Weighted Mean Difference Research Articles

In the absence of long-term research with respect to the impact of a ketogenic diet (KD) on liver disease progression, further investigation into the screening for liver enzymes is useful in attempting to elucidate whether a KD may result in positive or negative effects. The goal of this study was to thoroughly examine how a KD affects liver health. The PubMed/Medline, Web of Science, Scopus, Cochrane Library, and Embase databases were searched to find pertinent randomized controlled trials (RCTs). This systematic review featured 20 RCTs investigating the impact of a KD on liver enzymes and liver stiffness. A random-effects model analysis was undertaken, yielding pooled weighted mean differences and 95% CIs. A quantitative meta-analysis showed that a KD has a significant lowering effect on levels of aspartate aminotransferase (AST) [weighted mean difference (WMD): -3.56 U/L; 95% CI: -6.61, -0.51], alanine aminotransferase (ALT) (WMD: -3.03 U/L; 95% CI: -5.26, -0.81), gamma-glutamyl transferase (GGT) (WMD: -12.25 U/L; 95% CI: -22.08, -2.42), and alkaline phosphatase (ALP) (WMD: -5.29 U/L; 95% CI: -9.85 to -0.74). However, the findings obtained from the meta-analysis showed that a KD has no significant effect on liver fibrosis (liver stiffness) (WMD: 0.40; 95% CI: -0.23, 1.04). The findings also showed that a KD followed for a duration of less than 12 weeks caused greater reductions in liver enzymes, including AST, ALT, and GGT, in people with a BMI of less than 30. In general, KDs can reduce traditional liver enzyme levels (ALT, AST, ALP, and GGT), but they appear to have no significant effect on liver stiffness.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a serious disease and increasingly prevalent in children. MASLD is associated with health consequences such as type 2 diabetes, and cardiovascular disease. While, vitamin E is a potent antioxidant that has been proposed to improve liver function and cardiometabolic health including liver markers, lipid profile, glycemic control, and anthropometric measurements. A comprehensive search was conducted up to March 2025. Data on anthropometric measures, liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT)), glycemic indices (fasting blood sugar (FBS), insulin, homeostatic model assessment for insulin resistance (HOMA-IR)), lipid profiles (total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)), and serum vitamin E levels were extracted. Statistical analyses were performed using a random-effects model. Eleven RCTs involving 665 participants were included in this study. Vitamin E significantly reduced ALT (weighted mean difference (WMD)= -5.23 U/L;95% confidence interval (CI): -7.72, -2.75; P< 0.001) and AST (WMD= -3.00 U/L;95% CI: -4.59, -1.41; P< 0.001), reflecting improved liver function. It also decreased TC (WMD= -5.77 mg/dL;95% CI: -11.46, -0.09; P= 0.04) and HOMA-IR (WMD= -0.82;95% CI: -1.28, -0.37; P< 0.001), while significantly increasing serum vitamin E levels (WMD= 9.16 mg/L;95%CI: 3.29, 15.03; P=0.002). No significant changes were observed in the BMI, GGT, FBS, insulin, LDL, HDL, or TG levels. Vitamin E supplementation in pediatric MASLD appears to favorably influence key liver enzymes such as ALT, AST and certain metabolic factors including TC, and HOMA-IR levels, supporting its potential role as adjunctive therapy.

Epilepsy, antiepileptic drugs (AEDs), and adjuvant treatments may correlate with the development of subclinical atherosclerosis. We performed a systematic review and meta-analysis to evaluate the effects of epilepsy, AEDs, and adjuvant treatments on the structural and functional markers of subclinical atherosclerosis represented by carotid intima-media thickness (cIMT), epicardial adipose tissue thickness (EATT), and flow-mediated vasodilation (FMD). Weighted mean differences (WMD) and corresponding 95% confidence intervals (CIs) were analyzed. Thirty-one studies were included with 9 different outcomes. Compared with controls, the epileptic patients demonstrated significantly thicker cIMT (WMD [95% CI] = 0.063 [0.045-0.080], P < .001) and EATT (WMD [95% CI] = 1.985 [1.630-2.341], P < .001). There was no significant difference in FMD (P > .050). Moreover, cIMT was still thicker in the epileptic patients on old AEDs compared with those on new AEDs (WMD [95% CI] = 0.038 [0.000-0.076], P = .050), on multi-AEDs compared with on mono-AEDs (WMD [95% CI] = 0.025 [0.021-0.029], P < .001), and on enzyme-inducing AEDs compared with on non-enzyme-inducing AEDs (WMD [95% CI] = 0.027 [0.006-0.047], P = .011). No significant differences in cIMT were detected in any comparison of adjuvant treatments (ketogenic diet, Atkins diet, and folic acid supplements; all P > .050). Epilepsy and AEDs, especially old AEDs, multi-AEDs, and enzyme-inducing AEDs, could exacerbate the development of subclinical atherosclerosis. Early prevention as well as timely intervention for subclinical atherosclerosis should be considered for these patients.

Background/Objectives: Caffeine is widely recognized as an ergogenic aid, yet evidence regarding its acute effects on repeated sprint ability (RSA) remains inconsistent. This systematic review and meta-analysis aimed to evaluate the effects of acute caffeine ingestion on RSA across different populations, exercise modalities, and dosage levels. Methods: A comprehensive literature search was conducted in the PubMed, EBSCO, Cochrane Library, Web of science, and Scopus databases. Data were pooled using the weighted mean difference (WMD) with 95% confidence interval (CI). Results: Thirteen studies met the inclusion criteria. Acute caffeine ingestion significantly enhanced RSA peak power output (PPO) compared with placebo (WMD, 5.28; 95% CI, 2.49 to 8.07; p = 0.0002). Subgroup analyses revealed significant improvements in both males (WMD, 13.11; 95% CI, 5.63 to 20.59; p = 0.0006) and females (WMD, 4.03; 95% CI, 1.10 to 6.97; p = 0.007). A caffeine dose of ≥6 mg/kg body weight (BW) produced greater ergogenic benefits (WMD, 6.67; 95% CI, 3.32 to 10.02; p &lt; 0.0001) than lower doses (WMD, 2.16; 95% CI, −2.87 to 7.19; p = 0.40). Moreover, a more pronounced enhancement was observed in cycling-based RSA (WMD, 8.77; 95% CI, 1.98 to 15.56; p = 0.01) compared with running-based protocols (WMD, 4.56; 95% CI, 1.58 to 7.55; p = 0.003). Conclusions: Acute caffeine ingestion significantly enhances RSA, particularly at doses ≥6 mg/kg BW. This effect is consistent across both male and female participants, with no statistically significant sex difference observed in the pooled analysis. These findings reinforce caffeine’s role as an effective ergogenic aid for optimizing high-intensity intermittent performance, with the strongest benefits evident in cycling exercise.

In anterior cruciate ligament reconstruction (ACLR), the clinical benefits and limitations of nonpreserving versus different remnant-preserving ACLR are not well defined. There is also a lack of systematic analysis of ACL remnant length. Database searches were performed in PubMed, Embase, Web of Science and Cochrane CENTRAL from inception to 25 April 2025. Risk of bias was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa scale (NOS) critical appraisal tools. Certainty of evidence was evaluated using the grading of recommendations assessment, development and evaluation (GRADE) framework. The reported outcomes used for analysis included stability-related indicators, functional scores, synovial coverage and complications. Subgroup analyses were performed across three remnant-preserving surgical approaches: Augmentation, tension and sparing. Meta-regression and network meta-analyses were performed to investigate whether improved outcomes were associated with remnant length. Sensitivity analysis was used to assess the robustness of the results. Our analysis included 36 articles. For stability, the remnant-preserving (R) group showed improved outcomes compared to the nonremnant (NR) group in the Lachman test (weighted mean difference [WMD] = 1.61, p = 0.0003), Side-to-side anterior laxity (SSD, WMD = -0.27, p = 0.03) and Pivot shift test (WMD = 1.34, p = 0.03), with the highest improvement observed in the Sparing subgroup. For functional scoring, the R group exhibited significantly higher Lysholm knee scoring scale scores (WMD = 1.52, p = 0.01), Tegner athletic ability evaluation score (WMD = 0.40, p < 0.00001), and International Knee Documentation Committee (IKDC) subjective scores (WMD = 1.00, p = 0.001), with the Tension subgroup showing the highest overall improvement. The R group also achieved better synovial coverage (odds ratio [OR] = 2.00, p = 0.0004) and lower failure (OR = 0.48, p = 0.002), particularly in the augmentation subgroup. Meta-regression indicated a correlation between increased graft length and reduced SSD (β = -1.33, p = 0.01), improved IKDC scores (β = 20.03, p = 0.01), and fewer complications (β = -2.61, p = 0.01). Network meta-analysis indicated a 75% remnant preservation ratio minimised SSD alongside enhanced functional scores. Remnant-preserving ACLR showed improvements in stability and synovial coverage. However, in terms of clinical outcomes, the improvement in functional recovery has not reached a significant level. Sparing exceled in improving stability, while augmentation effectively reduced failure and tension favoured function. Increasing remnant preservation length significantly improved stability and function concomitantly reducing complications. CRD42024550746. Level III.

Background: Inclisiran, a small interfering RNA (siRNA), inhibits hepatic PCSK9 synthesis, leading to significant LDL-C reduction. Previous meta-analyses have addressed short-term efficacy; however, recent long-term data warranted an updated systematic review and meta-analysis to evaluate inclisiran’s lipid-lowering efficacy and safety in hyperlipidemic patients. Methods: A systematic search of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov was conducted from inception to April 2025 to identify randomized controlled trials (RCTs) comparing inclisiran with placebo or standard care in adults with hypercholesterolemia. Primary efficacy outcomes included percentage change in LDL-C, PCSK9, total cholesterol, apolipoprotein B (apo-B), and non-HDL-C. Safety outcomes included adverse events, cardiovascular events, and all-cause mortality. Data were analyzed using a random-effects model following PRISMA guidelines. Risk ratios (RR) and weighted mean differences (WMD) were calculated with 95% confidence intervals. The protocol was registered on PROSPERO (CRD420251059229). Results: Eleven RCTs with 5,601 patients were included; 3,135 received inclisiran and 2,466 received placebo. Inclisiran significantly reduced: LDL-C (WMD –48.99%, 95% CI: –54.29 to –43.69) PCSK9 (WMD –78.52%, 95% CI: –81.52 to –75.51) Total cholesterol (WMD –31.21%, 95% CI: –33.47 to –28.56) Apo-B (WMD –40.09%, 95% CI: –43.43 to –36.75) Non-HDL-C (WMD –35.22%, 95% CI: –41.25 to –29.20) Inclisiran showed no significant impact on all-cause mortality (RR 0.94; p=0.83), cardiovascular mortality (RR 1.19; p=0.60), myocardial infarction (RR 0.85; p=0.60), stroke (RR 0.89; p=0.86), or major adverse cardiovascular events (RR 0.80; p=0.07). Total adverse events were slightly higher with inclisiran (RR 1.06; p=0.02), but serious adverse events were not significantly different (RR 0.90; p=0.36). Injection site reactions were more common with inclisiran (RR 6.45; p&lt;0.001). Conclusion: Inclisiran significantly reduces LDL-C, PCSK9, total cholesterol, apo-B, and non-HDL-C, confirming strong lipid-lowering efficacy. It is generally well tolerated, with a slightly higher incidence of mild injection site reactions but no increase in serious adverse events. Longer-term studies are needed to assess its effect on cardiovascular outcomes.

Coffee contains various bioactive compounds, including chlorogenic acids (CGAs), caffeine, and hydroxyhydroquinone (HHQ), which may differently affect endothelial function. This meta-analysis of randomized controlled trials (RCTs) examined both longer-term and acute effects of coffee-related bioactive components on endothelial function in adults, measured by brachial artery flow-mediated vasodilation (FMD), a validated marker of cardiovascular disease (CVD) risk. A systematic literature search was conducted in Ovid Medline, Embase, Cochrane, and Web of Science up to July 2025. Relevant data were extracted from 19 eligible RCTs. Fixed or random-effects meta-analyses were conducted to estimate weighted mean differences (WMDs) with 95% CIs. Four RCTs investigating longer-term CGA intake (median dose: 300 mg/day) showed a significant increase in fasting FMD of 2.52 percentage points (PP; 95% CI: 1.19, 3.85, P < .001; I2 = 0.0%). Ten RCTs evaluating acute CGA intake also reported a significant FMD increase of 1.51 PP (95% CI: 0.91, 2.96; P < .001; I2 = 68.0%). These effects were more pronounced for studies using CGA-rich coffee beverages compared with those using isolated CGA supplements (ΔWMD: 1.41 PP; 95% CI: 0.27, 2.55; P = .016). Caffeine showed no significant effect on FMD across 6 acute studies (WMD: -0.05 PP; 95% CI: -2.78, 2.68, P = .971; I2 = 95.3%), while FMD was significantly reduced by 1.04 PP (95% CI: 0.20, 1.88; P = .015; I2 = 0.0%) in the 2 acute studies that examined HHQ. This meta-analysis provides evidence that both longer-term and acute CGA intake significantly improve endothelial function, especially when consumed as part of coffee beverages. These findings support the potential role of moderate coffee consumption in reducing CVD risk.

Background: Cardiogenic shock is associated with high mortality and usually requires ventilatory support. Non-invasive ventilation (NIV) has demonstrated benefits in cardiogenic pulmonary edema, including reduced risk of infection and shorter hospital stays compared to invasive mechanical ventilation (IMV). However, the efficacy and safety of NIV specifically in cardiogenic shock remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of NIV compared to IMV in patients with cardiogenic shock. Methods: A systematic search was conducted across 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to February 12, 2025, without language restrictions. Studies were included if they compared the efficacy and safety of NIV and IMV in patients with cardiogenic shock. Results: A total of 6 studies involving 2,302 participants were included in this meta-analysis, using a random-effects model. NIV was associated with a significantly lower risk of in-hospital mortality compared to IMV, with a risk ratio (RR) of 0.70 (95%CI 0.52 to 0.94), p=0.02. NIV was also associated with a lower risk of 30-day all-cause mortality, with an RR of 0.63 (95%CI 0.51 to 0.77), p&lt;0.01. NIV was associated with a shorter length of ICU/CCU stay (weighted mean difference (WMD) of -2.06 days; 95%CI -2.76 to -1.37; p&lt;0.01) and hospital stay (WMD of -3.20 days; 95%CI -5.33 to -1.07; p&lt;0.01) compared to IMV. Conclusions: NIV appears to be an effective and safe alternative to IMV in carefully selected patients with cardiogenic shock.

Objective This study aims to assess the effects of forest therapy on human mental health through meta-analytic methods and to examine the moderating variables that influence this relationship. The goal is to provide a scientific basis for optimizing forest therapy interventions tailored to different populations to enhance mental health outcomes. Methods Databases such as CNKI, Wanfang, Web of Science, PubMed, Cochrane, and Embase were utilized for data collection, and data processing was performed using EndNote X9 and Stata 16.0 statistical software. The weighted mean difference (WMD) and 95% confidence interval (CI) were used as effect size indicators for the meta-analysis, and relevant moderator variables were tested. Results The study analyzed three subgroups based on intervention duration, exercise intensity, and participant origin. Subgroup 1 ( t ≤ 15 min), Subgroup 2 (15 min &amp;lt; t &amp;lt; 60 min), and Subgroup 3 ( t ≥ 60 min) were categorized by intervention duration. Participants were further divided into Static forest therapy (Subgroup 1) and Dynamic forest therapy (Subgroup 2) based on exercise intensity. Additionally, participants were classified as either Asian (Subgroup 1) or European (Subgroup 2) based on their origin. The results indicated that longer single sessions of forest therapy were more beneficial in improving both positive and negative psychological states. Dynamic forest therapy was more effective than static forest therapy in enhancing these states. Furthermore, forest therapy was found to be more effective in improving both negative emotions (e.g., nervousness, depression, confusion) and positive emotions (e.g., vitality) in Asian populations compared to European populations. Conclusion Forest therapy has been shown to effectively alleviate anxiety, anger, depression, fatigue, and confusion, while also enhancing vitality. However, when the duration of the therapy is less than one hour, its effects on reducing fatigue and enhancing vitality are less pronounced.

Agomelatine, a melatoninergic antidepressant, is often prescribed to improve sleep disturbance, though meta-analytic evidence is currently lacking. This systematic review and meta-analysis assessed its efficacy and tolerability in sleep outcomes compared to placebo. We systematically searched clinical trial registries (Cochrane Central, WHO ICTRP, ClinicalTrials.gov) and databases (MEDLINE, Embase, APA PsycINFO) up to February 16, 2025, for Randomised Controlled Trials (RCTs) comparing agomelatine with placebo that reported sleep-related outcomes. Analyses were conducted using a random-effects model on an intention-to-treat basis. Risk ratios (RR) were used for dichotomous outcomes, weighted mean differences (WMD) for continuous outcomes, and Hedge's adjusted g (SMD) when different scales were used. Primary outcomes included subjective and objective total sleep time, subjective sleep quality, and treatment-emergent somnolence and insomnia. Subgroup and sensitivity analyses explored heterogeneity and assessed robustness. Twenty-five RCTs with 6812 participants were included. No significant effect was found for objective total sleep time (MD = -15.73 min, 95% CI: -49.68; 18.22), while subjective sleep quality improved more with agomelatine than placebo (SMD = 0.31, 95% CI: 0.21; 0.40). Agomelatine was associated with fewer incidents of insomnia (RR = 0.59, 95% CI: 0.39; 0.90) but more incidents of somnolence (RR = 1.34, 95% CI: 1.02; 1.75). Agomelatine was found to cause marginally more adverse effects than placebo (RR = 1.05, 95% CI: 1.00; 1.11). Overall, agomelatine appears to slightly improve sleep quality and is well-tolerated and safe, although the limited data for many outcomes warrant cautious interpretation.

This systematic review and meta-analysis investigates the diagnostic utility of [18F]Fluorodeoxyglucose (FDG) and Fibroblast activation protein inhibitor (FAPI) positron emission tomography (PET) in Crohn's disease (CD). A comprehensive literature search of Scopus, PubMed, and Web of Science up to April 1, 2025 was performed. Pooled detection rates, sensitivity, specificity, average maximum standardized uptake value (SUVmax), and biomarker correlations were assessed using Stata software. This systematic review evaluates 20 studies (547 patients, 1935 bowel segments) comparing [18F]FDG and FAPI PET tracers in CD. Seven [18F]FDG PET studies (247 patients, 872 segments) demonstrated pooled sensitivity, specificity, and accuracy of 76%, 81%, and 85%. Overall detection rate for CD inflammation was 89%, with SUVmax weighted mean difference (WMD) of 2.9 between inflammatory and non-inflammatory segments (p = 0.0001). [18F]FDG SUVmax correlated strongly with CRP (rho = 0.67, p = 0.001). Four FAPI PET studies (50 patients, 211 segments) showed 92%, 93%, and 96% sensitivity, specificity, and accuracy. Overall, the detection rate for CD fibrosis was 99%, and the WMD in SUVmax between fibrotic and non-fibrotic CD is 7 (p = 0.00001). FAPI SUVmax correlated strongly with histologic fibrosis grading (rho = 0.74, p = 0.0001). Indirect comparisons revealed FAPI's diagnostic effectiveness was twofold greater than FDG (p = 0.03), and has higher overall SUVmax with WMD of 1.3 (p = 0.01). Both PET tracers show promise, with [18F]FDG correlating with CD inflammation, and FAPI with CD fibrosis. FAPI PET imaging demonstrated greater accuracy and higher uptake metrics. Further research is needed to explore diagnostic and predictive utilities in larger studies.

Effectiveness of preventive gambling interventions in adolescents: a systematic review and meta-analysis.

Ultrasonographic assessment of the airway to evaluate for obstructive sleep apnea - a systematic review and meta-analysis.

Effects of carnitine supplementation on glycemic markers in women with overweight and obesity: A systematic review and meta-analysis of randomized controlled trials.

Gut microbiota has been implicated in bone health. However, the extent of the skeletal benefits of probiotic supplementation in humans remains unclear. A systematic review and meta-analysis was performed to appraise the efficacy of probiotic supplementation in improving bone health through a comprehensive qualitative and quantitative synthesis of the available randomized controlled trials. The PubMed, Web of Science, and China National Knowledge Infrastructure databases were searched for RCTs reporting the effects of probiotic supplementation on bone mineral density (BMD), C-terminal telopeptide of type 1 collagen (CTX), or procollagen type 1 N-propeptide (P1NP). A random-effects model was used to generate the pooled weighted mean differences and 95% confidence intervals. Probiotic supplementation significantly increased lumbar spine aBMD (areal BMD) (+ 0.010; n = 16) and hip aBMD (+ 0.022g/cm2; n = 9) but had no significant effect on femoral neck aBMD (n = 7), P1NP (n = 10), and CTX (n = 11). Moderate-to-high heterogeneity was present in all analyses, likely due to differences in participant characteristics and intervention characteristics. A tendency toward increased lumbar spine aBMD was observed across subgroups, although statistical significance was not always reached, while findings for other outcomes varied. Most trials included postmenopausal women, and restricting the analyses to this population yielded results consistent with the main analyses. The increase in lumbar spine aBMD remained significant regardless of trial exclusion, whereas the effect on hip aBMD became non-significant when key trials were omitted. Based on the evidence from the currently available RCTs, probiotic supplementation appears to lead to modest but statistically significant improvement in lumbar spine BMD and, to a lesser extent, hip BMD in postmenopausal women.

Clinical uncertainty remains regarding optimal atropine concentration, treatment duration and potential differences in efficacy for myopia control between Asian and non-Asian children. This systematic review and meta-analysis evaluated the efficacy of different concentrations of atropine for myopia control, comparing outcomes among East Asian, South Asian and white European children. Five databases were searched for randomised controlled trials (RCTs) including children ≤16 years with myopia who received atropine treatment. 34 RCTs with ≥12 months of follow-up were included. Weighted mean differences (WMD) in spherical equivalent refraction (SER) progression and axial length (AL) elongation were pooled by atropine concentration and ethnicity. Compared with controls, atropine significantly reduced myopia progression across all concentrations: <0.1% (WMD in SER: 0.44 (95% CI 0.35 to 0.52) dioptres (D)/year; AL: -0.20 (95% CI -0.24 to -0.16) mm/year), 0.1% to <0.5% (0.81 (95% CI 0.50 to 1.13) D/year) and ≥0.5% (1.06 (95% CI 0.88 to 1.24) D/year; -0.36 (95% CI -0.40 to -0.33) mm/year). The pooled effect on SER and AL progression across all concentrations was greater in East Asians (0.63 (95% CI 0.50 to 0.76) D/year; -0.26 (95% CI -0.31 to -0.20) mm/year) than in South Asians (0.40 (95% CI 0.11 to 0.70) D/year; -0.13 (95% CI -0.21 to -0.05) mm/year) or white Europeans (0.18 (95% CI 0.11 to 0.25) D/year; -0.11 (95% CI -0.16 to -0.05) mm/year). Atropine slows myopia progression in a dose-dependent manner in studies with 1-5 years. Efficacy appears greater in Asian children, particularly East Asians, who also exhibit greater photopic pupil dilation. These findings support the role of atropine in myopia control and highlight the importance of ethnicity-specific considerations when prescribing and tailoring treatment strategies. CRD42023454104.

Inositol and its derivatives may help mitigate risks associated with cardiovascular diseases; however, existing evidence remains inconsistent. The primary aim of this systematic review and meta-analysis of RCTs was to quantify the effects of inositol and its stereoisomers on anthropometric, and cardiometabolic measures. A systematic review and meta-analysis of RCTs was conducted to clarify this. Searches in PubMed and Scopus, along with hand-searching references, identified RCTs on inositol supplementation lasting ≥ 4-week. Using random-effects models, the analysis determined mean effect sizes as weighted mean differences (WMD) with 95% CIs. Heterogeneity was assessed via the Cochrane Chi-squared test and Galbraith plots, while the ROBI tool evaluated bias risk. The strength of the evidence was assessed using the GRADE framework. Eighteen RCTs (n = 898) were totally included in this meta-analysis. Significant reductions in BMI (WMD (95%CIs):-0.57kg/m²(-1.10, -0.03), I²=88.6), waist-to-hip ratio(WMD (95%CI):-0.02(-0.04, -0.001), I²=84.1), and waist circumference (WMD (95%CI):-2.36cm(-4.39, -0.33) I²=55.0) were noted with high heterogeneity and low to very low certainty evidence. Inositol significantly decreased glucose levels (WMD (95%CI):-7.25mg/dL(-10.98, -3.52), I²=90.7), insulin (WMD (95%CI):-4.74µU/mL(-6.16, -3.32), I²=90.6) and HOMA-IR (WMD (95%CI):-1.21(-1.58, -0.85), I²=85.0), both with moderate evidence certainty and high heterogeneity. Notable reductions in triglycerides (WMD (95%CI):-29.80mg/dL(-48.16, -11.44), I²=96.0) and total-cholesterol (WMD (95%CI):-18.26mg/dL(-30.75, -5.77), I² = 95.8) were observed, with high and low evidence certainty, respectively, and high heterogeneity. LDL-C and HDL-C improved with moderate certainty (WMDs (95%CIs):-5.15mg/dL(-8.89, -1.42), I²= 0.0; and 2.76mg/dL(1.16, 4.36), I²=52.9). Additionally, inositol significantly lowered systolic (WMD (95%CI):-5.34mmHg(-6.91, -3.78), I²=38.0) and diastolic blood pressure (WMD (95%CI):-6.12mmHg(-8.44, -3.80), I²=69.7) with low, and very low evidence certainty. Overall, inositol may offer modest cardiometabolic benefits, with moderate-to-high certainty for improvements in insulin resistance and lipid profiles. However, existing studies show a high risk of bias and low certainty of evidence, particularly for anthropometric outcomes, creating cautious interpretation. Future research should involve large-scale, rigorous trials with standardized protocols, longer follow-up, and diverse populations.

Background Few percutaneous coronary intervention (PCI) patients achieve low-density lipoprotein cholesterol (LDL-C) targets with statins alone. While proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors effectively diminish LDL-C levels, their combined use with statins for reducing major adverse cardiovascular events (MACE) and improving lipid profiles post-PCI requires further validation. This study seeks to appraise the therapeutic impact of PCSK9 inhibitors combined with statins on MACE and blood lipids in patients following PCI. Methods Randomized controlled trials (RCTs) and cohort studies as of February 2025 in the PubMed, Embase, Cochrane Library, and Web of Science databases were identified. Regarding the risk of bias evaluation, Cochrane ROB 2.0 was employed for RCTs. Moreover, cohort studies were appraised by means of the Newcastle-Ottawa Scale. In terms of heterogeneity, it was appraised by means of the I 2 statistics. The relative risk (RR) and 95% confidence interval (CI) for dichotomous variables, along with the weighted mean difference (WMD), standardized mean difference (SMD), and their respective 95% CIs for continuous variables. Results The meta-analysis included 17 studies, including 9 RCTs and 8 cohort studies, involving 5,607 subjects. The meta-analysis revealed that, against the statin group, the combination therapy group displayed a notable decline in MACE incidence (RR: 0.61; 95% CI: 0.50–0.75; p &amp;lt; 0.001; I 2 = 0.0%). Meanwhile, the combination therapy group demonstrated greater LDL-C reduction vs. statin monotherapy (SMD: −1.29; 95% CI: −1.70 to −0.87). Moreover, The combination therapy group achieved significantly higher LDL-C ≤ 1.4 mmol/L attainment rates vs. statin monotherapy (RR: 5.83; 95% CI: 5.20–6.55). Conclusion PCSK9 inhibitors combined with statins significantly reduces MACE incidence, improves lipid profiles in post-PCI patients compared to statin monotherapy. Systematic Review Registration https://www.crd.york.ac.uk/ , identifier (CRD420250650716).

To appraise the efficacy of anti-vascular endothelial growth factor (anti-VEGF) drugs as an adjunctive treatment before pars plana vitrectomy (PPV) in patients suffering from proliferative diabetic retinopathy (PDR). Relevant studies published up to December 2024 were retrieved from PubMed, Embase, Cochrane, and Web of Science. Data analysis was implemented by means of Stata version 15.0. Weighted mean difference (WMD), risk ratio (RR), and their corresponding 95% confidence intervals (CIs) were estimated. 17 randomized controlled trials (RCTs) were incorporated. The meta-analysis revealed that preoperative anti-VEGF treatment in PDR patients can reduce intraoperative vitreous hemorrhage (VH) (RR = 0.38, 95% CI 0.28, 0.52, P < 0.01), decrease the incidence of iatrogenic retinal tears (RR = 0.56, 95% CI 0.43, 0.72, P < 0.01), and shorten surgical duration (WMD = - 24.04, 95% CI - 30.37, - 17.71, P < 0.01). Additionally, this treatment improves postoperative best-corrected visual acuity (BCVA) (WMD = - 0.18, 95% CI - 0.28, - 0.09, P < 0.01), reduces both early (RR = 0.63, 95% CI 0.45, 0.89, P = 0.009) and late-stage (RR = 0.43, 95% CI 0.26, 0.70, P = 0.001) VH, and accelerates the absorption of recurrent VH. The preoperative use of anti-VEGF agents in PPV can reduce the incidence of intraoperative VH and retinal tears, thereby facilitating a quicker and easier surgical procedure.

Lipoprotein apheresis reduces low-density lipoprotein (LDL) cholesterol in high-risk patients, but its effects on plasma ion levels remain unclear. The objective of this study was to systematically evaluate the impact of apheresis on plasma calcium, sodium, potassium, magnesium, and chloride concentrations. Following PRISMA guidelines, we searched MEDLINE/PubMed, Scopus, and Web of Science to June 2025. Studies reporting pre- and post-apheresis ion levels with at least two sessions were included. Weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models. Subgroup analyses and meta-regression explored heterogeneity. Publication bias was assessed with Egger's test. Twelve studies (10 publications, 328 participants) showed a significant reduction in total calcium after apheresis (WMD = -0.10 mmol/L; 95% CI = -0.15 to -0.05; p < 0.001). Effects were stronger with ≥ 12 months of treatment and in patients with heart disease. No significant changes were found for sodium, potassium, magnesium, or chloride. Meta-regression identified treatment duration and publication year as sources of heterogeneity for calcium outcomes. No publication bias was detected except potentially for magnesium. Lipoprotein apheresis is associated with modest but significant reductions in plasma calcium, especially in patients with heart disease or prolonged treatment, highlighting the need for electrolyte monitoring. No consistent effects were observed for other plasma ions.