protocols from each laboratory were reviewed to identify general steps for performing the TEER assay, interlaboratory differences between steps, the rationale for differences, whether these differences impact results or cross-laboratory comparisons between TEER measurements. While the MIRTA recommendations are focused on respiratory epithelial cell systems, these recommendations can be adapted for other cell systems that form barriers. The use of these recommendations will support data transparency and reproducibility, reduce challenges in data interpretation, enable cross-laboratory comparisons, help assess study quality, and facilitate the incorporation of the TEER assay into national and international testing guidance.

Self-Regulated Learning and Learning Outcomes in Undergraduate and Graduate Medical Education: A Meta-Analysis.

Self-regulated learning (SRL) plays a pivotal role in medical education. There is a pressing need for a meta-analytical review to comprehensively evaluate the effect sizes of SRL strategies across diverse learning outcomes and levels of medical trainees. A meta-analysis was executed by searching five databases and resulted in 61 studies that met our inclusion criteria. A three-level meta-analysis was performed to examine the association between SRL strategies and various levels of learning outcomes (i.e., affective, cognitive, and behavioral learning outcomes). Moderator analyses were conducted using meta-regression, considering factors such as types of learning outcomes, training levels, SRL subscales, and quality of the studies. The analysis yielded an average effect size of .212, using Pearson's correlation coefficient, demonstrating a positive and significant association between SRL strategies and overall learning outcomes. Although our moderator analyses indicated that SRL subscales and study quality did not significantly influence the relationship between SRL strategies and learning outcomes, SRL strategies had a more pronounced effect on affective outcomes than on test scores, behavioral outcomes, and mental health outcomes. In addition, the association between SRL strategies and learning outcomes were significantly higher among the clerkship phase of undergraduate medical education than the pre-clerkship phase.

Deep Learning Denoising Improves CT Perfusion Image Quality in the Setting of Lower Contrast Dosing: A Feasibility Study.

Considering recent iodinated contrast shortages and a focus on reducing waste, developing protocols with lower contrast dosing while maintaining image quality through artificial intelligence is needed. This study compared reduced iodinated contrast media and standard dose CTP acquisitions, and the impact of deep learning denoising on CTP image quality in preclinical and clinical studies. The effect of reduced X-ray mAs dose was also investigated in preclinical studies. Twelve swine underwent 9 CTP examinations each, performed at combinations of 3 different x-ray (37, 67, and 127 mAs) and iodinated contrast media doses (10, 15, and 20 mL). Clinical CTP acquisitions performed before and during the iodinated contrast media shortage and protocol change (from 40 to 30 mL) were retrospectively included. Eleven patients with reduced iodinated contrast media dosages and 11 propensity-score-matched controls with the standard iodinated contrast media dosages were included. A residual encoder-decoder convolutional neural network (RED-CNN) was trained for CTP denoising using k-space-weighted image average filtered CTP images as the target. The standard, RED-CNN-denoised, and k-space-weighted image average noise-filtered images for animal and human studies were compared for quantitative SNR and qualitative image evaluation. The SNR of animal CTP images decreased with reductions in iodinated contrast media and milliampere-second doses. Contrast dose reduction had a greater effect on SNR than milliampere-second reduction. Noise-filtering by k-space-weighted image average and RED-CNN denoising progressively improved the SNR of CTP maps, with RED-CNN resulting in the highest SNR. The SNR of clinical CTP images was generally lower with a reduced iodinated contrast media dose, which was improved by the k-space-weighted image average and RED-CNN denoising (P < .05). Qualitative readings consistently rated RED-CNN denoised CTP as the best quality, followed by k-space-weighted image average and then standard CTP images. Deep learning-denoising can improve image quality for low iodinated contrast media CTP protocols, and could approximate standard iodinated contrast media dose CTP, in addition to potentially improving image quality for low milliampere-second acquisitions.

Outcome of post-prostatectomy stress urinary incontinence surgery in men with preoperative idiopathic detrusor overactivity.

Urodynamic evidence of storage dysfunction such as detrusor overactivity (DO) and/or poor compliance are present in up to 30-40% of patients after Radical Prostatectomy (RP). However, the current optimal management of men with DO on preoperative urodynamics prior to male stress urinary incontinence (SUI) surgery is not known. We performed a systematic search of the literature including articles on patients undergoing SUI surgery after prostatectomy with preoperative DO between January 2003 and May 2023 to ensure contemporaneous data was obtained. We identified 11 eligible publications with a total of 792 patients. On Urodynamics, 29% (n = 229) patients had DO prior to SUI surgery. Overall 69% patients had a successful outcome after SUI surgery while 26% (132/499) failed while 34% (32/95) patients who had proven DO preoperatively failed SUI surgery. The difference was not statistically significant. Considering the sub-group analysis, the failure rate with preoperative DO was significantly higher in the sling group (43%) than in the AUS group (18%). The review was limited by the outcome heterogeneity, variability in study inclusion criteria, reporting and analysis and the quality of the available studies. Within the limitations of the data, this review did not show a statistically significant higher failure rate of male incontinence surgery in patients with DO. Hence, patients with DO on preoperative urodynamics who are eligible for male SUI surgery should not be denied surgery but should be counselled appropriately of the risks and potential need for subsequent treatment, to manage expectations.

Systematic review of clinical prediction models for psychosis in individuals meeting At Risk Mental State criteria.

This study aims to review studies developing or validating a prediction model for transition to psychosis in individuals meeting At Risk Mental State (ARMS) criteria focussing on predictors that can be obtained as part of standard clinical practice. Prediction of transition is crucial to facilitating identification of patients who would benefit from cognitive behavioural therapy and, conversely, those that would benefit from less costly and less-intensive regular mental state monitoring. The review aims to determine whether prediction models rated as low risk of bias exist and, if not, what further research is needed within the field. Bibliographic databases (PsycINFO, Medline, EMBASE, CINAHL) were searched using index terms relating to the clinical field and prognosis from 1994, the initial year of the first prospective study using ARMS criteria, to July 2024. Screening of titles, abstracts, and subsequently full texts was conducted by two reviewers independently using predefined criteria. Study quality was assessed using the Prediction model Risk Of Bias ASessment Tool (PROBAST). Studies in any setting were included. The primary outcome for the review was the identification of prediction models considering transition risk and a summary of their risk of bias. Forty-eight unique prediction models considering risk of transition to psychosis were identified. Variables found to be consistently important when predicting transition were age, gender, global functioning score, trait vulnerability, and unusual thought content. PROBAST criteria categorised four unique prediction models as having an overall low-risk bias. Other studies were insufficiently powered for the number of candidate predictors or lacking enough information to draw a conclusion regarding risk of bias. Two of the 48 identified prediction models were developed using current best practice statistical methodology, validated their model in independent data, and presented low risk of bias overall in line with the PROBAST guidelines. Any new prediction model built to evaluate the risk of transition to psychosis in people meeting ARMS criteria should be informed by the latest statistical methodology and adhere to the TRIPOD reporting guidelines to ensure that clinical practice is informed by the best possible evidence. External validation of such models should be carefully planned particularly considering generalisation across different countries. https://www.crd.york.ac.uk/PROSPEROFILES/108488_PROTOCOL_20191127.pdf, identifier CRD42018108488.

Evaluation of Rehabilitation Techniques for Traumatic Ulnar Nerve Injuries After Surgical Repair: A Systematic Review.

Traumatic ulnar nerve injuries often result in significant loss of motor and sensory function, negatively impacting patients' quality of life. Physical rehabilitation is crucial for recovery, but standardized treatment protocols are lacking. This study aims to systematically review rehabilitation techniques to identify future research direction and improve existing protocols for ulnar nerve injury patients. PubMed, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and Scopus were queried from inception until July 31, 2023. Articles containing axonotmesis or neurotmesis injuries of the ulnar nerve were included. Reviews, opinions, editorials, technical reports without clinical outcomes, conference abstracts, non-English text, nonhuman studies, and studies without adult patients were excluded. Three independent reviewers performed screening and data extraction using Covidence, and risk of bias assessments utilizing Cochrane and JBI tools. Because of article heterogeneity, a narrative review was conducted. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number CRD42023442016. This systematic review included one randomized controlled trial and four observational studies (103 patients), which exhibited differences in study quality. Overall, motor and sensory outcomes improved after rehabilitation. Rehabilitation techniques varied widely, and early sensory reeducation appeared to improve sensory function. Only two studies included patient-reported outcomes. Diverse rehabilitation techniques are used to address ulnar nerve injuries. The low number of included studies, differences in study quality, and small sample size underscore the need for larger and more inclusive studies to improve functional recovery after ulnar nerve injuries. Future research should consider the impact of patient and injury characteristics to develop comprehensive treatment guidelines for these patients.

Patient satisfaction using wide-awake local anaesthesia no tourniquet (WALANT) in adults undergoing elective hand surgery: A systematic review and meta-analysis

BackgroundWide-awake local anaesthesia no-tourniquet (WALANT) is increasing in popularity within hand surgery. However, evidence is unclear on patient satisfaction rates when WALANT is compared against other more traditional anaesthetic techniques where pneumatic tourniquets have been used. The present study aims to evaluate the patient satisfaction rates of WALANT techniques. MethodsA literature search was performed using PubMed, Embase, and Cochrane databases looking for observational and randomised controlled trials (RCT) studies from 2003 up to June 2023. The review was carried out amongst adults undergoing elective hand surgery. The mean difference in operation time, as well as the standardised mean difference (SMD) for patient satisfaction and postoperative pain (<24hrs), were computed using the random effects model. The quality of studies was evaluated using RoB-2 for RCTs and ROBINS-I observational studies respectively. Data were collated and a meta-analysis was performed. ResultsThere were 5 RCTs and 15 observational studies included in our analysis, comprising a total cohort of 1800 patients. 899 patients received WALANT (50.0%). Among the RCTs, patient satisfaction was found to be higher in patients receiving WALANT (SMD 1.01, 95% CI 0.11 – 1.92, p = 0.03, I² = 93%). Post-operative pain was found to be non-significant using WALANT (95% CI -3.72 – 0.03, p = 0.10, I² = 99%), as was operative time difference (95% CI -0.42 – 0.40, p = 0.96, I² = 0%) ConclusionThe use of WALANT in elective hand surgery potentially carries higher satisfaction rates compared with anaesthesia with tourniquets. Postoperative pain and operation time are also non-inferior in WALANT, but more robust studies are needed to verify these findings.

Comprehensive analysis of clinical research profiles and study characteristics of oral potentially malignant disorders: an observational study

ObjectiveThe study aims to present an observational study of clinical trials on Oral Potentially Malignant Disorders (OPMDs) and corresponding publications. Study design and settingWe searched the OPMDs-related clinical studies registered in the ClinicalTrials.gov database before March 1, 2024. Subsequently, we investigated the publication status of primary completed studies using PubMed and Google Scholar. ResultsA total of 185 studies were identified for analysis, including 141 interventional studies and 44 observational studies. The most commonly studied disease type was oral lichen planus (OLP), accounting for 113 studies (61.1 %). Interventional studies on OPMDs were predominantly early-phased, blind, randomized, parallel and single-center. The primary purpose of these studies was treatment (106, 75.2 %). Among the treatments, herbal medicine (21, 19.8 %), photodynamic therapy (17, 16.0 %), and glucocorticoids (14, 13.2 %) were of greatest interest. In addition, 58 (63.0 %) of the primarily completed interventional studies were published, with a median time to publication of 33.6 months. Published interventional studies including OLP patients and factorial designs had shorter time to publication. However, these studies were less frequently published in high-impact journals and most primary results were positive. ConclusionsClinical trials on OPMDs predominantly focused on OLP and herbal medicine. The quality of studies is unsatisfactory and publication rate is suboptimal. Improvements are needed in ClinicalTrials.gov registration standards, high-quality study design and more stringent publishing requirements.

Fecal Microbiota Transplantation Outcome and Gut Microbiota Composition in Ulcerative Colitis: a Systematic Review and Meta-analysis

Background & aimsFecal microbiota transplantation (FMT) can induce remission in patients with ulcerative colitis (UC), yet its efficacy needs improvement. We conducted a comprehensive evaluation of the current literature on microbial factors affecting outcome, as well as a meta-analysis on some of the largest datasets regarding composition. MethodsMEDLINE, Embase and Cochrane were systematically searched through August 2024 for relevant studies. The quality of studies was analyzed with Joanna Briggs tools and a composite critical appraisal-score. Additionally, species-level data from two landmark FMT-trials (TURN and FOCUS) were re-analyzed from a compositional perspective. ResultsOut of 3755 citations identified, 56 met the inclusion criteria, of which 29 fulfilled quality standards. Higher microbial α-diversity, either in donors or recipients (at baseline or following FMT treatment), was associated with better clinical response rates. Engraftment of the donors’ microbiota could not be clearly linked with clinical response, possibly because not every donor has an ideal microbiome. Butyrate producing species from the Lachnospiraceae and Oscillospiraceae families were often related with response, whereas the reverse was true for Fusobacteria, many Proteobacteria and Ruminococcus gnavus. Compositional analyses showed that clinical response is associated with a shift from a low-diversity, often Bacteroides dominant composition to one with higher diversity, either dominated by various butyrate producers, the Christensenellaceae-Methanobrevibacter trophic network, or a moderate/high diversity composition with abundant but not excessive levels of Prevotella copri. ConclusionThis systematic review/meta-analysis yielded a coherent picture from a compositional perspective, which may help identify beneficial donor profiles and guide personalized FMT approaches.

The Association of Genetic Polymorphisms and Atypical Depression in Adults: A Systematic Review.

Atypical depression (AD) is a clinical subtype of depression characterised by mood reactivity and at least two of the following features: significant weight gain/increased appetite, hypersomnia, leaden paralysis, and/or interpersonal rejection sensitivity. The role of genetics in the development of depression remains a considerable level of interest among individuals. Due to the large number of breakthrough studies in genetics, there is currently a wealth of heterogeneous data on the existence of genetic markers for depression, including AD. However, it appears that there is a gap in the literature, as we were unable to identify any systematic reviews or meta-analyses that comprehensively describe these data. Therefore, our research aims to provide high-quality, solid evidence for further studies in this area. Electronic bibliographic databases (Scopus, MEDLINE) were systematically searched from inception to September 2023. We searched for any specific genetic markers that could be retrieved associated with AD. The quality of studies has been assessed by means of the Q-genie tool. Nine studies meeting the inclusion criteria were selected, which appeared to link genetic polymorphisms to atypical depression. Four studies examined genetic polymorphisms associated with the serotonin transporter gene (5-HTT), three studies examined genetic polymorphisms associated with endocrine regulation, two studies considered genetic polymorphisms associated with immune and/or cellular regulation, specifically the melanin-concentrating hormone receptor 2 (MCHR2), mineralocorticoid receptor (MR), and fat mass and obesity-associated protein (FTO) genes involved in the regulation of energy balance. The extracted data confirm that the atypical type of major depressive disorder is heritable to a certain extent. Individual risk markers for developing this type of depression may be identified in the future.

Systemic therapy in the management of metastatic or locally recurrent adenoid cystic carcinoma of the salivary glands: a systematic review of the last decade.

Recurrent/metastatic adenoid cystic carcinoma (R/M AdCC) presents a clinical challenge with limited treatment options, particularly in the face of unsatisfactory efficacy from current therapeutic approaches. This review underscores the unmet clinical needs in managing R/M AdCC, emphasising the imperative for novel therapeutic strategies to address this critical gap. The primary objective of this review is to comprehensively analyse and assess trials investigating therapeutic approaches for R/M AdCC. Emphasis is placed on endpoints such as tumour response rates and progression-free survival. The specific interventions, populations, and outcomes examined in these trials will be detailed to provide a focused and informative systematic review. The systematic search spanned databases, including PubMed, EMBASE, and the Cochrane database of systematic reviews. Employing terms like "Carcinoma, Adenoid Cystic" and "trial," the search focused on English full-text articles from April 1, 2010, to August 9, 2023. Inclusion criteria encompassed studies with patients having R/M AdCC, involving drug interventions. Study quality was assessed using the Newcastle-Ottawa Scale for retrospective studies, Cochrane ROBINS-I tool for non-randomised trials, and the ROB-2 tool for randomised controlled trials. A total of 46 trials involving 1244 patients are included in this review, encompassing a variety of therapeutic approaches for R/M AdCC. Targeted therapies, particularly Apatinib at 500 mg, exhibit efficacy with a 47.1% objective response rate (ORR). Conversely, immunotherapeutic agents demonstrate suboptimal performance, with an overall ORR ranging from 0 to 18%. While Apatinib shows promise, the review underscores the imperative for a thorough exploration of drugs targeting unique mechanisms in the immunologically cold nature of R/M AdCC. Substantial progress in systemic therapy for R/M AdCC is evident, driven by early-phase clinical trials, particularly with promising outcomes in VEGF-2 inhibitors. However, challenges persist, notably in immunotherapy due to the cancer's immunologically cold nature. Ongoing research, prioritising early-stage trials, is crucial, emphasising exploration of emerging therapies like cell therapy and antibody-drug conjugates. Transitioning to Phase III trials is essential for more precise therapeutic insights. Collaborative efforts and a focus on personalised precision medicine are vital for overcoming challenges and advancing our understanding of treatment efficacy in this rare cancer.

Postoperative Rehabilitation and Return-to-Sport Criteria After Distal Triceps Rupture Repair: A Scoping Review.

Distal triceps rupture is a rare injury that is commonly surgically repaired to improve elbow strength and function. Most patients are active and have goals to return to specific activities and sports. There is no gold standard rehabilitation protocol for return to sport (RTS) after distal triceps repair. To identify in the literature any criteria used for RTS after distal triceps repair. Scoping review; Level of evidence, 4. Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, level 1 to 4 studies that examined distal triceps repair and had a minimum follow-up duration of 12 months were deemed eligible for study inclusion. Exclusion criteria encompassed studies that employed nonoperative treatment, lacked specific RTS criteria, or involved revision cases. The selected studies underwent assessment regarding RTS outcomes, timelines, rates, and methodological quality. Of the initial 378 unique studies, 6 studies (including 116 patients involved in 16 different sports) met the inclusion criteria. Four of the studies reported RTS rates, with a mean of 89.3%. The duration of time for returning to sport was reported in 2 studies and varied from 4 to 6 months. The parameters most emphasized in the rehabilitation protocols were progressive range of motion exercises, followed by early immobilization and progressive strengthening exercises. Supervised therapy was reported in only 2 (33%) studies. Although all studies included a rehabilitation protocol and 5 studies included a timeline for RTS, only 1 study provided subjective criteria, and no studies utilized specific objective measurement criteria. The overall study quality was fair. This review demonstrated that the overall RTS rate after distal triceps repair was high (89.3%), with no consensus on RTS criteria. Most studies included initial immobilization followed by progressive range of motion and strengthening. Timing after surgery was used as a measure to RTS in the minority of studies and varied between 4 and 6 months. Further research is needed to develop functional and performance-based metrics to better standardize RTS criteria and rehabilitation protocols.

Efficacy and Long-Term Outcomes of Arthroscopic Meniscus Repair: A Systematic Review and Meta-Analysis.

The objective of this systematic review and meta-analysis was to evaluate the efficacy and long-term outcomes of arthroscopic meniscus repair, focusing on success, failure, and reoperation rates. A comprehensive literature search was conducted across PubMed, EMBASE, Cochrane Library, and Scopus, including studies that involved patients undergoing arthroscopic meniscus repair with a minimum follow-up of two years. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Meta-analyses were conducted using RStudio 4.3.1 software (RStudio Inc., Boston,MA), with pooled risk ratios (RR) and 95% confidence intervals (CIs) calculated for dichotomous outcomes using a random effects model. The meta-analysis included 10 studies totaling 1,004 patients. The pooled success rate for arthroscopic meniscus repair was 83% (95% CI: 77%-89%), while the pooled failure rate was 20% (95% CI: 15%-25%), and the pooled reoperation rate was 21% (95% CI: 17%-25%). Significant heterogeneity was observed across studies (I² > 50%). Subgroup analyses based on suture techniques and concurrent anterior cruciate ligament (ACL) reconstruction did not reveal significant outcome differences. Arthroscopic meniscus repair demonstrates high success rates and acceptable failure and reoperation rates, supporting its continued use in clinical practice. However, the variability in study quality and significant heterogeneity highlight the need for more rigorous, high-quality studies to refine techniques and better explore long-term outcomes.