Systematic Reviews最新文献

Background: The clinical characteristics, therapy, and outcome of Fournier Gangrene (FG) in patients using sodium-glucose cotransporter-2 inhibitors (SGLT2i) were examined in this systematic review.

Methods: Without a publication year restriction, we searched PubMed, ScienceDirect, and Cochrane. Additionally, we manually searched bibliographies using the terms "Fournier's gangrene" and "SGLT2 inhibitors." The requirements for inclusion were the English language case reports with specific patient data and FG patients with diabetes who were using SGLT2 medication. The risk of bias was analyzed utilizing the Joanna Briggs Institute checklists.

Results: A total of 78 studies were identified, and 14 of them were included in this review. The duration of SGLT2i use varied from 6 months to 6 years. The patients' age varied from 34 to 72 years, with 10 studies including male participants only and patients with obesity. All studies have discontinued SGLT2i and replaced them with other anti-diabetic drugs. Therapy options included perianal ring block, insulin, rigid sigmoidoscopy, aggressive debridement, antibiotics, fluid resuscitation, incision, drainage, surgery, hyperbaric oxygen therapy, plastic surgery, and fasciocutaneous flaps. Seven studies reported patients discharged in the range of 9-51 days.

Conclusions: The incidence of FG following SGLT2i use is rare. Therapy was performed by replacing SGLT2i with other anti-diabetic drugs. The patient's outcome improved after treatment.

Objective: The objective of this study was to evaluate the clinical efficacy and safety of neoadjuvant immunochemotherapy in the treatment of locally advanced, resectable esophageal cancer.

Methods: Literature published before November 2023 on the clinical efficacy and safety of neoadjuvant immunotherapy in resectable esophageal squamous cell carcinoma was searched in CNKI, VIP, Wanfang, Chinese Biomedical Literature, PubMed, Embase, Cochrane, and the Web of Science. A meta-analysis was conducted using Stata 17.0.

Results: The cumulative ranked probability results indicated that Camrelizumab + TN had the highest probability of achieving pCR, Camrelizumab + TP of achieving MPR, and Sintilimab + TP of achieving DCR and ORR. Camrelizumab + TP also had the highest probability of achieving an R0 resection rate. In terms of adverse events and postoperative complications, Pembrolizumab + TN had the highest likelihood of inducing myelosuppression and rash. Toripalimab + TP had the highest probability of inducing vomiting, while traditional chemotherapy alone had the highest likelihood of inducing postoperative cardiac adverse events.

Conclusion: Neoadjuvant immunotherapy combined with chemotherapy has demonstrated superior clinical efficacy and safety compared to chemotherapy alone. The regimen of Camrelizumab + TP showed significant advantages in pCR, MPR, DCR, and R0 resection rates, particularly excelling in MPR and R0 resection rates. However, it was associated with a higher incidence of rash compared to chemotherapy alone and the Toripalimab + TP regimen. Neoadjuvant immunotherapy, when combined with chemotherapy, has been shown to reduce the occurrence of postoperative cardiac adverse events. Among the various treatment options, Sintilimab + TP exhibited the most favorable outcomes.

Systematic review registration: PROSPERO Protocol Number: CRD42024623160.

There has been a global increase in the use of cannabinoids as a treatment for mental health (MH) and substance use disorders (SUD). In 2016, an Australian government-funded review found that although medicinal cannabinoids accounted for a small reduction in MH symptoms, the results varied according to study design. There has since been a rise in randomised controlled trials (RCTs) aiming to examine the efficacy of cannabinoids for the treatment of MH and SUD. Therefore, the current systematic review will (a) identify all RCTs examining the efficacy of cannabinoids in treating MH and SUD, (b) provide a quantitative or narrative synthesis of the evidence examining efficacy, and (c) synthesise adverse event data to examine evidence of harm. Electronic databases (Ovid MEDLINE, PsychINFO, Cochrane Central Register of Controlled Clinical Trials, Cochrane Database of Systematic Reviews, and Embase) were searched from 1980 to 24 May 2023. The study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. Articles will be screened to capture peer-reviewed RCTs evaluating the efficacy of plant-based and pharmaceutical cannabinoids in reducing or treating MH and SUD among people of any age. The Cochrane risk of bias tool 2.0 will be used to assess bias, while the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool will be used to assess the quality of evidence for each outcome. Study findings will be disseminated through published manuscripts, conferences, and health policy guidelines.Systematic review registration PROSPERO CRD42023392718.

Introduction: Lung cancer, particularly non-small cell lung cancer (NSCLC), is a leading cause of cancer-related deaths globally. Despite surgery being the main treatment for resectable NSCLC, many patients experience postoperative recurrence. Neoadjuvant chemotherapy may shrink tumors and improve surgical outcomes, while adjuvant chemotherapy targets residual disease post-surgery. Recent advancements in immunotherapy have introduced its use in the perioperative phase for resectable NSCLC. This study investigates the relative benefits and potential complications of neoadjuvant, adjuvant, and perioperative immunotherapy combined with chemotherapy compared to chemotherapy alone, focusing on event-free survival (EFS), overall survival (OS), and adverse events (AEs).

Methods: This systematic review and network meta-analysis followed PRISMA guidelines and was registered with PROSPERO. The authors searched PUBMED, Embase, and Cochrane databases for randomized controlled trials (RCTs) involving patients with resectable NSCLC treated with neoadjuvant/adjuvant immunotherapy or chemotherapy. Statistical analyses were performed using a frequentist network meta-analysis method in R software.

Results: From an initial 5902 articles, 13 RCTs involving 6704 patients were included after extensive filtering. PFS: Neoadjuvant and perioperative immunotherapy combined with chemotherapy showed significant benefits compared to chemotherapy alone. OS: Perioperative immunotherapy was notably more effective than adjuvant immunotherapy and standard chemotherapy. Chemotherapy generally had fewer severe adverse effects compared to neoadjuvant and perioperative immunotherapy. However, these immunotherapy combinations are generally well tolerated.

Conclusions: The findings indicate that neoadjuvant and perioperative immunotherapy combined with chemotherapy can significantly improve overall survival in patients with resectable NSCLC compared to standard chemotherapy. However, additional adverse effects associated with long-term immunotherapy require careful management. The lack of significant benefits in specific subgroups suggests a need for further research. The study stresses the importance of optimizing treatment strategies and potentially reassessing immunotherapy's role in certain patient populations. Future clinical trials are anticipated to clarify these results further.

Background: Parents and carers are increasingly expected to administer prescribed medicines to their children at home. However, parents and carers are not always able to administer medicines as directed by the prescriber and ultimately must rely on their own judgment to administer medicines safely. This process is often unseen but may contain important learning for professionals, academics, and wider society. Studying safety in everyday healthcare work presents researchers with many challenges. However, recent developments in our understanding of resilience and how it manifests within healthcare can provide an effective framework for enquiry. The aim of this review is to use resilience theory to explore parents' and carers' experiences when administering medicines to children at home.

Methods: This systematic review will follow the framework synthesis method. An iterative search strategy, using a scoping search of the major databases (Embase, PyscINFO, CINAHL, Cochrane and PubMed) will be used. The three main search terms are parents and carers, administration of medicines, and the home environment. Included studies will contain qualitative data and investigate the experiences of parents or carers who administer prescribed medicines to children at home. Relevant studies will be quality assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Framework synthesis will be completed by following five stages: familiarisation, thematic framework identification, indexing, charting, mapping, and interpretation. The findings identified in the data extraction phase will be indexed and charted according to the three elements of Moments of Resilience theory.

Discussion: This protocol describes a novel method to address an important patient safety issue. A strength of this review will be not only to identify, describe and collate existing studies, but also to learn about the application of resilience theory to a medication safety topic. The knowledge generated from this will inform intervention development to improve the support for families to administer medicines safely at home.

Systematic review registration: This review has been registered on the International Prospective Register of Systematic Reviews database (PROSPERO) #487154.

Background: Although intravesical Bacillus Calmette-Guerin (BCG) immunotherapy usually exhibits a favorable safety profile, it can lead to the development of BCG infections, both localized and disseminated. Understanding of BCG infections following intravesical BCG immunotherapy is limited because of the lack of consensus definitions of BCG infections and limited post-instillation follow-up. We aim to perform a systematic review of the literature of BCG infections following intravesical BCG immunotherapy to elucidate the epidemiology, risk factors, and outcomes of BCG infections.

Methods: Systematic review of peer-reviewed published articles that describe the treatment of one or more persons with intravesical BCG and the occurrence of BCG infections among these patients. No temporal, geographic, or demographic limitations will be applied. Animal studies will be excluded. Gray literature, editorials, and comments will be excluded. Information sources will include the following databases: MEDLINE, Embase, and Web of Science. A search concept representing BCG and intravesical administration will be applied after validation against a set of pre-selected articles. Screening and data extraction will be performed in duplicate by two independent reviewers. Disagreements will be resolved by a third independent reviewer. The methodological quality of studies will be assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the extracted data will be provided in line with the guidance from the Centre for Reviews and Dissemination. The quality of evidence for all outcomes will be judged using the Grading of Recommendations Assessment, Development, and Evaluation working group methodology.

Discussion: The data generated by this review will assist clinicians in managing BCG-infected patients and inform future research efforts.

Systematic review registration: In accordance with international guidelines, our systematic review protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on February 26, 2024.

Background: Individuals with neurofibromatosis type 1 (NF1) frequently report psychosocial problems, among which internalizing and externalizing symptoms are the most poorly understood due to limited research and inconsistent evidence. This hinders the overall attendance of their psychosocial needs and has a major impact on their quality of life. Thus, this systematic review and meta-analysis was conducted to synthesize existing findings on the degree to which individuals with NF1 experience internalizing and externalizing symptoms, compared with the unaffected population, and explore moderators of the group disparities.

Methods: Scopus, PsycINFO, Web of Science, PubMed, and ProQuest were searched from inception to March 26th, 2024, which identified 59 eligible studies (N of NF1 = 3182, mean ages 2.38 to 46.4 years). Hedges' g was calculated for differences in internalizing and externalizing symptoms between the NF1 group and the unaffected controls. Study effect sizes were pooled using robust variance estimation and random-effects models. Moderators of group differences were tested using meta-regression.

Results: Random-effects meta-analyses indicated that compared with unaffected controls, individuals with NF1 showed more severe depressive (k = 21; g = 0.43; 95% CI [0.21, 0.65]), anxiety (k = 24; g = 0.27; 95% CI [0.01, 0.54]), somatic (k = 27; g = 0.56; 95% CI [0.30, 0.83]), total internalizing (k = 75; g = 0.50; 95% CI [0.33, 0.67]), aggression (k = 33; g = 0.33; 95% CI [0.08, 0.58]), delinquency, (k = 37; g = 0.43; 95% CI [0.26, 0.60]), and total externalizing symptoms (k = 47; g = 0.24; 95% CI [0.13, 0.35]). Studies that included more participants with NF1 who had ADHD or a lower verbal IQ reported greater group disparities in total internalizing symptoms or aggression.

Conclusions: Findings highlight the importance of promptly recognizing internalizing and externalizing symptoms in individuals with NF1 for timely interventions. Future research should identify predictors of internalizing and externalizing symptoms within the NF1 population to inform our knowledge and intervention development. Other implications for future research were also discussed.

Systematic review registration: The study protocol of this meta-analysis was registered at PROSPERO (CRD42023478258).

Background: Extreme heat events (EHEs), driven by anthropogenic climate change, exacerbate the risk of cardiovascular disease (CVD), although the underlying mechanisms are unclear. A possible mechanism leading to heat-related CVD is disturbances in sleep health, which can increase the risk of hypertension, and is associated with ideal cardiovascular health. Thus, our objective was to systematically review the peer-reviewed literature that describes the relationship between EHEs, sleep health, and cardiovascular measures and outcomes and narratively describe methodologies, evidence, and gaps in this area in order to develop a future research agenda linking sleep health, EHEs, and CVD.

Methods: A comprehensive literature search was performed in the following databases from inception-June 2023: Ovid MEDLINE, Ovid Embase, CINAHL, Web of Science, and the Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. Then studies were described qualitatively in relation to study design, findings, and the evidence linking the relationship between sleep health, EHEs, and CVD.

Results: Of the 2035 records screened, only three studies met the inclusion criteria. In these three studies, EHE was measured as absolute temperatures (greater than 30 °C) or relative temperatures (i.e., 90th percentile daily maximum temperature within the region). Cardiovascular (CV) measures described included blood pressure (BP), heart rate (HR), and HR variability (no CVD outcomes were described), and objective and subjective measurements of sleep health outcomes included sleep duration, calmness, ease of falling asleep, ease of awakening, freshness after awakening, and sleep satisfaction. Two studies were controlled trials, and one was a cohort study. During EHEs, individuals slept for shorter periods of time and less efficiently, with greater degrees of HR variability in two of the three studies lasting at most 1-2 days; BP (both systolic and diastolic) significantly decreased during EHEs in two of the studies. No formal assessment of a mediating relationship between EHE exposure, sleep outcomes, and CV measures was undertaken.

Conclusions: Few studies examine the link between CVD, sleep, and extreme heat as a possible mechanism of elevated CVD risk during EHEs, despite a strong physiological rationale. Our findings highlight an important gap in the literature that should be closely examined as EHEs become more frequent and their harmful impacts of health increase.

Background: Hydrophilic monomer 2-hydroxyethyl methacrylate (HEMA)-free adhesive systems are gaining increasing popularity nowadays. Although the addition of HEMA to dental adhesives improves dentin wettability and resin diffusion into demineralized collagen fibrils, HEMA's high hydrophilicity can lead to hydrolytic degradation of the adhesive interface. Thus, HEMA-free adhesive systems have been developed. Unfortunately, the lack of HEMA in the adhesive composition may lead to a separation phase between hydrophobic and hydrophilic components. The aim of this systematic review was to evaluate the clinical performance of HEMA-free adhesive systems and compare them with HEMA-containing ones.

Methods: An electronic search of The National Library of Medicine (MEDLINE/PubMed) was conducted. Eligibility criteria were reporting empirical data from clinical studies published between 2013 and 2023 about the clinical performance of HEMA-free adhesive systems for direct resin composite restorations. Studies with at least 2-year clinical follow-up done in permanent dentition in any form of cavities were selected. The included studies were assessed for risk of bias using the modified Cochrane Collaboration tool criteria.

Results: The database search returned 147 studies; a total of 7 studies were included in this review; the majority of studies reported no significant difference between the two types of adhesives for the parameter of retention.

Conclusions: HEMA-free adhesive systems exhibited good clinical performance with regard to retention. There was some concern about their influence on marginal adaptation and marginal discoloration due to the conflicted results reported by the included trials. Thus, the results need to be confirmed with long-term evaluations.

Systematic review registration: PROSPERO CRD42023448952.

Purpose: Traumatic brain injury and spinal cord injury impact all areas of individuals' quality of life. A synthesis of available evidence for the Traumatic Brain Injury Quality of Life (TBI-QoL) and Spinal Cord Injury Quality of Life (SCI-QoL) measurement systems could inform evidence-based clinical practice and research. Thus, we aimed to systematically review the literature of existing evidence on the measurement properties of SCI-QoL and TBI-QoL among rehabilitation populations.

Methods: We used the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) framework for evaluating measures to guide this systematic review. We searched nine electronic databases and registries, and hand-searched reference lists of included articles. Two independent reviewers screened selected articles and extracted the data. We used COSMIN's thresholds to synthesize measurement properties evidence (insufficient, sufficient), and the modified GRADE approach to synthesize evidence quality (very-low, low, moderate, high).

Results: We included 16 studies for SCI-QoL and 14 studies for TBI-QoL. Both measurement systems have sufficient content validity, structural validity, internal consistency and construct validity across nearly all domains (GRADE: high). Most SCI-QoL domains and some TBI-QoL domains have sufficient evidence of cross-cultural validity and test-retest reliability (GRADE: moderate-high). Besides the cognition domains of TBI-QoL, which have indeterminate evidence for measurement error and sufficient evidence for responsiveness (GRADE: high), there is no additional evidence available for these measurement properties.

Conclusion: Rehabilitation researchers and clinicians can use SCI-QoL and TBI-QoL to describe and evaluate patients. Further evidence of measurement error, responsiveness, and predictive validity would advance the use and interpretation of SCI-QoL and TBI-QoL in rehabilitation.