Traditional Meta-analysis Research Articles

Oral traditional Chinese medicine for mild to moderate cases of COVID-19: a network meta-analysis based on RCTs

Introduction: This systemic review examines the effectiveness and safety of combining traditional Chinese medicine with standard therapy in the treatment of mild to moderate cases of coronavirus disease 2019 (COVID-19). Methodology: We retrieved articles from PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, Weipi (VIP), and China Biology Medicine disc (CBM). The deadline for retrieval was 20 August 2022, and it was updated on 1 July 2023. Two researchers worked independently on literature screening, data extraction, and evaluation of the quality of the literature. Results: A total of 21 randomized controlled trials were included in this review; consisting of 9 articles in English and 12 articles in Chinese. According to the fixed-effects model, the results of the traditional meta-analysis indicated a significantly superior efficacy of oral traditional Chinese medicine combined with standard therapy in treating mild to moderate cases of COVID-19, compared to standard treatment (OR = 1.81, 95% CI: 1.59–2.06), with no increased adverse effects (OR = 1.28, 95% CI: 0.95–1.73). The network meta-analysis results revealed Lianhua Qingke, Toujie Quwen, and Jinhua Qinggan granules as the three best Chinese medicines with the most effective treatment outcomes; while Lianhua Qingwen capsule/granules, Reyanning, and Shufeng Jiedu capsules were the top three Chinese medicines with the fewest side effects. Conclusions: The efficacy of oral traditional Chinese medicine combined with standard therapy in treating mild to moderate COVID-19 was significantly superior to standard therapy alone. However, the limited quality of evidence reduces the reliability of the meta-analysis.

Online Parenting Programs for Children's Behavioral and Emotional Problems: a Network Meta-Analysis.

Online parenting programs to support parents of children with behavioral problems and emotional problems have become widely available in recent years. Research has consistently shown their positive effects on child development, parents' adaptive parenting practices, and parents' mental health. However, knowledge is lacking on which type of content is more suitable to be delivered online. Our work addresses this knowledge gap by conducting traditional and network meta-analyses to improve our understanding of (1) how effective online parenting programs are to improve children's behavior and emotional problems, and (2) what clusters of components are most likely to yield the strongest effects. Following the PROSPERO preregistration, we systematically searched PsycINFO, MEDLINE, Web of Science, and Cochrane. Of the 8292 records retrieved, 28 records on 27 randomized controlled trials (N = 5,312) met the inclusion criteria. Results show moderate effect sizes of online parenting programs on reduced child behavioral and emotional problems, parents' ineffective parenting practices, and parents' mental health problems. Online programs adopting a learning theory perspective, either with or without additional parental self-care and parents as therapist approaches, are most likely to yield the strongest effects on child behavioral problems. Online programs adopting a learning theory perspective, parental self-care and parents as therapist approaches, with or without additional relationship perspectives, are most likely to yield the strongest effects on child emotional problems. Online parenting programs seem promising tools for improving child behavioral and emotional problems. Future research should identify the circumstances that allow parents and children to benefit more from specific components in these programs.

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.

Patterns of abnormal activations in severe mental disorders a transdiagnostic data-driven meta-analysis of task-based fMRI studies.

Studies suggest severe mental disorders (SMDs), such as schizophrenia, major depressive disorder and bipolar disorder, are associated with common alterations in brain activity, albeit with a graded level of impairment. However, discrepancies between study findings likely to results from both small sample sizes and the use of different functional magnetic resonance imaging (fMRI) tasks. To address these issues, data-driven meta-analytic approach designed to identify homogeneous brain co-activity patterns across tasks was conducted to better characterize the common and distinct alterations between these disorders. A hierarchical clustering analysis was conducted to identify groups of studies reporting similar neuroimaging results, independent of task type and psychiatric diagnosis. A traditional meta-analysis (activation likelihood estimation) was then performed within each of these groups of studies to extract their aberrant activation maps. A total of 762 fMRI study contrasts were targeted, comprising 13 991 patients with SMDs. Hierarchical clustering analysis identified 5 groups of studies (meta-analytic groupings; MAGs) being characterized by distinct aberrant activation patterns across SMDs: (1) emotion processing; (2) cognitive processing; (3) motor processes, (4) reward processing, and (5) visual processing. While MAG1 was mostly commonly impaired, MAG2 was more impaired in schizophrenia, while MAG3 and MAG5 revealed no differences between disorder. MAG4 showed the strongest between-diagnoses differences, particularly in the striatum, posterior cingulate cortex, and ventromedial prefrontal cortex. SMDs are characterized mostly by common deficits in brain networks, although differences between disorders are also present. This study highlights the importance of studying SMDs simultaneously rather than independently.

Causally interpretable meta-analysis combining aggregate and individual participant data

Abstract Recent work in causally-interpretable meta-analysis (CIMA) has bridged the gap between traditional meta-analysis and causal inference. While traditional meta-analysis results generally do not apply to any well-defined population, CIMA approaches specify a target population to which meta-analytic treatment effect estimates are transported. While theoretically attractive, these approaches currently have some practical limitations. Most assume that all studies in the meta-analysis have individual participant data (IPD), which is rare in practice because most trials share only aggregate data. We propose a method to perform CIMA using a combination of aggregate data and IPD. This method borrows information from studies with IPD to augment the aggregate data and create aggregate-matched synthetic IPD (AMSIPD), which can be used readily in the existing CIMA framework. By allowing use of both aggregate data and IPD, the method opens CIMA to more applications and can avoid biases arising from using only studies with IPD. We present a case study and simulations showing the AMSIPD approach is promising and merits further investigation as an advancement of CIMA.

Meta-analysis of effectiveness evaluation of preventive measures for acute kidney injury in children

Objective: To comprehensively evaluate the effectiveness of preventive measures for acute kidney injury (AKI) in children and identify the effective strategies. Methods: Databases were systematically searched including CNKI, Wanfang, VIP, China Biology Medicine National Knowledge Infrastructure, PubMed, Embase, Cochrane Library databases, and the reference lists of relevant papers for randomized controlled trials on preventing pediatric AKI up to December 2023. Literature screening was conducted based on the inclusion and exclusion criteria, followed by data extraction and quality assessment of included studies. Traditional and network meta-analyses were performed, along with trial sequential analysis (TSA). Results: A total of 21 studies involving 3 483 children were included. Traditional and network meta-analysis showed that dexmedetomidine was effective in preventing AKI in children undergoing cardiac surgery or cardiac angiography (OR=0.26, 0.27; 95%CI 0.11-0.64, 0.13-0.58). Remote ischemic preconditioning (RIPC) was effective in preventing AKI in children after cardiac surgery (OR=0.43, 0.44; 95%CI 0.24-0.79, 0.23-0.83). Traditional and network meta-analysis specific to children with sepsis or septic shock showed that balanced solution was effective in preventing pediatric AKI (OR=0.58, 0.52; 95%CI 0.42-0.79, 0.37-0.73). TSA indicated that the total sample sizes of dexmedetomidine (348 cases) and RIPC (666 cases) both reached the required information size (320 and 534 cases); additionally, the Z-curve for balanced solution (cumulative Z=3.38) crossed the TSA monitoring boundary (Z=3.29). Conclusion: Dexmedetomidine reduces the risk of AKI in children undergoing cardiac surgery or cardiac angiography, RIPC decreases the risk of AKI in children after cardiac surgery, and balanced solution lowers the risk of AKI in children with sepsis or septic shock.

The Endocannabinoid System in Alzheimer's Disease: ANetwork Meta-Analysis.

The findings concerning the association between endocannabinoid system (ECS) and Alzheimer's disease (AD) exhibited inconsistencies when examining the expression levels of endocannabinoids. This study aimed to provide a comprehensive summary of the studies regarding alterations of the ECS in AD. Six databases were thoroughly searched for literature to select relevant studies investigating the ECS in AD, including changes in cannabinoid receptors (CB1R and CB2R), endocannabinoids (2-AG and AEA), and their associated enzymes (FAAH and MAGL). Traditional meta-analysis evaluated the expression levels of the ECS in AD, and the results showed no significant differences in ECS components between healthy controls and AD patients. However, subgroup analysis revealed significantly lower expression levels of CB1R in AD than in controls, particularly in studies using western blot (SMD = -0.88, p < 0.01) and in studies testing CB1R of frontal cortex (SMD = -1.09, p < 0.01). For studies using HPLC, the subgroup analysis indicated significantly higher 2-AG levels in AD than in controls (SMD = 0.46, p = 0.02). Network meta-analysis examined the rank of ECS alterations in AD compared to controls, and the findings revealed that 2-AG and MAGL exhibited the largest increase and CB1R showed the largest decrease relative to the control group. Based on the findings of traditional meta-analysis and network meta-analysis, we proposed that AD patients may present decreased expression levels of CB1R and increased expression levels of 2-AG and its degrading enzyme MAGL. Our results may contribute to the growing body of research supporting the therapeutic potential of ECS modulation in the management of AD.

Exploring the effects of multiple forms of physical activity on social functioning in children with ASD: a meta-analysis of a controlled trial

The current meta-analysis aimed to assessing the effect of physical activity on social functioning in children with autism spectrum disorder (ASD).The PubMed, Web of Science, Embase, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) and controlled trials (CTs) examining the effects of physical activity on social functioning in children with ASD. Traditional meta-analysis, subgroup analysis and publication bias tests were performed using Stata software 18.0.A total of 18 studies were included. The results showed that physical activity has a moderate-to-high effect on social functioning in children with ASD, with an effect size of SMD=0.50 (95% CI=0.34∼0.65, P<0.001. Different types of exercise and intervention programs have different effects on social functioning in children with ASD.For 3- to 7-year-old children with ASD, a comprehensive exercise program involving cooperative physical activity with three or more sessions per week for 11 to 20 weeks can lead to improvements in social functioning

From Cognitive Function to Treatment Efficacy in Obsessive-Compulsive Disorder: Insights from a Multidimensional Meta-Analytic Approach.

Meta-analysis is a statistical tool used to combine and synthesise the results of multiple independent studies on a particular topic. To this end, researchers isolate important moderators and mediators to investigate their influence on outcomes. This paper introduces a novel approach to meta-analysis, known as multidimensional meta-analysis (mi-MA), to study memory performance in those with obsessive-compulsive disorder (OCD). Unlike traditional meta-analyses, mi-MA allows researchers to extract multiple data points (e.g., using different measures) from single studies and groups of participants, facilitating the exploration of relationships between various moderators while avoiding multicollinearity issues. Therefore, in the first instance, we outline the use of the mi-MA approach to quantify the impact of complex models of memory performance in individuals with OCD. This approach provides novel insights into the complex relationship between various factors affecting memory in people with OCD. By showcasing the effectiveness of mi-MA in analysing intricate data and modelling complex phenomena, the paper establishes it as a valuable tool for researchers exploring multifaceted phenomena, both within OCD research and beyond.

Comparison of the accuracy of hematological parameters in the diagnosis of neonatal sepsis: a network meta-analysis.

Currently, there are hundreds of hematological parameters used for rapid diagnosis of neonatal sepsis, but there is no network meta-analysis to compare the diagnostic efficacy of these parameters. We searched for literature on the diagnostic neonatal sepsis and selected 20 of the most common parameters to compare their diagnostic efficacy. We used Bayesian network meta-analysis, Frequentist network meta-analysis, and individual traditional diagnostic meta-analysis to analyze the data and verify the stability of the results. Based on the above analysis, we ranked the diagnostic efficacy of 20 parameters and searched for the optimal indicator. We also conducted subgroup analysis based on different designs. GRADE was used to evaluate the quality of evidence. 311 articles were included in the analysis, of which 206 articles were included in the network meta-analysis. Bayesian models fond the top three of the advantage index were P-SEP, SAA, and CD64. In Individual model, P-SEP, SAA, and CD64 had the best sensitivity; ABC, SAA, and P-SEP had the best specificity. Frequentist model showed that CD64, P-SEP, and IL-10 ranked in the top three for sensitivity, while P-SEP, ABC, and I/M in specificity. Overall, P-SEP, SAA, CD64, and PCT have good sensitivity and specificity among all the three methods. The results of subgroup analysis were consistent with the overall analysis. All evidence was mostly of moderate or low quality. P-SEP, SAA, CD64, and PCT have good diagnostic efficacy for neonatal sepsis. However, further studies are required to confirm these findings.

Efficacy and safety of combined Chinese and western medicine in the treatment of metabolic syndrome: A network meta-analysis of randomized controlled trials

ObjectivesTo comprehensively analyze the randomized controlled clinical trials of integrated traditional Chinese medicine (TCM) and western medicine in the treatment of metabolic syndrome (MetS), and to explore the clinical efficacy and safety of different TCM combined with western medicine for MetS. The purpose of this study is to provide specific suggestions for clinical guidance in the treatment of MetS. MethodsA comprehensive literature review was conducted across several databases, including China Knowledge Network, Wanfang Data, VIP Information, China Biomedical Literature Service System, Embase, PubMed, and Web of Science, up to October 2023. The scope of this review was confined to RCTs focusing on the treatment of metabolic syndrome through an integrated approach of TCM and Western medicine. The primary efficacy endpoints analyzed were clinical efficacy, fasting blood glucose (FBG), triglyceride (TG), and high-density lipoprotein (HDL). Data synthesis and analysis were performed using Stata 16 and RevMan 5.4 for both traditional and network meta-analyses. ResultsThe findings from both traditional and network meta-analyses reveal that the combination of JiangZhiHuoXue pills (JZHX) + Conventional Western Medicine (CWM) significantly reduces FBG levels. Similarly, the AnShenNingXin capsules (ASNX) + CWM combination markedly lowers TG levels, while the FuFangQiMa capsules (FFQM) + CWM combination shows enhanced efficacy in elevating HDL levels. Notably, the combination of KangNing capsules (KNJN) + CWM demonstrates a more pronounced clinical effect compared to CWM/placebo alone. ConclusionsThe study concludes that the synergistic combination of TCM and Western medicine exhibits superior therapeutic benefits in treating MetS compared to CWM/Placebo treatments alone. The combinations of JZHX, AXNX, FFQM, and KNJN with CWM emerge as potentially effective treatments.

Effect of SNPs on Litter Size in Swine.

Although sows do not directly enter the market, they play an important role in piglet breeding on farms. They consume large amounts of feed, resulting in a significant environmental burden. Pig farms can increase their income and reduce environmental pollution by increasing the litter size (LS) of swine. PCR-RFLP/SSCP and GWAS are common methods to evaluate single-nucleotide polymorphisms (SNPs) in candidate genes. We conducted a systematic meta-analysis of the effect of SNPs on pig LS. We collected and analysed data published over the past 30 years using traditional and network meta-analyses. Trial sequential analysis (TSA) was used to analyse population data. Gene set enrichment analysis and protein-protein interaction network analysis were used to analyse the GWAS dataset. The results showed that the candidate genes were positively correlated with LS, and defects in PCR-RFLP/SSCP affected the reliability of candidate gene results. However, the genotypes with high and low LSs did not have a significant advantage. Current breeding and management practices for sows should consider increasing the LS while reducing lactation length and minimizing the sows' non-pregnancy period as much as possible.

Endoscopic Versus Traditional Thoracic Discectomy: A Multicenter Retrospective Case Series and Meta-Analysis.

Surgical treatment for symptomatic thoracic disc herniations (TDH) involves invasive open surgical approaches with relatively high complication rates and prolonged hospital stays. Although advantages of full endoscopic spine surgery (FESS) are well-established in lumbar disc herniations, data are limited for the endoscopic treatment of TDH despite potential benefits regarding surgical invasiveness. The aim of this study was to provide a comprehensive evaluation of potential benefits of FESS for the treatment of TDH. PubMed, MEDLINE, EMBASE, and Scopus were systematically searched for the term "thoracic disc herniation" up to March 2023 and study quality appraised with a subsequent meta-analysis. Primary outcomes were perioperative complications, need for instrumentation, and reoperations. Simultaneously, we performed a multicenter retrospective evaluation of outcomes in patients undergoing full endoscopic thoracic discectomy. We identified 3190 patients from 108 studies for the traditional thoracic discectomy meta-analysis. Pooled incidence rates of complications were 25% (95% CI 0.22-0.29) for perioperative complications and 7% (95% CI 0.05-0.09) for reoperation. In this cohort, 37% (95% CI 0.26-0.49) of patients underwent instrumentation. The pooled mean for estimated blood loss for traditional approaches was 570 mL (95% CI 477.3-664.1) and 7.0 days (95% CI 5.91-8.14) for length of stay. For FESS, 41 patients from multiple institutions were retrospectively reviewed, perioperative complications were reported in 4 patients (9.7%), 4 (9.7%) required revision surgery, and 6 (14.6%) required instrumentation. Median blood loss was 5 mL (IQR 5-10), and length of stay was 0.43 days (IQR 0-1.23). The results suggest that full endoscopic thoracic discectomy is a safe and effective treatment option for patients with symptomatic TDH. When compared with open surgical approaches, FESS dramatically diminishes invasiveness, the rate of complications, and need for prolonged hospitalizations. Full endoscopic spine surgery has the capacity to alter the standard of care for TDH treatment toward an elective outpatient surgery.

A network meta-analysis comparative the efficacy of angiotensin-converting enzyme inhibitors and calcium channel blockers in hypertension.

Currently, most studies primarily focus on directly comparing the efficacy and safety of angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers (CCBs), the two major classes of antihypertensive drugs. Moreover, the majority of studies are based on randomized controlled trials and traditional meta-analyses, with few exploring the efficacy and safety comparisons among various members of ACEIs and CCBs. ACEIs and CCB were searched for in randomized controlled trials in CNKI, Wanfang, VIP, China Biology Medicine Disc (Si-noMed), PubMed, EMbase, and Cochrane Library databases. The search can be conducted till November 2022. Stata software (version 16.0) and R 4.1.3 was used for statistical analysis and graphics plotting, applying mvmeta, gemtc, and its packages. Meta-regression analysis was used to explore the inconsistencies of the studies. In 73 trials involving 33 different drugs, a total of 9176 hypertensive patients were included in the analysis, with 4623 in the intervention group and 4553 in the control group. The results of the analysis showed that, according to the SUCRA ranking, felodipine (MD = -12.34, 95% CI: -17.8 to -6.82) was the drug most likely to be the best intervention for systolic blood pressure, while nitrendipine (MD = -8.01, 95% CI: -11.71 to -4.18) was the drug most likely to be the best intervention for diastolic blood pressure. Regarding adverse drug reactions, nifedipine (OR = 0.32, 95% CI: 0.14-0.74) was the drug most likely to be the safest. The research findings indicate that nifedipine is the optimal intervention for reducing systolic blood pressure in hypertensive patients, nitrendipine is the optimal intervention for reducing diastolic blood pressure in hypertensive patients, and felodipine is the optimal intervention for safety.

Efficacy and safety of antithrombotic therapy for preventing and treating pediatric thromboembolic disease: a systematic review

This review used traditional and network meta-analyses (NMA) to conduct a comprehensive study of antithrombotic therapies in children with thromboembolic disease. We searched the PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov databases from their inception to 26 February, 2023. And we finally included 16 randomized controlled trials. In the prevention of thromboembolic events (TEs), the use of anticoagulants had a low risk of TEs (relative risk (RR) 0.73, 95% CI 0.56 to 0.94) and a high risk of minor bleeding (RR 1.43, 95% CI 1.09 to 1.86) compared with no anticoagulants. In the treatment of TEs, direct oral anticoagulants (DOACs) were not inferior to standard anticoagulation in terms of efficacy and safety outcomes. In NMA, rivaroxaban and apixaban showed the lowest risk for TEs and major or clinically relevant nonmajor bleeding. According to the overall assessment of efficacy and safety, dabigatran may be the best choice for children with thromboembolic disease. The results of our study will provide references and suggestions for clinical drug selection.

Efficacy and acceptability of different probiotic products plus laxatives for pediatric functional constipation: a network meta-analysis of randomized controlled trials

The prevalence of pediatric constipation ranges from 0.7 to 29.6% across different countries. Functional constipation accounts for 95% of pediatric constipation, and the efficacy of pharmacotherapy is limited, with a success rate of 60%. Several randomized controlled trials (RCTs) have shown the benefits of probiotic supplements in treating this condition. However, the reported strains of probiotics varied among the RCTs. We aimed to compare the efficacy and acceptability of different probiotic supplements for pediatric functional constipation. The current frequentist model–based network meta-analysis (NMA) included RCTs of probiotic supplements for functional constipation in children. The primary outcome was changes in bowel movement or stool frequency; acceptability outcome was all-cause discontinuation. Nine RCTs were included (N = 710; mean age = 5.5 years; 49.4% girls). Most probiotic products, used either alone or combined with laxatives, were associated with significantly better improvement in bowel movement or stool frequency than placebo/control. Protexin plus laxatives (standardized mean difference (SMD) = 1.87, 95% confidence interval (95% CI) = 0.85 to 2.90) were associated with the greatest improvement in bowel movement or stool frequency among all the investigated probiotic products. For the single probiotic interventions, only Lactobacillus casei rhamnosus Lcr35 was associated with significant efficacy compared to placebo/control treatments (SMD = 1.37, 95% CI: 0.32 to 2.43). All the investigated probiotic products had fecal incontinence and patient drop-out rates similar to those of placebo/control treatments. Conclusion: The results of our NMA support the application of an advanced combination of probiotics and laxatives for pediatric functional constipation if there is no concurrent contraindication. Registration: PROSPERO (CRD42022298724).What is Known:• Despite of the high prevalence of pediatric constipation, which ranges from 0.7% to 29.6%, the efficacy of pharmacotherapy is limited, with a success rate of 60%. Several randomized controlled trials (RCTs) have shown the benefits of probiotic supplements in treating this condition. However, the reported strains of probiotics varied among the RCTs. The widely heterogeneous strains of probiotics let the traditional meta-analysis, which pooled all different strains into one group, be nonsense and insignificant.What is New:• By conducting a comprehensive network meta-analysis, we aimed to compare the efficacy and acceptability of different strains of probiotic supplements for pediatric functional constipation. Network meta-analysis of nine randomized controlled trials revealed that the most probiotic products, used either alone or combined with laxatives, were associated with significantly better improvement in bowel movement or stool frequency than placebo/control. Protexin plus laxatives was associated with the greatest improvement in bowel movement or stool frequency among all the investigated probiotic products. For the single probiotic interventions, only Lactobacillus casei rhamnosus Lcr35 was associated with significant efficacy compared to placebo/control treatments. All the investigated probiotic products had fecal incontinence and patient drop-out rates similar to those of placebo/control treatments.

Non-pharmacological interventions to prevent PICS in critically ill adult patients: a protocol for a systematic review and network meta-analysis

BackgroundPostintensive care syndrome (PICS) is common in critically ill adults who were treated in the intensive care unit (ICU). Although comparative analyses between types of non-pharmacological measures and usual care to prevent PICS have been performed, it remains unclear which of these potential treatments is the most effective for prevention.MethodsTo obtain the best evidence for non-pharmaceutical interventions in preventing PICS, a systematic review and Bayesian network meta-analyses (NMAs) will be conducted by searching nine electronic databases for randomized controlled trials (RCTs). Two reviewers will carefully screen the titles, abstracts, and full-text papers to identify and extract relevant data. Furthermore, the research team will meticulously check the bibliographic references of the selected studies and related reviews to discover any articles pertinent to this research. The primary focus of the study is to examine the prevalence and severity of PICS among critically ill patients admitted to the ICU. The additional outcomes encompass patient satisfaction and adverse effects related to the preventive intervention. The Cochrane Collaboration’s risk-of-bias assessment tool will be utilized to evaluate the risk of bias in the included RCTs. To assess the efficacy of various preventative measures, traditional pairwise meta-analysis and Bayesian NMA will be used. To gauge the confidence in the evidence supporting the results, we will utilize the Confidence in NMA tool.DiscussionThere are multiple non-pharmacological interventions available for preventing the occurrence and development of PICS. However, most approaches have only been directly compared to standard care, lacking comprehensive evidence and clinical balance. Although the most effective care methods are still unknown, our research will provide valuable evidence for further non-pharmacological interventions and clinical practices aimed at preventing PICS. The research is expected to offer useful data to help healthcare workers and those creating guidelines decide on the most effective path of action for preventing PICS in adult ICU patients.Systematic review registrationPROSPERO CRD42023439343.Graphical

Analgesia for the treatment of acute pancreatitis: a protocol for a systematic review and network meta-analysis

IntroductionGastrointestinal hospitalisations in the USA cause over US$130 billion in expenditures, and acute pancreatitis is a leading cause of these hospitalisations. Adequate pain control is one of the primary treatment...

Effects of mind-body exercise on perimenopausal and postmenopausal women: a systematic review and meta-analysis.

The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly used to alleviate menopausal symptoms, it carries a potential risk of cancer. Recently, mind-body exercises have emerged as innovative approaches for improving menopausal symptoms and bone health. However, research findings have needed to be more consistent, highlighting the significance of this study's systematic review of mind-body exercise effects on perimenopausal and postmenopausal women. This study aims to evaluate the impact of mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin, and mindfulness-based stress reduction, on bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women. Four electronic databases-PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science-were systematically searched from inception until July 2023. The search focused exclusively on randomized controlled trials to examine the impact of mind-body exercise interventions on perimenopausal and postmenopausal women. The methodological quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool. A total of 11 randomized controlled trials, comprising 1,005 participants, were included in the analysis. Traditional meta-analysis indicated that mind-body exercise significantly enhanced bone mineral density in perimenopausal and postmenopausal women compared with control groups, with a standardized mean difference (SMD) of 0.41 (95% CI, 0.17 to 0.66; P = 0.001, I2 = 7%). In addition, significant improvements were observed in sleep quality (SMD, -0.48; 95% CI, -0.78 to -0.17; P = 0.002, I2 = 76%), anxiety reduction (SMD, -0.80; 95% CI, -1.23 to -0.38; P = 0.0002, I2 = 84%), depressive mood (SMD, -0.80; 95% CI, -1.17 to -0.44; P < 0.0001, I2 = 79%), and fatigue (SMD, -0.67; 95% CI, -0.97 to -0.37; P < 0.0001, I2 = 0%). The findings of this meta-analysis demonstrate that mind-body exercise positively influences bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.

Effect-Size Discrepancies in Literature Versus Raw Datasets from Experimental Spinal Cord Injury Studies: A CLIMBER Meta-Analysis.

Translation of spinal cord injury (SCI) therapeutics from pre-clinical animal studies into human studies is challenged by effect size variability, irreproducibility, and misalignment of evidence used by pre-clinical versus clinical literature. Clinical literature values reproducibility, with the highest grade evidence (class 1) consisting of meta-analysis demonstrating large therapeutic efficacy replicating across multiple studies. Conversely, pre-clinical literature values novelty over replication and lacks rigorous meta-analyses to assess reproducibility of effect sizes across multiple articles. Here, we applied modified clinical meta-analysis methods to pre-clinical studies, comparing effect sizes extracted from published literature to raw data on individual animals from these same studies. Literature-extracted data (LED) from numerical and graphical outcomes reported in publications were compared with individual animal data (IAD) deposited in a federally supported repository of SCI data. The animal groups from the IAD were matched with the same cohorts in the LED for a direct comparison. We applied random-effects meta-analysis to evaluate predictors of neuroconversion in LED versus IAD. We included publications with common injury models (contusive injuries) and standardized end-points (open field assessments). The extraction of data from 25 published articles yielded n = 1841 subjects, whereas IAD from these same articles included n = 2441 subjects. We observed differences in the number of experimental groups and animals per group, insufficient reporting of dropout animals, and missing information on experimental details. Meta-analysis revealed differences in effect sizes across LED versus IAD stratifications, for instance, severe injuries had the largest effect size in LED (standardized mean difference [SMD = 4.92]), but mild injuries had the largest effect size in IAD (SMD = 6.06). Publications with smaller sample sizes yielded larger effect sizes, while studies with larger sample sizes had smaller effects. The results demonstrate the feasibility of combining IAD analysis with traditional LED meta-analysis to assess effect size reproducibility in SCI.