Emergency department-initiated interventions to reduce risk of recurrent falls in older adults: a systematic review and meta-analysis

Abstract: Older adults presenting to the emergency department (ED) following a fall are at high risk for recurrent falls, injuries and increased healthcare utilisation. This systematic review and meta-analysis evaluated the effectiveness of interventions initiated upon ED presentation in reducing falls (primary outcome) and fall-related outcomes (secondary outcomes) among older adults. A comprehensive search was performed in Ovid Medline, Embase, CINAHL, PEDro, Web of Science, and Scopus up to June 2025, following PRISMA guidelines. This yielded 9624 references, of which 4811 records remained after deduplication and were screened for eligibility. Meta-analyses and descriptive methods, including vote counting, were applied where appropriate. Sensitivity and subgroup analyses were conducted. Thirty articles were included. Interventions were associated with a significant reduction in fall incidence (rate ratio 0.69; 95% CI 0.54-0.88; I2 = 95%), supported by vote counting. While reductions were also observed in the proportion of fallers (odds ratio 0.87; 95% CI 0.71-1.07; I2 = 61%), fall-related and all-cause ED revisits, hospital admissions, recurrent falls and mortality, these trends did not reach statistical significance. Sensitivity analysis excluding studies with modified usual care showed a significant reduction in fall-related ED revisits and people sustaining an injurious fall. Secondary outcomes including quality of life, fear of falling and physical functioning generally showed trends favouring the intervention group. Considerable heterogeneity and variation in intervention characteristics were noted across studies. Interventions for older adults presenting to the ED after a fall suggest a favourable effect on fall rate. Non-significant trends favouring the intervention group were observed for several other outcomes, but heterogeneity and methodological limitations preclude definitive conclusions.

Charmant W
Jansen S
van Schoor NM
de Vries R
Nanayakkara P
Willems HC
van der Velde N

Humans
Accidental Falls
Emergency Service, Hospital
Aged
Emergency Room Visits
Recurrence
Risk Factors
Aged, 80 and over
Risk Assessment

Journal Article
Systematic Review
Meta-Analysis


Pregnancy Outcomes in Patients with Tuberculosis: A Systematic Review and Meta-analysis

Abstract: Tuberculosis (TB) is an important global health problem, especially for pregnant women, a vulnerable group. This systematic review and meta-analysis was conducted in this group to obtain cumulative results in a collective effort toward the World Health Organization (WHO) End TB Strategy. The databases Ovid MEDLINE, Embase, PubMed, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials were searched for the last 10 years till 14th January 2025. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this analysis. Pregnancy outcomes in terms of maternal complications and perinatal complications, including observed mortality, were considered for analysis. A total of 9,873 records were identified through database searching, and 15 studies, including 3,045 pregnant women with TB, were selected for final analysis. The pooled mean maternal age was 27.6 years, and more than half of TB cases were diagnosed antenatally. Among pregnancy-related complications, fetal growth restriction, pregnancy-induced hypertension, oligohydramnios, and gestational diabetes were seen in 19, 15, 11, and 10% of cases, respectively. Low birth weight, preterm birth, small for age, and low Apgar score (<7) had pooled prevalences of 30, 22, 20, and 13%, respectively. Maternal mortality and neonatal mortality showed pooled prevalences of 0.05 [95% confidence interval (CI): 0.03-0.08] and 5% (95% CI: 3-8%), respectively. Low to moderate heterogeneity was found among observations. This systematic review and meta-analysis showed continued maternal and perinatal adverse outcomes in pregnant women with TB even in the current era, highlighting the need to optimize healthcare.

The Journal of the Association of Physicians of India

Sharma H
Garg S
Sharma S
Sharma U
Kumar A

Humans
Female
Pregnancy
Pregnancy Outcome
Pregnancy Complications, Infectious
Tuberculosis
Infant, Newborn


Digital patient safety interventions in primary care: a systematic review and meta-analysis

Abstract: Patient safety events are among the top ten causes of death and disability worldwide, with most considered preventable, particularly in primary care. Digital interventions are increasingly used in primary care to improve patient safety, targeting errors and preventing adverse events. Evaluating their effectiveness and implementation is essential to inform clinical practice and policy. The study aims included a systematic review and meta-analysis of the effectiveness of digital patient safety interventions in primary care, comparing single and multicomponent interventions, identifying effective components, and exploring factors influencing their success. MEDLINE, EMBASE, and CENTRAL were searched from January 2001 to June 2025, restricted to English-language publications. This review followed PRISMA guidelines. Randomized controlled trials assessing digital interventions aimed at improving patient safety outcomes in primary care were included. Safety outcomes were grouped into medication safety and non-medication process measures, and adverse events. Two reviewers independently extracted and verified data and assessed risk of bias, resolving discrepancies by consensus. Random-effects meta-analysis was performed for predefined safety outcomes, and a narrative synthesis described implementation factors. Seventy-four randomized controlled trials (RCTs) were included. Meta-analysis demonstrated benefits for medication safety process measures (k = 54; Odds Ratio (OR) 1.46, 95% confidence interval (CI): 1.30-1.64), non-medication process measures (k = 40; OR 1.77, 95% CI: 1.56-2.01), and adverse events (k = 12; OR 1.17, 95% CI: 1.06-1.30). Overall, multicomponent interventions consistently showed greater improvements than single-component interventions. Interventions combining components of clinical decision support and audit and feedback were most effective for medication safety, while patient-facing components had greater impact on non-medication process measures. Results remained consistent in sensitivity analyses restricted to higher-quality RCTs. Effectiveness was likely influenced by implementation factors, including workflow integration and relational support. Digital interventions in primary care are associated with moderate improvements across multiple patient safety process measures. Multicomponent approaches appear most promising, with effectiveness potentially shaped by implementation, patient engagement and contextual factors. These findings support the broader adoption of well-designed, contextually adapted digital strategies to enhance patient safety and underscore the need for ongoing evaluation of the sociotechnical factors supporting delivery of these interventions.

Tsang JY
Planner C
Low CN
Stewart S
Morris C
Wong B
Delitheos SM
Kulangara G
Yu LKD
Babu ABS
Ajabnoor A
Ashcroft DM
Panagioti M

Humans
Patient Safety
Primary Health Care
Digital Health
Randomized Controlled Trials as Topic
Digital Media

Systematic Review
Journal Article
Meta-Analysis


[Efficacy of Shuxuening Injection in treatment of unstable angina pectoris: study on TCM efficacy evidence chain]

Abstract: This study aimed to construct an evidence chain for the efficacy of Shuxuening Injection(SXN) in the treatment of unstable angina pectoris(UAP) and clarify its efficacy and underlying mechanisms. Eight major Chinese and English databases, including CNKI, VIP, Wanfang, SinoMed, PubMed, Cochrane Library, EMbase, and Web of Science, were systematically searched to collect clinical studies, animal experiments, cell experiments, and molecular experiments on SXN for UAP. Two researchers independently screened the literature and extracted data. Meta-analysis or descriptive analysis was used for data integration. The TCM evidence chain construction method was applied to establish evidence chains, which were then evaluated. A total of 2 evidence chains were constructed, incorporating 64 clinical studies, 12 animal experiments, 11 cell experiments, and 86 outcome indicators. The evidence chains elucidated the efficacy and mechanisms of SXN for UAP from 2 dimensions: improvement of myocardial ischemia and protection of cardiac function. SXN exerted a synergistic effect on the core pathological processes of UAP through multiple mechanisms, including regulating oxidative stress, promoting angiogenesis, modulating inflammation and matrix remodeling, inhibiting apoptosis, and balancing endoplasmic reticulum stress. SXN demonstrated efficacy in the treatment of UAP. However, due to the limitations in the quantity and quality of included studies, the robustness of the evidence chains was insufficient. High-quality clinical and basic research is required to further verify its core mechanisms. Additionally, it is recommended that subsequent studies include more indicators reflecting plaque stability and thrombosis in the selection of clinical outcome indicators.

Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica

Li YY
Wu XL
Sang ZF
Zhu HZ
Cao LJ
Pang B
Yang FW
Pang WT
Zhang JH

Drugs, Chinese Herbal
Animals
Humans
Angina, Unstable
Injections
Apoptosis

Journal Article
English Abstract
Review
Meta-Analysis


The Rehabilitative Effects of Online Pelvic Floor Muscle Exercises on Female Urinary Incontinence Across Various Life Stages: A Systematic Review and Meta-Analysis

Abstract: This paper aims to evaluate the effects of online pelvic floor muscle training on urinary incontinence frequency, symptom severity, quality of life and adherence across defined female life stages. Urinary incontinence is a significant public health issue affecting women's physical and mental well-being. The paper is designed as a systematic review and meta-analysis of randomized controlled trials. Nine databases were searched for RCTs of online PFMT in women with UI. Outcomes included UI incidence, symptom severity, quality of life and compliance. Data extraction, risk-of-bias (RoB 2) and GRADE assessment were performed. Random-effects meta-analyses used RevMan 5.4. Sixteen studies were included. Online pelvic floor muscle training significantly reduced postpartum urinary incontinence incidence (RR = 0.56; 95% CI: 0.38 to 0.82) and symptom severity (SMD = -0.25; 95% CI: -0.45 to -0.05), but not in elderly patients (SMD = -0.12; 95% CI: -0.25 to 0.02). Exercise compliance improved in both subgroups. No significant difference was found in quality of life. Moderate-to-high heterogeneity was observed. Online pelvic floor muscle exercise may improve urinary incontinence outcomes across different life stages. In postpartum women, it reduces incontinence incidence, alleviates symptom severity and enhances training compliance, whereas in elderly patients, its benefit is limited to improved compliance.

International journal of nursing practice

Wang Y
Zhang H
Wang J
Feng W
Sun Z
Chen Y

Humans
Female
Urinary Incontinence
Pelvic Floor
Exercise Therapy
Quality of Life
Internet


Effects of exercise on reproductive endocrine hormones in adult patients with polycystic ovary syndrome: a systematic review and three-level meta-analysis

Abstract: This study aims to systematically evaluate the impact of exercise interventions on reproductive endocrine profiles in adult patients with polycystic ovary syndrome (PCOS) using a three-level meta-analytical approach. We performed a systematic search of PubMed, Web of Science, The Cochrane Library, and Embase for randomized controlled trials (RCTs) investigating the effects of exercise on reproductive endocrine profiles in PCOS patients, spanning from database inception through April 7, 2026. A three-level meta-analysis was conducted in R using a random-effects model fitted via restricted maximum likelihood (REML). Effect sizes were quantified as Hedges' g with 95% confidence intervals (CIs). Global heterogeneity was assessed using the Cochran's Q test, and the robustness of results was verified through leave-one-out sensitivity analyses. Model fit was compared using likelihood ratio tests (LRT). Publication bias was scrutinized via Egger's test, with the trim-and-fill method employed as a corrective measure where necessary. Methodological quality was appraised using the PEDro scale, and the certainty of evidence was graded via the GRADE profiler. Nineteen studies involving 1,018 participants were synthesized. Exercise interventions significantly lowered testosterone levels (g = -0.34; 95% CI [-0.61 to -0.07]; P = 0.0146). Subgroup analysis revealed that the "aerobic exercise" group was statistically significant (k = 14, g = -0.5120, 95% CI [-0.8230 to -0.2010], P = 0.0027). The mean body mass index (BMI) "25 to 29.9" group was also statistically significant (k = 17, g = -0.4859, 95% CI [-0.7775 to -0.1943], P = 0.0025), as was the mean age group of "26 to 30 years old" (k = 13, g = -0.4878, 95% CI [-0.8465 to -0.1290], P = 0.0105). In conclusion, exercise interventions exert a favorable impact on serum testosterone (T) levels in adult patients with polycystic ovary syndrome (PCOS). PROSPERO (registration no. CRD420251108464; https://www.crd.york.ac.uk/prospero/).

Humans
Polycystic Ovary Syndrome
Female
Testosterone
Exercise
Adult
Randomized Controlled Trials as Topic


Peroneus longus autograft versus hamstring tendon autograft in primary anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials

Abstract: Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure aimed at restoring knee stability and function following ligament injury. Although hamstring tendon (HT) autografts are widely used, concerns regarding donor-site morbidity and graft-related limitations persist. The peroneus longus tendon (PLT) has recently gained attention as an alternative autograft, offering favourable biomechanical properties and potentially reduced morbidity. However, evidence comparing clinical outcomes between PLT and HT autografts remains limited and inconsistent. Therefore, this study aimed to systematically evaluate and compare the efficacy and safety of PLT versus HT autografts in primary ACLR using high-level evidence from randomised controlled trials (RCTs). A systematic review and meta-analysis of RCTs comparing PLT and HT autografts in primary ACLR was conducted. Databases were searched up to December 2025. Outcomes included patient-reported scores, knee stability, graft characteristics, donor-site morbidity, and ankle function. Four RCTs involving 407 patients were included. Lysholm and IKDC scores were comparable between groups. The PLT group demonstrated significantly better modified Cincinnati scores (MD, 3.02; P = 0.0004) and larger graft diameter. Donor-site morbidity was significantly lower with PLT (OR 0.12; P = 0.007). Knee stability and graft failure rates were similar. AOFAS scores showed no significant postoperative decline. PLT autografts provide outcomes comparable to HT with potential advantages in donor-site morbidity and graft characteristics, supporting their use as a reliable alternative in ACLR.

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

Anterior Cruciate Ligament Reconstruction

Journal Article
Systematic Review
Meta-Analysis
Comparative Study
Review


Magnitude and factors associated with diabetes mellitus among people living with HIV/AIDS in Eastern Africa. Evidence from Ethiopia, Kenya, Uganda and Tanzania. A systematic review and meta-analysis

Abstract: The introduction of combination antiretroviral therapy (cART) has improved survival among people living with HIV (PLHIV) but increased the risk of non-communicable diseases, including diabetes mellitus (DM). In East Africa, estimates of DM prevalence among PLHIV vary widely, and contributing factors are not well defined. This study aimed to estimate the pooled prevalence of DM and identify associated risk factors among PLHIV in the region. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines (PROSPERO: CRD420251129591). Databases including PubMed, Embase, CINAHL, Web of Science, African Journals Online, and Google Scholar were searched for cross-sectional, cohort, and case-control studies reporting DM prevalence or associated factors among PLHIV aged ≥ 16 years in East Africa. Data were extracted independently by two reviewers, and study quality was assessed using the Joanna Briggs Institute checklist. A random-effects model using DerSimonian-Laird method was applied to estimate pooled prevalence. Heterogeneity was assessed with Cochran's Q and I², and publication bias was evaluated via funnel plot, Egger's test, and trim-and-fill analysis. Adjusted odds ratios (AORs) were pooled to identify factors associated with DM. A total of fourteen studies were included. The pooled prevalence of DM was 6.4% (95% CI: 4.3-9.7%; I² = 94.9%). Trim-and-fill analysis did not change the estimate. Significant risk factors included higher education (AOR = 8.56, 95% CI: 3.82-19.17), obesity/overweight (AOR = 6.68, 95% CI: 2.58-17.32), positive family history of diabetes (AOR = 7.60, 95% CI: 3.56-16.22), longer duration of ART (AOR = 4.78, 95% CI: 1.22-18.81), and history of hypertension (AOR = 2.98, 95% CI: 1.69-5.27). Male sex and elevated triglycerides were not significantly associated. DM affects one in every 16 PLHIV in East Africa, with modifiable and non-modifiable risk factors identified. Integrating DM screening and preventive strategies into HIV care is critical to reduce cardio-metabolic complications.

Markos Z
Lonsako DT
Tekletsadik YA
Aligaz EM
Godebo AS
Mamo T
Hassen AA
Tafesse D
Lorato SS
Lema DA

Humans
Diabetes Mellitus
Risk Factors
HIV Infections
Prevalence
Africa, Eastern
Uganda
Kenya
Tanzania
Ethiopia
East African People


Posterior lumbar interbody fusion versus interspinous stabilization in lumbar spinal stenosis: a meta-analysis

Abstract: Posterior lumbar interbody fusion (PLIF) and interspinous stabilization (ISS) are both used to treat lumbar spinal stenosis (LSS), but their comparative effectiveness and safety remain debated. Evidence comparing these approaches has evolved with the introduction of newer ISS devices and advances in contemporary surgical practice. A systematic search of PubMed, Google Scholar, Embase, and Scopus was conducted up to December 2, 2025, to identify comparative studies evaluating PLIF versus ISS for LSS. Nineteen studies met the inclusion criteria, comprising 214,155 patients (203,414 PLIF; 10,741 ISS). Outcomes included pain and functional measures, reoperation and revision rates, perioperative parameters, and complications. Three additional analyses were performed: subgroup analysis by publication period (before 2017 vs. 2017 onward), sensitivity analysis after excluding studies with very large sample sizes, and a study-design sensitivity analysis after excluding randomized controlled trials (RCTs). PLIF and ISS showed no significant differences in short- and mid-term pain or disability outcomes, including VAS leg and back pain at 3 months and 1 year, ΔVAS, ODI at 3 months and 1 year, and ΔODI. PLIF was associated with a greater change in segmental range of motion (ΔROM) (MD 6.96, 95% CI 4.94-8.97; p < 0.001). Compared with PLIF, ISS was associated with shorter operative time (MD 80.26 min, 95% CI 55.97-104.55; p < 0.001), lower blood loss (MD 260.54 mL, 95% CI 173.89-347.18; p < 0.001), and shorter hospital stay (MD 3.50 days, 95% CI 2.07-4.94; p < 0.001). Reoperation rates did not differ significantly between groups (RR 1.09, 95% CI 0.47-2.51). Similarly, revision rates were not significantly different between PLIF and ISS (RR 1.14, 95% CI 0.56-2.31). PLIF was associated with higher rates of mechanical complications (RR 1.60, 95% CI 1.09-2.33; p = 0.015), infectious complications (RR 3.50, 95% CI 2.67-4.58; p < 0.001), cardiopulmonary complications (RR 5.29, 95% CI 1.07-26.19; p = 0.041), and overall complications (RR 2.44, 95% CI 1.82-3.26; p < 0.001). In studies published before 2017, PLIF was associated with greater ΔROM and lower reoperation rates, but these differences were no longer observed in studies published from 2017 onward. Excluding studies with very large sample sizes did not materially change the main findings. Similarly, exclusion of the two RCTs did not materially alter the direction or statistical significance of the pooled estimates. PLIF and ISS provide broadly comparable short- and mid-term pain and functional outcomes for LSS. ISS is associated with consistent perioperative advantages and lower overall complication rates, while differences in reoperation and revision rates were not significant. Subgroup and sensitivity analyses, including the analysis excluding RCTs, suggest that earlier PLIF advantages in ΔROM and reoperation were not maintained in more recent studies, whereas the perioperative benefits of ISS remained robust. Larger randomized studies with longer follow-up and device-specific analyses are needed.

Boutros M
Awad G
Assi A
Al Khatib R
Hammad S
Tannouri C

Humans
Spinal Stenosis
Spinal Fusion
Lumbar Vertebrae
Reoperation
Postoperative Complications
Treatment Outcome

Journal Article
Meta-Analysis
Comparative Study
Systematic Review
Review


Robot-assisted vs. open ureteric reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis

Abstract: The standard surgical approach to the treatment of pediatric VUR is ureteral reimplantation. Although open surgery is still the standard benchmark for its long-term durability and high success rate, the development of minimally invasive techniques led to the creation of laparoscopic ureteral reimplantation. The high learning curve and technical difficulty needed for accurate intracorporeal suturing, however, have limited its widely adopted in clinical practice. Robotic platforms have since emerged as a promising alternative, offering enhanced dexterity and improved visualization, which facilitate complex suturing and achieve success rates comparable to open surgery. However, most available meta-analytical data are limited by high degrees of heterogeneity because previous studies have often combined laparoscopic and robotic procedures and have combined intravesical and extravesical reimplantation. This is a very general classification that can introduce systematic bias and mask underlying differences between modalities. Through this direct comparison of these two specific surgical approaches, the goal of this study is to isolate these variables to provide highly granular, clinically relevant evidence to inform surgical selection for modern practice. We conducted a comprehensive literature search across PubMed, Embase, Web of Science, and the Cochrane Library to identify clinical studies that directly compared the efficacy of RAUR via the extravesical approach with OUR for the treatment of VUR in pediatric patients. For the OUR group, no restriction was placed on the surgical approach, and both extravesical and intravesical techniques were included. The operative time, hospital stay, success rates, and postoperative complications such as urinary tract infection, urinary retention, and other complications were extracted for comparative analysis. A total of 473 patients from seven studies were analyzed. The results of the meta-analysis showed that there was no significant difference between the two groups in terms of total complications, but the RAUR group had significantly longer operative time (WMD = 48.1 min, 95% CI [27.43, 68.76], p < 0.05) and significantly shorter length of hospitalization (WMD = -0.54 days, 95% CI [-0.96, -0.13], p < 0.05) when compared with the OUR group. When assessing surgical success rate, postoperative urinary tract infection, postoperative urinary retention, or overall complications, no significant differences were recorded between the two groups. In summary, these preliminary findings indicate that RAUR is associated with significantly longer operative time, which should be interpreted in the context of the learning curve. Although RAUR showed a statistically shorter hospital stay, the clinical benefit may be limited as most patients were discharged after overnight observation. Success and complication rates, including urinary tract infection and retention, were comparable to OUR, supporting the safety and efficacy of the robotic platform. Given equivalent key outcomes and expected experience accumulation, RAUR may be a viable alternative to OUR. However, owing to inherent confounding factors such as study design and surgical approach variations, these conclusions require further validation through high-quality multicenter randomized controlled trials.

Humans
Vesico-Ureteral Reflux
Robotic Surgical Procedures
Ureter
Replantation
Child
Urologic Surgical Procedures
Laparoscopy
Female
Treatment Outcome
Child, Preschool
Length of Stay

Systematic Review
Journal Article
Meta-Analysis
Comparative Study
Review


Clinical outcomes following cyberknife radiosurgery for cerebral arteriovenous malformations: A systematic review and meta-analysis

Abstract: Despite the well-established efficacy of stereotactic radiosurgery in achieving obliteration of cerebral arteriovenous malformations (AVMs), a subset of patients, particularly those with large, deep-located AVMs, fail to achieve substantial obliteration. The CyberKnife machine offers a novel radiosurgery strategy by enhancing targeted precision and dosimetric flexibility. Herein, the authors performed a meta-analysis to explore clinical outcomes following CyberKnife radiosurgery for patients with cerebral arteriovenous malformations (AVMs), with a particular focus on obliteration rates and post-CKRS hemorrhagic rates. A systematic review of the literature was conducted under PRISMA guidelines through four electronic databases (PubMed, Scopus, Embase, and Web of Science) to identify studies on CyberKnife Robotic Radiosurgery for AVMs up to July 2025. Baseline data and data pertaining to post-CKSR outcomes were extracted for analysis, and a meta-analysis of proportions was performed. A total of fifteen retrospective cohort studies comprising 1101 patients describing the results of CyberKnife radiosurgery for cerebral AVM were included. The overall rates of AVM complete obliteration and partial obliteration over a median follow-up period of 38.6 months (range, 20.4-89 months) were 59% (95% CI: 0.48 _ 0.69) and 38% (95% CI: 0.27 _ 0.49), respectively. The median time to achieve complete obliteration was 36 months. The pooled rate of post-CKRS hemorrhage was 5% (95% CI: 0.01 _ 0.09), whereas the incidence of post-CKRS neurological deficits was 17% (95% CI: 0.09 _ 0.26). Subgroup analysis for 5 studies based on Spetzler-Martin (SM) grade revealed a significantly higher obliteration rate for grades I-III (69.92%, 95% CI 64.3-75.5%) than for grades IV-VI (34.3%, 95% CI 25.1-43.5%). Single-fraction CKRS resulted in complete obliteration of 422/495 completely obliterated. For the radiation dose, a subgroup analysis revealed no statistically significant difference in the obliteration rates between doses > 18 Gy (42.2%) and those < 18 Gy (57.9%). CKRS appears to be a feasible modality for AVM management, demonstrating acceptable pooled obliteration and hemorrhage rates. However, the certainty of evidence remains low due to retrospective designs, cohort heterogeneity, and a lack of direct comparative studies. Patients with prior hemorrhage or high-risk features may be more likely to have favorable outcomes from this machine.

Hassan GA
Hussein AFA
Saydo B
Buccilli B
Hammad EM
Hameed ATA
Alwartari MA
Abdulwahaab ZH
Shimal AA
Alwattary OSA
Chichan ZM
Satea M
Hassan SE

Journal Article
Systematic Review
Meta-Analysis
Review


Comparative outcomes of robotic versus laparoscopic inguinal hernia repair: a systematic review and meta-analysis

Abstract: To compare clinical, operative, patient-reported, and economic outcomes of robotic versus laparoscopic inguinal hernia repair in adults. We conducted a PRISMA 2020-compliant systematic review and meta-analysis of PubMed, Web of Science, and Google Scholar through June 13, 2025. The protocol was retrospectively registered in PROSPERO (CRD420251075296). Comparative randomized and observational studies of elective robotic versus laparoscopic inguinal hernia repair in adults were eligible. Random-effects meta-analyses used restricted maximum-likelihood estimation with Hartung-Knapp confidence intervals; risk of bias was assessed using RoB 2 and MINORS, and certainty was evaluated using GRADE. Nineteen reports representing 18 unique cohorts and 78,940 participants were included. Nine reports (3,200 participants) contributed recurrence data; robotic repair was associated with a lower observed recurrence risk (RR 0.32, 95% CI 0.17-0.59; I2 = 0%), although certainty was low and the randomized evidence was imprecise. Robotic repair required longer operative time (11 studies; MD + 30.04 min, 95% CI 9.87-50.20; I2 = 99.6%); after excluding the influential Holleran 2022 cohort, the estimate was + 22.09 min (95% CI 8.87-35.30). Pooled immediate and postoperative-day-1 pain estimates did not show a statistically significant difference. Length of stay was not significantly different in the primary analysis (MD + 0.33 days, 95% CI -0.03 to 0.70), while an influence analysis suggested a small increase after robotic repair (+ 0.18 days). Overall complication estimates were unstable, and no clear differences were found for hematoma, surgical-site infection, or urinary retention. Robotic repair was consistently more expensive across heterogeneous healthcare settings. Robotic inguinal hernia repair was associated with lower observed recurrence in predominantly non-randomized evidence, but this finding should not be interpreted as proof of causal superiority. Robotic repair generally required approximately 22-30 additional operative minutes and incurred higher costs, while pooled pain, length-of-stay, and complication findings were uncertain or clinically small. Technique selection should therefore consider patient and hernia characteristics, surgeon experience, institutional resources, and the low to very low certainty of the available evidence.

Alraddadi SE
Almeghthawi AH
Alahmadi HN
Aljahani AS
Aljohani JA
Aljohani NA
Alali RW
Alrashedi RR
Albalawi SA
Almakky MG

Humans
Hernia, Inguinal
Robotic Surgical Procedures
Laparoscopy
Treatment Outcome
Herniorrhaphy
Operative Time
Recurrence
Length of Stay
Postoperative Complications

Journal Article
Systematic Review
Meta-Analysis
Comparative Study


Predicting hormonal deterioration following transsphenoidal surgery for non-functioning pituitary adenomas: A systematic review and meta-analysis

Abstract: Endoscopic transsphenoidal surgery is indicated when non-functioning pituitary adenomas (NFPAs) cause visual compromise, but its timing is less certain in patients with preserved vision and intact pituitary function, where the risk of new post-operative pituitary dysfunction influences decision-making. This systematic review aimed to determine the rate of new post-operative endocrine deficits following transsphenoidal surgery for NFPAs and to identify predictive factors. This review followed PRISMA guidelines. Studies reporting predictors of post-operative endocrine deterioration in adults undergoing transsphenoidal surgery for NFPAs were included. Predictors were synthesised narratively, with meta-analysis where at least two studies used comparable definitions. Pooled proportions estimated the overall rate of deterioration. Certainty of evidence was assessed using GRADE. Eleven studies comprising 2,350 patients were included. The pooled proportion developing new post-operative endocrine deterioration was 16% (95% CI 13-20%; I² = 60%). Larger tumour volume was associated with deterioration, and gross total resection with reduced odds compared with subtotal resection. Cavernous sinus invasion and other predictors showed inconsistent associations, while age, sex, comorbidities, apoplexy, pituitary gland or stalk visibility, surgeon experience and surgical approach were not associated with risk. Overall certainty of evidence was low to very low. New post-operative endocrine deficits affect approximately one in six patients after transsphenoidal surgery for NFPAs. Tumour volume was the most consistent predictor of endocrine deterioration, suggesting a potential role for earlier intervention in selected patients, although evidence certainty was low to very low. Standardised reporting and prospective studies are needed to guide risk stratification decision-making.

Ameen D
ElSabban Y
Kalaitzoglou D
Shapey J
Barazi S
Thomas N
Aylwin S
Maratos E

Humans
Pituitary Neoplasms
Adenoma
Postoperative Complications


Diagnostic accuracy of intravesical prostatic protrusion (IPP) for bladder outlet obstruction using urodynamics as reference standard: a systematic review and meta-analysis

Abstract: To evaluate the diagnostic accuracy of intravesical prostatic protrusion (IPP) for detecting bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH), using urodynamic studies as the reference standard. A systematic review and meta-analysis was performed in accordance with PRISMA-DTA guidance. Studies were included if they evaluated IPP in adult men with LUTS attributed to BPH and defined BOO using urodynamic criteria, specifically BOO index > 40. Data were extracted to construct 2 × 2 diagnostic tables. Pooled sensitivity and specificity were estimated using a bivariate random-effects model, and overall diagnostic performance was assessed using a summary receiver operating characteristic curve. A random-effects model was also used to estimate the association between IPP > 10 mm and BOO. Ten studies including 1253 men met inclusion criteria. Greater IPP was associated with increased odds of urodynamically confirmed BOO, with a pooled odds ratio of 2.67 (95% CI, 1.48-4.79; I² = 94.6%). The 95% prediction interval ranged from 0.32 to 22.49, indicating substantial between-study variability and uncertainty regarding the association in future populations. Diagnostic meta-analysis across study-defined IPP thresholds of approximately 10-12 mm demonstrated a pooled sensitivity of 71.0% and specificity of 75.5% for detecting BOO. The area under the summary receiver operating characteristic curve was 0.795, consistent with moderate overall diagnostic accuracy. Available evidence suggests that IPP is associated with urodynamically confirmed BOO and that a threshold of approximately 10 mm may provide moderate diagnostic accuracy. However, the certainty of these findings is limited by the observational design, relatively small sample sizes, methodological heterogeneity, and unclear risk of bias in several included studies. IPP may therefore be useful as an adjunct to other clinical findings but should not replace urodynamic evaluation when diagnostic certainty is required.

Han Y
Yaghi MH
Polo J
Elsadany M
Elterman D
Bhojani N
Chughtai B

Urinary Bladder Neck Obstruction
Male
Humans
Urodynamics
Prostatic Hyperplasia
Reference Standards
Prostate
Urinary Bladder


Prevalence of undiagnosed type 2 diabetes in South Asia: A systematic review and meta-analysis

Abstract: Although South Asia exhibits a considerable burden of type 2 diabetes mellitus (T2DM), the numbers of undiagnosed T2DM remains inadequately characterized at the regional level. This systematic review and meta-analysis aimed to approximate the pooled prevalence of undiagnosed T2DM among the general adult population and to assess country-specific variations in South Asian countries. A comprehensive literature search was directed in PubMed, Scopus, Cochrane Library, ScienceDirect, and Web of Science for studies published between 1994 and 2022. Observational studies reporting the prevalence of undiagnosed T2DM among adults aged 20-79 years in South Asia were included. By using logit transformation, Random-effects meta-analysis was conducted to assess pooled prevalence. While using Cochran's Q and I² statistics Heterogeneity was calculated, publication bias was assessed using funnel plots and Egger's test, and subgroup analyses were performed by country. In this review, a total of 28 studies containing 104,019 participants and 5719 undiagnosed T2DM cases were included. The observed pooled prevalence of undiagnosed T2DM was 6.67% (95% CI: 4.99-8.58%) with considerable uncertainty as indicated by a very wide prediction interval (0.33%-19.75%) and extreme heterogeneity (I² = 98.5%, p < 0.001). At country-level substantial variation was seen, with the highest prevalence in Sri Lanka (30.54%; 95% CI: 17.90-44.82%), followed by Nepal (7.02%; 95% CI: 4.24-10.44%), Pakistan (5.97%; 95% CI: 3.97-8.33%), Bangladesh (5.84%; 95% CI: 5.28-6.42%) and India (5.26%; 95% CI: 3.66-7.14%). The results of Egger's test (t = 1.84, p = 0.0773) suggested no statistical significance evidence of publication bias. These findings should be interpreted with attentiveness because of extensive heterogeneity and variability across studies. However, the high number of undiagnosed T2DM in general population of South Asia reflects a great burden and indicates inter-country differences. Therefore, this conclusion highlights the need for advanced surveillance systems, valid diabetes screening, and approach to health care facilities, especially in deprived and high-risk population in the region.

Afzal F
Ahmad I
Khalid K
Bashir I
Akhtar S

Adult
Humans
Asia, Southern
Diabetes Mellitus, Type 2
Prevalence
Undiagnosed Diseases

Journal Article
Meta-Analysis
Systematic Review


Accuracy and stability of virtual surgical planning for maxillary advancement in patients with cleft lip and palate: a systematic review and meta-analysis

Abstract: Cleft lip and palate (CLP) frequently cause maxillary hypoplasia, requiring surgical advancement, and virtual surgical planning (VSP) is increasingly used to improve accuracy. This systematic review and meta-analysis synthesized the evidence on VSP-assisted maxillary advancement in patients with CLP, with surgical accuracy as the primary outcome and skeletal stability, intraoperative efficiency, complications, patient-reported outcomes, and software utility as the secondary outcomes. This review followed the PRISMA 2020 statement and was prospectively registered (PROSPERO CRD420251011475). PubMed, Scopus, Web of Science, Embase, and ScienceDirect were searched. Methodological quality and certainty of evidence were assessed. Conventional osteotomy and distraction osteogenesis were analyzed separately; an exploratory random-effects meta-analysis was performed only for the homogeneous conventional Le Fort I osteotomy subset. Twelve studies were included. VSP achieved clinically acceptable accuracy, with mean linear deviations of 0.05-2.75 mm and most angular deviations below 4°. In the conventional Le Fort I subset, random-effects pooling with Hartung-Knapp adjustment gave mean absolute deviations of 0.65 mm mediolaterally (95% CI 0.58-0.73) and 1.10 mm superoinferiorly (0.49-1.71), both highly consistent (I2 = 0%). Anteroposterior deviation was not pooled owing to substantial heterogeneity (I2 = 88%) and ranged from 1.03 to 2.75 mm across studies. Where reported, relapse was generally 1-2 mm but heterogeneous. Current evidence supports the accuracy and feasibility of VSP-assisted maxillary advancement in patients with CLP; however, it is insufficient to prove reduced relapse or superiority over conventional planning. Because certainty is low to very low, VSP should be regarded as a promising adjunct rather than a proven standard of care; adequately powered prospective comparative studies with standardized outcomes are needed.

Humans
Cleft Palate
Cleft Lip
Surgery, Computer-Assisted
Osteotomy, Le Fort
Maxilla
Patient Care Planning
Orthognathic Surgical Procedures
Osteogenesis, Distraction


Closed-incision negative-pressure wound therapy in abdominal wall reconstruction: a systematic review and meta-analysis

Abstract: Closed-incision negative-pressure wound therapy (ciNPWT) has been shown to reduce complications in high-risk wounds, but there is still no consensus in literature to whether it is effective when compared to standard wound dressing (SWD). Therefore, we aimed to perform a systematic review and meta-analysis to assess the ongoing uncertainty regarding its clinical benefits. PubMed, Embase and Web of Sciences were systematically searched from inception to November 2025 for both observational and randomized studies comparing ciNPWT with SWD for patients submitted to abdominal wall reconstruction (AWR). A DerSimonian-Laird random-effect model and heterogeneity (assessed with Cochran's Q test and I² statistics) were performed using R software (version 4.4.0). 16 studies comprising 1,859 patients which underwent AWR, of whom 50% received ciNPWT and 50% SWD. The mean age was 56 years. The analysis showed that ciNTWT group presented significant reductions in both SSO (OR 0.56; 95%CI 0.36 to 0.86; p-value = 0.008; I² = 69.5%) and SSI (OR 0.61; 95%CI 0.39 to 0.91; p-value = 0.032; I² = 51.6%), no difference regarding readmission (OR 0.61; 95%CI 0.35 to 1.05; p-value = 0.072; I² = 26.5% ), reoperation (OR 0.69; 95%CI 0.39 to 1.23; p-value = 0.205; I² = 22.3%), hernia recurrence rates (OR 0.61; 95%CI 0.29 to 1.29; p-value = 0.1984; I² = 24.3%) and length of hospital stay (MD 0.26; 95%CI -1.22 to 1,75; p-value 0.729; I² = 92.1%). ciNPWT was associated with lower odds of SSI and SSO with no difference in LOS when compared to SWD.

Hernia : the journal of hernias and abdominal wall surgery

Cardoso JHCO
Collaco BG
Macret JZ
de Almeida DPA
Torves MM
Nogueira R
Malcher F
Lima DL

Humans
Negative-Pressure Wound Therapy
Abdominal Wall
Surgical Wound Infection
Wound Healing
Plastic Surgery Procedures


Do Acceptance- and Mindfulness-Based Interventions Improve Psychological Flexibility in People With Chronic Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract: Acceptance- and mindfulness-based interventions are effective for improving pain-related outcomes, yet their effects on psychological flexibility have not been meta-analyzed. This systematic review and meta-analysis addressed this gap by comparing these interventions with control conditions on psychological flexibility and its core dimensions in adults with chronic pain. Searches were conducted in PsycINFO, MEDLINE, Cochrane CENTRAL, Scopus and Web of Science from inception to May 2025. Sixty randomized controlled trials comprising 6692 participants were included. Meta-analyses were conducted for global psychological flexibility (k = 17), acceptance (k = 38), committed action (k = 4) and values (k = 4). Heterogeneity, risk of bias and certainty of evidence were assessed. Interventions significantly improved psychological flexibility at post-treatment, short-term (≤ 6 months) and long-term (> 6 months) follow-up (g = 0.35-0.69), and acceptance across all time points (g = 0.41-0.77). Effects for committed action and values were non-significant. Heterogeneity was substantial, most trials had a high risk of bias, and the certainty of evidence was low to very low. Moderator analyses indicated larger effects when interventions were compared with inactive controls, delivered by psychologists or implemented as stand-alone programs. Evidence suggests that acceptance- and mindfulness-based interventions may improve global psychological flexibility and acceptance. However, the certainty of evidence was low to very low, and most included trials were at high risk of bias. More rigorous trials are needed to clarify effects across specific dimensions of psychological flexibility. This systematic review and meta-analysis provide the first comprehensive synthesis of the effects of acceptance- and mindfulness-based interventions on psychological flexibility in chronic pain. These findings show that these interventions improve psychological flexibility, particularly pain acceptance, supporting it as a clinically relevant treatment target. PROSPERO: CRD420251018441.

European journal of pain (London, England)

Sanabria-Mazo JP
Rodríguez-Freire C
Royuela-Colomer E
Ponce-López P
Alonso-Coello P
Barrios V
Navarrete J
Pérez-Aranda A
McCracken LM
Luciano JV

Humans
Chronic Pain
Mindfulness
Randomized Controlled Trials as Topic
Acceptance and Commitment Therapy
Cognitive Flexibility


Comparative Diagnostic Performance of Cone Beam Computed Tomography and Dual-Energy X-Ray Absorptiometry for Low Bone Density Assessment. A Systematic Review and Meta-Analysis

Abstract: This systematic review evaluated the diagnostic accuracy of CBCT for BMD assessment using DEXA as the reference standard and aimed to quantify its performance through meta-analysis. This review included prospective and retrospective observational studies assessing CBCT's diagnostic performance in detecting low BMD, with DEXA as the reference. Searches in PubMed, Embase, and Scopus identified 13 eligible studies involving adult participants (≥ 18 years). Two reviewers independently extracted data and assessed study quality using the QUADAS-2 tool. Meta-analysis was conducted using random-effects models. Pooled sensitivity and specificity of CBCT for detecting low BMD were 0.58 (95% CI: 0.50-0.67) and 0.78 (95% CI: 0.69-0.86), respectively. The summary receiver operating characteristic (SROC) curve showed an area under the curve (AUC) of 0.73 (95% CI: 0.69-0.77), indicating moderate diagnostic accuracy. Subgroup analyses revealed heterogeneity influenced by sample size and anatomical site. CBCT demonstrates moderate diagnostic accuracy in detecting low BMD, with better specificity than sensitivity. While promising, standardization of CBCT protocols and larger studies are needed to confirm its role in clinical assessment. PROSPERO REGISTRATION NUMBER: (CRD42024598958).

Clinical and experimental dental research

Alrashidi M
Elbishari H
Aljanahi M
Amir-Rad F
Chaudhry J
Atieh M

Humans
Cone-Beam Computed Tomography
Bone Density
Absorptiometry, Photon
Sensitivity and Specificity
Osteoporosis


Diagnostic Validation of PERC and Resource Utilization in Suspected Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

Abstract: Background and AimsPulmonary embolism (PE) is a frequent and potentially fatal diagnosis in the emergency department (ED). The Pulmonary Embolism Rule-out Criteria (PERC), an eight-item clinical decision rule used to identify patients at very low risk of pulmonary embolism, is widely applied to exclude PE in low-risk patients; however, its real-world diagnostic performance and impact on imaging utilization remain incompletely defined. This systematic review aimed to evaluate the diagnostic accuracy of PERC and its effect on reducing computed tomography pulmonary angiography (CTPA) use.Materials and MethodsThis review followed the Joanna Briggs Institute (JBI) methodology for diagnostic test accuracy studies. Eligible studies enrolled ED patients with suspected PE who were classified as low risk according to the original study-specific approaches, including clinician gestalt, Wells score, revised Geneva score, or YEARS-based assessment. PubMed, Web of Science Core Collection, the Cochrane Library, and ClinicalTrials.gov were searched for eligible studies published between 2004 and 2025.ResultsTen studies involving 13,672 patients were included. The pooled PE prevalence was 7%. The pooled sensitivity, specificity, and negative predictive value of PERC were 95% (95% CI: 89%-98%), 26% (95% CI: 16%-40%), and 98.2% (95% CI: 97.8%-99.0%), respectively. PERC application was associated with a significant reduction in imaging utilization (RR = 0.85, 95% CI: 0.80-0.91).ConclusionsPERC provides a highly sensitive and safe strategy for ruling out PE in low-risk ED patients and significantly reduces unnecessary use of advanced imaging without compromising diagnostic safety.

Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis

Pulmonary Embolism
Humans
Acute Disease
Emergency Service, Hospital

Journal Article
Meta-Analysis
Systematic Review
Review


Prevalence and Clinical Impact of Multidrug-Resistant Bacterial Colonization and Infection in Liver Transplant Recipients: A Systematic Review and Meta-Analysis of Observational Studies

Abstract: To our knowledge, a systematic review that has comprehensively evaluated the prevalence and clinical impact of multidrug -resistant bacteria in adult liver transplant recipients is not available. This review assessed the prevalence and clinical impact of multidrug -resistant bacteria among liver transplant recipients. In accordance with PRISMA guidelines, we searched Web of Science, PubMed, and Google Scholar through August 2025. The study protocol was registered in PROSPERO (CRD420251181202 ). We included cohort and case -control studies that reported on adult first liver transplant recipients harboring and not harboring multidrug -resistant bacteria. Two reviewers assessed eligibility and conducted a risk of bias evaluation using the Newcastle -Ottawa Scale. We synthesized data using the web -based Review Manager for a meta -analysis, with a random -effects model to compute the pooled odds ratio and 95 % CI. Statistical heterogeneity was determined using the I2 statistic. In the 13 included studies (12 cohort studies, 1 case -control study ), multidrug -resistant bacteria were identified in 507 of 28 599 liver transplant recipients. Multidrug -resistant bacteria colonization significantly increased posttransplant infection (odds ratio 5.98; 95 % CI, 2.24 -15.94 ), and their presence significantly increased mortality (odds ratio 5.32; 95 % CI, 2.36 -11.97 ). Subgroup analyses suggested a regional variation in mortality risk with a higher association in China and Japan (odds ratio, 22.26; 95 % CI, 6.83 -72.6 ). Exposure to these bacteria was also associated with prolonged hospital and intensive care unit stay and showed a borderline association with acute kidney injury but not with graft rejection. Colonization with multidrug -resistant bacteria is associated with increased infection, and both colonization and infection raise the risk of mortality. Despite the variations across studies in geography, follow -up duration, and screening methods, actions to prevent colonization in transplant candidates are warranted.

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation

Humans
Liver Transplantation
Drug Resistance, Multiple, Bacterial
Prevalence
Risk Factors
Bacterial Infections
Treatment Outcome
Observational Studies as Topic
Bacteria
Female
Risk Assessment
Male
Adult
Middle Aged
Anti-Bacterial Agents


Subcutaneous methotrexate compared with oral methotrexate in rheumatoid arthritis: a systematic review and meta-analysis

Abstract: To integrate evidence from randomized controlled trials (RCTs) comparing subcutaneous (SC) and oral methotrexate (MTX) for rheumatoid arthritis (RA) to provide optimal clinical treatment strategies. This meta-analysis conducted comprehensive search of PubMed, Web of Science, Embase and Cochrane Library, retrieving all relevant RCTs published up to June 18, 2025. Random-effects models were utilized to calculate the relative risk (RR), mean difference (MD) and their 95% confidence intervals (CIs), to evaluate efficacy and safety between subcutaneous injections and oral administration of MTX. A total of 1,034 articles were retrieved, and 9 RCTs that met the criteria were ultimately included, involving 974 RA patients in total. In the primary random-effects analyses, compared to oral MTX, subcutaneous MTX increased the ACR20 response rate (RR = 1.15; 95%CI: 1.05, 1.25), increased the ACR50 response rate (RR = 1.14; 95%CI: 1.01, 1.29), and reduced the incidence of gastrointestinal (GI)-related adverse event (AE) (RR = 0.58; 95%CI: 0.40, 0.83) and diarrhea (RR = 0.42; 95%CI: 0.21, 0.84). Fixed-effect sensitivity analyses supported the ACR20 and GI-related safety findings, but the ACR50 result was attenuated. Subcutaneous MTX did not show statistically significant differences in ACR70 response rate, DAS28-ESR score, bioavailability area under the curve, Cmax, or the incidence of other AE. Compared with oral administration, subcutaneous MTX was associated with a higher ACR20 response and lower GI-related AE and diarrhea in the primary random-effects analyses. These findings suggested that subcutaneous MTX may be an effective and generally well-tolerated option, particularly for patients with inadequate response or poor gastrointestinal tolerability to oral MTX, while evidence for ACR50, ACR70, DAS28-ESR and bioavailability remains less certain.

Humans
Methotrexate
Arthritis, Rheumatoid
Administration, Oral
Injections, Subcutaneous
Antirheumatic Agents
Treatment Outcome
Randomized Controlled Trials as Topic


Dose-response efficacy of horticultural therapy for geriatric depression: a systematic review and meta-analysis of randomized controlled trials

Abstract: Horticultural therapy (HT) is a promising non-pharmacological intervention for geriatric depression. However, the optimal "dose" required for maximum clinical efficacy remains poorly defined. To evaluate the efficacy of HT in alleviating geriatric depression and to quantify the dose-response relationship between intervention intensity and clinical outcomes. A systematic search was conducted across eight databases (including PubMed, Embase, and Cochrane Library, etc) for randomized controlled trials (RCTs) published up to 24 February 2026. Standardized mean differences (SMD) were pooled using a random-effects model. The dose-response relationship was modeled using restricted cubic splines (RCS). A total of eight RCTs involving 585 participants were initially identified. Systematic sensitivity analysis identified one study as a significant statistical outlier. After its exclusion, the final meta-analysis included seven studies with 435 participants. HT was associated with a significant reduction in geriatric depression scores (SMD = -0.52; 95% CI: -0.86 to -0.18; p = 0.0078). Heterogeneity remained moderate (I2 = 65.6%). The RCS model revealed an exploratory, hypothesis-generating non-linear dose-response relationship (p = 0.076), suggesting that the antidepressant benefit might peak at a cumulative dose of approximately 700-800 min. However, this finding should be interpreted with caution due to the limited number of studies. Subgroup analysis indicated that the GDS-30 scale showed a marginally significant trend toward higher sensitivity to treatment effects than the GDS-15 (p = 0.055). No significant publication bias was detected via Egger's test (p = 0.936) and Begg's test (p = 0.652). HT is an effective intervention for geriatric depression. A cumulative dose of 700-800 min represents a potential exploratory therapeutic window for maximizing efficacy while minimizing potential fatigue in frail older adults. PROSPERO, CRD420261323722.

Humans
Randomized Controlled Trials as Topic
Depression
Horticultural Therapy
Aged
Treatment Outcome


Efficacy of Gegen Qinlian decoction plus metformin for type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

Abstract: Gegen Qinlian Decoction (GQD) is frequently used as an adjunctive therapy to metformin for type 2 diabetes mellitus (T2DM), but the certainty and consistency of the supporting clinical evidence remain unclear. We searched CNKI, Wanfang Data, PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials from database inception to January 31, 2026. Randomized controlled trials comparing GQD plus metformin with metformin alone in adults with T2DM were included. The primary outcome was glycated hemoglobin (HbA1c), and secondary outcomes were fasting plasma glucose (FPG) and 2-hour postprandial glucose (2hPG). Risk of bias was assessed using the Cochrane RoB 2 tool, and the certainty of evidence was evaluated using the GRADE framework. Random-effects meta-analyses were performed, with the primary analyses based on change-from-baseline values. Eight randomized controlled trials involving 725 participants were included. In the primary change-score analysis, GQD plus metformin did not show a statistically significant reduction in HbA1c compared with metformin alone (mean difference [MD] = -1.92, 95% confidence interval [CI]: -4.43 to 0.59, P = 0.13). Statistically significant reductions were observed for FPG (MD = -1.08, 95% CI: -1.71 to -0.44, P = 0.0009) and 2hPG (MD = -1.73, 95% CI: -3.05 to -0.42, P = 0.010). However, substantial heterogeneity was present across analyses (I² = 85%-100%), and the certainty of evidence was rated as very low because of risk of bias, inconsistency, and imprecision. Post-treatment sensitivity analyses using all eight trials showed statistically significant reductions in HbA1c, FPG, and 2hPG, but these analyses were also affected by substantial heterogeneity and high risk of bias across the included trials. Current evidence is insufficient to confirm a reliable clinical benefit of GQD as an adjunct to metformin for T2DM. Although reductions in FPG and 2hPG were observed, these findings should be interpreted as exploratory because of substantial heterogeneity, methodological limitations, and very low certainty of evidence. Larger, prospectively registered, well-designed, and adequately blinded randomized trials are needed.

Metformin
Humans
Diabetes Mellitus, Type 2
Drugs, Chinese Herbal
Randomized Controlled Trials as Topic
Hypoglycemic Agents
Drug Therapy, Combination
Blood Glucose
Glycated Hemoglobin
Treatment Outcome


Prevalence and associated factors of gestational diabetes mellitus among women with polycystic ovary syndrome: a systematic review and meta-analysis

Abstract: Polycystic ovary syndrome (PCOS), the most common endocrine disorder in reproductive-aged women, often leads to gestational diabetes mellitus (GDM). This study aimed to systematically evaluate GDM prevalence and its associated factors in PCOS. We searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, Sinomed, and VIP from inception to December 31, 2025. Studies reporting GDM prevalence or associated factors in PCOS were included. A random-effects model pooled prevalence with odds ratios. Egger's test assessed publication bias, and subgroup analysis with meta-regression explored heterogeneity. A logit transformation was applied for pooling. Twenty-two studies with 5,507 PCOS patients were included. The pooled GDM prevalence was 24% (95% CI: 20%-28%; prediction interval: 10%-46%), with substantial heterogeneity (I² = 89.9%). The primary prevalence estimate, based on cohort studies (n=13), was 21.7% (95% CI: 17.7%-25.8%), while the overall estimate including case-control studies was 24% (95% CI: 20%-28%). By diagnostic criteria, GDM prevalence was 26.0% for one-step vs. 18.7% for two-step. Potentially associated factors included pre-pregnancy BMI (OR = 1.39), gestational weight gain (OR = 1.58), HOMA-IR (OR = 3.41), and family history of diabetes (OR = 2.88). Although the pooled GDM prevalence in PCOS was 24%, substantial heterogeneity and a wide prediction interval (10%-46%) suggest the true prevalence varies considerably across settings. Associated factors included HOMA-IR, family history, pre-pregnancy overweight, and excessive gestational weight gain. PCOS patients should be considered a high-risk group, and early monitoring of glucose metabolism and weight management may be beneficial, though these recommendations derive from observed rather than interventional evidence. https://www.crd.york.ac.uk/PROSPERO/view/CRD42026128476, identifier: CRD420261284765.

Humans
Female
Polycystic Ovary Syndrome
Diabetes, Gestational
Pregnancy
Prevalence
Risk Factors


Prevalence and Impact of Pelvic Floor Symptoms in Performing Artists and Artistic Athletes: A Systematic Review With Meta-analysis

Abstract: OBJECTIVES: To (1) estimate the prevalence of pelvic floor symptoms in performing artists and artistic athletes and (2) quantify the impact of symptoms during and outside performance and training. DESIGN: Epidemiology systematic review with meta-analysis. LITERATURE SEARCH: Six databases were searched from inception to February 2025. STUDY SELECTION CRITERIA: Studies involving participants from any artistic discipline and with data on pelvic floor symptom or disorder prevalence or impact were included. DATA SYNTHESIS: Critical appraisal was conducted using the JBI (Joanna Briggs Institute) Critical Appraisal Checklist, and the certainty of evidence was judged using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Data were pooled for pelvic floor symptom proportions in performing artists and artistic athletes, with subgroup analyses for any type of urinary incontinence by discipline. We descriptively synthesized pelvic floor symptoms and impact data that were not included in the meta-analysis. RESULTS: Nineteen articles were included. Half (52%; 95% confidence interval [CI]: 38%, 66%; I2 = 92.7%) of the performing artists and artistic athletes reported urinary incontinence, 79% (95% CI: 69%, 88%; I2 = 80.6%) reported anal incontinence, and 47% (95% CI: 41%, 53%; I2 = not reported (NR)) reported dyspareunia. The discipline most affected by any type of urinary incontinence was trampolining (87%; 95% CI: 70%, 98%; I2 = NR). Up to 83% of the performing artists and artistic athletes reported some negative impact from their symptoms. CONCLUSION: At least half of the performing artists and artistic athletes reported pelvic floor symptoms, particularly urinary and flatal incontinence. The symptoms negatively impacted 83% of the athletes during performance. J Orthop Sports Phys Ther 2026;56(8):530-545. Epub September 19 2025. doi:10.2519/jospt.2025.13452.

The Journal of orthopaedic and sports physical therapy

Frydenberg JC
Ferrar K
Dakic J
Rio E
Mayes S
Frawley H

Humans
Urinary Incontinence
Prevalence
Pelvic Floor Disorders
Athletes
Fecal Incontinence
Female
Art
Sports


Neural Recovery After Carpal Tunnel Release: A Systematic Review With Meta-Analysis

Abstract: OBJECTIVE: The primary aim was to quantify changes in structural and functional nerve parameters following carpal tunnel release. The secondary aims were to describe recovery trajectories and describe the regenerative capacity of the median nerve. DESIGN: Prognosis systematic review with meta-analysis. LITERATURE SEARCH AND SELECTION CRITERIA: Six databases were searched from inception to June 2024 for studies reporting at least 1 of the following outcomes: electrodiagnostic measures, quantitative sensory testing, grip/pinch strength, 2-point discrimination, Semmes-Weinstein monofilament, intraepidermal nerve fiber density, autonomic measures, brain function/structure, or Boston Carpal Tunnel Questionnaire. DATA SYNTHESIS: Outcomes were categorized by time post surgery: <2, 2 to 4, 5 to 7, 8 to 12, and >12 months. Randomized and observational studies were included, with quality assessed using the RoB 2 tool (revised Cochrane Risk of Bias tool for randomized trials) and the Newcastle-Ottawa Scale, respectively. RESULTS: A total of 199 studies comprising 15 636 patients and 578 healthy controls were included. We observed significant, time-dependent improvement in most outcomes. Grip and pinch strength did not show marked recovery until 5 to 7 months postoperatively. Compared to healthy controls, patients had persistent deficits in several electrodiagnostic measures even 1 year after surgery. Impairments in warm, vibration, and mechanical detection thresholds persisted up to 6 months postoperatively. CONCLUSION: Carpal tunnel release led to gradual improvement in median nerve function and structure. Key measures-including electrodiagnostics, detection thresholds, and intraepidermal nerve fiber density-often remained below normal levels after surgery. J Orthop Sports Phys Ther 2026;56(8):482-529. Epub 19 May 2026. doi:10.2519/jospt.2026.13846.

Sobeeh MG
Elsisy M
Abozaid EM
Samir A
Mansour A
Youssef S
Kamel FO
Lialy HE
Abdel-Mageed RS
Hassan KA
Schmid AB

Carpal Tunnel Syndrome
Humans
Median Nerve
Recovery of Function
Nerve Conduction Studies
Nerve Regeneration
Hand Strength
Electrodiagnosis


Predictors of Multiple Sclerosis After Clinically Isolated Syndrome: A Systematic Review and Meta-Analysis

Abstract: Most people with multiple sclerosis (MS) present with a clinically isolated syndrome (CIS); however, not all individuals with CIS are subsequently diagnosed with MS. A systematic literature review was conducted until December 2025. Observational studies of adults with CIS that were later diagnosed with MS were included. Odds ratios (ORs) were pooled using random-effects meta-analysis. Heterogeneity was assessed with I2, sensitivity analyses with leave-one-out procedures, and publication bias with funnel plots and Egger's test. Meta-regression was performed to explore further sources of heterogeneity when appropriate. Seventy-two studies with 9915 adults were included. In the meta-analysis, younger age (OR = 1.6, p < 0.01) and multifocal presentation (OR = 1.55, p = 0.02) were associated with a diagnosis of MS after a CIS. Magnetic resonance imaging findings, including a higher number of T2 lesions (OR = 7.46, p = 0.02), periventricular lesions (OR = 4.08, p < 0.01), corpus callosum lesions (OR = 14.89, p = 0.02), infratentorial lesions (OR = 2.16, p = 0.03), spinal cord lesions (OR = 1.4, p = 0.03), and gadolinium-enhancing lesions (OR = 1.91, p = 0.01), as well as cerebrospinal fluid inflammatory markers such as oligoclonal bands (OR = 3.57, p < 0.01) and pleocytosis (OR = 3.34, p = 0.02), were also associated with a subsequent diagnosis of MS. This meta-analysis identified factors associated with an increased likelihood of MS after a CIS. These findings may help identify high-risk individuals and guide personalized treatment strategies.

Zafra-Sierra MP
Ferreira-Atuesta C
Rodríguez DS
Gaitán J
Otero S
Tintoré M
Lublin F
Giovannoni G
Toro J
Reyes S

Humans
Multiple Sclerosis
Demyelinating Diseases
Magnetic Resonance Imaging


Cognitive Motor Dissociation in Disorders of Consciousness: An Individual Participant Data Meta-Analysis

Abstract: In patients with disorders of consciousness (DoC), behavioral assessment often underestimates awareness when motor output is absent or unreliable. Cognitive motor dissociation (CMD) refers to patients who appear unresponsive but demonstrate volitional brain responses during neurodiagnostic tests. We characterized clinical and methodological factors associated with CMD detection. Studies published between January 2000 and May 2026 were identified through MEDLINE, Embase, and Scopus. Individual participant data were analyzed using mixed-effects logistic regression. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Fifty-six studies with 1248 patients (mean age 45.5 years; 66.1% male; 44.5% unresponsive wakefulness syndrome [UWS]) were included. In unadjusted analyses, CMD detection was lower in anoxic (OR 0.43, 95% CI 0.29-0.66) and cerebrovascular (OR 0.59, 95% CI 0.37-0.98) compared to traumatic brain injury, and higher in minimally conscious state minus (MCS-) compared to UWS (OR 1.64, 95% CI 1.14-2.35). In multivariable models, anoxic (OR 0.35, 95% CI 0.23-0.55) and cerebrovascular (OR 0.51, 95% CI 0.32-0.84) etiologies remained independently associated with lower CMD detection, while MCS- remained associated with higher detection (OR 1.50, 95% CI 1.02-2.23). Time since injury, diagnostic modality and task paradigms were not independently associated with CMD detection. Overall, the studies showed a relatively low risk of bias. CMD is common but varies by etiology and clinical state. Its detection appears to be independent of the time of injury, the task paradigm, and the diagnostic modality, highlighting the importance of standardized protocols and longitudinal studies.

Laigaard PP
Abla FW
Hassani M
Eigenbrodt AK
Kondziella D

Humans
Consciousness Disorders
Dissociative Disorders
Middle Aged
Male


IgM-Enriched Immunoglobulin As Adjunctive Therapy in Adult Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract: To evaluate randomized adult evidence on adjunctive immunoglobulin M (IgM)-enriched immunoglobulin for sepsis and septic shock, with emphasis on short-term mortality, endpoint heterogeneity, statistical robustness, and harms reporting. MEDLINE, PubMed, Embase, CENTRAL, and Web of Science were searched from inception to September 2025. Reference lists of eligible articles and relevant reviews were screened, forward citation searching was performed, and study registers were checked for additional records. Randomized controlled trials enrolling adults with sepsis, severe sepsis, or septic shock were eligible when they evaluated an IgM-enriched immunoglobulin preparation in addition to standard care and reported extractable mortality or clinically relevant outcomes. The protocol-concordant core synthesis included English-language adult Pentaglobin trials with extractable short-term mortality data. Two post hoc extensions were labeled explicitly: a language-inclusive Pentaglobin sensitivity analysis and an exploratory formulation-class analysis incorporating the phase II Concentrated IgM for Application (CIGMA) trimodulin trial. Two reviewers independently screened records, assessed full texts, extracted study characteristics, endpoint timing, mortality events, and reported adverse events, and resolved disagreements by discussion or third-reviewer adjudication. Risk of bias was assessed with Cochrane Risk of Bias 2 tool for randomized trials, and certainty was judged with the Grading of Recommendations Assessment, Development, and Evaluation principles. Six English-language randomized Pentaglobin trials with extractable short-term mortality data (411 participants) contributed to the protocol-concordant core synthesis. The primary pooled estimate was directionally favorable but statistically inconclusive (odds ratio [OR], 0.65; 95% CI, 0.39-1.07; I2 = 9%). Restriction to exact 28-day mortality also remained inconclusive (OR, 0.84; 95% CI, 0.50-1.43; I2 = 0%). An alternative risk-ratio model was similarly nonsignificant (risk ratio, 0.76; 95% CI, 0.55-1.06; I2 = 0%). Statistically significant estimates arose only in exploratory post hoc analyses: the language-inclusive Pentaglobin sensitivity analysis (OR, 0.57; 95% CI, 0.34-0.95; I2 = 16%) and the exploratory formulation-class model including CIGMA (OR, 0.64; 95% CI, 0.43-0.94; I2 = 5%). Safety reporting was incomplete in most Pentaglobin reports. Current randomized adult evidence does not justify routine use of IgM-enriched immunoglobulin in unselected sepsis or septic shock. Direct Pentaglobin evidence remains statistically inconclusive, whereas statistically significant estimates appear only after exploratory expansion to historical or indirect formulation-level evidence. Efficacy remains unproven, but the recurrent direction of effect supports a modern, adequately powered, phenotype-guided trial with standardized day-28 mortality and rigorous safety assessment.

Sewify K
Elmessery R
Alzuwayed O
Gomaa W
Alshaer A
Almutairi A
Abdelshafey E
Girardis M

Humans
Immunoglobulin M
Randomized Controlled Trials as Topic
Shock, Septic
Sepsis
Adult


Long-Acting Growth Hormone Versus Daily Growth Hormone for Growth Hormone Deficiency Patients: A Network Meta-Analysis of Clinical Trials

Abstract: Current guidelines recognize daily recombinant human growth hormone (rhGH) as standard care and long-acting growth hormone (LAGH) as an alternative for paediatric growth hormone deficiency (CHD). In this network meta-analysis (NMA), we updated the evidence to evaluate comparative efficacy and safety of multiple dosing nodes of LAGH versus daily somatropin. Major databases, including PubMed, Embase, Cochrane Central, Scopus, Web of Science, and http://ClinicalTrials.Gov, were searched through April 2026 for randomized controlled trials (RCTs)in children with CHD. Outcomes included height velocity (HV), height SDS, and adverse events. Direct and indirect evidence was synthesized using a frequentist random-effects NMA (OSF: https://doi.org/10.17605/osf.io/nugpe). Eighteen RCTs (n = 3137) were analysed. In the primary random-effects model for HV, weekly YPEG-rhGH 0.1 mg/kg/week showed a significantly higher velocity compared to daily Somatropin (SMD: 5.02), whereas Somatrogon 0.25/0.48/0.66 mg/kg/week and Somapacitan 0.04 mg/kg/week showed lower HV. No significant differences were observed across treatments for height SDS. For IGF-1 SDS, Lonapegsomatropin 0.24 mg/kg/week significantly increased levels (SMD: 0.74 [0.36-1.12]), while Somatrogon and Somapacitan 0.04 mg/kg/week demonstrated reductions. Safety profiles showed that Somatrogon significantly increased the risk of localized injection site erythema (RR: 10.55) and pain. However, overall discontinuation rates did not differ significantly between LAGH formulations and daily therapy across the network. Once-weekly LAGH provides an effective frontline alternative to daily acting growth hormone, without compromising overall linear growth or safety, while displaying no differences in overall treatment discontinuation. Selection should be based on the patients' clinical profiles, specifically considering higher localized reactions with Somatrogon. Clinicians should adhere to formulation-specific sampling windows (2-5 days post dose for Lonapegsomatropin; 96 h for Somatrogon) to accurately monitor steady-state IGF-1 levels.

Abadi A
Ghanem U
Ghanem H
Sawafta AJ
Abulehia A
Ataya M
Nairat R
Sammour AM
Ayesh H

Humans
Human Growth Hormone
Child
Growth Disorders
Randomized Controlled Trials as Topic
Recombinant Proteins
Body Height
Delayed-Action Preparations
Drug Administration Schedule
Treatment Outcome

Journal Article
Network Meta-Analysis
Review


Comparing adherence strategies and facility DOT in TB care: a systematic review with meta-analysis

Abstract: <sec><title>BACKGROUND</title>Adherence to TB treatment is crucial for successful outcomes. While facility-based directly observed therapy (FB-DOT) is a common strategy, recognition of its limitations has spurred the development of flexible approaches. We have compared the effectiveness of alternative adherence-enhancing strategies with FB-DOT.</sec><sec><title>METHODS</title>We searched three databases and four registries from June 2013 to May 2025. We included comparative studies evaluating interventions designed to improve adherence to TB treatment in people aged 15 years or older, excluding adherence to multiple therapies. Meta-analyses were conducted for treatment success, treatment completion, cure rate, and loss to follow-up.</sec><sec><title>RESULTS</title>Twenty-five studies involving 19,103 participants were included. Self-administered treatment and reminder-based interventions achieved treatment success comparable to FB-DOT. Community-based DOT showed similar cure and completion rates but was effective at reducing loss to follow-up (71% reduction). Video-supported treatment and digital adherence technologies demonstrated neutral effects across treatment outcomes. Multicomponent strategies showed heterogeneous results.</sec><sec><title>CONCLUSION</title>Alternative adherence strategies can offer improvements over FB-DOT in specific contexts. However, their variable effectiveness limits universal implementation. Adherence support, community engagement, and social determinants should guide programmatic design and implementation.</sec>.

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

Ramos JP
Vieira M
Araújo M
Ferreira LL
Barbosa P
Aguiar A
Duarte R

Humans
Directly Observed Therapy
Antitubercular Agents
Tuberculosis
Adherence Interventions
Reminder Systems
Treatment Outcome
Medication Adherence


Efficacy of mindfulness-based interventions on psychological distress, hyperandrogenism, and metabolic profile in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials

Abstract: Polycystic ovary syndrome (PCOS) negatively impacts women's metabolic health, reproductive hormones, and psychological well-being. The aim of this study was to systematically evaluate the efficacy of mindfulness-based interventions (MBIs), such as yoga and mindfulness meditation, on anthropometric indices, metabolic profiles, reproductive hormones, and quality of life in women with PCOS. A systematic review and meta-analysis was conducted with 10 randomized controlled trials (RCTs) involving 356 participants, selected from databases including PubMed and Cochrane Library up to January 2025. Data were synthesized using Review Manager 5.3 to calculate mean differences (MDs) and standardized mean differences (SMDs). Women in the MBI groups showed significant reductions in BMI, body weight, abdominal circumference, and preliminary improvements in insulin resistance (HOMA-IR; based on two studies), alongside improvements in total testosterone levels and clinical hirsutism. Although generic depression and anxiety scores did not show significant differences, disease-specific quality of life improved significantly. MBIs show potential as metabolic and endocrine modulators and may offer benefits in insulin sensitivity, weight management, and hyperandrogenism beyond mere stress reduction for women with PCOS.

Applied psychology. Health and well-being

Humans
Female
Polycystic Ovary Syndrome
Mindfulness
Hyperandrogenism
Randomized Controlled Trials as Topic
Psychological Distress
Yoga
Quality of Life
Insulin Resistance


The Impact of Early Versus Delayed Chemotherapy on Survival in Patients with Colorectal Cancer after Surgery: A Systematic Review and Meta-Analysis

Abstract: This study systematically evaluates the impact of the initiation time of postoperative chemotherapy on overall survival (OS) in patients with colorectal cancer, providing evidence to guide clinical decisions on chemotherapy timing. Following PRISMA and MOOSE guidelines, PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched up to February 2025. Cohort studies comparing early versus delayed postoperative chemotherapy were included. Two researchers independently performed literature screening, data extraction, and quality assessment. Review Manager 5.3 was used, with hazard ratios (HRs) and 95% confidence intervals (CIs) as effect measures. Random- or fixed-effects models were applied based on heterogeneity, and subgroup and sensitivity analyses were conducted. Eleven studies involving 72,873 patients were included. Pooled results showed that delayed chemotherapy significantly increased the risk of death (HR = 1.32, 95% CI: 1.20-1.45, P < 0.00001). Heterogeneity was high (I² = 88%), and sensitivity analyses confirmed the robustness of the findings. Subgroup analysis, using an 8-week cutoff, revealed that patients who initiated chemotherapy within ≤ 8 weeks had significantly better survival than those who started > 8 weeks (HR = 1.47, 95% CI: 1.14-1.91, P = 0.003). Delayed postoperative chemotherapy markedly increases mortality risk. Initiating adjuvant chemotherapy within 8 weeks after surgery is recommended to achieve optimal survival benefits.

Antineoplastic Combined Chemotherapy Protocols


Genetic ancestry and risk of atrial fibrillation in individuals of Black ethnicity in the UK Biobank

Abstract: Black individuals have a lower incidence of atrial fibrillation (AF) than White individuals, despite a higher burden of traditional risk factors. Prior studies have suggested that European genetic ancestry may contribute to this paradox, but findings have been inconsistent. We examined the association between European genetic ancestry and incident AF among 6920 UK Biobank (UKB) participants who self-identified as Black and were free of AF at baseline. European ancestry proportions were estimated by comparing participants to HapMap populations and were analysed both continuously and categorically using Cox proportional hazards models. Non-linear associations were evaluated using flexible spline curves. We then conducted a meta-analysis combining these results with those from the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study and the Women's Health Initiative. During a median follow-up of 13.7 years, 205 (3%) participants developed incident AF. Each 10% increase in European ancestry was non-significantly associated with increased AF risk (HR 1.07 (95% CI 0.95 to 1.20)), and individuals in the highest European ancestry category had a higher AF incidence rate compared with all other categories. Random-effects meta-analysis of all four cohorts yielded a pooled relative risk (RR) of 1.09 (95% CI 0.99 to 1.21), with substantial heterogeneity largely driven by the Women's Health Initiative (WHI) study. Excluding WHI resulted in a pooled estimate (RR 1.14 (95% CI 1.05 to 1.23)) without heterogeneity. In UKB, European ancestry proportion was not significantly linked to incident AF, and pooled cross-cohort results were heterogeneous. Excluding WHI in sensitivity analyses produced a modest positive pooled association with no heterogeneity.

Liu C
Sun YV
Li L
Collin LJ
Shah AJ
Alonso A

Humans
Atrial Fibrillation
Female
United Kingdom
Incidence
Middle Aged
Risk Factors
Risk Assessment
UK Biobank
Male
Aged
Genetic Predisposition to Disease
Black People
White People
Biological Specimen Banks
African People


Efficacy and Safety of Tesamorelin in People Living With HIV (PLWH) With Lipodystrophy: A Systematic Review and Meta-Analysis

Abstract: BackgroundHIV-associated lipodystrophy, a complication of combined antiretroviral therapy (CART), causes significant physical and psychological distress in people living with HIV (PLWH), compromising treatment adherence. Tesamorelin, a growth hormone-releasing hormone (GHRH) analogue, has emerged as a therapeutic option.ObjectiveTo systematically evaluate the efficacy and safety of tesamorelin in HIV-infected individuals with lipodystrophy receiving CART, incorporating GRADE assessment.MethodsWe searched PubMed, https://ClinicalTrials.gov, and Scopus from inception to February 9, 2026, for randomized controlled trials evaluating tesamorelin in HIV-associated lipodystrophy. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models with heterogeneity assessed by I2.ResultsFour RCTs (909 patients) were included. Tesamorelin 2mg significantly reduced visceral adipose tissue (MD= -21.47, 95%CI[-34.73,-8.22],I2=74%,p=0.002), waist circumference (MD-1.61cm,95% CI[-2.28,-0.95],I2=0%,p<0.00001), trunk fat (MD-1.20kg, 95%CI[-1.47,-0.93],I2=0%,p<0.00001), and increased lean body mass (MD1.42kg,95% CI[1.13,1.71],I2=0%,p<0.00001). Modest lipid improvements occurred in total cholesterol (MD-0.16mmol/L,95%CI[-0.27,-0.06],I2=0%,p=0.003). Growth hormone-related adverse effects and higher discontinuation rates (RR2.25,95%CI[0.98,5.17],p=0.06) were observed.ConclusionsTesamorelin demonstrates efficacy in reducing visceral adiposity in PLWH with lipodystrophy on CART. However, limited data on long-term safety, optimal dosing strategies, and durability of treatment effects warrant caution. Future research should evaluate extended treatment duration, dose-response relationships, and patient-reported outcomes to establish comprehensive clinical utility.

Journal of the International Association of Providers of AIDS Care

Ditta AM
Naeem RM
Sami MM
Abdul Rafey M
Ali H
Amjad MW
Jahangir F
Rizvi KA
Mohammad F
Abu Dawood H
Suleman M
Saddique MN

Humans
Growth Hormone-Releasing Hormone
HIV-Associated Lipodystrophy Syndrome
HIV Infections
Randomized Controlled Trials as Topic


Glucagon-like peptide-1 receptor agonists are associated with improved 90-day outcomes after total hip and knee arthroplasty : a systematic review and meta-analysis

Abstract: Obesity and diabetes are risk factors for developing osteoarthritis and associated with worse outcomes following total hip (THA) and total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1as) improve glycaemic control and promote weight loss. The aim of this study was to assess the impact of GLP-1a treatment on 90-day surgical complications following THA and TKA. A systematic review was undertaken according to PRISMA guidelines. Studies were included if they reported at least one outcome of interest following primary THA or TKA. In all the studies which were included, a GLP-1a was prescribed for the management of type 2 diabetes mellitus or for weight loss in obese patients. The primary outcome was the 90-day surgical complication rate in the combined THA and TKA cohort. The 90-day surgical complications were defined as: periprosthetic joint infection (PJI), wound dehiscence, periprosthetic fracture (PPF), haematoma, nerve injury, or surgical site infection (SSI). Secondary outcomes included 90-day medical complications and readmission rates, all-cause revision, healthcare costs, and length of stay. A total of 78 studies were reviewed, and ten matched cohort studies with a total of 96,356 patients (30,350 THAs and 66,606 TKAs) were included. The mean age of the patients was 61.9 years; 60.1% female (n = 57,939). Two studies had a serious risk of overall bias and eight had a moderate risk. The confidence of evidence according to the GRADE assessment was very low for all but one outcome measure (healthcare cost: moderate). The rate of 90-day surgical complications was lower in the GLP-1a cohort (pooled risk ratio (RR) 0.73). The use of a GLP-1a lowered the 90-day medical complications and readmission rates (RR 0.78 and RR 0.79 (I2 = 61.6%), respectively). At two years, the revision rate ranged from 1.7% to 3.3% for the GLP-1a cohort and 1.7% to 4.5% for the controls. Sub-group analysis showed a stronger association in the THA group, in which the use of a GLP-1a was associated with significantly lower rates of 90-day surgical complications (RR 0.63), 90-day medical complications (RR 0.55), and 90-day readmissions (RR 0.82). In contrast, the use of a GLP-1a in the TKA group was only sigificantly associated with a lower 90-day readmission rate (RR 0.77). GLP-1a treatment before THA and TKA potentially reduces the 90-day surgical and medical complications and 90-day readmission rates in high-risk diabetic and obese patients. The use of a GLP-1a may also be associated with substantial cost savings.

Rudran B
Little CDJ
Palmer AJR
Judge A
Carli A
Price AJ
Alvand A

Glucagon-Like Peptide-1 Receptor Agonists


Accuracy of Machine Learning Algorithms Based on Electroencephalogram in Sleep Apnea Detection: Systematic Review and Meta-Analysis

Abstract: Sleep apnea (SA) is a serious sleep disorder, and its diagnostic gold standard, polysomnography, is costly and time-consuming. Electroencephalogram (EEG) signals, due to their direct correlation with neural activity and ease of extraction, represent a promising tool. Despite increasing research on machine learning (ML) and deep learning for EEG-based SA detection, model performance has not been consistently evaluated. This systematic review evaluated the accuracy of ML in detecting SA from EEG data and provided an evidence base for further clinical application and future research. Following the PRISMA-DTA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 expanded checklists, we systematically searched PubMed, Embase, Web of Science, Cochrane Library (CENTRAL), Scopus, IEEE Xplore, and ClinicalTrials.gov databases from inception to April 2026. Studies evaluating the value of ML algorithms for detecting SA based only on EEG data were included. The Quality Assessment of Diagnostic Accuracy Studies-2 and Prediction Model Risk of Bias Assessment Tool for Artificial Intelligence tools were used to assess the risk of bias in each study. Statistical analysis was performed using the mada and metafor packages in R (version 4.6.0; R Foundation for Statistical Computing) and the Meta-DiSc (version 1.4; Hospital Ramón y Cajal) software. We used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to evaluate the certainty of evidence. A total of 27 retrospective studies were included. Segment-level analyses showed high diagnostic performance, with a pooled sensitivity of 0.90 (95% CI 0.85-0.94; 95% prediction interval 0.43-0.99) and specificity of 0.92 (95% CI 0.87-0.95; 95% prediction interval 0.46-0.99). The pooled area under the summary receiver operating characteristic curve was 0.95 (95% CI 0.92-0.99). Meta-regression identified EEG channel configuration, region, and validation strategy as significant sources of heterogeneity (P=.004, P=.003, and P=.046, respectively). Multichannel EEG, deep learning approaches, and hold-out validation strategies generally demonstrated better diagnostic performance. Only 2 studies evaluated patient-level diagnostic performance, which was summarized qualitatively. To our knowledge, this is the first systematic review and meta-analysis specifically focused on the diagnostic accuracy of EEG-based ML models in the detection of SA. This meta-analysis indicates that ML models based on EEG demonstrate good diagnostic accuracy in detecting SA at the segment level and show promise as tools for SA screening and clinical decision support. However, most current studies are retrospective segment-level analyses, which may overestimate the practical value of this technology in real-world clinical settings. To reliably integrate EEG-based ML models into clinical diagnostic workflows, further prospective studies incorporating full-night monitoring and patient-level validation are needed.

Li X
Wang L
Tang T
Chen Y
Yang L
Cai H
Wang C
Zhang S
Ding N
Liu K

Humans
Electroencephalography
Machine Learning
Sleep Apnea Syndromes
Algorithms
Polysomnography


Exergaming Interventions for Preventing Falls and Injurious Falls in Older People: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract: Exergames, which combine physical exercise with interactive gameplay, are increasingly being incorporated into fall prevention programs for older adults. Gamified elements, such as real-time feedback and progress tracking, may enhance motivation, engagement, and adherence. Although several systematic reviews have examined the effects of exergaming on balance and physical function, fewer have focused specifically on clinically meaningful outcomes, such as falls and injurious falls, or on indicators that may influence real-world adoption of exergames. This study aimed to evaluate the effectiveness of exergaming interventions for preventing falls and injurious falls in people aged ≥60 years and to synthesize evidence on implementation-related outcomes, including adherence, acceptability, concerns about falling, quality of life, adverse events, and cost-effectiveness. MEDLINE, Embase, CINAHL Plus, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to February 2025 for randomized controlled trials evaluating exergaming interventions in older adult populations across all settings. Outcomes included fall rate, number of fallers and injurious falls, and implementation-related secondary outcomes. Risk of bias was assessed using RoB 2.0, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were synthesized narratively and, where appropriate, pooled using meta-analysis. Nine studies (N=1385) met the inclusion criteria. Comparator-specific analyses suggested that exergaming may reduce fall rates compared with active intervention comparators, although the magnitude and certainty of effect varied, and substantial heterogeneity was present across analyses. Moderate-certainty evidence also suggested that exergames reduced the number of older adults experiencing one or more falls at 12-month follow-up compared with usual care (risk ratio 0.75, 95% CI 0.61-0.92). Evidence for injurious falls, quality of life, concerns about falling, adherence, acceptability, and cost-effectiveness was limited or inconsistent. When pooled across all control groups, exergaming interventions were associated with a lower overall fall rate than comparator interventions (incidence rate ratio 0.53, 95% CI 0.41-0.68), although substantial heterogeneity was present (I²=76%). Low- to moderate-certainty evidence suggests that exergames may reduce fall rates, particularly in comparisons with active intervention control groups, and may reduce the number of fallers compared with usual care. These findings indicate that exergaming may offer a useful adjunct to established fall prevention strategies for older adults, particularly where sustained engagement with conventional exercise is challenging. However, substantial heterogeneity, modest sample sizes, and limited long-term follow-up reduce confidence in these estimates, and more rigorous, large-scale trials are needed before routine implementation can be recommended. This review extends previous exergaming syntheses by focusing on clinically meaningful outcomes, including falls and injurious falls, while also considering implementation-related factors relevant to real-world uptake.

Eost-Telling C
McGarrigle L
Shi C
Money A
Yang Y
Lazo Green K
Ahmed S
Christie R
Aminu A
Delbaere K
de Bruin ED
Stanmore E
Todd C

Humans
Accidental Falls
Randomized Controlled Trials as Topic
Video Games
Aged
Exercise Therapy
Female
Exercise
Quality of Life
Middle Aged
Aged, 80 and over


Impact of Large Language Model-Based AI Tools on Physician-Patient Communication: Systematic Review and Meta-Analysis

Abstract: Recent advances in large language models (LLMs) such as GPT-3/4 have spurred the development of artificial intelligence (AI) chatbots and advisory tools in medicine. These systems are posited to assist or augment physician-patient communication, potentially improving empathy, clarity, and responsiveness. However, their actual impact on communication outcomes remains uncertain. This study aimed to systematically review and meta-analyze peer-reviewed studies (2020-2025) evaluating how LLM-based interventions affect physician-patient communication, including empathy, clarity, trust, and patient understanding. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we searched PubMed/MEDLINE, Embase, Scopus, and Web of Science for studies published from 2020 to 2025 examining LLM or chatbot applications in clinical communication contexts. Eligible designs included randomized, observational, cross-sectional, and qualitative studies. Two reviewers (WHP and SR) independently screened titles or abstracts, assessed full texts, and extracted data on study design, population, LLM type, communication measures, and outcomes. We conducted a qualitative synthesis and random-effects meta-analysis, reporting pooled standardized mean differences or odds ratios with 95% CIs. From 312 records, 10 studies were included, all quantitative and predominantly cross-sectional. Populations ranged from patients with chronic conditions to health care professionals and laypersons. Outcomes assessed included empathy (8 studies), clarity or information quality (6 studies), satisfaction or usefulness (4 studies), and trust perceptions (2 studies). In 6 direct comparisons of AI- versus physician-generated responses, LLMs were rated significantly higher in empathy in 5 studies. One large study found that chatbot replies were judged empathetic in 45.1% of cases versus 4.6% for physician replies (odds ratio approximately 9.8, P<.001). Similarly, ChatGPT-4 answers scored higher in empathy on a 5-point scale than human-written responses (mean 4.18 vs 2.70, P<.001). One neurology study showed higher empathy scores (Consultation and Relational Empathy Scale +1.38, P<.01) for ChatGPT answers. Only 1 study found no significant empathy difference. LLM content was also longer and more information-rich, improving patient-perceived clarity and understanding. On the other hand, GPT-4 simplified pathology reports, increasing patient comprehension scores (7.98 vs 5.23/10, P<.001) and reducing consultation time by 70%. However, AI replies were sometimes less concise or less readable for low-literacy patients. In pooled analyses (k=4 studies; total evaluations N=2604), LLM assistance showed a large positive effect on empathy (standardized mean difference 1.02, 95% CI 0.44-1.60; random-effects model). Patient satisfaction results were mixed. No study directly assessed long-term trust. Current evidence suggests that LLM-based chatbots can enhance physician-patient communication by producing more empathetic, detailed, and understandable responses. These improvements may positively influence patient experience and engagement. However, LLMs may also generate overly lengthy or occasionally inaccurate advice, emphasizing the need for physician oversight. While meta-analytic findings are promising, robust randomized controlled trials, real-world and longitudinal studies are needed to confirm benefits, assess trust outcomes, and define optimal clinical integration strategies.

Richter S
Buszello CH
Prem M
Willkommen S
Hasani E
Uckermann O
Juratli TA
Eyüpoglu IY
Polanski WH

Physician-Patient Relations
Humans
Large Language Models
Artificial Intelligence
Communication
Empathy
Generative Artificial Intelligence