Subgroup Meta-analysis Research Articles

Dietary patterns and periodontitis: A systematic review.

The systematic review aimed to investigate the associations between index-based dietary patterns and the risk and severity of periodontitis. Four public databases were searched for relevant published articles. Two independent researchers conducted the study selection, quality assessment, and data extraction. Methodological quality of the selected studies was evaluated using Joanna Briggs Institute Checklists. The review was registered with PROSPERO (CRD42023395049). Twenty-five studies were eligible for this review, including 23 cross-sectional studies and two prospective cohort studies. The most utilized dietary indices were the Healthy Eating Index (HEI), the Mediterranean Diet Score (MDS), and the Dietary Inflammatory Index (DII). The results indicated a positive association between higher diet quality (i.e., higher HEI and MDSs and lower DII scores) and healthier periodontal status. Subgroup meta-analysis for four studies utilizing HEI and CDC/AAP case definition indicates the protective effect of higher HEI scores on the risk of periodontitis (OR [95% CI] = 0.77[0.68, 0.88]) with statistical significance (Z = 3.91 [p < 0.0001]). Dietary assessment was conducted by validated food frequency questionnaires (FFQ) in 52% of the studies and 24-h dietary recalls in 36% of the studies. One study utilized a validated 15-item questionnaire to measure patients' adherence to the Mediterranean Diet (QueMD). The quality assessment showed that all studies were of high quality. High HEI and MDSs and low DII scores were associated with a low risk of periodontitis and better periodontal conditions. The standardized and repeatable diet guidelines might be provided for preventing periodontitis. Future prospective studies and clinical trials are needed to confirm this causal association.

Prognostic significance of oligodendrocyte transcription factor 2 expression in glioma patients: A systematic review and meta-analysis.

Gliomas are the most common primary central nervous system neoplasm. Despite recent advances in the diagnosis and treatment of gliomas, patient prognosis remains dismal. Therefore, it is imperative to identify novel diagnostic biomarkers and therapeutic targets of glioma to effectively improve treatment outcomes. To investigate the association between oligodendrocyte transcription factor 2 (Olig2) expression and the outcomes of glioma patients. The PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure databases were searched for studies (published up to October 2023) that investigated the relationship between Olig2 expression and prognosis of glioma patients. The quality of the studies was assessed using the Newcastle Ottawa Scale. Data analyses were performed using Stata Version 12.0 software. A total of 1205 glioma patients from six studies were included in the meta-analysis. High Olig2 expression was associated with better outcomes in glioma patients [hazard ratio (HR): 0.81; 95% (confidence interval) CI: 0.51-1.27; P = 0.000]. Furthermore, the results of subgroup meta-analysis showed that high expression of Olig2 was associated with poor overall survival in European patients (HR: 1.34; 95%CI: 0.79-2.27) and better prognosis in Asian patients (HR: 0.43; 95%CI: 0.22-0.84). The sensitivity analysis showed that no single study had a significant effect on pooled HR, and there was also no indication of publication bias according to the Egger's and Begger's P value test or funnel plot test. High Olig2 expression may have a positive impact on the prognosis of glioma patients, and should be investigated further as a prognostic biomarker and therapeutic target for glioma.

Exposure range matters: considering non-linear associations in the meta-analysis of environmental pollutant exposure using examples of per- and polyfluoroalkyl substances and birth outcomes.

Meta-analysis is a powerful analytic method for summarizing effect estimates across studies. However, conventional meta-analysis often assumes a linear exposure-outcome relationship and does not account for variability over the exposure ranges. In this work, we first used simulation techniques to illustrate that the linear-based meta-analytical approach may result in oversimplistic effect estimation based on three plausible non-linear exposure-outcome curves (S-shape, inverted U-shape, and M-shape). We showed that subgroup meta-analysis that stratifies on exposure levels can investigate non-linearity and identify the consistency of effect magnitudes in these simulated examples. Next, we examined the heterogeneity of effect estimates across exposure ranges in two published linear-based meta-analyses of prenatal exposure to per- and polyfluoroalkyl substances (PFAS) on changes in mean birth weight or risk of preterm birth. The re-analysis found some varying effect sizes and potential heterogeneity when restricting to different PFAS exposure ranges, but findings were sensitive to the cut-off choices used to rank the exposure levels. Finally, we discussed methodological challenges and recommendations for detecting and interpreting potential non-linear associations in meta-analysis. Using meta-analysis without accounting for exposure range could contribute to literature inconsistency for exposure-induced health effects and impede evidence-based policymaking. Therefore, investigating result heterogeneity by exposure range is recommended.

Qualitative Comparative Analysis of exercise interventions for fall prevention in residential aged care facilities

BackgroundExercise interventions are highly effective at preventing falls in older people living in the community. In residential aged care facilities (RACFs), however, the evidence for effectiveness is highly variable, warranting exploration of drivers of successful trials. This study aims to identify the conditions of randomised controlled trials (RCTs) that are associated with reducing falls in RACFs and test whether it can explain the variability.MethodsRCTs testing exercise interventions in RACFs compared to usual care, reporting rate or risk of falls from the 2018 Cochrane Collaboration review and a search update to December 2022 were included. Two authors independently extracted and coded trial conditions and outcomes according to a theory developed from prior Intervention Component Analysis. Trial outcomes were coded as successful or unsuccessful based on point estimates for the rate or risk ratio for falls, or p value. Qualitative Comparative Analysis (QCA), utilising Boolean minimisation theory, was conducted to determine the key conditions driving trial success. A subgroup meta-analysis and the GRADE approach was applied to the final theory.ResultsEighteen trials undertaken in 11 countries with 2,287 residents were included. Participants were predominately ambulant females aged 70 to 80 with cognitive impairment. Most interventions were fully supervised or supervised at the start of the intervention. QCA identified two configurations as drivers of successful exercise falls prevention programs: (i) group exercise that is moderate or low intensity, or (ii) for independent ambulatory residents, exercise for more than 1 h per week. The combination of configuration (i) and (ii) had consistency and total coverage scores of 1, indicating all trials were explained. This combination was associated with a reduction in falls (rate ratio 0.45, 95%CI 0.34 to 0.59; risk ratio 0.66, 95%CI 0.53 to 0.82; low certainty evidence).ConclusionTo successfully reduce falls in RACFs, exercise programs should provide continuous supervised moderate-intensity group exercise. For programs that mostly include independent ambulatory residents, exercise for at least 80 min per week should be provided. As many current residents are frail, tailored exercise is likely necessary and an individualised dose may be required. Future trials should test exercise interventions for less mobile residents.

Total mercury and methylmercury levels in Brazilian Amazon fish: A scope review with meta-analysis and local population health risk assessment

IntroductionThe Brazilian Amazon has one of the richest biomes and the largest source of freshwater on the planet. However, anthropogenic activities have also turned this region into one of the highest points of human exposure to mercury ever recorded. Therefore, the aim of the present work was to perform a scope review with meta-analysis in order to evaluate the total mercury (THg) and methylmercury (MeHg) levels in Brazilian Amazon fish, as well as to carry out a local population health risk assessment. MethodsA literature search was systematically performed in research databases and gray literature, remaining 14 studies from 2017 to 2022 for final analysis. The studies were submitted to raw mean and subgroup meta-analysis, followed by a risk characterization and the calculation of a maximum safe consumption of fish for the Amazonian population. ResultsThe selected studies covered 4 Amazonian states, as well as included the analysis of >30 fish species of different trophic levels and sampling in >15 cities. The overall total mercury mean obtained for Brazilian Amazon fish was 0.29 ug g⁻¹. Significant difference was observed between THg levels according to fish trophic level (p < 0.05), which reinforces the MeHg biomagnification. When THg levels from all fish samples were pooled, it was not observed a significant difference among the Amazonian states and the fish sampling season. However, significant variations between microregions and species-specific variations over the seasons should not be discarded. All estimated daily methylmercury intake exceeded the reference dose of 0.1 ug kg BW⁻¹ day⁻¹, resulting in a hazard quotient (HQ) greater than 1 and indicating a risk of chronic exposure by the local population. The maximum safe consumption of fish calculated based on the overall total mercury mean was set as 31, 147 and 173 g week⁻¹ for children, adult women and adult men, respectively, which is much lower than the reality of consumption by the riverside communities (2870 g week⁻¹). ConclusionThere is an urgent need to reduce Hg exposure levels in the region as well as to recommend other protective nutritional strategies to the local population such as defining the fish species with lower mercury contamination levels and their safe weekly consumption.

The Worldwide Prevalence of Internet Addiction among Medical Students: A Systematic Review and Meta-Analysis.

The internet helps us obtain necessary information, facilitates social communication, and provides access to entertainment content. The internet can also lead to the behavioral addictive condition termed internet addiction (IA) if used excessively. As active internet users, medical students are susceptible to IA, which is known to lead to depression and improper medical care delivery, poor academic performance, worse sleep quality, and undesirable financial issues. This systematic review and meta-analysis aimed to assess medical students' pooled IA prevalence. The analysis included thirteen cross-sectional studies involving 4787 medical students. Cumulative, subgroup, and meta-regression meta-analyses were applied, using the random-effects model and the restricted maximum likelihood method. The cumulative meta-analysis revealed a rise in the proportion of IA from 0.08 to 0.29, with minor fluctuations between 2015 and 2022. The IA prevalence in lower-middle-income countries was approximately three times higher than in high-income ones. Age and gender were not associated with IA among medical students. The worldwide prevalence of IA was 0.29, with a 95% CI between 0.19 and 0.41. Considering negative IA implications for medical students' well-being, policymakers and all stakeholders should pay special attention to addressing IA within the medical student community.

Role of Chemoablation Using UGN-101 in Upper Tract Urothelial Carcinoma: A Systematic Review and MetaAnalysis of Available Evidence.

To examine the safety and efficacy of chemoablation using UGN-101 in patients with upper tract urothelial cancer (UTUC). We conducted a systematic search through 7 databases/registries to identify key observational and experimental studies reporting either the efficacy or safety of UGN-101 in UTUC patients regardless of the risk or grade of the disease. The outcomes included efficacy (complete/partial/no response, survival, death, recurrence, or progression) and safety endpoints. All meta-analyses were conducted through STATA. The prevalence rate and its 95% CI were pooled across studies. A subgroup meta-analysis was conducted on follow-up. The quality was assessed using the Newcastle Ottawa Scale. Twenty studies (1051 patients) were analyzed. Complete response was reported in 49% (39%-60%) of cases, and 5% (0%- 15%) had disease progression. Treatment cessation was reported in 13% (3%-27%) of patients. Four percent of cases needed radical nephroureterectomy. Recurrence and death occurred in 14% (7%-23%) and 6% (2%-10%) of patients. Complications occurred in 63% (39%-85%), the majority of which were of grades I, II, and III. Ureteral stenosis was the most common complication accounting for 35% of cases. Chemoablationrelated complications occurred more than procedure-related ones. Based on available evidence, the intracavitary instillation of UGN-101 gel provides an alternative therapeutic option for upper tract urothelial cancer. Chemoablation provides good clinical outcomes in terms of complete response, disease progression and recurrence, and the need to undergo nephroureterectomy. Complications were encountered in more than half the population; however, most of them were of low grades.

A meta-analysis of livestock brucellosis prevalence in Indonesia

Indonesia has a long history of livestock brucellosis, but the overall pooled prevalence remains unclear. This study aims to determine the pooled estimated prevalence of livestock brucellosis in Indonesia using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Five databases were searched and screened using predefined inclusion and exclusion criteria. Data from included studies were extracted and analyzed using a random effects model in R 4.3.0 for pooled estimated prevalence, subgroup meta-analysis, and meta-regression. Publication bias and sensitivity tests were conducted using Egger’s test, funnel plot, trim and fill plot, and leave-one-out. The screening process identified 46 included studies, representing 47,057 samples for brucellosis testing. The pooled estimated prevalence for livestock brucellosis was 3.25% (95% CI, 1.81%–5.78%) with high heterogeneity (Q = 2130.91, p = 0, I2 =98%). Subgroup meta-analysis indicated no significant difference in the prevalence of livestock brucellosis across the main islands in Indonesia (p = 0.44) and across provinces in Sulawesi Island (p = 0.83), but significant differences were found among provinces in Java (p < 0.01). The subgroup meta-analysis based on animal type showed no significant difference between cattle, small ruminants, and pig brucellosis estimated prevalence (p = 0.26). Between serological tests, no significant difference was found (p = 0.77). Meta-regression showed no significant difference in brucellosis prevalence from 1988–2023. Egger’s test and funnel plot showed publication bias. Trim and fill test indicated 21 studies should be added. As most studies were conducted in Java and Sulawesi Islands, caution should be exercised in interpreting the results, emphasizing the necessity of increasing the study of brucellosis in other regions.

Systematic Review and Meta-Analysis of Adjuvant Radiation Dose for Pediatric Patients (≤22 years) with Nonmetastatic Intracranial Ependymomas

Ependymomas are the third most common brain tumors in children. Standard of care is surgery followed by adjuvant radiotherapy. Controversy in the literature still exists over optimal radiotherapy dose. We completed a systematic review and meta-analysis to determine the optimal dose for local control (LC), event-free survival (EFS), and overall survival (OS) in pediatric patients. We searched MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and Web of Science through January 2024. We included cohort studies that compared adjuvant radiotherapy of ≤54Gy to >54Gy in pediatric patients (≤22 years) with non-metastatic intracranial ependymomas. We assessed study quality using the Newcastle-Ottawa Quality Assessment Scale of Cohort Studies. We pooled studies using a random effects meta-analysis for hazard ratios (HR), 95% confidence intervals (CI), and assessed statistical heterogeneity via I2. When HRs were unavailable, we transformed risks using established methods. We narratively summarized qualitative outcomes. Seven studies met our inclusion criteria, covering a combined 1321 patients. Studies included a range of doses from 45-66.6Gy. Compared with >54Gy, we found no difference in LC for those receiving ≤54Gy (HR=0.83, 95% CI 0.56-1.24, I2=49.1%), in EFS (HR=1.02, 95% CI 0.95-1.09, I2=0.00%), and OS (HR=0.99, 95% CI 0.82-1.20, I2=37.5%). Two studies reported on subtotal resection by radiotherapy dose, neither study reporting statistical differences in LC, EFS, or OS, though the number of patients was small (n≤30). Five studies reported on late effects, with brainstem radionecrosis, radiation-induced vasculopathy, and secondary tumors being the most frequent. Overall study quality was high, though lower scores were consistently seen in comparability of cohorts. No studies reported on molecular subgroups. We found no difference in LC, EFS, or OS for those treated with ≤54Gy compared to >54Gy. There was insufficient data to complete a subgroup meta-analysis on radiotherapy dosing based on extent of resection or molecular subgroups.

Prevalence of hepatitis B virus infection among pregnant women in Africa: A systematic review and meta-analysis.

Africa exhibits a considerably high prevalence of the hepatitis B virus among pregnant women. Furthermore, there is a discernible lack of a well-established surveillance system to adequately monitor and comprehend the epidemiology of the hepatitis B virus, particularly among pregnant women. The eradication efforts of the virus in Africa have been impeded by the significant disease burden in the region, and there is a lack of evidence regarding the pooled prevalence of the hepatitis B virus in Africa. Consequently, this systematic review and meta-analysis aims to determine the prevalence of hepatitis B virus infection among pregnant women in Africa. We conducted a systematic literature search using reputable databases such as PubMed, Advanced Google Scholar, Scopus, and the Cochrane Library. The search spanned from July 2013 to July 2023 and included all relevant articles published within this period. To identify potentially eligible articles, we conducted a comprehensive manual review of the reference lists of the identified studies. Our review encompassed articles from the African Journal Online. The analysis focused on observational studies published in peer-reviewed journals that reported the prevalence of hepatitis B surface antigen-positive testing among pregnant women. We utilized the Newcastle-Ottawa critical appraisal checklist to assess the methodological quality of each paper. Finally, a meta-analysis was conducted using a random-effects model. Out of the 774 studies identified, 31 studies involving 33,967 pregnant women were selected for the meta-analysis. According to the random-effects model, the combined prevalence of hepatitis B virus among pregnant women was 6.77% [95% CI: 5.72, 7.83]. The I2 statistic was calculated to be 95.57% (p = 0.00), indicating significant heterogeneity among the studies. The high I2 value of 95.57% suggests a substantial degree of heterogeneity. A subgroup meta-analysis revealed that factors such as time-dependent bias, sample size dependence, or individual variation among study participants contributed to this heterogeneity (p-difference < 0.05). According to the findings of this study, the pooled prevalence of hepatitis B infection among pregnant women in Africa was found to be intermediate-high. It is recommended that policymakers implement hepatitis B virus immunization programs targeting pregnant women and their new-born babies at higher risk of exposure.

Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery-A Systematic Review and Meta-Analysis.

(1) Background: Body dysmorphic disorder (BDD) presents significant challenges in aesthetic and reconstructive plastic surgery, impacting patient outcomes and well-being. Understanding its prevalence and associated factors is crucial for effective patient care. (2) Methods: A systematic review of national and international databases on body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence yielded 999 studies between 1878 and April 2024. Inclusion criteria focused on studies reporting prevalence while excluding those with small sample sizes (<20 participants), unclear diagnostic criteria for BDD, and non-English accessibility. (3) Results: A meta-analysis using a random effects model was conducted on 65 studies involving 17,107 patients to estimate the prevalence of BDD. The overall estimated prevalence of BDD was 18.6%; 10,776 (62.9%) were females, with a mean age of 35.5 ± 11.7 years. Subgroup meta-analysis found significant variability in effect sizes across countries and types of specialty, of which Brazil showed the highest proportion and dermatology exhibited the smallest. Meta-regression analysis found no significant relationship between the year of publication and prevalence rates. (4) Conclusions: Our findings update the current literature on BDD prevalence in aesthetic and reconstructive plastic surgery. We emphasize the importance of proactive screening and multidisciplinary care approaches to address the complex challenges posed by patients with BDD. Further research is needed to explore evolving trends in BDD prevalence and factors influencing its expression across different cultural contexts.

Genetics and sleep bruxism: a systematic review and meta-analysis of studies with twins.

To systematically review the literature regarding the concordance of sleep bruxism (SB) between monozygotic (MZ) and dizygotic (DZ) twins. The registration for this systematic review was accomplished in the International Prospective Register of Systematic Reviews (PROSPERO, No. CRD42021251751). As of July 2022, four databases were searched, including PubMed, Scopus, Embase, and Web of Science, as well as the grey literature in Google Scholar and OpenGrey. Observational studies evaluating SB in MZ and DZ twins of any age and sex were included. For the evaluation of the risk of bias, the Joanna Briggs checklist was utilized. The certainty of evidence was assessed via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Pooled and subgroup meta-analyses were performed to estimate concordance of SB ​​between twins (p < 0.05). In total, 3,155 records were identified. In the qualitative analysis, eleven studies were included; of these, seven were included in the meta-analysis. The majority of the articles exhibited a low risk of bias (63.6%). Greater SB concordance was observed between MZ twins than between DZ twins in the analysis of general concordance (OR = 1.47; 95% CI = 1.07-2.02) and also positive concordance (OR = 1.53; 95% CI = 1.29-1.81). Within the subgroup analyses, the significance of the findings remained only for the reported/self-reported SB regarding general concordance (OR = 1.44; 95% CI = 1.07-1.95) and positive concordance (OR = 1.55; 95% CI = 1.28-1.88). Low certainty of the evidence was observed for the general concordance analysis, while moderate certainty was observed for the positive concordance. There was a higher concordance of SB in MZ twins compared to DZ twins, indicating a possible genetic influence on the condition's occurrence.

A Comparative Review of Standardized Incidence Ratios of De Novo Malignancies Post Liver Transplantation in Males Versus Females

After liver transplantation (LTx), the most common cause of death in the long-term is de-novo malignancy (DNM). The aim is to review the gender differences in the standardized incidence ratio (SIR) of DNM within the same geographical locations. MethodsFour studies were identified comparing post-LTx SIR between males and females. ResultsFrom 6663 males and 2780 females LTx recipients, the mean SIR from each of the four studies for males is 2.8, 2.0, 1.94, and 3.4, and 3.5, 1.3, 1.95, and 2.3 for females. On meta-analysis using a random effect model for each gender group. No significant difference was revealed after logarithmic transformation and subgroup meta-analysis. Overall mean SIR with 95% Confidence Interval (CI) for males is 2.53 (95% CI 1.65-3.88) and 2.3 (1.25-4.24) for females. lung malignancy, 1.97 (1.14-3.41) for males and 2.65 (0.67-10.47) for females. For colorectal malignancy, the combined SIR for males is 1.98 (0.58-6.78) and 1.85 (1.02-3.37) for females. The SIR for female gender-specific malignancies; SIR for breast is 1.1±4.4, cervix 2.9±1.9, uterus 2.8, and ovarian 0.7, and for males, testis 1.6±1.3, prostate 1.2±0.4. However, rare malignancies, male breast cancers (n=1, SIR, 22.6), and Kaposi's sarcoma, in males (n=6) and in females (n=1), had SIR 120. and 212.7, respectively ConclusionOverall, there are no statistical differences between male and female DNM. Female-specific cervix, uterus, ovarian, and male-specific testis and prostate have similar SIR. Rare malignancies have very high SIR.

What is the usual eating window for children and adolescents aged 6-20 years: a systematic review

This abstract was awarded the Student Competition prize.Time-limited eating is a dietary intervention whereby calorie intake is limited to a specific window of time during the day(1). The usual eating windows (EW) of adults, and how this can be manipulated for dietary interventions, is well documented(2). However, there is a paucity of data on the usual EW of children and adolescents, which may be a useful intervention for reducing obesity.The primary objective was to systematically review existing literature on the usual EW of children and adolescents. Secondary objectives were to identify average clock times of first and last food/drink intakes and also variations in EW and clock times by age, nationality or weight status subgroups, if available data allowed.Two databases (Medline and Embase) were searched for eligible papers published between February 2013 and February 2023. Included papers were forward searched using the citation network on Web of Science. 6347 papers were identified, and after deduplication 4569 papers were screened by two independent reviewers. Methodological quality was assessed using a Joanna Briggs Institute checklist(3).Ten studies were included, with both observational and experimental designs. These studies had a total population of 4,589 participants, with individual study sample sizes ranging from 22 to 2195. Ages of participants ranged from 6 – 20 years, with six studies involving adolescents alone (≥10 years), and four involving children and adolescents. There were four studies from the USA, two from Germany and one each from Brazil, India, The Netherlands and pan-European.Narrative synthesis showed large variations in average eating windows from 9.7 to 16.4 hours. Only four studies included clock times of intake, with large variations in both first and last intake times. Five studies were included in a random-effects meta-analysis, in which heterogeneity was considerable (I2 = 95.8%), and pooled duration of usual daily eating was 11.3 hours (95% confidence interval (CI) 10.95, 11.73). Sources of heterogeneity included differences in study design and populations, variation in dietary assessments methods and definition of eating windows. Narrative synthesis of an adolescent sub-group showed eating windows increased as children got older. Four studies were included in a random-effects sub-group meta-analysis, with a pooled EW of 11.2 hours (95% CI 10.27, 12.05; I2 = 96.6%) in adolescents. Insufficient data prevented further subgroup analysis.In conclusion large variations in eating windows exist across different study populations, with limited data available on first and last intake times; however, the pooled data suggest it may be possible to design time-limited eating interventions in paediatric populations aimed at reducing eating windows. Further high-quality research, of eating windows and associations with health outcomes, is needed.

Feasibility of laparoscopic adrenalectomy in adrenal masses greater than 5 centimeters: a systematic review and meta-analysis.

Laparoscopic adrenalectomy (LA) has emerged as the primary treatment for adrenal masses. This systematic review and meta-analysis assessed LA's feasibility, safety, effectiveness, and complications for adrenal masses exceeding 5 cm. The study was conducted using PRISMA guidelines with PROSPERO registration No. CRD42023462901. Adults with unilateral adrenal masses >5 cm who underwent unilateral LA were included. Intraoperative and postoperative measurements and complications were assessed. A systematic literature review employed a comprehensive search strategy which was last searched on September 8, 2023, through PubMed, Google Scholar, Web of Science, and ProQuest databases. Meta-analysis was utilized to analyze the outcomes. Risk of bias was assessed using the Newcastle-Ottawa scale. This systematic review encompassed 25 studies involving 963 patients who underwent LA. Tumor size varied 7.05 cm [95% confidence interval (CI): 6.24-7.70], with 50% on the right and 45% on the left. The subgroup meta-analysis comparing the transperitoneal and retroperitoneal approaches revealed the transperitoneal approach h was utilized for the largest tumor size with a mean of 12.10 cm (95% CI: 11.30-12.96), compared to the retroperitoneal approach 5.83 cm (95% CI: 5.52-6.14). Notably, the mean operative time across studies was 137.4 minutes (95% CI: 113.36-150.94), bleeding prevalence was 0.02% (95% CI: 0.01-0.03%), and average blood loss was 110.6 mL (95% CI: 78.2-156.3). Postoperative complications such as pulmonary edema, pulmonary embolism, gastric dysfunction, and wound infection were very low, ranging from 0.03% to 0.4%. Out of 963 patients, only 49 were converted to open surgery. Patient hospital stay averaged 3.72 days (95% CI: 2.97-4.66); blood transfusion was required in 1.3% (95% CI: 0.30-8.88%). The feasibility and safety of LA for tumors exceeding 5 cm in size have notable implications for intraoperative and postoperative outcomes. Underreporting in the included studies may impact the generalizability of findings.

Neutrophil to lymphocyte ratio in Alzheimer's disease: A systematic review and meta-analysis.

The Neutrophil-to-Lymphocyte Ratio (NLR) is a clinical indicator of peripheral inflammation that is easily accessible. It is worth noting that the formation of amyloid-β (Aβ) plaques and neurofibrillary tangles has been linked to inflammation and immune dysregulation. The main objective of this systematic review and meta-analysis is to comprehensively evaluate the existing body of research concerning the NLR in the context of Alzheimer's disease (AD) and mild cognitive impairment (MCI). We conducted a comprehensive online search and included studies that evaluated the NLR in 1) patients with AD or MCI and 2) healthy control (HC) participants. We also pooled mean and standard deviation (SD) data for each group. Ultimately, 12 studies encompassed 1,309 individuals diagnosed with AD with mean NLR levels of 2.68, 1,929 individuals with MCI with mean NLR levels of 2.42, and 2,064 HC with mean NLR levels of 2.06 were included in this systematic review and meta-analysis. The mean NLR was 0.59 higher in AD patients compared to HC participants (mean difference (MD) = 0.59 [0.38; 0.80]). Similarly, the mean NLR was higher in AD than MCI patients (MD = 0.23 [0.13; 0.33]). Additionally, the mean NLR was higher in individuals with MCI compared to HC participants (MD = 0.37 [0.22; 0.52]). In the subgroup meta-analysis based on the Mini-Mental State Examination (MMSE), AD patients with lower MMSE scores (using a cut-off of 20) exhibited significantly higher mean NLR (3.10 vs. 2.70, with a p-value for subgroup differences < 0.01). The NLR, which serves as a marker of peripheral inflammation, shows increased levels in individuals with AD and MCI compared to HC participants. Furthermore, our study indicates that NLR levels are significantly higher in AD than MCI. Additionally, our novel finding suggests significantly higher NLR levels among AD patients with more severe cognitive decline compared to AD patients with less severe cognitive decline. So, it can be concluded that the higher cognitive decline in humans is accompanied by higher NLR levels. Further longitudinal researches are needed to explore more details about the relationship between inflammation and dementia.

Application of CT and MRI images based on artificial intelligence to predict lymph node metastases in patients with oral squamous cell carcinoma: a subgroup meta-analysis.

The performance of artificial intelligence (AI) in the prediction of lymph node (LN) metastasis in patients with oral squamous cell carcinoma (OSCC) has not been quantitatively evaluated. The purpose of this study was to conduct a systematic review and meta-analysis of published data on the diagnostic performance of CT and MRI based on AI algorithms for predicting LN metastases in patients with OSCC. We searched the Embase, PubMed (Medline), Web of Science, and Cochrane databases for studies on the use of AI in predicting LN metastasis in OSCC. Binary diagnostic accuracy data were extracted to obtain the outcomes of interest, namely, the area under the curve (AUC), sensitivity, and specificity, and compared the diagnostic performance of AI with that of radiologists. Subgroup analyses were performed with regard to different types of AI algorithms and imaging modalities. Fourteen eligible studies were included in the meta-analysis. The AUC, sensitivity, and specificity of the AI models for the diagnosis of LN metastases were 0.92 (95% CI 0.89-0.94), 0.79 (95% CI 0.72-0.85), and 0.90 (95% CI 0.86-0.93), respectively. Promising diagnostic performance was observed in the subgroup analyses based on algorithm types [machine learning (ML) or deep learning (DL)] and imaging modalities (CT vs. MRI). The pooled diagnostic performance of AI was significantly better than that of experienced radiologists. In conclusion, AI based on CT and MRI imaging has good diagnostic accuracy in predicting LN metastasis in patients with OSCC and thus has the potential for clinical application. https://www.crd.york.ac.uk/PROSPERO/#recordDetails, PROSPERO (No. CRD42024506159).

Associations of prior lung diseases on risk of lung cancer in populations with no smoking history: A systematic review and meta-analysis.

10561 Background: Individuals without prior tobacco use account for a growing proportion of lung cancer cases, but the impact of prior lung diseases on lung cancer risk in this population remains unclear. We performed a meta-analysis of studies examining the association of prior lung diseases – tuberculosis (TB), asthma (AS), and chronic bronchitis (CB) – with lung cancer risk among individuals without prior tobacco use. Methods: PubMed and Embase were searched from inception to Jan 20th, 2024 for studies examining the association between TB, AS, and/or CB and lung cancer risk in populations over 18 years old who never smoke. Studies were excluded if (1) “never-smoking” was not defined as having never smoked or smoked less than 100 cigarettes in their lifetime; (2) they were not written in English, Mandarin, or Korean; (2) odds ratios (OR)/hazard ratios (HR) were not reported. Summary effect estimates with 95% CI were calculated for case-control (summary OR) and cohort (summary HR) studies using random effects models with inverse variance weighting. Subgroup meta-analyses and meta-regressions were conducted among case-control studies by continent [Asia vs. non-Asia (North America and Europe)]. There was insufficient information to examine differences across the subgroups of sex and race and ethnicity. Results: 17 case-control studies and five cohort studies were examined. Among case-control studies, history of TB (13 studies), AS (10 studies), and CB (nine studies) were statistically significantly associated with an increased risk of lung cancer in patients without prior tobacco use (TB: summary OR=1.75, 95% CI 1.43-2.15, I2 = 29; AS: summary OR=1.46, 95% CI 1.06-2.02, I2 = 34; CB: summary OR=1.36, 95% CI 1.07-1.72, I2 = 0). Among cohort studies, TB (four studies) was associated with a statistically significant increase in lung cancer risk (summary HR=1.81, 95% CI 1.34-2.44, I2 = 44). There were insufficient number of cohort studies to summarize the associations of CB (no studies) or AS (one study) with lung cancer risk. The summary OR for TB and AS with lung cancer risk was larger in Asian vs. non-Asian populations (TB: Asian populations summary OR=1.79 95% CI 1.40-2.28, I2 = 47 vs. non-Asian populations summary OR=1.47 95% CI 0.88-2.44, I2 = 0; AS: Asian populations summary OR=2.63 95% CI 1.10-6.28, I2 = 40 vs. non-Asian populations summary OR=1.31 95% CI 0.96-1.79, I2 = 20). However, there was no evidence of heterogeneity in summary OR by continent using meta-regression (TB: p=0.58; AS: p=0.16). Conclusions: In this meta-analysis, history of TB, AS, and CB were associated with lung cancer risk among populations who never smoked, informing potential etiologies of the shifting global burden of lung cancer. Future studies examining these associations should analyze more diverse patient populations and disaggregate findings by sex, race and ethnicity, socioeconomic status, and geography.

Neoadjuvant and perioperative immunotherapy in resectable non-small cell lung cancer (NSCLC): A systematic review and extracted individual patient data meta-analysis.

8045 Background: Neoadjuvant and perioperative immunotherapy are emerging approaches for resectable NSCLC. However, survival outcomes are still immature and subgroup analyses are underpowered. We report extracted individual patient (pt) data (eIPD) and trial-level (TL) meta-analyses of phase II and III randomized controlled trials (RCTs) in this setting. Methods: The systematic review included Cochrane, Embase, and major oncology conferences (ASCO annual meetings, ESMO meetings, WCLC meetings). Primary objectives were eIPD event-free survival (EFS) and overall survival (OS). Secondary objectives included eIPD and TL meta-analysis of subgroups. Kaplan-Meier plots of time-to-event outcomes were reconstructed with WebPlotDigitizer (v4.6, 2022), and eIPD was estimated with IPDfromKM (v0.1.10, 2020) stratified by study. Comparisons between arms were made in a 1-stage model with a Cox Proportional Hazards model stratified by study. The difference of restricted mean survival time (D-RMST), a quantification of the postponement of an event during a specified interval, was used to compare survival when the proportional hazard assumption (PHA) was violated, tau being the shortest follow-up time of the available trials. TL meta-analysis was performed with a random effects model. This meta-analysis was registered in the PROSPERO database under CRD42024502150. Results: Seven RCTs (AEGEAN, CM816, CM77T, KN671, NADIM II, NeoTorch, and Lei et al. [ESMO IOTECH 2022, #56O]) were identified, comprising 2995 pts. EFS analysis included all pts, with HR of 0.58 (0.52-0.65; p&lt;0.01). OS analysis (1645 evaluable pts from 4 trials) showed a D-RMST of 5.17 mo. (p&lt;0.01) due to PHA violation. Full eIPD analysis in the table. TL meta-analysis showed benefit in all subgroups, including PD-L1 expression, histology, stage, smoking status, sex, and age. TL EFS and OS results were comparable to results obtained from eIPD analysis, with low heterogeneity measures. Conclusions: This meta-analysis provides robust and nuanced insights into the positive impact of immunotherapy in resectable NSCLC. While evidence supports its efficacy, uncertainty surrounding the benefit in stage &lt; III disease highlights the need for additional research and more mature results to guide clinical decision-making effectively. [Table: see text]

Educational interventions to reduce depression and anxiety in older adults with cancer in the community: a systematic review, meta-analysis and meta-regression of randomised controlled trials.

Older adults make up half of those with cancer and are prone to mood disorders, such as depression and severe anxiety, resulting in negative repercussions on their health-related quality-of-life (HRQOL). Educational interventions have been shown to reduce adverse psychological outcomes. We examined the effect of educational interventions on the severity of psychological outcomes in older adults with cancer (OAC) in the community. This PRISMA-adherent systematic review involved a search of PubMed, MedLine, Embase and PsycINFO for randomised controlled trials (RCTs) that evaluated educational interventions impacting the severity of depression, anxiety and HRQOL in OAC. Random effects meta-analyses and meta-regressions were used for the primary analysis. Fifteen RCTs were included. Meta-analyses showed a statistically insignificant decrease in the severity of depression (SMD = -0.30, 95%CI: -0.69; 0.09), anxiety (SMD = -0.30, 95%CI: -0.73; 0.13) and improvement in overall HRQOL scores (SMD = 0.44, 95%CI: -0.16; 1.04). However, subgroup analyses revealed that these interventions were particularly effective in reducing the severity of depression and anxiety in specific groups, such as OAC aged 60-65, those with early-stage cancer, those with lung cancer and those treated with chemotherapy. A systematic review found that having attained a higher education and income level increased the efficacy of interventions in decreasing the severity of adverse psychological outcomes. Although overall meta-analyses were statistically insignificant, subgroup meta-analyses highlighted a few specific subgroups that the educational interventions were effective for. Future interventions can be implemented to target these vulnerable groups.