The goal of this meta-analysis intended to identify the efficacy of platelet-rich plasma (PRP) alone or in combination with low intensity shock wave therapy (Li-SWT) as a therapy for erectile dysfunction (ED).

This study integrated and analyzed the data using Cochrane method and GRADEpro GDT grading system. The registration number for this study was CRD42024618240.

Seven randomized controlled trials with 660 patients were analyzed. The results indicated that compared with the control group, IIEF score of patients in the PRP group improved significantly at 12-week (p = 0.03) and 24-week (p = 0.0004), while there was no significant difference at 4-week. The PRP group had no significant advantages over the control group in terms of MCID and SEP Q3. For peak systolic velocity, patients in the PRP group demonstrated greater improvement than those in the control group (p < 0.00001). Subgroup analysis revealed that adding PRP regimen can considerably improve IIEF scores of ED patients compared to using Li-SWT alone (p < 0.0001).

PRP demonstrated a better efficacy in treating ED, especially during a follow-up period of 6 months. Compared with using Li-SWT alone, the addition of PRP can considerably improve the IIEF score of ED patients. These findings still required large-scale clinical trials for verification.

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age that significantly impacts their reproductive health. Acupuncture and its combined therapies may have beneficial effects on the endocrine and metabolic states of women with PCOS. This systematic review and meta-analysis evaluated the treatment effects and potential mechanisms of acupuncture and its combined therapies compared to oral metformin in treating PCOS patients.

The evaluation focused on three sets of outcomes: hormonal indicators, metabolic indicators, and body weight indicators. Studies that involved additional therapies beyond the specified interventions or included patients with other diseases were excluded. Additionally, data mining methods were used, including frequency statistics to analyze the frequency of acupuncture points and the meridians involved, and the Apriori algorithm to perform association rule analysis for the most effective interventions.

The study included 46 articles (51 studies) involving six interventions: acupuncture combined with metformin, acupuncture treatment, acupuncture with Chinese herbal medicine and metformin, acupuncture with Chinese herbal medicine, acupuncture combined with cupping, and auricular acupuncture combined with metformin showed significant improvements in all evaluated indicators. Data mining revealed the Stomach meridian of foot yangming was the most frequently used, and the most commonly used combination of points included CV4, SP6, and ST36.

This study suggests that acupuncture and its combined therapies may benefit PCOS. However, risk of bias and heterogeneity observed were noted. Future high-quality, rigorously designed randomized controlled trials are needed to confirm these findings and provide stronger clinical recommendations for acupuncture in PCOS treatment.

To evaluate the efficacy and safety of intensive blood pressure control in patients over 60 years.

Databases including PubMed, Embase and Cochrane library were searched from inception through February 1, 2024. Randomized controlled trials evaluating the efficacy or safety of intensive blood pressure control in patients over 60 years were included in the meta-analysis.

Intensive blood pressure control in individuals with mild hypertension has been shown to reduce the risk of heart failure, stroke, myocardial infarction, major cardiovascular events, cardiovascular mortality, and all-cause mortality. The benefits of intensive blood pressure control in patients with moderate to severe hypertension are comparable to those observed in individuals with mild hypertension, with the exception of a reduced impact on all-cause mortality and cardiovascular mortality. Compared with maintaining systolic blood pressure (SBP) above 140 mmHg, SBP below 140 mmHg is associated with a decreased risk of major cardiovascular events in patients aged over 70, as well as a reduced risk of stroke in patients aged 60-69. Furthermore, compared to maintaining SBP above 130 mmHg, SBP below 130 mmHg is linked to a lower risk of major cardiovascular events, heart failure and myocardial infarction in patients over 60, a reduced risk of stroke and cardiovascular mortality in patients aged 60-69, and a decreased risk of all-cause mortality in patients over 70. However, a lower baseline blood pressure or more aggressive blood pressure control may be associated with an increased risk of hypotension.

Patients with hypertension aged over 60 years can derive benefits from intensive blood pressure management without experiencing significant adverse events, aside from hypotension.

The comparative effects of phototherapy and topical therapy in patients with vitiligo remain unclear. A network meta-analysis (NMA) was conducted to assess which combination therapy was more beneficial for patients with vitiligo.

This study analyzed phototherapy, including narrowband ultraviolet B (NB-UVB) and 308-nm excimer laser/light (EL) combined with topical therapies. Randomized controlled trials were sourced from PubMed, Embase, and Cochrane Library. Data analysis was based on a random-effects model, and surface under the cumulative ranking (SUCRA) curves employed to assess the efficacy of the interventions.

This NMA included 27 trials, with a total of 2417 lesions (patches). According to the results of the SUCRA, for achieving ≥50% repigmentation, the top three combination therapies were phototherapy combined with antioxidants (SUCRA 87.7), corticosteroids (SUCRA 69.6), and calcineurin inhibitors (SUCRA 52.5), while for ≥75% repigmentation, the leading therapies were phototherapy combined with antioxidants (SUCRA 89.0), calcineurin inhibitors (SUCRA 70.3), and fractional CO2 laser (SUCRA 63.6).

This meta-analysis suggests that combining phototherapy with topical antioxidants, corticosteroids, or calcineurin inhibitors may offer superior outcomes for vitiligo patients. This study provides a reference for clinicians to develop personalized treatment plans for patients with vitiligo.

To compare the effects of laparoscopic sleeve gastrectomy (LSG) with antrum preservation (AP) and antrum resection (AR) on weight loss and postoperative complications.

A meta-analysis of randomized controlled trials (RCTs) followed PRISMA guidelines. The databases searched included PubMed, Web of Science, Embase Medline, and the Cochrane Library up to October 2022. Extracted data included operation time, hospital stay, excess weight loss, total weight loss, body mass index (BMI), weight, and complications.

Eleven RCTs were included with 843 patients: 422 with AR and 421 with AP. The AR group exhibited higher total weight loss at 3 months (p = 0.02), 6 months (p < 0.001), and 1 year (p < 0.001) postoperatively. They also showed greater excess weight loss at 6 months (p < 0.001), 1 year (p < 0.001), and 2 years (p = 0.03). BMI reduction was more significant in the AR group at 3 (p = 0.007) and 6 months (p < 0.001). The AR group lost weight more rapidly at 3 months (p = 0.05), 6 months (p = 0.04), and 1 year (p < 0.001). No significant differences were found in operation time, hospital stay, bleeding, staple line disruption, Clavien-Dindo complications, or remission rates of diabetes, hypertension, arthritis/back pain, hyperlipidemia, or gastroesophageal reflux disease (p > 0.05).

LSG with AR offers better short-term weight loss than AP without increasing surgical complications, but the long-term effects and complications need further investigation in larger RCTs.

Although compound glycyrrhizin (CG) has been widely used to alopecia areata (AA) in China, its efficacy and safety remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of CG for AA.

Eight literature databases were retrieved from their inceptions to 29 February 2024 to identify the eligible randomized controlled trials comparing CG plus conventional treatments with conventional treatments alone for the treatment of AA. Risk ratio (RR), mean difference and 95% confidence interval (CI) were used to estimate the pooled results. RevMan 5.4 (Cochrane Collaboration, Copenhagen, Denmark) and Stata 12.0 software (StataCorp., College Station, TX) were used for statistical analysis.

A total of 23 eligible studies with 2219 patients were included. The pooled results revealed that CG plus conventional treatments was superior to conventional treatments alone in cure rate (RR = 1.60, 95%CI [1.47, 1.74], p < .001), total efficacy rate (RR = 1.37, 95%CI [1.29, 1.45], p < .001) and the Severity of Alopecia Tool (SALT) score, regardless of different conventional treatments, treatment courses and doses of CG. In terms of safety, a few patients suffered from adverse events (AEs), including oedema, elevated blood pressure and gastrointestinal tract discomfort, and the incidence of oedema was higher in the patients receiving CG (RR = 2.53, 95%CI [1.04, 6.19], p = .04).

The combination of CG and conventional treatments was effective and safe for patients with AA, and CG could promote hair regrowth with mild AEs.

The results of randomized controlled trials (RCTs) evaluating the effect of vitamin D on the prevention of acute respiratory tract infections (RTIs) are conflicting. The aim of this study was to assess the level of evidence for the efficacy of vitamin D in preventing acute RTIs by performing a sensitivity analysis of the meta-analysis carried out by Jolliffe and al., using the Rebuild the Evidence Base (REB) method.

The main inclusion criteria were double-blind, placebo-controlled, open-label RCTs. The exclusion criteria were RCTs in which vitamin D was associated with other nutrients and unpublished RCTs. The primary outcome was the number of people who had at least one RTI, including upper and lower RTIs. A bias analysis was performed of the included RCTs, followed by a hypothetico-deductive analysis to determine whether they were confirmatory or exploratory. Then, we used the REB method to determine the level of evidence for the effectiveness of vitamin D in preventing RTIs.

The main meta-analysis included 25 RCTs with a low risk of bias, involving 41 847 people. There was no significant difference between groups in the number of patients who had at least one RTI. According to the REB, there was a lack of evidence when assessing the effectiveness of vitamin D in preventing RTI.

According to the REB, the analysis of the RCTs, considering the risk of bias, showed that there is a lack of evidence to justify the prescription of vitamin D for the preventing of RTIs.

Meta-analysis assesses the safety and efficacy of Tranexamic Acid (TXA) in patients with hip fracture surgery compared to placebo.

On September 28, 2023, qualified RCT studies, including randomized control trials and cohort study, of intravenous Tranexamic Acid (TXA) in patients undergoing hip fracture surgery was searched. Review Manager was used for the meta-analysis.

The TXA group had significantly lower intraoperative total blood loss and overall blood loss across eighteen investigations. The blood transfusion rate in the TXA group was lower than that in placebo group. TXA maintained higher hemoglobin levels on the postoperative first and third day. TXA did not raise any possible complication or problems such as deep vein thrombosis, pulmonary embolism, and mortality.

The TXA treatment in patients undergoing hip fracture surgery reduced intraoperative blood loss, overall blood loss, transfusion rate, and length of hospital stay effectively and appeared to be safe to use without significant complication or problems.

This study assessed the impact of radiotherapy (RT) techniques on chronic skin reactions and health-related quality of life (HRQoL) in breast cancer patients, comparing conventional RT with modern techniques such as intensity-modulated RT (IMRT).

A comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL from inception to April 26, 2024. Conventional RT, which uses 2D or 3D imaging to shape radiation beams without dynamic intensity modulation, was compared with alternate RT techniques for adjuvant breast cancer treatment. Primary outcomes included chronic grade ≥ 2 skin toxicities (hyperpigmentation, breast fibrosis, telangiectasia, edema, and atrophy/retraction) and HRQoL, assessed mainly with EORTC QLQ-C30 and QLQ-BR23 modules. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.

From 1305 screened studies, nine articles representing seven studies (2418 patients), including three randomized controlled trials, met inclusion criteria. Most studies used conventional fractionation (45-50 Gray in 25 fractions). IMRT was associated with a lower incidence of chronic grade ≥ 2 hyperpigmentation (RR: 0.39, 95%CI: 0.17-0.89, I2 = 0%) compared to conventional RT. No significant differences were found for grade ≥ 2 breast fibrosis, telangiectasia, edema, and atrophy/retraction. Cosmetic outcomes from IMRT were favorable in the short term, with no long-term differences. Three studies reported no significant HRQoL differences between IMRT and conventional RT.

IMRT may reduce certain chronic skin toxicities compared to conventional RT. However, consistent long-term differences in cosmetic outcomes or HRQoL were not observed. These findings are limited by the small number of studies and variability in reporting standards.

Acute kidney injury (AKI) is a frequent complication of cardiac surgery, contributing to increased morbidity, longer hospital stays, and higher mortality. Evidence suggests amino acid (AA) supplementation may enhance renal blood flow and glomerular filtration rate (GFR), potentially reducing AKI risk; however, findings remain inconclusive. This study evaluated the efficacy of perioperative AA supplementation in preventing AKI and related complications post-cardiac surgery.

PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing AA supplementation versus standard care in preventing cardiac surgery-associated AKI. Main outcomes included AKI incidence (defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria), 30-day mortality, and renal replacement therapy (RRT) requirement. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Statistical significance was set at p < 0.05. The certainty of the evidence (CoE) was assessed using the GRADE approach.

Six RCTs involving 4501 cardiac surgery patients were included. AA mixture interventions significantly reduced the risk of AKI stage 1 (RR: 0.56; 95% CI: 0.77-0.96; p = .009; CoE: Moderate) and Stage 3 (RR: 0.53; 95% CI: 0.34-0.83; p = .005; CoE: Moderate), but not stage 2 (RR: 1.24; 95% CI: 0.60-2.55; p = .568; CoE: Low). Preliminary findings from glutamic acid and glutamine (single AA interventions) showed potential benefits in reducing AKI incidence (CoE: Very low) and improving surrogate biomarkers, respectively. No significant effects were observed on mortality or RRT incidence for any intervention.

AA mixtures likely reduce AKI incidence following cardiac surgery but show limited effects on mortality and RRT. Further trials are needed to confirm the benefits of glutamic acid and glutamine supplementation.

Use of amino acid supplementation for the prevention of acute kidney injury after cardiac surgery may be effective, but more trial data and confidence in a beneficial effect is needed for this to be implemented in everyday clinical practice.

Deficits in executive functioning are a common consequence of Traumatic Brain Injury (TBI) and the severity of TBI is known to predict functional outcomes. In this review, the authors examine the ability of three commonly used tests of executive functioning [The Trail Making Test (TMT-B), The Wisconsin Card Sorting Test (WCST), and Verbal Fluency (VF)] to predict domains of function.

Seven hundred and twenty articles were identified and twenty-four met inclusion criteria (original articles published in English examining an adult TBI population). Data were subject to a study quality analysis and then meta-analyzed to assess whether tests of executive functioning (TMT-B, WCST, and VF) can predict functional, employment, and driving outcomes following a TBI.

The TMT-B (r = 0.29; 95% CI 0.17-0.41) and the WCST (r = 0.20; 95% CI 0.02-0.37) were significantly associated with functional outcomes. The TMT-B was also associated with a person's ability to return to driving (r = 0.3890; 95% CI 0.2678-0.5103). No test of executive functioning was associated with employment outcomes following a TBI.

These findings are important to guide rehabilitation strategies and future planning. This review has also highlighted the scarcity of research on specific outcomes.

Effective treatments for post-traumatic stress disorder (PTSD) have been established, but their applicability in complex post-traumatic stress disorder (CPTSD) is largely unknown.

We searched Pubmed, Web of Science, PsycInfo, Embase, CNKI, wanfang data, and SinoMed databases to seek out studies assessing the impact of psychological therapies on CPTSD among individuals with complex trauma. The quality of studies was assessed using the Cochrane Risk of Bias tool, and the moderating influence of study characteristics on the effect was examined.

The pooled effect of psychotherapies compared with the control groups was significant, with PTSD (k = 27, g = -1.16, 95 % CI: -1.49 to -0.82), depression (k = 23, g = -1.12, 95%CI: -1.47 to -0.75), anxiety (k = 13, g = -1.25, 95%CI: -1.82 to -0.68), and dissociation (k = 7, g = -0.47, 95%CI: -0.74 to -0.19). At follow-up, the effect sizes decreased slightly, but there was still significant remission of symptoms except for anxiety and dissociation symptoms. Subgroup analysis and meta-regression showed that participants with childhood trauma had lower effects than those with other trauma types, and risk of bias and female proportion were the moderators. There were some indications of publication bias.

Psychological interventions for CPTSD showed significant effects after the intervention, and the effect was largely maintained during follow-up. Future studies could investigate how interventions can be further optimized and tailored to suit individuals' performance.

Tranexamic acid (TXA) use has become the gold standard in total joint arthroplasty to limit intraoperative blood loss and transfusion rates. More recently, the indications for TXA have expanded to knee and shoulder arthroscopy with promising early results. However, the effectiveness of TXA during arthroscopic rotator cuff repair (RCR) is unclear. Therefore, the purpose of this study was to investigate perioperative outcomes following the use of TXA during RCR.

A systematic review was performed via the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, MEDLINE, Embase, and Cochrane databases in November 2024. Studies were assessed for quality of visual clarity, operative time, mean arterial pressure (MAP), volume of arthroscopy irrigation used, arthroscopic pump pressure, and clinical outcomes.

A total of 12 clinical trials involving 999 patients were included. 9 studies reported on visual clarity and 6 of these reported improvements in visual clarity with TXA administration. Four studies reported improvements in postoperative pain, however outcomes varied greatly depending on when follow-up assessment occurred. A majority of studies did not report differences in operative time, irrigation volume, or postoperative swelling. There were no venous thromboembolism events reported in the included studies.

TXA dosing during RCR surgery may improve visual clarity, however its effect on other perioperative outcomes remains unclear.

Level I.

Clinical data comparing intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI for chronic total occlusions (CTOs) are limited. This study aimed to compare clinical outcomes of IVI-guided versus angiography-guided PCI in patients with CTOs. A systematic review and meta-analysis were conducted to identify randomized controlled trials (RCTs) comparing IVI-guided with angiography-guided PCI in CTO populations. The primary endpoint was the incidence of major adverse cardiac events (MACE), a composite of death/cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary outcomes included the individual components of MACE. A prespecified subgroup analysis was performed for intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Five RCTs, including 1,296 patients, were analyzed, with 713 (55%) undergoing IVI-guided PCI. Over 1 to 3 years, MACE was significantly lower in the IVI-guided PCI group (7.2% vs 13%; relative risk [RR] 0.55; 95% confidence interval [CI] 0.35 to 0.88; p = 0.012; I² = 31%). In the secondary analysis, TVR incidence was lower in the IVI group (3.1% vs 6.7%; RR 0.52; 95% CI 0.29 to 0.97; p = 0.038). No statistical differences were observed for MI or death/cardiac death. In the IVUS subgroup, MACE was also lower in the IVI-guided PCI group (8.4% vs 14.3%; RR 0.59; 95% CI 0.37 to 0.91; p = 0.019). A trial sequential analysis suggested a low likelihood of type I error. In conclusion, IVI-guided PCI is associated with improved clinical outcomes compared with angiography-guided PCI for the treatment of CTOs.

Endometriosis is a common cause of chronic pelvic pain and lacks precise pathophysiological mechanisms. Advanced oxidation protein products (AOPPs), markers of oxidative stress and inflammation, are implicated in pain-related diseases and have been suggested to play a crucial role in endometriosis pathophysiology. We aim to assess the significance of AOPP in endometriosis by analyzing their levels across serum, follicular fluid, peritoneal fluid, and ovarian endometrioma tissue, and their association with different disease stages. A systematic review of articles published up to Nov 2024 examining AOPP levels in endometriosis patients compared to controls was conducted (PROSPERO: CRD42022343714). Using the Newcastle-Ottawa Scale (NOS), the quality and risk of bias of included studies were assessed, and publication bias was evaluated using Egger's and Begg's tests. The analysis 12 studies involving 561 control patients without endometriosis and 670 patients with endometriosis. Compared to controls, elevated AOPP levels were observed in endometriosis patients' serum and peritoneal fluid. Patients with type III/IV endometriosis exhibited higher AOPP levels in serum and plasma compared to control patients, suggesting a potential association with disease severity. The study underscores the potential of AOPP levels as biomarkers for endometriosis severity and proposes them as pharmacological targets for disease management, including pelvic pain treatment.

Androgen-receptor pathway inhibitors (ARPIs) have dramatically changed the management of advanced/metastatic prostate cancer (PCa). However, their cardiovascular toxicity remains to be clarified.

To analyze and compare the risks of cardiovascular events secondary to treatment of PCa patients with different ARPIs.

In August 2023, we queried PubMed, Scopus, and Web of Science databases to identify randomized controlled studies (RCTs) that analyze PCa patients treated with abiraterone, apalutamide, darolutamide, and enzalutamide. The primary outcomes of interest were the incidence of cardiac disorder, heart failure, ischemic heart disease (IHD), atrial fibrillation (AF), and hypertension. Network meta-analyses (NMAs) were conducted to compare the differential outcomes of each ARPI plus androgen deprivation therapy (ADT) compared to standard of care (SOC).

Overall, 26 RCTs were included. ARPIs were associated with an increased risk of cardiac disorders (RR: 1.74, 95% CI: 1.13-2.68, p = 0.01), heart failure (RR: 2.49, 95% CI: 1.05-5.91, p = 0.04), AF (RR: 2.15, 95% CI: 1.14-4.07, p = 0.02), and hypertension (RR: 2.06, 95% CI: 1.67-2.54, p < 0.01) at grade ≥3. Based on NMAs, abiraterone increased the risk of grade ≥3 cardiac disorder (RR:2.40, 95% CI: 1.42-4.06) and hypertension (RR:2.19, 95% CI: 1.77-2.70). Enzalutamide was associated with the increase of grade ≥3 AF(RR: 3.17, 95% CI: 1.05-9.58) and hypertension (RR:2.30, 95% CI: 1.82-2.92).

The addition of ARPIs to ADT increases the risk of cardiac disorders, including IHD and AF, as well as hypertension. Each ARPI exhibits a distinct cardiovascular event profile. Selecting patients carefully and vigilant monitoring for cardiovascular issues is imperative for those undergoing ARPI + ADT treatment.

Multiple sclerosis (MS) is a chronic disabling disorder with several features affecting muscle, mobility, gait, and balance performance. Home or community-based strength training (HCBST), alone or combined with other types of training, can be used to improve the aforementioned outcomes of interest. This systematic review and meta-analysis assessed the scientific evidence regarding the effects of HCBST on muscle, walking, mobility, and balance performances in patients with MS.

The Cochrane library, EMBASE, PEDro, Web of Science, and PubMed databases were searched. Randomized controlled trials were retrieved, and their risk of bias and methodological quality were evaluated using the Cochrane risk-of-bias tool and PEDro scale respectively. Qualitative and quantitative syntheses were used for data analysis.

The results revealed that, in patients with multiple sclerosis, HCBST combined with balance training significantly improved balance performance (standardized mean difference [SMD]= 1.08, P < 0.0001), postural sway (mean difference [MD] = -29.40, P < 0. 00001), physiologic fall risk (P = 0.02), physical activity (P < 0.00001), psychological impact of MS (P = 0.01), and satisfaction with life (P < 0.0001) compared with the control condition. Additionally, strength training (ST) alone significantly improved leg strength (SMD = 0.42, 95 % CI:0.01 to 0.84, P = 0.05), functional mobility (MD = -8.20, P = 0.01), waking speed (P < 0.00001), walking ability (p = 0.01) and physical fatigue (P = 0.03) compared with comparison groups.

In patients with MS, HCBST significantly improves leg strength, walking, mobility and physical fatigue; while HCBST combined with balance training significantly improved walking, balance, fall, physical activity and quality of life.

Several studies have demonstrated the positive impact of non-pharmacological Traditional Chinese Medicine (TCM) therapies on pain, fatigue, sleep quality, and quality of life in cancer survivors. However, no research has compared the effectiveness of these therapies. This study aims to compare various interventions and identify the most effective non-pharmacological TCM therapies to provide evidence-based recommendations for cancer survivors.

A systematic search was conducted in PubMed, Embase, Web of Science, CNKI, and Wanfang Data. RCTs investigating the effects of Taichi, Qigong, acupuncture, acupressure, TCM emotional therapy, and mixed therapies as interventions for cancer survivors were screened was conducted. Data from the creation of the database to February 2025 were included. Two independent reviewers evaluated the study quality. A Bayesian Network Meta-analysis was conducted to carry out a random effects model.

Seventy-one RCTs involving 6473 patients were included in the analysis. Network meta-analysis showed significance for all five intervention therapies in pain control in cancer patients. The best efficacy was observed for acupressure (SMD=-1.1 [-1.55, -0.66]) and Taichi/Qigong (SMD=-1.08[-1.64, -0.53]), followed by TCM emotional therapy (SMD=-0.93 [-1.42, -0.44]) and acupuncture (SMD=-0.54 [-0.93, -0.15]), with the latter showing comparatively lower efficacy. None of the interventions demonstrated superior efficacy in improving fatigue compared to the control group. Mixed therapies (SMD=-1.36[-2.56, -0.28]) demonstrated the greatest effect in improving sleep quality. Taichi/Qigong (SMD=1.87 [0.96, 2.83]) demonstrated certain advantages in improving quality of life. However, acupuncture and TCM emotional therapy had no significant effect on sleep quality or overall quality of life.

The evidence from this study suggests that acupressure and Taichi/Qigong are recommended as the most effective therapies for pain relief and quality of life improvement, respectively. The efficacy of these therapies for fatigue remains inconclusive. However, due to the limited number of included studies and the high risk of bias, these results should be interpreted with caution. Future studies should include more rigorously designed high-quality randomized controlled trials to confirm their long-term efficacy and safety.

PROSPERO CRD42024601976.

Oral lichen planus (OLP) is a relatively common immunological mucocutaneous disease that causes pain, burning sensations and poor quality of life. The use of low-level light therapy (LLLT) to treat OLP is still debated. This systematic review and meta-analysis aimed to systematically and quantitatively assess the efficacy of LLLT in the treatment of OLP.

The PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Web of Science electronic databases were searched up to February 28, 2023, to identify randomized controlled trials (RCTs) examining the use of LLLT in OLP patients reporting pain or other outcomes. The mean difference (MD) or log risk ratio (log RR) with 95% confidence intervals (CIs) were estimated separately for each outcome to determine the effect sizes. Subgroup analysis was used to detect the sources of heterogeneity. Sensitivity analysis was used to test the robustness of the pooled results. Funnel plots, Egger's test, and Begg's test were used to test publication bias. All the statistical analyses were performed using Stata 16.0 software. A graph of risk of bias was drawn using RevMan 5.4.1 software for the assessment of bias.

A total of twelve RCTs were included in this systematic review, 7 of which were also included in the meta-analysis. Among the included studies, 1 had a low risk of bias, whereas 7 had an unclear risk of bias. The meta-analysis results indicated that LLLT significantly improved long-term analgesic efficacy (over 12 weeks posttreatment, measured by the visual analogue scale; MD = -1.20, 95% CI -2.01 to -0.38, P < .001), whereas no significant changes were observed in either the short term (MD = -0.68, 95% CI -1.38 to 0.01, P = .05) or the medium term (MD = -0.89, 95% CI -1.96 to 0.17, P = .10). Furthermore, LLLT improved the clinical severity of lesions (as assessed by the biopsy sign scores or reticular atrophic erosive scores; MD = -1.13, 95% CI -1.62 to -0.63, P < .001) and reduced the recurrence rate (log RR = -1.34, 95% CI -2.30 to -0.37, P = .01). Additionally, there were no statistically significant differences in the clinical response rate (measured by efficacy indices; log RR = -0.12, 95% CI -0.37 to 0.13, P = .35). No adverse events related to LLLT were reported.

LLLT appears to alleviate pain, enhance the clinical outcomes of OLP lesions, and lower the likelihood of relapse in OLP patients. Future research should focus on longer intervention courses, larger sample sizes, and multidisciplinary intervention designs.

This meta-analysis was registered on PROSPERO (CRD42023384852).

The objective of this systematic review and meta-analysis was to assess the efficacy of melatonin in drug- or contrast-induced AKI in preclinical and clinical studies.

PubMed, Embase, Scopus, Web of Science (WOS), the Cochrane Database of Systematic Reviews (CDSR), and clinical trials.GOV from the beginning until August 1, 2024. On the basis of the inclusion and exclusion criteria, the articles were included by two independent researchers. Data regarding study design, patient characteristics, the number of patients with and without AKI, and the means and SDs of the serum creatinine and BUN levels were extracted from relevant studies. STATA version 17.0 was used to compute pooled measures of standardized mean differences, standardized mean differences, risk ratios and risk differences. I2 and chi-square tests were used to assess heterogeneity between studies. Funnel plots, Egger tests and the trim-and-fill method were used to evaluate small study effects (publication bias). The risk of bias of the included clinical and preclinical studies was assessed via the Cochrane ROB tool and SYRCLE tool, respectively. The credibility of the results was evaluated via GRADE. Sensitivity analysis was performed via the one-out removal method.

We identified 1,696 nonduplicate records, of which the full texts of 159 articles were examined. Twenty-nine animal experimental studies and 5 clinical trials met the inclusion criteria and were included in the review. The results of the meta-analysis confirmed that melatonin was significantly effective at reducing the serum creatinine level (standardized mean difference: - 3.04; 95% CI - 3.904 to - 2.183, with 95% prediction interval: - 7.201 to 1.163) and the BUN level (standardized mean difference: - 3.464; 95% CI - 4.378 to - 2.549, with 95% prediction interval: - 7.839 to 0.911) in drug-induced AKI animal studies. Melatonin did not have a significant effect on the serum creatinine level (standardized mean difference: - 2.67; 95% CI - 9.69 to - 4.35, with 95% prediction interval: - 42.618 to 37.278) or the BUN level (standardized mean difference: - 1.77; 95% CI - 5.533 to - 1.994, with 95% prediction interval: -22.943 to 19.404) in contrast-induced AKI animal studies. Furthermore, in clinical studies, melatonin had no significant effect on reducing the serum creatinine level (standardized mean difference: 0.183; 95% CI - 1.309 to 1.675, with 95% prediction interval: - 7.975 to 8.340), BUN level (standardized mean difference: 0.206; 95% CI - 0.0871 to 1.283, with 95% prediction interval: - 5.115 to 5.528) or risk of AKI incidence (risk ratio: 0.877; 95% CI 0.46 to 1.64, with 95% prediction interval: - 0.238 to 3.174; risk difference: - 0.06 mg/dl; 95% CI - 0.259 to 0.40 mg/dl, with 95% prediction interval: - 0.467 to 0.348). There were no significant publication biases, and after sensitivity analysis, no considerable changes were observed, indicating the robustness of the results.

This meta-analysis indicates that melatonin may protect against drug-induced AKI in animal models but is not effective in clinical studies and that melatonin has no significant effect on contrast-induced AKI. Owing to the inconclusive results in clinical trials and very low certainty of evidence, further research with higher methodological quality is needed to reach a more certain conclusion.

This study aimed to gather a compilation of intervention studies that address whether there are ways to get post-pubertal and adult tennis players of intermediate or higher level to enhance the velocity and accuracy of their groundstrokes. After searching Web of Science, Scopus, and SportDiscus, 10 articles were analyzed. Findings from training protocol studies revealed that strength endurance sessions or medicine ball throws do not significantly affect the speed or accuracy of serves, forehands, and backhands. Similarly, wristbands with small weights used during on-court training also did not impact performance, without compromising technical tennis skills. However, a 6-week strength training program involving medicine ball throws or heavier rackets improved forehand stroke speed but reduced hitting accuracy. Additionally, vision training improved accuracy and speed in forehands, accuracy in backhands, and both accuracy and speed in serves. High-intensity interval training that included hitting drills did not improve stroke accuracy and temporarily reduced stroke speed and efficiency during sessions, although it increased maximal aerobic power. Notably, the use of motor imagery during recovery periods in high-intensity-interval-training helped maintain on-court performance. Proper training periodization leads to better adaptations and improvements. The studies also identified that grunting was found to improve stroke speed during forehand and backhand strokes without affecting perceived exertion, oxygen consumption, or fatigue. Regarding supplementation, a 10-week creatine regimen did not significantly affect serve speed, forehand speed, or backhand speed. These findings aim to optimize tennis players' performance by identifying effective training strategies.

Type 2 diabetes mellitus and hypertension frequently coexist, increasing the risk of cardiovascular and renal complications. Urinary Albumin Creatinine Ratio (UACR) serves as a crucial predictor of these outcomes. While renin-angiotensin system inhibitors are often initial therapy, evidence suggests a potential role for Azelnidipine, a non-dihydropyridine calcium channel blocker, in reducing UACR, especially in cases of persistent proteinuria despite optimal therapy. However, conflicting results from existing studies necessitate a comprehensive systematic review and meta-analysis to clarify Azelnidipine's (AZL) efficacy in reducing UACR in people with type 2 diabetes mellitus and hypertension.

This meta-analysis, following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, included randomized controlled trials (RCTs) published until January 15, 2024. Studies involving individuals with type 2 diabetes mellitus and hypertension were included, comparing AZL or AZL-containing regimens with other antihypertensive agents. The primary outcome was changes in UACR, with secondary outcomes including alterations in Glycated Hemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), and estimated glomerular filtration rate (eGFR).

Six RCTs involving 731 participants were included. Meta-analysis revealed a significant reduction in UACR in the AZL group compared to controls (Mean Difference (MD) = -47.96; 95% Confidence Interval (CI): -79.56, -16.37; p = 0.003). AZL also significantly decreased HR (MD = -3.70; 95% CI: -6.66, -0.74; p = 0.01), while no significant changes were observed in HbA1c, SBP, DBP, or eGFR. Sensitivity analyses demonstrated the nuanced impacts of individual studies on results, highlighting the importance of careful interpretation.

This meta-analysis confirms AZL's efficacy in reducing UACR and HR in people with type 2 diabetes mellitus and hypertension.

Clinical investigation has shown that the addition of saffron or crocin to standard antidiabetic medications improves a patient's metabolic profile, oxidative stress (OS), and inflammatory response. Despite a large number of studies examining the impact of saffron supplementation on OS, inflammation, and renal and liver function parameters, no systematic review or meta-analysis has been conducted to compile the outcomes in patients with type 2 diabetes mellitus (T2DM).

The current systematic review and meta-analysis was performed to investigate the effect of saffron or crocin intake on OS, inflammation, and renal and liver function parameters in patients with T2DM.

Online databases including PubMed, Scopus, ISI Web of Science, and Cochrane Library were searched up to December 2023.

The mean differences and their respective SDs were extracted. Using a random-effects model, the pooled data were calculated as standardized mean difference (SMD) with 95% CI.

17 eligible randomized controlled trials were included in this meta-analysis. The pooled findings showed that saffron supplementation remarkably decreased the levels of tumor necrosis factor-α (SMD: -0.37; 95% CI: -0.69 to -0.05; I2 = 40.77%, P = .15), interleukin-6 (IL-6) (SMD: -0.38; 95% CI: -0.65 to -0.10; I2 = 0%, P = .68), and malondialdehyde (MDA) (SMD: -0.36; 95% CI: -0.65 to -0.07; I2= 20.51%, P = .02) compared with the control. In addition, based on subgroup analyses, taking ≥100 mg of saffron daily in individuals with T2DM reduced the serum levels of IL-6 (SMD: -0.50; 95% CI: -0.90 to -0.10; I2 = 0%, P = .50) and MDA (SMD: -0.36; 95% CI: -0.68 to -0.03; I2 = 0, P = .97). Furthermore, the level of alanine transaminase was decreased (SMD: -0.43; 95% CI: -0.73 to -0.12; I2 = 0, P = .66) with a treatment period of <60 days of saffron or crocin supplementation.

Larger studies with more follow-up and higher doses of both saffron and crocin are needed in order to understand the efficacy and safety of these herbs for long-term use as routine therapies.

PROSPERO registration no. CRD42023458119.

Upper limb fractures in children are often managed in casts. Waterproof casts which allow safe immersion in water may be used. These may improve comfort, convenience, and satisfaction when compared with standard casts. The aim of this review was to compare the efficacy, safety, and satisfaction of waterproof casts with standard casts in the management of upper limb fractures in children.

A systematic review of randomized controlled trials (RCTs) was conducted in September 2024. Comprehensive searches of Medline, PubMed, Cochrane CENTRAL, and EMBASE databases were performed. Studies were included which recruited children aged 0 to 18 years with upper limb fractures, which were managed in waterproof or standard casts. Patient-reported outcomes, functional outcomes, and complication rates were assessed.

A total of five studies involving 390 children were included. Those managed with a waterproof cast reported significantly superior satisfaction with regard to comfort (mean difference (MD) 1.92 (95% CI 0.15 to 3.69); p = 0.034), itchiness (MD 0.21 (95% CI 0.00 to 0.43); p = 0.047), and overall child and parent satisfaction (MD 0.53 (95% CI 0.01 to 1.05); p = 0.048). Those managed with a waterproof cast also had significantly improved functional outcomes as measured by the Activities Scale for Kids-Performance (ASK-P) score, with a MD of 16.90 (95% CI 6.87 to 26.93; p = 0.001). There were no significant differences regarding heat or sweatiness, pain, return to recreational activities, unexpected returns for cast maintenance, radiological deformity, or skin problems.

Waterproof casts seem to provide an alternative to standard casts in the management of upper limb fractures in children. There were improved functional outcomes at the time of removal of the cast, improved comfort, and less itching. Pooling of the studies was limited due to the heterogeneity of the reporting of outcomes and the small sizes of the studies. Neither long-term outcomes, nor economic analysis based on healthcare-related quality of life, are available. A definitive RCT based on a core outcome set is required to confirm the efficacy and investigate the cost-effectiveness of waterproof casts in children.

The perinatal period, spanning from pregnancy through the first year after childbirth, is characterized by significant physiological, psychological, and socio-contextual changes. Women face complex stressors including psychosocial pressures, financial constraints, interpersonal dynamics, anticipatory stress related to parenthood, hormonal fluctuations, and societal expectations. These factors collectively influence the perinatal experience, increasing vulnerabilities and stress levels.

A systematic review was conducted in October 2023 using PubMed, SPORTDiscus, PsycInfo, and Scopus databases. Only English-language publications were included. For the meta-analysis, only randomized controlled trials (RCTs) using the Edinburgh Postnatal Depression Scale (EPDS) were considered. Data extraction was performed independently by two reviewers using Covidence, focusing on study characteristics, population demographics, interventions, and outcomes.

The initial search identified 2,373 articles, with 1,196 duplicates removed, leaving 1,177 articles. After screening titles and abstracts, 1,247 were excluded for not meeting the inclusion criteria, resulting in 30 full-text articles reviewed for eligibility by two researchers. Nineteen studies were included in the systematic review, with four in the meta-analysis. Results indicated that higher levels of physical activity during pregnancy were consistently associated with improved postpartum mental health outcomes, including reduced depressive symptoms, lower anxiety, and enhanced overall well-being. Low-intensity exercises, such as yoga, were particularly effective in reducing postpartum depressive symptoms. The impact of moderate-intensity exercise varied, with some studies showing no significant effects. The meta-analysis of four RCTs using the EPDS demonstrated a significant reduction in depression and anxiety symptoms among postpartum women who participated in physical activity interventions, with a substantial overall effect size.

Developing physical activity and exercise regimens encompassing a range of intensities can address the unique physiological and psychological demands of the perinatal period, maximizing the therapeutic benefits of physical activity interventions.

Previous studies have led to conflicting results regarding the effect of walnut consumption on glycemic control, and anthropometric indices. This study aimed to evaluate the efficacy of walnut consumption on serum levels of fasting blood sugar (FBS), fasting insulin, hemoglobin A1C (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), weight and body mass index (BMI) through a systematic review and meta-analysis of randomized controlled trials (RCTs).

PubMed, Scopus, Web of Science, and the Cochrane databases were searched up to February 2023. Weighted mean difference (WMD) was analyzed using random effects models to assess the overall effect.

A total of thirty-two RCTs were included in the systematic review and meta-analysis. Walnut supplementation was found to significantly reduce HOMA-IR (WMD = -0.29; 95% CI: -0.57, -0.01, P = 0.04), and body weight (WMD = -0.14 kg; 95% CI: -0.24, -0.04; P = 0.008). However, the meta-analysis showed that walnut supplementation did not have a significant effect on FBS (WMD = 0.62 mg/dL; 95% CI: -0.66, 1.91; P = 0.34), insulin levels (WMD = 1.27 mIU/ml; 95% CI: -0.59, 3.14; P = 0.18), HbA1C (WMD = 0.00%; 95% CI: -0.09, 0.10; P = 0.95), and BMI (WMD = -0.10 kg/m2; 95% CI: -0.40, 0.20; P = 0.50).

In conclusion, this study found a significant reduction in HOMA-IR levels and body weight with walnut supplementation, while other glycemic markers, and obesity-related indices did not change significantly. Future well-designed trials are needed to confirm these results.

A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding precise indications for ORIF remain unclear and non-uniform. We aimed to refocus the debate regarding the optimal treatment for CFs by identifying the recent indications for ORIF in the literature and assessing the quality of the existing evidence for each indication. This systematic review searched Medline, Embase and the Cochrane Central Register of Controlled Trials for eligible studies. The included studies consisted of articles from the past 15 years involving patients with any type of CF who underwent ORIF based on specified indications. From 4711 papers, 100 studies were included. In these, 121 indications were identified. The most cited indications for ORIF were those proposed by Zide and Kent, namely displacement/angulation ≥10° and ramus height shortening of ≥2 mm. Evidence supporting these indications is weak, relying mainly on expert opinion rather than robust data, with a focus on treatment comparisons. Clear, evidence-based cutoffs regarding when ORIF is the only viable treatment option are needed for a consensus.

The development of liposomal bupivacaine (LB) as an anesthetic was widely lauded due to the potential benefits this drug claimed to carry. This systematic review and meta-analysis aimed to assess the efficacy of LB versus standard bupivacaine (SB) in improving postoperative outcomes, including pain scores and morphine use.

PubMed, Cochrane CENTRAL, Web of Science, and MedLine databases were searched until April 2024. All trials evaluating the efficacy of LB versus SB in abdominal surgeries like colorectal procedures, bariatric surgeries, and hemorrhoidectomy were included. Data analysis was conducted in Review Manager employing a random-effects model.

Eight clinical trials with 810 patients were included. No statistically or clinically significant result was obtained on using LB over SB in reducing postoperative pain score on postoperative day 0 (POD0) (mean difference (MD) = -0.19, [95% confidence interval (CI): -0.91, 0.53]; p = 0.60), POD1 (MD = -0.11 [95% CI: -1.12, 0.91]; p = 0.84), POD2 (MD = -0.18 [95% CI: -0.57, 0.22]; p = 0.22), and POD3 (MD = 0.01 [95% CI: -0.55, 0.22]; p = 0.57). Additionally, there was no reduction in morphine use in PODs 0-3, time to ambulation, hours to postoperative flatus, or length of hospital stay between the groups.

Our findings showed that LB is not superior to SB in the surgical plane for individuals undergoing abdominal procedures.

Various invasive and non-invasive treatment modalities have been performed for the treatment of Myofascial pain dysfunction syndrome (MPDS). Topical agents may be effective with minimal disadvantages, and can be the first line of non-invasive treatment option in the management of MPDS. This systematic review was done to evaluate the safety and effectiveness of topical agents and patches in the management of pain associated with MPDS as a non-invasive management option. According to PRISMA guidelines, the PubMed, Embase, Web of science and Cochrane engine databases were searched for clinical trials which were published till July 2023. A total of 5 articles met the study inclusion criteria. Data were extracted from these studies and a qualitative analysis was performed. Topical agents in forms of ointment, gels and patches was found to improve the pain symptoms along with better quality of life and range of motion in patients with MPDS. This systematic review showed that topical interventions provide a non-invasive option for pain management in MPDS, demonstrating efficacy compared to placebo with a favorable safety profile. However, direct comparisons with invasive methods are limited and further studies directly comparing topical and invasive interventions are needed before establishing them as a first-line treatment.

Prior studies have demonstrated the dual-layer stent (DLS) was associated with encouraging results in carotid revascularization. This meta-analysis aimed to study the comparative efficacy between DLS and single-layer stent (SLS).

The studies were retrieved from PubMed, Embase, and Scopus up to June 2023. The methodological evaluation was performed using the corresponding scale. Pooled analysis was conducted using R Studio to calculate the effects, including odds ratio (OR) and mean difference (MD). Heterogeneity among results was assessed using the I2 statistic. Sensitivity analysis and subanalysis were also performed.

In this meta-analysis, nine articles comprising 1,127 patients who underwent carotid stenting (606 with DLS) were studied. No significant difference between DLS and SLS was found in stroke (at 30 days DLS: 4/555 vs. SLS: 11/496; OR 0.38, 95% confidence interval [CI] 0.14-1.03; at 12 months DLS: 1/249 vs. SLS: 4/152; OR 0.21, 95% CI 0.03-1.36), death (at 30 days DLS: 3/526 vs. SLS: 0/467; OR 0.80, 95% CI 0.20-3.11; at 12 months DLS: 5/249 vs. SLS: 3/152; OR 1.12, 95% CI 0.25-5.03), stroke/death (at 30 days DLS: 6/526 vs. SLS: 11/467; OR 0.43, 95% CI 0.16-1.17; at 12 months DLS: 6/249 vs. SLS: 7/152; OR 0.52, 95% CI 0.17-1.61), new lesions (DLS: 56/202 vs. SLS: 96/254; OR 0.62, 95% CI 0.28-1.40), lesion count (MD = -0.24, 95% CI -0.82-0.34), lesion diameter (MD = -0.03, 95% CI -1.21-1.15), in-stent restenosis (ISR; DLS: 5/204 vs. SLS: 8/190; OR 0.61, 95% CI 0.21-0.74) and acute thrombosis (DLS: 4/146 vs. SLS: 1/122; OR 2.03, 95% CI 0.31-13.26). Subgroup analysis indicated that CGuard and Casper had shown similar efficacy in preventing stroke, death, and new brain lesions.

DLS has shown comparable prognoses to the first-generation stent concerning stroke, stroke/death, new magnetic resonance imaging lesion incidence, lesion count, lesion diameter, ISR and acute thrombosis. Further randomized trials are warranted to demonstrate whether patients with high-risk carotid plaques can benefit significantly from DLS.

Direct oral anticoagulant (DOAC) agents are established as the anticoagulation strategy of choice for a variety of clinical risks. Despite this, uncertainty still exists with regard to their efficacy and safety for the prevention of stroke and systemic embolism in some patient populations; most notably those with low body weight (LBW) (<60 kg or body mass index [BMI] <18 kg/m2). Currently, there is a paucity of trial and non-trial data to support a prescriptive recommendation for their use in these patient cohorts. We have carried out a pooled systematic review of the most up to date published data of patients stabilized on various DOAC analogs with the view to ascertaining the exact matrices of their efficacy and safety in these cohorts of patients.

We initially carried out a comprehensive search of databases from inception to June 2023 for eligible studies exploring the efficacy and safety of various analogs of direct oral anticoagulants in patients with atrial fibrillation who had low body weight. Databases accessed include PubMed, EMBASE, the Science Citation Index, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effectiveness. We carried out a weighted comparison of derived pooled odd ratios (with their corresponding confidence intervals) of mortality outcomes between various DOACs using the random effects model.

Thirteen studies (n = 165,205 patients) were included in our meta-analysis. DOAC analogs were associated with increased stroke-related events, composite outcome, and mortality in low body weight patients compared to non-low body weight patients (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.17-1.92), (OR 1.55, 95% CI 1.29-1.86), (OR 2.92, 95% CI 1.87-4.58), respectively. There was no significant difference in the safety outcome (major bleeding events) between the DOAC analogs (OR 1.19, 95% CI 0.93-1.52).

In this meta-analytical review comprising both real-world and randomized controlled studies, the use of DOAC analogs in low body weight patients (body weight of <60 kg or BMI<18 kg/m2) with atrial fibrillation was associated with increased risks of stroke-related events, composite outcomes, and mortality compared to non-low body weight cohorts patients. At the same time, there was no significant difference in terms of major bleeding events. This finding has provided the first resolution of pervading uncertainty surrounding the use of DOAC analogs in these patient cohorts and suggests the need for follow-up confirmatory systematic studies in this group of patients.

Emotions significantly impact decision-making, teamwork, stress management, and resilience in high-pressure occupations such as the military, emergency services and competitive sports, making effective emotion regulation (ER) essential to performance and mental health. However, there are considerable knowledge gaps about ER in active-service military populations, particularly regarding the measures used to quantify ER, the variables studied, and identified relationships. Synthesising this literature is critical to progressing the ER research toward realistic solutions to enhancing performance and mental health in this population. This systematic review aimed to explore measurement tools, the variables examined alongside ER, and the relationship between ER and performance and military variables in active-service military personnel. Preregistered (PROSPERO; CRD42023358657) and adhering to PRISMA guidelines, this review focused on English peer-reviewed publications on ER or coping strategies in active-service military populations without date restrictions. Scopus, Web of Science, Military database, Medline and PsycINFO were last searched on 12/10/2022. Two reviewers screened studies, conducted data extraction and risk of bias assessment. A tabular synthesis method was used to systematically organise study details, ER measures, strategies, performance and military variables, outcomes, and quality. The literature search yielded 5780 studies, 46 of which were deemed relevant. The review identified 17 measurement tools, with the Coping Orientation to Problems Experienced Inventory (COPE) and Emotion Regulation Questionnaire being the most used. Psychological factors such as personality, resilience, and stress were most frequently examined (54%), while performance variables were studied in 3 (6.5%) and military variables in 6 (13%) of the source studies. Of the 10 performance and military variables examined, 50% were identified as being at high risk of bias, 30% moderate risk and 20% low risk. This review highlights a scarcity of published research on ER and performance and military variables in active-service military members. Overall, studies suggest that ER may be associated with performance and military variables in varying contexts and capacity. The review examines the implications of these relationships in detail. However, these studies vary in quality, the measurement tools used, and the variables assessed alongside ER, making synthesis challenging. The high risk of bias identified suggests that the relationships with ER should be interpreted with caution. This review suggests a link between ER and performance and military outcomes, however further research is needed to understand this nuanced relationship in the military context.

Radiotherapy quality assurance (RTQA) is a critical aspect of randomized controlled trials (RCTs) and is associated with validity and reproducibility of the study findings. We conducted a systematic review and meta-analysis to assess the impact of RTQA results in contemporary RCTs on patient outcomes.

We searched MEDLINE and CENTRAL from January 2010, to April 2024, for papers that report on the impact of RTQA on patient outcomes in contemporary RCTs. We conducted random-effects meta-analyses to examine the association of radiotherapy protocol deviations with overall survival (OS), progression free survival (PFS), and locoregional recurrence (LR).

Of 2,723 citations, 16 publications reporting on 13 RCTs were included across various disease sites. Of 7,170 total randomized patients across 1,076 institutions in over 25 countries, 5,560 patients had radiotherapy quality data and were included in RTQA analyses. Most included RCTs (7/12; 58 %) conducted exclusively retrospective RTQA after treatment completion. Our meta-analyses found that protocol deviations may be associated with worse OS [HR = 1.65 (95 % CI: 1.23-2.22; p < 0.001)] and PFS [HR = 1.79 (95 % CI: 1.00-3.21; p = 0.03)]. No significant association was demonstrated between protocol deviations and LR [HR = 2.09 (95 % CI: 0.85-5.15; p = 0.108)].

Quality of radiotherapy continues to have an important, measurable impact on patient outcomes in oncology RCTs, and rigorous, real-time RTQA procedures may diminish these effects by standardizing RT. Future trials should provide patient outcome data in relation to RTQA and continue to report on the effect of protocol deviations in the context of modern RT techniques.

Chemotherapy-induced peripheral neuropathy (CIPN) affects up to 80% of patients undergoing cytotoxic chemotherapy. This painful condition significantly impairs quality of life and often necessitates dose reduction or discontinuation of chemotherapy, negatively impacting overall survival. Currently, duloxetine is the only pharmacological treatment recommended by the American Society of Clinical Oncology (ASCO). This systematic review aims to evaluate the efficacy of various pharmacological interventions in CIPN treatment, providing substantial evidence for clinical practice and future research.

This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess the effectiveness of pharmacological treatments for CIPN.

Only randomized controlled trials (RCTs) were included. Herbal and phytotherapeutic treatments were excluded. Two independent reviewers performed the study selection, with a third reviewer resolving disagreements. Risk of bias assessment was conducted using the COCHRANE's RoB 2 tool.

Out of 860 screened articles, 17 RCTs met the inclusion criteria, encompassing 15 different pharmacological agents. Duloxetine, pregabalin, and amitriptyline were the most studied. Thirteen studies utilized a placebo as a control. Investigated medications exhibited varied outcomes, with some showing significant benefits in reducing neuropathic pain while others did not demonstrate statistically significant efficacy.

Duloxetine is an effective and well-tolerated option, while pregabalin shows promising results but requires further investigation. Other agents, such as venlafaxine and tapentadol, lack strong supporting evidence. Treatments like acetyl-l-carnitine, monosialotetrahexo-sylganglioside 1, and tetrodoxine yield inconsistent results, highlighting the need for additional research. Larger RCTs are recommended for comprehensive evaluation. Nurses are essential in CIPN care by monitoring symptoms, educating patients, and collaborating with the team.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce major cardiovascular events among individuals with heart failure regardless the ejection fraction. The effect of SGLT2 inhibitors on health-related quality of life (HRQoL) and physical capacity are still unclear.

To investigate the effects of SGLT2 inhibitors on HRQoL and physical capacity in patients with heart failure.

We systematically searched PubMed, Embase, and Cochrane Central databases for randomized controlled trials (RCTs) comparing SGLT2 inhibitors to placebo in this population. The outcomes analyzed were mean changes in Kansas City Cardiomyopathy Questionnaire (KCCQ) score and its domains: total symptoms score (TSS), physical limitations score (PLS), clinical summary score (CSS) and overall summary score (OSS), as well as the six-minute walk test (6MWT) and peak oxygen uptake (peak VO2).

Eighteen RCTs with 23,848 participants were included. There was a statistical significant improvement in KCCQ TSS (MD: 3.33; 95% CI 1.84 to 4.81; p < 0.001) in HFrEF, HFpEF and non-diabetic subgroups. Consistent findings were found in KCCQ PLS, KCCQ CSS, and KCCQ OSS. The distance covered in the 6MWT was significant higher (MD: 12.8; 95% CI 1.06 to 24.54; p = 0.03) and peak VO2 was increased (MD: 1.06; 95% CI 0.57 to 1.55; p < 0.001).

SGLT2 inhibitors improve HRQoL and functional capacity in patients with HF regardless the ejection fraction and co-diagnosis of diabetes.