BACKGROUND : Endometrial cancer (EC) ranks as the 6th most common cancer among women worldwide. Despite early detection often yielding favorable outcomes, approximately 13% of early-stage EC patients still experience recurrence. This study aimed to identify prognostic factors for EC recurrence. METHODS : A systematic review and meta-analysis were conducted following preferred reporting items for systematic reviews and meta-analyses guidelines (International Prospective Register of Systematic Reviews ID: CRD42024501501). PubMed, Scopus, and Cochrane Library were searched for cohort and case-control studies published on January 1, 2018–January 1, 2024. The primary outcome was disease recurrence (any, locoregional, or distant). Inclusion criteria included adult women with histologically confirmed EC after primary surgery, ≥12-month follow-up, and sample size ≥100. Risk of bias was assessed using Quality in Prognosis Studies; certainty was rated using Grading of Recommendations Assessment, Development and Evaluation. RESULTS : 8 studies met inclusion criteria from 5,633 records screened. Significant prognostic factors included lymphovascular space invasion (LVSI) (relative risk [RR]: 4.83, 95% confidence interval [CI]: 3.49–6.69), cancer grade (RR: 2.15, 95% CI: 1.86–2.48), histology type (RR: 0.46, 95% CI: 0.34–0.61), cancer stage (RR: 2.58, 95% CI: 2.13–3.12), cervical stromal invasion (RR: 3.36, 95% CI: 1.30–8.73), myometrial invasion (RR: 2.60, 95% CI: 2.03–3.32), and chemotherapy history (RR: 1.81, 95% CI: 1.41–2.31). High heterogeneity was observed for chemotherapy history (I² = 92%) and cancer stage (I² = 77%). CONCLUSIONS Various clinicopathological factors, particularly LVSI, grade, stage, histology, and myometrial invasion, significantly influence EC recurrence. These findings support the need for individualized risk stratification and treatment planning.
endometrial cancer ; meta-analysis ; neoplasm recurrence ; prognostic factors ; systematic review

OBJECTIVE: To reveal the gap between the evidence of systematic reviews (SRs) and clinical concerns by systematically summarizing the evidence on acupuncture and moxibustion for frozen shoulder and investigating the concerns and needs of clinicians in treatment with acupuncture and moxibustion for this disease. METHODS: The articles of SR and Meta-analysis on acupuncture and moxibustion for frozen shoulder were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase and Cochrane Library, starting from the inception of each database up to December 31st, 2022. Two researchers screened the articles and extracted data independently. Using AMSTAR-2, the methodological quality of the included studies was evaluated. Based on systematic reviews and expert discussion, a questionnaire on clinical concerns of acupuncture and moxibustion for frozen shoulder was developed and distributed to clinicians. The discrepancies between the evidence and clinical concerns were compared from 5 dimensions, including population, interventions, control measures, outcome indicators and review time points. RESULTS: The evidence gaps existed between SRs and clinical concerns. In the existing studies, the needs of personalized treatment were not fully considered in terms of different syndromes/patterns of frozen shoulder and stages of illness, the outcome indicators were not employed properly, the time for outcome measurement was vague, the control groups were set up outside of standardization, and the methodological quality was lower. CONCLUSION It is suggested that future studies should improve the quality of methodology, lay more consideration to different patient groups, optimize outcome indicators and standardize the setting of control groups, so as to better meet the needs of patients and achieve the best match between evidence and clinicians' needs.
Humans ; Acupuncture Therapy ; Bursitis/therapy* ; Evidence Gaps ; Moxibustion ; Systematic Reviews as Topic ; Meta-Analysis as Topic

OBJECTIVE

This meta-analysis aimed to evaluate the diagnostic capability of machine learning (ML) models in predicting stone-free status following percutaneous nephrolithotomy (PCNL).

A comprehensive literature search was conducted across MEDLINE, Embase, Scopus, Cochrane, Google Scholar and supplementary databases was undertaken until June 2023. Inclusion criteria were English publications assessing the sensitivity and specificity of ML in predicting post PCNL stone-free status. Studies on non-human subjects or with incomplete data sets were excluded. Quality assessment utilized the Cochrane Risk of Bias Tool. Pooled sensitivity, specificity, and other diagnostic metrics were calculated using Meta-Disc 1.4 software.

Of the 65 initial articles, 5 met the inclusion criteria, representing a total of 1,773 participants. The accuracy of ML models ranged from 44% to 94.8%. The pooled sensitivity and specificity were 0.60 (95% CI [0.57, 0.63]) and 0.87 (95% CI [0.84, 0.89]), respectively. The pooled positive likelihood ratio was 4.69 (95% CI [3.82, 5.77]) and the negative likelihood ratio was 0.45 (95% CI [0.41, 0.48]). The diagnostic odds ratio was 10.93 (95% CI [8.35, 14.33]). The area under the curve (AUC) stood at 0.9372, signifying an excellent diagnostic performance.

Machine learning models demonstrate significant potential in accurately predicting stone-free status post-PCNL. However, the small number of included studies, retrospective designs, and heterogeneity in ML approaches limit generalizability. Standardized definitions, larger multicenter datasets, and prospective validation are required before routine clinical adoption.

OBJECTIVE: To systematically evaluate and re-evaluate the surgical outcomes of robotic-assisted total knee arthroplasty(RA-TKA) compared with to conventional total knee arthroplasty(C-TKA). METHODS: Ten databases, including PubMed, EmBase, Web of Science, Cochrane Library, CINAHL, JBI, CNKI, Wanfang, VIP, CBM, were comprehensively searched from inception to September 2024. Eligible studies included systematic reviews and meta-analysis comparing the surgical outcomes of RA-TKA and C-TKA. Two independen researchers performed data extraction and quality assessment. Methodological quality was evaluated using the AMSTAR tool, while the certainty of evidence was graded using GRADE system. The degree of overlap among primary studies included in the systematic reviews/meta-analyses was investigated using the corrected covered area (CCA). RESULTS: A total of 15 systematic reviews/Meta-analyses were included, 5 were rateak as high quality, 1 as moderate quality, and 9 as low quality. A total of 53 pieces of evidence were identified, 11 pieces of evidence were of high quality, 19 were of moderate quality, 16 were of low quality, and 7 were of very low quality. Ten studies assessed the Knee Society score(KSS) and performed a meta-analysis. Among these, seven studies reported that there was no statistically significant difference in postoperative KSS scores between the two surgical methods. Nine studies evaluated the Hospital for Special Surgery(HSS) score, with seven indicating no statistically significant difference in HSS scores following surgery. Twelve studies examined the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score postoperatively, and five found no significant difference between the two surgical approaches. Five studies compared the hip-knee-ankle (HKA) angle deviation between the two groups, all of which demonstrated that the HKA angle deviation in RA-TKA was significantly lower than in C-TKA. Eight studies reported on the range of motion (ROM) of the knee joint after surgery, with six showing no statistically significant difference between the two methods. Finally, nine studies compared the duration of the surgical procedures, all of which concluded that RA-TKA required a longer operative time than C-TKA. CONCLUSION With regard to functional outcomes, no statistically significant difference was observed between RA-TKA and C-TKA. Nevertheless, RA-TKA demonstrates advantages in terms of surgical accuracy, precision, and alignment correction.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Robotic Surgical Procedures/methods* ; Treatment Outcome ; Meta-Analysis as Topic ; Systematic Reviews as Topic

BACKGROUND: Hospitalization in neonatal intensive care units (NICU) exposes preterm infants to adverse stimuli, including continuous 24-hour lighting. There is currently no standardized NICU layout advised for the best development of preterm neonates. This meta-analysis aimed to assess the impact of cycled light (CL) exposure on clinical outcomes in premature infants admitted to NICU as synthesized in previous studies. MATERIALS AND METHODS: This meta-analysis protocol was developed following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. A search was performed in PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases using the MeSH/key words: ―light exposure‖ AND pre-term AND cycled AND (RCT OR trials OR ―randomized controlled trial). The pooled Mean Difference with corresponding 95% CI was computed for weight gain, duration until start of enteral feeding, and duration of ICU stay using the Mantel–Haenszel random-effect model. RESULTS: Nine studies were included. The pooled mean difference showed that among preterm infants who had cycled light exposure, average daily weight gain (MD=6.24 grams, 95%CI=1.36 to 11.13, p=0.01) was significantly higher than those with continuous light exposure. The average time to start enteral feeding (MD=-3.84 days, 95%CI=-7.56 to -0.13, p=0.04) and average ICU stay (MD=-8.43 days, 95%CI=-12.54 to -4.31, p<0.0001) among neonates who had cycled light exposure were significantly shorter. CONCLUSION Benefits were seen in preterm infants when exposed to cycled light as opposed to continuous light. CL exposed infants showed a daily weight gain that was 6.24 grams higher, on average, and began enteral feeding nearly 4 days sooner. It led to a decrease in the duration of ICU stay by around 8 to 9 days on average. Further trials to determine the impact of cycled light exposure on morbidity and mortality among preterm neonates is recommended.
Human ; Male,Female ; Systematic review ; Meta-analysis ; Infant, Premature ; Intensive care units, Neonatal ; Intensive care, Neonatal ; Light ; Lighting ; Critical care

OBJECTIVE: Attention Deficit Hyperactivity Disorder (ADHD) is a common mental disorder in children. It is unclear how nutrition and dietary components relate to ADHD. Some studies suggest that children with ADHD have lower serum levels of vitamin D than healthy controls. In the current study, the effects of Vitamin D supplementation on ADHD were reviewed and analyzed using available literature. MATERIALS AND METHODS: A meta-analysis and systematic review were performed. Children less than 18 years old diagnosed with ADHD given Vitamin D supplementation or placebo were included. A search was performed in PubMed/MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases from inception to August 2024 using the MeSH keywords: "Vitamin D" AND (ADHD OR Attention Deficit Hyperactivity Disorder) AND (children OR pediatric OR adolescents) AND randomized controlled trial. Standardized Mean Difference (SMD) was used as an effect measure and pooled using random effects meta-analysis. RESULTS: The pooled SMS showed significantly lower ADHD scores (SMD=-0.59, 95%CI=-1.06 to -0.11, p=0.01), lower inattentive scores (SMD=-0.61, 95%CI=-1.00 to -0.23, p=0.002), and lower hyperactivity scores (SMD=-0.64, 95%CI=-1.08 to -0.20, p=0.004) in children given Vitamin D supplementation. The adverse events reported were minor only and did not vary significantly between intervention and control groups. CONCLUSION Vitamin D treatment as an adjuvant to methylphenidate alleviated ADHD symptoms without significant adverse effects, correlating with enhanced vitamin D levels. Given the robust evidence and well-structured randomized controlled trials, we strongly advocate for the integration of vitamin D supplementation with ADHD treatment.
Human ; Male,Female ; Adolescent: 13-18 yrs old ; Child Preschool: 2-5 yrs old ; Child: 6-12 yrs old ; Vitamin D ; meta-analysis ; systematic review

BACKGROUND

Chronic kidney disease (CKD) poses a global health threat with significant morbidity and mortality. Despite current therapies, there is a need for innovative interventions to slow CKD progression. Probiotic supplementation shows promise due to its positive effects on gastrointestinal health and inflammation. However, existing research is inconclusive, necessitating a meta-analysis to assess probiotics’ impact on CKD outcomes.

To evaluate the existing scientific literature among probiotic supplementation and the improvement in glomerular filtration rate (GFR) among chronic kidney disease (CKD) patients compared to placebo treatment.

A comprehensive search of electronic databases was conducted to identify relevant studies published up to 2023. Studies that meet the predefined eligibility criteria were included. Data extraction was performed, and methodological quality and risk of bias assessment was conducted for each study. Effect measures, such as mean differences or standardized mean differences, were used to quantify the association between probiotic supplementation and GFR improvement. The random-effects model was applied to estimate the overall effect size, and subgroup analyses were performed to explore potential sources of heterogeneity. Publication bias was assessed, and sensitivity analyses was conducted to evaluate the robustness of the findings.

The meta-analysis encompassed three randomized controlled trials (RCTs) conducted from 2017 to 2023, involving 121 chronic kidney disease (CKD) patients. The analysis focused on the impact of probiotic supplementation on CKD, examining Glomerular Filtration Rate (GFR), Blood Urea Nitrogen (BUN), and Urine Protein Creatinine Ratio (UPCR). While no significant distinctions were found in GFR and BUN changes between probiotics and placebos, there was a statistically significant reduction in UPCR associated with probiotic supplementation in one study. Notably, considerable heterogeneity in GFR and significant heterogeneity in UPCR reduction were observed among the trials. Sensitivity analysis, excluding studies with small sample sizes or high bias risk, remained consistent with overall findings.

The meta-analysis indicated no significant impact of probiotic supplementation on GFR and BUN, but there was a notable reduction in Urine UPCR. The observed heterogeneity among the studies calls for cautious interpretation due to variations in study designs, patient populations, and probiotic formulations. While the results suggest a potential role for probiotics in reducing proteinuria in chronic kidney disease (CKD) patients, the need for further research with larger sample sizes and standardized methodologies is emphasized to establish definitive conclusions.

Introduction: Chinese medicine (CM) external therapy is commonly used to treat rheumatoid arthritis (RA) in combination with conventional drug. This study aims to provide a comprehensive synthesis on the efficacy of CM external therapy combined with conventional drug treatment in RA. Methods: Randomised controlled trials (RCTs) experimenting the efficacy of CM external therapy (acupuncture, moxibustion and CM fumigation) combined with conventional drug in comparison with conventional drug only in RA patients were collected from PubMed, Medline, Cochrane Central of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Quality was assessed using the Cochrane Risk of Bias Tool. The outcome measures which include Disease Activity Score-28 (DAS28), Visual Analogue Scale (VAS), Swollen Joint Count (SJC), Tumour Necrosis Factor (TNF-α), serum levels of C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were analysed using Review Manager 5.4.1 and GRADEpro GDT online software. Results: Fifty RCTs fulfilling the criteria were included. Although some level of efficacy was statistically noted on the use of CM external therapies, their certainty levels are mixed, ranging only in between moderate and low. Conclusions Mixed levels of certainty has hindered the drawing of conclusion. The addition of CM external therapies to conventional drug treatment may provide some benefits in RA. Further clinical trials with considerations in minimising the risk of bias are recommended to provide more high-quality evidence in the effect of CM external therapies as a complementary treatment in RA.
Medicine, Chinese Traditional ; Fumigation ; Meta-Analysis [Publication Type] ; Moxibustion ; Arthritis, Rheumatoid ; Systematic Review [Publication Type]

Background: The number of individuals with mild cognitive impairment (MCI), or those people without dementia who are experiencing age-related cognitive decline, has increased in recent years. Conveniently, several interventions to delay cognitive decline exist, where cognitively stimulating activities (CSA) have been receiving too much attention. However, its beneficial effects have not been well established among older people with MCI due to conflicting findings. Objectives: This study aimed to assess and summarize the available evidence on the effects of CSA on the overall cognitive functioning of older people with MCI. Specifically, it sought to answer the PICO question, “In older people with MCI, does engagement in cognitively stimulating activities improve cognitive function?” Methods: A systematic review and meta-analysis of randomized controlled trials examining the effects of CSA on older people with MCI were conducted. Three studies met the inclusion criteria from the 1,328 records from BioMed Central, CINAHL, Cochrane Library, Health Source: Nursing/Academic Edition, MEDLINE, and PubMed databases and 156 articles from WorldCat, DSpace Saint Louis University, and Google Scholar databases and catalogs. Effect size values were inspected using the random-effects model. Data were summarized as standardized mean difference (SMD) with corresponding 95% confidence intervals in the forest plot. Results: This meta-analysis which compared studies that employed similar methodologies, found that CSA has a significant, large effect in improving cognitive functioning among older people with MCI, evidenced by an SMD of 0.798 (95% CI = 0.510-1.085, p = 0.001). While its superiority over other interventions that improve cognitive function was not observed in this study, it was still found that using CSA was helpful in terms of its cost-effectiveness. Also, heterogeneity across studies was non-significant (Cochran’s Q = 0.151, df = 2, p = 0.927, I2 = 0.00%). These results mean that clinical heterogeneity was absent even though a diverse range of CSA was employed. Additionally, methodological diversity was not present since there were no variations in the study design and minimal variability in the risk of bias assessment. Conclusion Overall, it is acknowledged that CSA are effective and practical, inexpensive, non-pharmacologic cognitive training approaches to delay cognitive decline among older people with MCI. However, interpreting this study’s significant, large effect, and non-significant heterogeneity warrants caution.
Cognition ; Cognitive Dysfunction ; Meta-Analysis

Systematic reviews and meta-analysis combine results and analysis of data from different primary studies (e.g. cross-sectional studies, case-control studies, cohort studies) conducted on similar or related research topics. They are secondary studies that guide clinical decision-making, delivery of care and policy development. This article aims to discuss how to conduct a systematic review and meta-analysis. The steps in conducting a systematic review and meta-analysis include: 1) Identify the purpose including formulating the research question and validating the purpose of the literature scan, 2) Formulate the objectives, 3) Literature search including selection of studies based on population, intervention, comparison and outcome, 4) Retrieval of full text articles, 5) Critical appraisal of articles, 6) Data extraction, 7) Data analysis and 8) Writing the final report. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is a useful guide in conducting and write systematic review and meta-analysis. While ethics approval is not usually required for systematic review and meta-analysis, authors of such study should still observe good practices including avoiding plagiarism, maintaining transparency and ensuring data accuracy.