Comparative efficacy and safety of clozapine and olanzapine in schizophrenia and related disorders: An updated systematic review.

Risk factors for urethrocutaneous fistula following primary hypospadias repair in children: a systematic review and meta-analysis.

Stable isotope measurement of in vivo nitric oxide production in health and disease: an updated systematic review and meta-analysis.

To determine whether middle meatal spacers reduce postoperative synechiae following endoscopic sinus surgery (ESS) and to compare the effectiveness of absorbable versus nonabsorbable spacer materials. A PRISMA 2020-guided systematic review and meta-analysis was performed. PubMed/MEDLINE, Embase, and Web of Science were searched (January 2012-March 2025) for randomized controlled trials in adults undergoing ESS comparing middle meatal spacers versus no-spacer controls. The primary outcome was synechiae within 3 months. Random-effects meta-analysis generated pooled relative risks (RR) with 95% confidence intervals (CI); prespecified subgroup and sensitivity analyses assessed robustness. Nine randomized controlled trials comprising 703 patients met inclusion criteria, with eight studies providing dichotomous synechiae data for meta-analysis. Middle meatal spacers significantly reduced postoperative synechiae compared with no spacer (RR 0.43; 95% CI 0.26-0.71; p = 0.001), with moderate heterogeneity (I 2 = 52.3%). Absorbable spacers demonstrated a statistically significant protective effect (RR 0.48; 95% CI 0.25-0.93; p = 0.03), whereas nonabsorbable spacers showed a nonsignificant protective trend under random-effects modeling. No significant difference was observed between absorbable and nonabsorbable spacer subgroups. Trials evaluating steroid-eluting spacers did not demonstrate clear superiority over nonsteroid absorbable spacers for synechiae prevention. Middle meatal spacers reduce postoperative synechiae after ESS, with the most consistent evidence supporting absorbable materials. Given wide variation in baseline synechiae risk, selective rather than routine use is supported.

To assess the efficacy and safety of pitolisant, a selective histamine H₃ receptor antagonist/inverse agonist, for excessive daytime sleepiness (EDS) in narcolepsy or obstructive sleep apnea (OSA). PubMed, Cochrane, Embase, Scopus, and Web of Science were searched through August 2025 for randomized placebo-controlled trials (RCTs). Eligible RCTs reported Epworth Sleepiness Scale (ESS) or Pediatric Daytime Sleepiness Scale (PDSS), mean sleep latency, EQ-5D, or global impression outcomes. Two reviewers independently screened studies, extracted data, and assessed bias using Cochrane RoB 2.0. Publication bias was evaluated using funnel plots and Egger's test; certainty of evidence was rated with GRADE. Six RCTs (n = 1149) met the inclusion criteria. Compared with placebo, pitolisant significantly reduced Sleepiness Scale scores (SSS) (mean difference [MD] = -2.97; 95% confidence interval [CI] -3.62 to -2.33), increased mean sleep latency (MD = 3.06; 95% CI 2.12-3.99), and improved EQ-5D scores (MD = 2.68; P = 0.009). Patient global opinion (risk ratio [RR] = 1.40) and clinical global impression of change (CGI-C) (RR = 1.41) also favored pitolisant. Rates of treatment-emergent adverse events, serious adverse events, and withdrawals were comparable with placebo, and common adverse effects, such as headache, insomnia, nausea, and anxiety, were infrequent and not significantly increased. Pitolisant provides an effective, nonstimulant option for EDS in narcolepsy and OSA, including residual symptoms despite continuous positive airway pressure (CPAP). Its distinct mechanism and tolerability profile make it a valuable alternative or adjunct to existing therapies, supporting personalized care and enhanced daily functioning. Pitolisant significantly improves subjective and objective wakefulness and quality of life in EDS due to narcolepsy or OSA, with robust evidence for ESS benefit and a favorable safety profile.

From the archives of MD Anderson Cancer Center: Paraneoplastic autoimmune multiorgan syndrome (PAMS) associated with stroma-rich Castleman disease.

Growth hormone-releasing hormone (GHRH) is a hypothalamic releasing hormone that plays a crucial physiological role in regulating the synthesis and release of anterior pituitary hormones. In recent years, studies have found that GHRH possesses functions like anti-inflammation, promoting cell proliferation, and facilitating cell migration. It participates in regulating the development of uveitis and diabetic retinopathy. Additionally, it also has an impact on the development of retinal ganglion cells by modulating the inflammatory response and mediating the immune response. Given the important roles of GHRH in ophthalmic diseases, elucidating the molecular regulation of the GHRH-GHRH receptor (GHRHR) signal and the innovative development of intervention pathways that directly or indirectly target GHRH serve as strong evidence of how basic research guides innovation and translation. In this review, research reports on GHRH in ophthalmic diseases including retinal diseases and uveitis were summarized and analyzed.

The incidence and risk factors of secondary hip fractures is unknown. This study aims to evaluate the sex-specific incidence and risk factors of secondary hip fractures in elderly patients after hip fracture. We did a systematic search of PubMed, Web of Science, Cochrane Library, Embase, MEDLINE, CBM, CNKI, VIP, and Wanfang Database from January 1, 2000 to August 1, 2025, for cohort studies that assessed incidence and risk factors among patients with secondary hip fracture. Eligible studies were appraised using the Newcastle-Ottawa Scale. The primary outcomes were incidence rates for secondary hip fracture, reported separately for man and woman. The secondary outcomes were risk factors for secondary hip fractures. Effect sizes included odds ratio (OR) with 95% confidence intervals (CI). Sensitivity analyses and subgroup analyses were performed to explore sources of heterogeneity. We used the population attributable fraction (PAF) and the grading of recommendations, assessment, development and evaluation (GRADE) to assess contribution and evidence quality. 19 eligible studies were included. The pooled incidence of secondary hip fractures among older adults was 10.63% (95% CI, 9.9%-11.4%), higher in females (14.94%; 95% CI, 0.123-0.178) than in males (9.89%; 95% CI, 0.083-0.116). Significant risk factors were reduced gluteus medius/minimus (G.Med/MinM) and gluteus maximus muscle density, reduced bone mineral density at hip, femoral neck, and intertrochanteric regions, osteoporosis, cognitive impairment, and calcium/vitamin D deficiency. Among these, G.Med/MinM density lower (moderate quality evidence, PAF, 6.54%, 95% CI 0.038-0.093), and calcium/vitamin D deficiency (moderate quality evidence, PAF,1.12%, 95% CI 0.007-0.016) were important factors. Roughly one in ten older adults suffers a secondary hip fracture, with substantially higher rates in women. Muscle degeneration and inadequate calcium/vitamin D intake emerged as the most influential and potentially modifiable contributors. Targeted postoperative interventions addressing these factors may reduce recurrent fracture burden in aging populations. CRD420251136318.

Recent years have seen greater interest, and hence, many trials published on the topic of probiotics as a treatment for irritable bowel syndrome (IBS). Given the anticipated "multiplicity problem" and inadequacy of traditional meta-analysis, this study aims to evaluate the efficacy of probiotics in alleviating symptoms of IBS and improve quality of life through a trial sequential analysis (TSA). Medline, Embase, Web of Science, and Cochrane were screened for randomized controlled trials (RCTs) comparing probiotics to placebo in adult patients with IBS. Primary outcomes included changes in IBS Symptom Severity Score (IBS-SSS) and IBS Quality of Life (IBS-QOL) scores. A traditional pairwise meta-analysis conducted in DerSimonian and Laird was conducted, with subsequent TSA. Study quality was graded according to risk-of-bias 2 (ROB-2), and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 40 studies were included. Overall, probiotics demonstrated significant improvements in IBS-SSS (MD: 33.42, 95% confidence interval [CI]: -55.96 to -10.88, p < 0.01) but nonsignificant improvements in IBS-QOL (MD: 1.79, 95% CI: -3.00-6.57, p = 0.46). TSA conducted on IBS-SSS demonstrated current evidence has not reached the required information size. Cumulative Z-curve demonstrated no evidence of futility, benefit, or detrimental effect. Evaluation by ROB-2 indicates the majority of studies were of low risk of bias, while GRADE evaluation of existing evidence demonstrated low certainty of evidence, mainly attributed to inconsistency. TSA findings recommend further high-powered trials. GRADE evaluation emphasizes the importance of standardization in future trials and further efforts to identify sources of heterogeneity.

Hemorrhage remains the leading preventable cause of trauma-related death. The effectiveness of whole-blood vs component therapy remains uncertain, particularly given heterogeneous patient populations and resuscitation protocols. To determine whether whole-blood transfusion is associated with reduced mortality compared with component therapy in adult trauma patients, with prespecified analysis by civilian vs military settings. In this updated systematic review and meta-analysis, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL were searched from January 1, 2006, through June 30, 2025. Two reviewers independently screened 6888 records and extracted data. Randomized clinical trials and observational studies comparing whole-blood vs component therapy in adults (aged ≥16 years) with traumatic hemorrhage were included. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool was used to assess the risk of bias in observational studies, while the Cochrane Risk of Bias 2 (RoB 2) tool was applied for randomized clinical trials. Random-effects meta-analysis used restricted maximum likelihood with Hartung-Knapp adjustment. Forty studies (2 randomized clinical trials, 38 cohort studies; n = 49 776) were included. Whole-blood transfusion, compared with component therapy, was associated with reduced 24-hour mortality (odds ratio [OR], 0.76; 95% CI, 0.60-0.95; τ2 = 0.27; I2 = 87%; 95% prediction interval [PI], 0.30-1.89). In civilians (24 studies; n = 39 028), mortality reduction was significant (OR, 0.73; 95% CI, 0.57-0.93; τ2 = 0.27; I2 = 89%; 95% PI, 0.28-1.91), corresponding to an absolute risk reduction of 4.6 percentage points (95% CI, 1.4-8.6 percentage points) based on median control mortality of 20% (range, 15%-25%). No benefit was observed in military settings (5 studies; n = 2171; OR, 0.99; 95% CI, 0.58-1.70). Civilians also showed reduced 30-day mortality (OR, 0.76; 95% CI, 0.60-0.98) and transfusion requirements (mean difference, -2.66 units; 95% CI, -3.96 to -1.35 units). In this updated systematic review and meta-analysis, whole-blood transfusion was associated with reduced mortality in civilian but not military adult trauma patients, although the wide 95% PIs suggest substantial heterogeneity, indicating that benefits may vary considerably across settings. These findings support selective whole-blood transfusion protocol implementation in civilian centers while highlighting the need for refined patient selection criteria.

To provide an updated evaluation of the efficacy and safety of asenapine in bipolar disorder using evidence from randomized controlled trials. An updated systematic review and pairwise meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and ClinicalTrials.gov were searched from inception to October 2025. Randomized controlled trials comparing asenapine with placebo were included. The primary outcome was change from baseline in Young Mania Rating Scale (YMRS) scores. Secondary outcomes included Clinical Global Impressions-Bipolar Severity (CGI-BP-S) overall and mania scores, Montgomery-Åsberg Depression Rating Scale (MADRS) scores, and incidence of adverse events. Random-effects models with restricted maximum-likelihood estimation and Hartung-Knapp adjustment were applied. Five trials comprising 1,593 participants were included. Asenapine significantly reduced manic symptoms compared with placebo (YMRS mean difference -4.00, 95% CI -5.55 to -2.45). Significant improvements were observed in CGI-BP-S overall severity (-0.51, 95% CI -0.78 to -0.24) and mania scores (-0.47, 95% CI -0.77 to -0.16). modest improvement was observed in MADRS scores (-1.38, 95% CI -2.52 to -0.24). Adverse events were more frequent with asenapine. Asenapine is an effective short-term treatment for acute mania in bipolar disorder, with tolerability considerations.

Chronic pain resulting from postoperative adhesions represents a significant clinical concern due to its substantial impact on patient quality of life; however, optimal therapeutic management remains contentious. This systematic review and meta-analysis aimed to evaluate the efficacy of laparoscopic adhesiolysis in alleviating chronic pain attributable to postoperative adhesions, and to assess the influence of adhesion barriers on treatment outcomes. A comprehensive systematic review was conducted by searching PubMed, Embase, and Web of Science from database inception through August 2025. Studies reporting pain improvement as the primary outcome, along with safety outcomes (including complication incidence and mortality), were eligible for inclusion. Pooled estimates were calculated using a random-effects model, and heterogeneity was quantified employing the I2 statistic.. A total of 30 studies involving 1,450 patients were included in the systematic review. In 27 single-arm observational studies (n = 1,150), laparoscopic adhesiolysis was associated with a pooled pain improvement rate of 67.3% (95% CI 57.5-76.2%), with substantial heterogeneity (I2 = 91%). In contrast, pooled analysis of four randomized controlled trials (n = 271) demonstrated no statistically significant difference in pain improvement between laparoscopic adhesiolysis and diagnostic laparoscopy alone (38.9% vs 36.2%; risk ratio 1.05, 95% CI 0.61-1.83). Although observational studies report relatively high rates of pain improvement, these findings should be interpreted as descriptive and hypothesis-generating. The highest level of available evidence from randomized controlled trials does not demonstrate a clinically meaningful benefit of laparoscopic adhesiolysis over diagnostic laparoscopy alone. PROSPERO CRD42023478049.

Recent systematic reviews have demonstrated the efficacy of doxycycline prophylaxis in preventing bacterial sexually transmitted infections (STIs)in randomised controlled trials (RCTs). In this review, we updated evidence from RCTs and non-RCTs and compared the effectiveness of doxycycline as pre- (doxy PrEP) and post-prophylaxis (doxy PEP) across different groups. We searched PubMed, Web of Science, Embase, Cochrane Library, and two conference abstract archives for publications from January 2010 to April 2025. Eligible RCT and non-RCT studies on doxy PrEP and doxy PEP to prevent STIs were included in the analysis.Pooled risk ratios were calculated using fixed-effects and random-effects models. This study was registered with PROSPERO (CRD42024568934). Fourteen eligible studies (4 doxy PrEP, 10 doxy PEP) were included for analysis. Participants were primarily men who have sex with men (MSM) and transgender women (TGW). Doxycycline (either PrEP or PEP) reduced the risk of acquiring any STIs by 60% (risk ratio (RR),0.40;95% CI,0.30-0.52) in RCT and non-RCT trials. Doxycycline was associated with fewer incidences of chlamydia (RR,0.18;95% CI,0.11-0.28), gonorrhoea (RR,0.61;95% CI: 0.44-0.86), and syphilis (RR,0.20; 95% CI;0.12-0.33). Meta-analysis of seven RCTs showed 76% decrease on chlamydia (RR: 0.24; 95% CI: 0.13-0.45), 33% decrease on gonorrhoea (RR,0.67; 95% CI;0.45-0.98), and 78% decrease on syphilis (RR,0.22; 95% CI;0.14-0.36). HIV-positive and HIV-negative people benefited from using doxy PrEP and PEP regimens prevented bacterial STIs. RCT and non-RCT data demonstrated the effectiveness of doxy PrEP and doxy PEP in reducing STIs among MSM/TGW. Integrating doxy PrEP or doxy PEP as a biomedical tool into STI prevention strategies should be considered.

Diagnosing acute appendicitis during pregnancy is challenging due to physiological changes and concerns regarding fetal radiation exposure from Computed Tomography (CT). This systematic review and meta-analysis evaluates the diagnostic accuracy and safety of Magnetic Resonance Imaging (MRI) for suspected acute appendicitis, providing an updated synthesis based on a large dataset and modern MRI protocols. Following PRISMA guidelines and PROSPERO registration, we performed a systematic review and diagnostic meta-analysis. Studies involving pregnant women with suspected appendicitis, extractable diagnostic accuracy data (true positives, false positives, false negatives, true negatives), and surgical/histopathological confirmation were included. PubMed, EMBASE, and Cochrane Central were systematically searched until September 3, 2025. Risk of bias was assessed using QUADAS-2, and evidence certainty with GRADE. Statistical analysis used R, employing bivariate random-effects models for sensitivity/specificity, sROC curves, meta-regression, and Deeks' test for publication bias. Thirty-four studies were included. Pooled sensitivity was 0.95 (95% CI: 0.91-0.98; I² = 0%) and pooled specificity 0.97 (95% CI: 0.96-0.98; I² = 55.3%), demonstrating strong diagnostic performance (AUC = 0.961; Diagnostic Odds Ratio = 273.1). A positive MRI result increased post-test probability from 30% to 93%, while a negative result reduced it to 2.2%. QUADAS-2 revealed patient selection and index-test interpretation as common bias sources, particularly in older retrospective studies. Moderate heterogeneity in specificity (I² = 55.3%) was observed, but not explained by gestational age. Deeks' test indicated potential publication bias (p = 0.0024), though pooled estimates remained robust in sensitivity analyses. Non-contrast MRI is a highly accurate and safe diagnostic tool for suspected acute appendicitis in pregnancy, demonstrating performance comparable to CT in non-pregnant populations. We recommend MRI as the standard second-line imaging modality following inconclusive ultrasound findings to enhance diagnostic confidence, minimize fetal radiation exposure, and reduce unnecessary surgical interventions.

An elevated lipoprotein (a) concentration has been established as an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). There is a high prevalence of elevated lipoprotein (a) in the general population, and given the significant burden of ASCVD, researchers have developed novel therapeutic drugs with a direct lipoprotein (a) reducing effect that are currently under investigation. One of these medications is lepodisiran, a small interfering RNA targeting lipoprotein (a). This drug has undergone safety assessment (in Phase 1 and 2 randomized control trials [RCTs]) as well as efficacy assessment (Phase 2 RCT, ALPACA Trial). A phase 3 RCT, ACCLAIM-Lp(a), is currently ongoing with the main purpose of assessing the effect on major cardiovascular events in patients with established ASCVD or at high cardiovascular risk. Herein, we present an updated review on this lipoprotein (a) lowering agent, including the results of the published clinical trials and the design of the ongoing phase 3 clinical trial.

Chikungunya virus (CHIKV) is a mosquito borne alphavirus that causes chikungunya disease, which is characterized by debilitating arthritis. While the acute phase is marked by fever and joint pain, many patients develop chronic arthritis that persists for years. The pathogenesis of chikungunya arthritis (CA) is not fully understood, prompting us to perform an updated review of the literature to describe the mechanisms contributing to this condition. A comprehensive search was conducted on numerous electronic databases for all studies relating to pathogenesis of CA. The search strategy included the key word search "pathogenesis", "chikungunya", "arthritis". Two reviewers independently determined eligibility, rated study quality, and extracted data. The methodology followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The data from included articles were charted and a qualitative thematic analysis formulated. A total of 623 records were identified from the electronic database search. This was narrowed to 63 records which were eligible after excluding by title and then by abstract. Following the surveying of 58 available full texts, 35 articles were eligible for inclusion, from which data was extracted. Key mechanisms identified for chronic CA included host risk factors, viral component persistence in joints, a robust pro-inflammatory cytokine response, the resulting joint destruction from pannus formation and the activation of matrix metalloproteases (MMPs) and osteoclasts. This scoping review extrapolates factors that contribute to the pathogenesis for developing chronic CA. Namely host factors and the ability of CHIKV to establish persistence within synovial fibroblasts. The inflammatory mediators and signalling pathways triggered by the host fibroblast synoviocytes, the secretion of MMPs, and promoting of osteoclastogenesis, contribute to ongoing inflammatory immune response and joint destruction. Thus, this review synthesizes evidence for a multifactorial pathogenesis of chronic CA, paralleling mechanisms of rheumatoid arthritis and highlighting targets for potential therapeutic intervention.

Rates of tobacco use disorder (TUD) are high among individuals with opioid use disorder (OUD), who consistently show lower response rates to evidence-based treatment approaches for TUD relative to the general population. This systematic review aims to provide a comprehensive and updated examination of the current evidence regarding TUD treatments for individuals with OUD. We first summarize potential mechanisms driving TUD and treatment nonresponse among those with OUD, given the likely roles of overlapping reward and withdrawal processes in co-occurrence and treatment challenges. We then provide an updated review of the relevant literature on treating TUD among those with OUD. Our review identified a total of 25 studies, with 9 examining pharmacological treatments, 5 examining behavioral treatments, and 11 examining a combination treatment approach. Consistent with previous research, pharmacological treatments were generally ineffective for smoking cessation among those with OUD. No studies reported continuous abstinence at 6 months post-quit date. Contingency management interventions showed some promise but smoking largely resumed after incentives were removed. Overall, findings demonstrate limited progress in identifying durable, effective smoking cessation interventions for individuals with OUD. Traditional cessation treatment approaches fail to address smoking in individuals with OUD. Novel pharmacological and behavioral strategies that can be implemented into existing medications for OUD clinical care are necessary.

Multiple sclerosis (MS) is a chronic, inflammatory, autoimmune disease of the central nervous system and represents one of the most common causes of accumulated disability in young adults. Although, currently in the vast majority of cases MS is not a determinant of death, its effects on patients can result in considerable health problems. This research provides new estimations of the total economic burden (direct -based on the difference in the total average annual amount vs matched controls without MS - and indirect costs- e.g., labor market productivity losses (premature death, presenteeism, and absenteeism losses, costs of paid and unpaid caregivers, home changes-). A literature review of English language studies published in the last 6 years is conducted to analyze the costs of MS. We search PubMed, Web of Science and Scopus as databases. The search identified 131 unique records, 31 of which met the inclusion criteria. Living with MS is expensive as a significant chronic disease. The important cost determinants are the direct costs of drugs and indirect productivity loss. Our findings show that the burden of MS needs to overcome the underestimation problems.

The clinical utility of sequencing in prenatal diagnosis is known, but diagnostic yield varies widely depending on clinical indication. Here we update an earlier systematic review reporting the diagnostic yield of prenatal sequencing in structurally abnormal fetuses, with particular focus on factors affecting diagnostic yield. The search strategy outlined in the previous review (2018-2022) was repeated to include reports published between October 2021 and January 2025. Combining these records with those from the earlier review, an overall incremental diagnostic yield of sequencing compared to chromosomal microarray analysis (CMA) was calculated and pooled in a meta-analysis. Subgroup analyses were performed on selected, unselected, and exploratory cohorts, as well as individual phenotypic subgroups. 155 records were reviewed (89 from the current and 66 from the earlier publication). The overall pooled diagnostic yield of sequencing above CMA across all indications was 27% (95% CI 24%-30%, p<0.0001). Subgroup analysis showed that the diagnostic yield was 40%, 20%, and 17% in selected, unselected, and exploratory subgroups, respectively. Concurrent CNV analysis of sequencing data provided nine additional diagnoses over sequential sequencing after a non-diagnostic CMA. Prenatal sequencing provides an additional yield of 27% following a non-diagnostic CMA across a range of fetal structural anomalies, and this increases to 40% with careful case-selection. Sequencing continues to be a powerful diagnostic tool when performed for well-evidenced indications.

To provide an up-to-date systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the postoperative outcomes of two lateral osteotomy techniques (external vs. internal) in patients undergoing rhinoplasty. We conducted a comprehensive search in PubMed, Scopus, Web of Science, Embase, and the CENTRAL from their inception until January 2025. Eligible RCTs were assessed for risk of bias using Cochrane's risk of bias tool. The specific outcomes included clinically relevant measures, such as eyelid edema, ecchymosis, and step-off deformity. Standardised mean differences (SMD) and risk ratios (RR) with 95% confidence intervals (CIs) were used to combine the data. STATA software was used for statistical analysis. A total of 13 RCTs involving 1008 patients were included. Five RCTs demonstrated a low risk of bias, six had some concerns, and two exhibited a high risk of bias. The pooled analysis showed no significant difference in eyelid edema between the external and internal osteotomy groups at 2 days (SMD = -0.13, 95% CI [-0.49, 0.22]), 3 days (SMD = -0.14, 95% CI [-0.77, 0.48]), and 7 days (SMD = -0.08, 95% CI [-0.27, 0.12]). Similarly, no significant difference was observed in ecchymosis between the two groups at 2 days (SMD = -0.12, 95% CI [-0.51, 0.27]), 3 days (SMD = -0.21, 95% CI [-1.11, 0.70]), and 7 days (SMD = -0.10, 95% CI [-0.33, 0.12]). The mean score of step-off deformity was significantly higher in the external osteotomy group compared to the internal osteotomy group (SMD = 0.54, 95% CI [0.19, 0.89]), whereas the rate of step-off deformity did not differ significantly between the groups (RR = 0.79, 95% CI [0.43, 1.44]). This updated systematic review and meta-analysis of 13 RCTs involving 1008 patients demonstrated comparable outcomes between external and internal lateral osteotomy in terms of postoperative eyelid edema, ecchymosis, and step-off deformity in patients undergoing rhinoplasty. PROSPERO: CRD420251003922.