BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate...BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate the association between preoperative serum cholinesterase(ChE)activity—specifically butyrylcholinesterase(BuChE)and acetylcholinesterase(AChE)—and the risk of POD in adult surgical patients in a meta-analysis.METHODS A systematic search was conducted in PubMed,EMBASE,and Web of Science up to March 28,2025 for studies reporting preoperative serum BuChE or AChE activity in relation to subsequent POD incidence.Standardized mean differences(SMDs)and odds ratios(ORs)with 95%confidence intervals(CIs)were pooled using random-effects models.Subgroup and sensitivity analyses were performed based on follow-up duration and analytic models.RESULTS Thirteen studies(n=2730 patients)were included.Patients who developed POD had significantly lower preoperative BuChE activity than those who did not(SMD=-0.28;95%CI:-0.39 to-0.16;I²=18%).Higher BuChE activity was associated with a reduced risk of POD(OR per 100 unit increment=0.97;95%CI:0.95-0.99;I2=0%).In contrast,pooled AChE activity did not differ significantly between POD and non-POD groups(SMD=-0.25;95%CI:-0.53 to 0.03;P=0.08;I2=80%),and the ORs per 1 unit increment in AChE activity were not statistically significant(OR=0.98;95%CI:0.95-1.01).CONCLUSION Lower preoperative serum BuChE activity is associated with an increased risk of POD in adults undergoing surgery.BuChE activity may serve as a potential preoperative biomarker for POD risk stratification.展开更多
BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs ...BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs other second-line therapies in advanced HCC.METHODS This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.A comprehensive search of PubMed,EMBASE,Web of Science,and the Cochrane Library was performed on June 6,2025.Studies were included if they reported at least one relevant clinical outcome:Overall survival,progression-free survival,objective response rate,or disease control rate.Data was extracted independently by two reviewers.Quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.Pooled effect estimates were calculated using random-or fixed-effects models depending on the degree of heterogeneity.Sensitivity analyses and Egger’s test were performed to evaluate the robustness of the results and potential publication bias.RESULTS Nine studies met inclusion criteria.Regorafenib significantly improved overall survival compared to controls[weighted mean difference=2.54 months;95%confidence interval(CI):0.26-4.81;P<0.05],but no significant benefit was observed for progression-free survival(weighted mean difference=1.04;95%CI:-1.27 to 3.36).The pooled objective response rate showed no overall difference,though regorafenib was inferior to nivolumab in subgroup analysis(odds ratio=0.34;95% CI:0.20-0.58).Disease control rate did not differ significantly.No publication bias was detected.CONCLUSION Regorafenib offers a survival advantage in advanced HCC but does not significantly improve tumor response rates compared to alternative therapies.展开更多
BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehe...BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.展开更多
BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different ...BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.展开更多
Background:Neurological disorders(NDs),including ischemic stroke(IS),Parkinson’s disease(PD),and Alzheimer’s disease(AD),are major contributors to global morbidity and mortality.Boswellia extract has demonstrated ne...Background:Neurological disorders(NDs),including ischemic stroke(IS),Parkinson’s disease(PD),and Alzheimer’s disease(AD),are major contributors to global morbidity and mortality.Boswellia extract has demonstrated neuroprotective properties,yet a comprehensive systematic review assessing its efficacy remains absent.This study aims to evaluate the efficacy of Boswellia extract in treating NDs,with a particular focus on its effects in AD and its potential for long-term neurorestoration,thereby supporting further investigation into Boswellia’s therapeutic role in ND management.Methods:A systematic literature search was performed in PubMed,Web of Science,ScienceDirect,and Google Scholar for English-language studies published up to March 2024.Eighteen studies met the inclusion criteria and were included in the meta-analysis.The study protocol was registered on PROSPERO(CRD42024524386).Eligible studies involved rodent models of IS,PD,or AD with post-operative interventions using Boswellia extract.Data extraction focused on mechanisms of action,dosages,treatment durations,and therapeutic outcomes.Studies were excluded if they involved non-ND models,combined treatments,or had incomplete data.Two researchers independently conducted literature screening and data extraction.Statistical analyses were conducted using Stata(version 17)and RevMan(version 5.4),employing fixed or random-effects models based on heterogeneity assessments.Result s:Boswellia extract significantly improved the mean effect size for NDs(ES=1.28,95%CI(1.05,1.51),P<0.001).Specifically,it reduced cerebral infarct volume in IS(SMD=−2.87,95%CI(−3.42,−2.32))and enhanced behavioral outcomes in AD(SMD=3.26,95%CI(2.07,5.14))and PD(SMD=5.37,95%CI(3.93,6.80)).Subgroup analyses revealed that Boswellia extract exhibited superior efficacy in AD when administered orally and via intra-cerebroventricular injection.Long-term treatment with Boswellia extract suggested potential neurorestorative effects.Additionally,Boswellia extract was more effective than its monomeric constituents,highlighting its promising role in ND treatment.Conclusion:Boswellia extract demonstrates significant neuroprotective effects across various NDs,particularly in AD and in promoting long-term neurorestoration.These findings support the need for further research into Boswellia’s potential as a therapeutic agent in the management of neurological disorders.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therape...BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.展开更多
BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(D...BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.展开更多
Objectives:This systematic review and meta-analysis aimed to identify and synthesize the factors correlated with posttraumatic growth(PTG)in patients with colorectal cancer(CRC).Methods:PubMed,Web of Science,Embase,Ps...Objectives:This systematic review and meta-analysis aimed to identify and synthesize the factors correlated with posttraumatic growth(PTG)in patients with colorectal cancer(CRC).Methods:PubMed,Web of Science,Embase,PsycINFO,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang database,China Science and Technology Journal Database(VIP)and SinoMed were searched for studies that reported data on the correlated factors associated with PTG in patients with CRC from inception to September 3,2024.The methodological quality of the included studies was assessed via the Agency for Healthcare Research and Quality(AHRQ)methodology checklist and the Newcastle-Ottawa Scale(NOS).Pearson correlation coefficient(r)was utilized to indicate effect size.Meta-analysis was conducted in R Studio.Results:Thirty-one eligible studies encompassing 6,400 participants were included in this review.Correlated factors were identified to be significantly associated with PTG in patients with CRC including demographic factors:residential area(r=0.13),marital status(r=0.10),employment status(r=0.18),education level(r=0.19),income level(r=0.16);disease-related factors:time since surgery(r=0.17),stoma-related complications(r=0.14),health-promoting behavior(r=0.46),and sexual function(r=0.17);psychosocial factors:confrontation coping(r=0.68),avoidance coping(r=-0.65),deliberate rumination(r=0.56),social support(r=0.47),family function(r=0.50),resilience(r=0.53),selfefficacy(r=0.91),self-compassion(r=-0.32),psychosocial adjustment(r=0.39),gratitude(r=0.45),stigma(r=-0.65),self-perceived burden(r=-0.31),fear of cancer recurrence(r=-0.45);and quality of life(r=0.32).Conclusions:This meta-analysis identified 23 factors associated with PTG in CRC patients.Medical workers can combine those relevant factors from the perspective of positive psychology,further explore the occurrence and development mechanism of PTG,and establish targeted interventions to promote PTG.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a signif...BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase bra...Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).展开更多
This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinom...This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.展开更多
BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a n...BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a non-treatable condition.Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life.Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.AIM To evaluate the efficacy of triple probiotic combination on glycaemic,metabolic,oxidative stress,and inflammatory parameters in the diabetic population.METHODS Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified.The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool.Meta-analysis was conducted using RevMan software,and sensitivity analysis was performed using OpenMeta Analyst software.The study protocol was registered in PROSPERO(CRD42-024530999).RESULTS Five good-quality clinical trials were included.Low-to-moderate risk of bias was observed.Data from 300 participants were included(150 participants in both groups).Probiotics supplementation significantly improved glycaemic and insulin parameters(glucose level:-23.86 mg/dL;insulin level:-5.02μIU/mL;HOMA-IR:-1.82 score;QUICKI:+0.02 score;HOMA-B:-16.30 score;P<0.05 for all parameters),reduced oxidative stress and improved antioxidant parameters[TAC:+92.55 mmol/L;glutathione(GSH):+40.55μmol/L;nitric oxide(NO):+6.45μmol/L;malondialdehyde(MDA):-0.48μmol/L;hs-CRP:-2.24 mg/L;P<0.05 for all parameters except GSH],and improved lipid parameters(total cholesterol(TC):-3.43 mg/dL;triglycerides(TG):-4.26 mg/dL;low-density lipoprotein:-4.62 mg/dL;very low-density lipoprotein:-0.83 mg/dL;high-density lipoprotein(HDL):+1.83 mg/dL;TC/HDL ratio:-0.25;P<0.05 for HDL and TC/HDL ratio parameters)compared to the control group.CONCLUSION The combination of L.acidophilus,L.casei,and B.bifidum is effective in diabetic patients with cardio/renal complications.Further well-designed studies are warranted to support the results of current research.展开更多
BACKGROUND There is a need to synthesize the different patterns of fever treatment and phobias in Nigeria and to document these behavioral issues among caregivers.Although,fever is commonly seen in children and this m...BACKGROUND There is a need to synthesize the different patterns of fever treatment and phobias in Nigeria and to document these behavioral issues among caregivers.Although,fever is commonly seen in children and this make the mothers to seek medical care when all effort of theirs have failed.Yet,this behavioral and anxiety disorders among mothers still persists several years after the word“Fever phobia”was coined.AIM To document the knowledge of fever among Nigerian mothers and to determine heterogeneity in these practices across the nation.METHODS A search of articles on fever phobias among mothers or caregivers in Nigeria was performed via the Cochrane Database of Systematic Reviews,PubMed,Google Scholar,and MEDLINE.Articles published between 2008,and 2023 were included in the study.The keywords used in the literature search included fever,phobias,perceptions,mothers,caregivers,perceptions,drugs,knowledge,and practices.Boolean operators were also used in the search for items,such as“fever AND phobia”,“fever AND perception”,“fever AND mothers”,“fevers AND/OR phobia”,“AND OR mothers/caregivers”,to help narrow parameters in the search engine and enhance reproducibility.Studies that fulfilled the inclusion criteria were presented via the PRISMA model.I2 statistics were used to assess heterogeneity.RESULTS The studies show wide variation in the reported levels of knowledge about fever,with proportions ranging from as low as 35%to as high as 94%.The pooled proportion estimate using the common effect model is 65%(95%CI:64%-67%),assuming that all studies reflect a single underlying value.However,the random effects model,which accounts for differences among studies,yields a higher estimate of 70%(95%CI:56%-82%).This divergence reflects significant heterogeneity in the data,with a Tau^(2)of 0.7007,I²of 95.7%,and,an H statistic of 4.80,all indicating that most of the variability is due to actual differences among studies rather than random chance.The Q test further confirms this,with a P value less than 0.0001,reinforcing that the variability across studies is statistically significant.The subgroup analysis revealed that studies in Group A(six studies)reported a pooled knowledge proportion of 75%,with a confidence interval ranging from 56%to 88%,and relatively lower heterogeneity(Tau^(2)=0.5709,Tau=0.7556),indicating greater consistency in their findings.In contrast,Group B(four studies)had a lower pooled estimate of 62%,but with a much wider confidence interval(27%to 88%)and greater heterogeneity(Tau^(2)=0.8380,Tau=0.9154),suggesting greater variation across studies in that group.Fear of brain damage,convulsions,witches/wizards,and death was high in many of the studies.Herbal concoctions,and prayers were the mostly used measures to cure fever by mothers.CONCLUSION Mothers’knowledge of fever detection in children is low.There was heterogeneity in the sample size of the studies,which may have affected the knowledge of fever.展开更多
This systematic review and meta-analysis considered the results of randomized controlled clinical trials(RCTs)to evaluate the efficacy of systemic or local antibiotic therapy in peri-implantitis.Two independent author...This systematic review and meta-analysis considered the results of randomized controlled clinical trials(RCTs)to evaluate the efficacy of systemic or local antibiotic therapy in peri-implantitis.Two independent authors screened publications from three electronic databases to include RCTs meeting all the inclusion and exclusion criteria.A meta-analysis was performed to evaluate the weighted mean differences in survival rate(SR)and changes in pocket probing depth(PPD),bone level(BL),and clinical attachment level(CAL).The study cohorts were defined as antibiotic and control groups with subgroups for analysis.Seven studies including 309 patients(390 implants)were considered.Within the limitations of this review,patients in the antibiotic groups exhibited significant improvements in PPD.Subgroup analysis indicated that the administration of systemic antibiotics or the use of antibiotics in non-surgical treatments did not result in a significant alteration in BL.It was established that the addition of antibiotics can ameliorate PPD and SR in the treatment of peri-implantitis,whether through surgical or non-surgical approaches,and also shows moderate performance regarding BL and CAL.Considering the lack of application of new technologies in the control group and the hardship of assessing the potential risks of antibiotics,careful clinical judgment is still necessary.展开更多
BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;ho...BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;however,the absence of the PCL results in abnormal knee kinematics,which may cause injuries to other ligaments.The ideal tendon source for PCL reconstruction is still a subject of debate.AIM To evaluate the results of employing the peroneus longus tendon(PLT)in PCL reconstruction.METHODS A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction.Studies published up to August 2024 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included five studies on PLT use for PCL reconstruction:(1)Four prospective studies with 104 patients;and(2)One retrospective study with 18 patients.Most studies followed up participants for 24 months,while one had a shorter follow-up of 18 months.Lysholm and modified cincinnati scores improved by pooled means of 32.2(95%CI:29.3-35.1,I2=0%)and 31.1(95%CI:27.98-34.22,I2=0%),respectively.Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5(I2=61.5%)and 94.5(I2=80.09%),respectively.Single-hop and triple-hop test scores averaged 95.5(95%CI:94.5-96.5)and 92.4(95%CI:91.9-92.9)respectively.No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.CONCLUSION Evidence supports PLT autografts for PCL reconstruction,improving knee function and patient outcomes.Larger randomized trials are needed to confirm efficacy and compare graft options.展开更多
BACKGROUND Meta-analysis is a critical tool in evidence-based medicine,particularly in cardiology,where it synthesizes data from multiple studies to inform clinical decisions.This study explored the potential of using...BACKGROUND Meta-analysis is a critical tool in evidence-based medicine,particularly in cardiology,where it synthesizes data from multiple studies to inform clinical decisions.This study explored the potential of using ChatGPT to streamline and enhance the meta-analysis process.AIM To investigate the potential of ChatGPT to conduct meta-analyses in interventional cardiology by comparing the results of ChatGPT-generated analyses with those of randomly selected,human-conducted meta-analyses on the same topic.METHODS We systematically searched PubMed for meta-analyses on interventional cardiology published in 2024.Five metaanalyses were randomly chosen.ChatGPT 4.0 was used to perform meta-analyses on the extracted data.We compared the results from ChatGPT with the original meta-analyses,focusing on key effect sizes,such as risk ratios(RR),hazard ratios,and odds ratios,along with their confidence intervals(CI)and P values.RESULTS The ChatGPT results showed high concordance with those of the original meta-analyses.For most outcomes,the effect measures and P values generated by ChatGPT closely matched those of the original studies,except for the RR of stent thrombosis in the Sreenivasan et al study,where ChatGPT reported a non-significant effect size,while the original study found it to be statistically significant.While minor discrepancies were observed in specific CI and P values,these differences did not alter the overall conclusions drawn from the analyses.CONCLUSION Our findings suggest the potential of ChatGPT in conducting meta-analyses in interventional cardiology.However,further research is needed to address the limitations of transparency and potential data quality issues,ensuring that AI-generated analyses are robust and trustworthy for clinical decision-making.展开更多
Desertification is a global crucial ecological and environmental issue,and China is among the countries most seriously affected by desertification.In recent decades,numerous independent studies on desertification dyna...Desertification is a global crucial ecological and environmental issue,and China is among the countries most seriously affected by desertification.In recent decades,numerous independent studies on desertification dynamics have been carried out using remote sensing technology,but there has been a lack of systematic research on desertification trends in China.This study employed the meta-analysis to integrate the findings of 140 published research cases and examined the dynamics of desertification in the eight major deserts,four major sandy lands,and their surrounding areas in China from 1970 to 2019,with a comparative analysis of differences between the eastern(including the Mu Us Sandy Land,the Otindag Sandy Land,the Hulunbuir Sandy Land,the Horqin Sandy Land,and the Hobq Desert)and western(including the Taklimakan Desert,the Gurbantunggut Desert,the Kumtagh Desert,the Ulan Buh Desert,the Qaidam Basin Desert,the Badain Jaran Desert,and the Tengger Desert)regions.The results revealed that from 1970 to 2019,desertification first expanded and then reversed in the whole region.Specifically,desertification expanded from 1980 to 1999 and reversed after 2000.The desertification trend exhibited distinct spatio-temporal variations between the eastern and western regions.From 1970 to 2019,the western region experienced relatively minor changes in desertified land area compared to the eastern region.In the context of global climate change,beneficial climatic conditions and ecological construction projects played a crucial role in reversing desertification.These findings provide valuable insights for understanding the development patterns of desertification in the most representative deserts and sandy lands in China and formulating effective desertification control strategies.展开更多
Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online data...Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online databases,including PubMed,Embase,Web of Science,and the Cochrane Library.The articles included in this review were published from inception to July 31,2024.The Iain Crombie assessment tool was used to assess study quality.Meta-analysis was performed using RevMan(version 5.4)software.The review protocol has been registered with PROSPERO(CRD42024570491).Results A total of 1,434 research articles were initially identified,among which 18 were incorporated into this study,and all of the included studies were cross-sectional.Meta-analysis results demonstrated that gender(male;OR=1.37,95%CI:1.28–1.47),profession(healthcare provider;OR=0.17,95%CI:0.06–0.47),knowledge and skill level(OR=1.63,95%CI:1.25–2.11),willingness to undergo training(OR=2.68,95%CI:1.89–3.79),interest in first aid(OR=2.08,95%CI:1.60–2.69),previous training(OR=2.14,95%CI:1.49–3.08),and previous first-aid experience(OR=1.70,95%CI:1.37–2.11)were the principal influencing factors of the public’s willingness to engage in out-of-hospital cardiopulmonary resuscitation.Conclusion Demographic factors,knowledge,belief,and behavior are crucial in influencing public emergency decision-making.Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.展开更多
BACKGROUND Pelvic fractures are often associated with significant morbidity,including injuries to the urinary tract.Understanding the incidence and risk factors for urinary tract injury in these patients is crucial fo...BACKGROUND Pelvic fractures are often associated with significant morbidity,including injuries to the urinary tract.Understanding the incidence and risk factors for urinary tract injury in these patients is crucial for prompt diagnosis and management.This meta-analysis aims to synthesize existing evidence to determine the overall incidence and identify specific risk factors associated with urinary tract injuries in patients with pelvic fractures.AIM To determine the incidence and risk factors for urinary tract injuries in patients with pelvic fractures.METHODS A systematic search of PubMed,EMBASE,Scopus,and the Cochrane Library was conducted without date restrictions.Studies examining the incidence and risk factors of urinary tract injuries in patients with pelvic fractures were included.Data extracted included demographics,injury mechanism,pelvic fracture type,urinary tract injury incidence,mortality,and discharge disposition.Review Manager 5.4 was used for data analysis.RESULTS Ten studies comprising 22700 patients were included.The pooled incidence of urinary tract injury associated with pelvic fracture was 6.88%(95%CI:6.20%-7.55%).Vehicle,motorcycle,and pedestrian accidents were identified as risk factors for urinary tract injury,with relative risks(RR)of 1.08(95%CI:1.06-1.11),1.89(95%CI:1.78-2.00),and 1.53(95%CI:1.20-1.95),respectively.Pubic fracture and pelvic ring disruption were significantly associated with urinary tract injury[odds ratio(OR)1.94,95%CI:1.09-3.44 and OR 5.53,95%CI:4.67-6.54,respectively)].Patients without urinary tract injury were more likely to be discharged home(RR 0.79,95%CI:0.67-0.92).Mortality was higher in patients with urinary tract injury(OR 1.92,95%CI:1.77-2.09).CONCLUSION Urinary tract injury occurs in nearly 7%of patients with pelvic fractures.Motorcycle accidents,pubic fractures,and pelvic ring disruptions are significant risk factors.Urinary tract injury following pelvic fracture is associated with increased mortality.展开更多
文摘BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate the association between preoperative serum cholinesterase(ChE)activity—specifically butyrylcholinesterase(BuChE)and acetylcholinesterase(AChE)—and the risk of POD in adult surgical patients in a meta-analysis.METHODS A systematic search was conducted in PubMed,EMBASE,and Web of Science up to March 28,2025 for studies reporting preoperative serum BuChE or AChE activity in relation to subsequent POD incidence.Standardized mean differences(SMDs)and odds ratios(ORs)with 95%confidence intervals(CIs)were pooled using random-effects models.Subgroup and sensitivity analyses were performed based on follow-up duration and analytic models.RESULTS Thirteen studies(n=2730 patients)were included.Patients who developed POD had significantly lower preoperative BuChE activity than those who did not(SMD=-0.28;95%CI:-0.39 to-0.16;I²=18%).Higher BuChE activity was associated with a reduced risk of POD(OR per 100 unit increment=0.97;95%CI:0.95-0.99;I2=0%).In contrast,pooled AChE activity did not differ significantly between POD and non-POD groups(SMD=-0.25;95%CI:-0.53 to 0.03;P=0.08;I2=80%),and the ORs per 1 unit increment in AChE activity were not statistically significant(OR=0.98;95%CI:0.95-1.01).CONCLUSION Lower preoperative serum BuChE activity is associated with an increased risk of POD in adults undergoing surgery.BuChE activity may serve as a potential preoperative biomarker for POD risk stratification.
文摘BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs other second-line therapies in advanced HCC.METHODS This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.A comprehensive search of PubMed,EMBASE,Web of Science,and the Cochrane Library was performed on June 6,2025.Studies were included if they reported at least one relevant clinical outcome:Overall survival,progression-free survival,objective response rate,or disease control rate.Data was extracted independently by two reviewers.Quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.Pooled effect estimates were calculated using random-or fixed-effects models depending on the degree of heterogeneity.Sensitivity analyses and Egger’s test were performed to evaluate the robustness of the results and potential publication bias.RESULTS Nine studies met inclusion criteria.Regorafenib significantly improved overall survival compared to controls[weighted mean difference=2.54 months;95%confidence interval(CI):0.26-4.81;P<0.05],but no significant benefit was observed for progression-free survival(weighted mean difference=1.04;95%CI:-1.27 to 3.36).The pooled objective response rate showed no overall difference,though regorafenib was inferior to nivolumab in subgroup analysis(odds ratio=0.34;95% CI:0.20-0.58).Disease control rate did not differ significantly.No publication bias was detected.CONCLUSION Regorafenib offers a survival advantage in advanced HCC but does not significantly improve tumor response rates compared to alternative therapies.
文摘BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.
基金Supported by the National Natural Science Foundation of China,No.82402789Beijing Jishuitan Hospital Youcai Plan,No.KYYC202402+2 种基金Beijing Jishuitan Research Funding,No.HL202402and Beijing Natural Science Foundation,No.L232062No.L222063.
文摘BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.
基金supported by the National Natural Science Foundation of China,specifically through grants(No.8227431382304947)Key Research and Development Project of Shaanxi Province(2023GHZD43).Peer re v iew information。
文摘Background:Neurological disorders(NDs),including ischemic stroke(IS),Parkinson’s disease(PD),and Alzheimer’s disease(AD),are major contributors to global morbidity and mortality.Boswellia extract has demonstrated neuroprotective properties,yet a comprehensive systematic review assessing its efficacy remains absent.This study aims to evaluate the efficacy of Boswellia extract in treating NDs,with a particular focus on its effects in AD and its potential for long-term neurorestoration,thereby supporting further investigation into Boswellia’s therapeutic role in ND management.Methods:A systematic literature search was performed in PubMed,Web of Science,ScienceDirect,and Google Scholar for English-language studies published up to March 2024.Eighteen studies met the inclusion criteria and were included in the meta-analysis.The study protocol was registered on PROSPERO(CRD42024524386).Eligible studies involved rodent models of IS,PD,or AD with post-operative interventions using Boswellia extract.Data extraction focused on mechanisms of action,dosages,treatment durations,and therapeutic outcomes.Studies were excluded if they involved non-ND models,combined treatments,or had incomplete data.Two researchers independently conducted literature screening and data extraction.Statistical analyses were conducted using Stata(version 17)and RevMan(version 5.4),employing fixed or random-effects models based on heterogeneity assessments.Result s:Boswellia extract significantly improved the mean effect size for NDs(ES=1.28,95%CI(1.05,1.51),P<0.001).Specifically,it reduced cerebral infarct volume in IS(SMD=−2.87,95%CI(−3.42,−2.32))and enhanced behavioral outcomes in AD(SMD=3.26,95%CI(2.07,5.14))and PD(SMD=5.37,95%CI(3.93,6.80)).Subgroup analyses revealed that Boswellia extract exhibited superior efficacy in AD when administered orally and via intra-cerebroventricular injection.Long-term treatment with Boswellia extract suggested potential neurorestorative effects.Additionally,Boswellia extract was more effective than its monomeric constituents,highlighting its promising role in ND treatment.Conclusion:Boswellia extract demonstrates significant neuroprotective effects across various NDs,particularly in AD and in promoting long-term neurorestoration.These findings support the need for further research into Boswellia’s potential as a therapeutic agent in the management of neurological disorders.
基金Hubei Province Top Medical Youth Talent Program,Wuhan Knowledge Innovation Special Basic Research Project,No.2023020201020558Clinical Research Project of Affiliated Hospital of Guangdong Medical University,No.LCYJ2021B004 and No.LCYJ2019B010Science and Technology Plan Project of Zhanjiang,No.2022A01191.
文摘BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.
文摘BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.
基金supported by the‘Double First-Class’Construction Specialized Discipline Project at Zhejiang University(No HL2024012).
文摘Objectives:This systematic review and meta-analysis aimed to identify and synthesize the factors correlated with posttraumatic growth(PTG)in patients with colorectal cancer(CRC).Methods:PubMed,Web of Science,Embase,PsycINFO,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang database,China Science and Technology Journal Database(VIP)and SinoMed were searched for studies that reported data on the correlated factors associated with PTG in patients with CRC from inception to September 3,2024.The methodological quality of the included studies was assessed via the Agency for Healthcare Research and Quality(AHRQ)methodology checklist and the Newcastle-Ottawa Scale(NOS).Pearson correlation coefficient(r)was utilized to indicate effect size.Meta-analysis was conducted in R Studio.Results:Thirty-one eligible studies encompassing 6,400 participants were included in this review.Correlated factors were identified to be significantly associated with PTG in patients with CRC including demographic factors:residential area(r=0.13),marital status(r=0.10),employment status(r=0.18),education level(r=0.19),income level(r=0.16);disease-related factors:time since surgery(r=0.17),stoma-related complications(r=0.14),health-promoting behavior(r=0.46),and sexual function(r=0.17);psychosocial factors:confrontation coping(r=0.68),avoidance coping(r=-0.65),deliberate rumination(r=0.56),social support(r=0.47),family function(r=0.50),resilience(r=0.53),selfefficacy(r=0.91),self-compassion(r=-0.32),psychosocial adjustment(r=0.39),gratitude(r=0.45),stigma(r=-0.65),self-perceived burden(r=-0.31),fear of cancer recurrence(r=-0.45);and quality of life(r=0.32).Conclusions:This meta-analysis identified 23 factors associated with PTG in CRC patients.Medical workers can combine those relevant factors from the perspective of positive psychology,further explore the occurrence and development mechanism of PTG,and establish targeted interventions to promote PTG.
基金Supported by Research Project of Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine,No.2024ZL753and Research Project of Zhejiang Provincial Medical and Health Science and Technology Plan,No.2024KY1406.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
基金supported by the STI 2030-Major Projects,No. 2021ZD0200500 (to XS)。
文摘Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).
文摘This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.
文摘BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a non-treatable condition.Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life.Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.AIM To evaluate the efficacy of triple probiotic combination on glycaemic,metabolic,oxidative stress,and inflammatory parameters in the diabetic population.METHODS Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified.The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool.Meta-analysis was conducted using RevMan software,and sensitivity analysis was performed using OpenMeta Analyst software.The study protocol was registered in PROSPERO(CRD42-024530999).RESULTS Five good-quality clinical trials were included.Low-to-moderate risk of bias was observed.Data from 300 participants were included(150 participants in both groups).Probiotics supplementation significantly improved glycaemic and insulin parameters(glucose level:-23.86 mg/dL;insulin level:-5.02μIU/mL;HOMA-IR:-1.82 score;QUICKI:+0.02 score;HOMA-B:-16.30 score;P<0.05 for all parameters),reduced oxidative stress and improved antioxidant parameters[TAC:+92.55 mmol/L;glutathione(GSH):+40.55μmol/L;nitric oxide(NO):+6.45μmol/L;malondialdehyde(MDA):-0.48μmol/L;hs-CRP:-2.24 mg/L;P<0.05 for all parameters except GSH],and improved lipid parameters(total cholesterol(TC):-3.43 mg/dL;triglycerides(TG):-4.26 mg/dL;low-density lipoprotein:-4.62 mg/dL;very low-density lipoprotein:-0.83 mg/dL;high-density lipoprotein(HDL):+1.83 mg/dL;TC/HDL ratio:-0.25;P<0.05 for HDL and TC/HDL ratio parameters)compared to the control group.CONCLUSION The combination of L.acidophilus,L.casei,and B.bifidum is effective in diabetic patients with cardio/renal complications.Further well-designed studies are warranted to support the results of current research.
文摘BACKGROUND There is a need to synthesize the different patterns of fever treatment and phobias in Nigeria and to document these behavioral issues among caregivers.Although,fever is commonly seen in children and this make the mothers to seek medical care when all effort of theirs have failed.Yet,this behavioral and anxiety disorders among mothers still persists several years after the word“Fever phobia”was coined.AIM To document the knowledge of fever among Nigerian mothers and to determine heterogeneity in these practices across the nation.METHODS A search of articles on fever phobias among mothers or caregivers in Nigeria was performed via the Cochrane Database of Systematic Reviews,PubMed,Google Scholar,and MEDLINE.Articles published between 2008,and 2023 were included in the study.The keywords used in the literature search included fever,phobias,perceptions,mothers,caregivers,perceptions,drugs,knowledge,and practices.Boolean operators were also used in the search for items,such as“fever AND phobia”,“fever AND perception”,“fever AND mothers”,“fevers AND/OR phobia”,“AND OR mothers/caregivers”,to help narrow parameters in the search engine and enhance reproducibility.Studies that fulfilled the inclusion criteria were presented via the PRISMA model.I2 statistics were used to assess heterogeneity.RESULTS The studies show wide variation in the reported levels of knowledge about fever,with proportions ranging from as low as 35%to as high as 94%.The pooled proportion estimate using the common effect model is 65%(95%CI:64%-67%),assuming that all studies reflect a single underlying value.However,the random effects model,which accounts for differences among studies,yields a higher estimate of 70%(95%CI:56%-82%).This divergence reflects significant heterogeneity in the data,with a Tau^(2)of 0.7007,I²of 95.7%,and,an H statistic of 4.80,all indicating that most of the variability is due to actual differences among studies rather than random chance.The Q test further confirms this,with a P value less than 0.0001,reinforcing that the variability across studies is statistically significant.The subgroup analysis revealed that studies in Group A(six studies)reported a pooled knowledge proportion of 75%,with a confidence interval ranging from 56%to 88%,and relatively lower heterogeneity(Tau^(2)=0.5709,Tau=0.7556),indicating greater consistency in their findings.In contrast,Group B(four studies)had a lower pooled estimate of 62%,but with a much wider confidence interval(27%to 88%)and greater heterogeneity(Tau^(2)=0.8380,Tau=0.9154),suggesting greater variation across studies in that group.Fear of brain damage,convulsions,witches/wizards,and death was high in many of the studies.Herbal concoctions,and prayers were the mostly used measures to cure fever by mothers.CONCLUSION Mothers’knowledge of fever detection in children is low.There was heterogeneity in the sample size of the studies,which may have affected the knowledge of fever.
基金supported by the Fundamental Research Funds for the Central Universities(No.2023QZJH59/226-2023-00155)the National Natural Science Foundation of China(Nos.82370990 and 82201051)+1 种基金the Medical Health Science and Technology Project of Zhejiang Provincial Health Commis-sion(No.WKJ-ZJ-2335)the Innovative Talent of Zhejiang Provincial Health Commission,the Zhejiang“Xinmiao”Tal-ents Program(No.2023R401211),China.
文摘This systematic review and meta-analysis considered the results of randomized controlled clinical trials(RCTs)to evaluate the efficacy of systemic or local antibiotic therapy in peri-implantitis.Two independent authors screened publications from three electronic databases to include RCTs meeting all the inclusion and exclusion criteria.A meta-analysis was performed to evaluate the weighted mean differences in survival rate(SR)and changes in pocket probing depth(PPD),bone level(BL),and clinical attachment level(CAL).The study cohorts were defined as antibiotic and control groups with subgroups for analysis.Seven studies including 309 patients(390 implants)were considered.Within the limitations of this review,patients in the antibiotic groups exhibited significant improvements in PPD.Subgroup analysis indicated that the administration of systemic antibiotics or the use of antibiotics in non-surgical treatments did not result in a significant alteration in BL.It was established that the addition of antibiotics can ameliorate PPD and SR in the treatment of peri-implantitis,whether through surgical or non-surgical approaches,and also shows moderate performance regarding BL and CAL.Considering the lack of application of new technologies in the control group and the hardship of assessing the potential risks of antibiotics,careful clinical judgment is still necessary.
文摘BACKGROUND The posterior cruciate ligament(PCL)is vital for regulating posterior tibial translation in relation to the femur,which is critical for knee stability.PCL tears are infrequently isolated in knee injuries;however,the absence of the PCL results in abnormal knee kinematics,which may cause injuries to other ligaments.The ideal tendon source for PCL reconstruction is still a subject of debate.AIM To evaluate the results of employing the peroneus longus tendon(PLT)in PCL reconstruction.METHODS A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction.Studies published up to August 2024 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included five studies on PLT use for PCL reconstruction:(1)Four prospective studies with 104 patients;and(2)One retrospective study with 18 patients.Most studies followed up participants for 24 months,while one had a shorter follow-up of 18 months.Lysholm and modified cincinnati scores improved by pooled means of 32.2(95%CI:29.3-35.1,I2=0%)and 31.1(95%CI:27.98-34.22,I2=0%),respectively.Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5(I2=61.5%)and 94.5(I2=80.09%),respectively.Single-hop and triple-hop test scores averaged 95.5(95%CI:94.5-96.5)and 92.4(95%CI:91.9-92.9)respectively.No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.CONCLUSION Evidence supports PLT autografts for PCL reconstruction,improving knee function and patient outcomes.Larger randomized trials are needed to confirm efficacy and compare graft options.
文摘BACKGROUND Meta-analysis is a critical tool in evidence-based medicine,particularly in cardiology,where it synthesizes data from multiple studies to inform clinical decisions.This study explored the potential of using ChatGPT to streamline and enhance the meta-analysis process.AIM To investigate the potential of ChatGPT to conduct meta-analyses in interventional cardiology by comparing the results of ChatGPT-generated analyses with those of randomly selected,human-conducted meta-analyses on the same topic.METHODS We systematically searched PubMed for meta-analyses on interventional cardiology published in 2024.Five metaanalyses were randomly chosen.ChatGPT 4.0 was used to perform meta-analyses on the extracted data.We compared the results from ChatGPT with the original meta-analyses,focusing on key effect sizes,such as risk ratios(RR),hazard ratios,and odds ratios,along with their confidence intervals(CI)and P values.RESULTS The ChatGPT results showed high concordance with those of the original meta-analyses.For most outcomes,the effect measures and P values generated by ChatGPT closely matched those of the original studies,except for the RR of stent thrombosis in the Sreenivasan et al study,where ChatGPT reported a non-significant effect size,while the original study found it to be statistically significant.While minor discrepancies were observed in specific CI and P values,these differences did not alter the overall conclusions drawn from the analyses.CONCLUSION Our findings suggest the potential of ChatGPT in conducting meta-analyses in interventional cardiology.However,further research is needed to address the limitations of transparency and potential data quality issues,ensuring that AI-generated analyses are robust and trustworthy for clinical decision-making.
基金supported by the State Key Research and Development Program of China(2023YFF1305304)the Open Bidding for Selecting the Best Candidates Project of Inner Mongolia Autonomous Region(2024JBGS0020).
文摘Desertification is a global crucial ecological and environmental issue,and China is among the countries most seriously affected by desertification.In recent decades,numerous independent studies on desertification dynamics have been carried out using remote sensing technology,but there has been a lack of systematic research on desertification trends in China.This study employed the meta-analysis to integrate the findings of 140 published research cases and examined the dynamics of desertification in the eight major deserts,four major sandy lands,and their surrounding areas in China from 1970 to 2019,with a comparative analysis of differences between the eastern(including the Mu Us Sandy Land,the Otindag Sandy Land,the Hulunbuir Sandy Land,the Horqin Sandy Land,and the Hobq Desert)and western(including the Taklimakan Desert,the Gurbantunggut Desert,the Kumtagh Desert,the Ulan Buh Desert,the Qaidam Basin Desert,the Badain Jaran Desert,and the Tengger Desert)regions.The results revealed that from 1970 to 2019,desertification first expanded and then reversed in the whole region.Specifically,desertification expanded from 1980 to 1999 and reversed after 2000.The desertification trend exhibited distinct spatio-temporal variations between the eastern and western regions.From 1970 to 2019,the western region experienced relatively minor changes in desertified land area compared to the eastern region.In the context of global climate change,beneficial climatic conditions and ecological construction projects played a crucial role in reversing desertification.These findings provide valuable insights for understanding the development patterns of desertification in the most representative deserts and sandy lands in China and formulating effective desertification control strategies.
基金supported by Major Scientific Research Special Project for High-level Talents in Health and Wellness,Hunan Province(R2023072)Project of Hunan Provincial Department of Finance(2050205)Hunan Provincial Department of Finance Project(050205).
文摘Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online databases,including PubMed,Embase,Web of Science,and the Cochrane Library.The articles included in this review were published from inception to July 31,2024.The Iain Crombie assessment tool was used to assess study quality.Meta-analysis was performed using RevMan(version 5.4)software.The review protocol has been registered with PROSPERO(CRD42024570491).Results A total of 1,434 research articles were initially identified,among which 18 were incorporated into this study,and all of the included studies were cross-sectional.Meta-analysis results demonstrated that gender(male;OR=1.37,95%CI:1.28–1.47),profession(healthcare provider;OR=0.17,95%CI:0.06–0.47),knowledge and skill level(OR=1.63,95%CI:1.25–2.11),willingness to undergo training(OR=2.68,95%CI:1.89–3.79),interest in first aid(OR=2.08,95%CI:1.60–2.69),previous training(OR=2.14,95%CI:1.49–3.08),and previous first-aid experience(OR=1.70,95%CI:1.37–2.11)were the principal influencing factors of the public’s willingness to engage in out-of-hospital cardiopulmonary resuscitation.Conclusion Demographic factors,knowledge,belief,and behavior are crucial in influencing public emergency decision-making.Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.
文摘BACKGROUND Pelvic fractures are often associated with significant morbidity,including injuries to the urinary tract.Understanding the incidence and risk factors for urinary tract injury in these patients is crucial for prompt diagnosis and management.This meta-analysis aims to synthesize existing evidence to determine the overall incidence and identify specific risk factors associated with urinary tract injuries in patients with pelvic fractures.AIM To determine the incidence and risk factors for urinary tract injuries in patients with pelvic fractures.METHODS A systematic search of PubMed,EMBASE,Scopus,and the Cochrane Library was conducted without date restrictions.Studies examining the incidence and risk factors of urinary tract injuries in patients with pelvic fractures were included.Data extracted included demographics,injury mechanism,pelvic fracture type,urinary tract injury incidence,mortality,and discharge disposition.Review Manager 5.4 was used for data analysis.RESULTS Ten studies comprising 22700 patients were included.The pooled incidence of urinary tract injury associated with pelvic fracture was 6.88%(95%CI:6.20%-7.55%).Vehicle,motorcycle,and pedestrian accidents were identified as risk factors for urinary tract injury,with relative risks(RR)of 1.08(95%CI:1.06-1.11),1.89(95%CI:1.78-2.00),and 1.53(95%CI:1.20-1.95),respectively.Pubic fracture and pelvic ring disruption were significantly associated with urinary tract injury[odds ratio(OR)1.94,95%CI:1.09-3.44 and OR 5.53,95%CI:4.67-6.54,respectively)].Patients without urinary tract injury were more likely to be discharged home(RR 0.79,95%CI:0.67-0.92).Mortality was higher in patients with urinary tract injury(OR 1.92,95%CI:1.77-2.09).CONCLUSION Urinary tract injury occurs in nearly 7%of patients with pelvic fractures.Motorcycle accidents,pubic fractures,and pelvic ring disruptions are significant risk factors.Urinary tract injury following pelvic fracture is associated with increased mortality.
