Systematic Reviews最新文献

Background: Chronic hepatitis C virus infection presents a substantial global health burden, frequently resulting in severe liver conditions. Hepatitis C virus (HCV) therapy requires complex decision-making. Direct-acting antivirals (DAAs) offer a potential solution by targeting viral proteins to inhibit replication. Understanding DAAs real-world effectiveness and how they impact long-term outcomes beyond clinical trials is essential. We aim to comprehensively evaluate the benefits and harms of DAAs in individuals with chronic HCV infection, reported in observational studies.

Methods: We will consider for inclusion prospective and retrospective observational studies with quasi-randomised, cohort, case-control, controlled before-and-after, and cross-sectional designs. Our experimental interventions will be any class of DAAs available on the market or in development. DAAs could have been administered alone, in combination, or with other medical co-interventions. Our control interventions will be untreated chronic HCV conditions, with or without placebo. Participants will be adults, regardless of demographics, treatment history, or healthcare setting. Our primary outcomes will be participants experiencing hepatitis C-related morbidity or all-cause mortality, serious adverse events, and health-related quality of life. Secondary outcomes will include all-cause mortality, cirrhosis, variceal bleeding, hepato-renal syndrome, hepatocellular carcinoma, hepatic encephalopathy, non-serious adverse events, liver transplantation, lack of sustained virological response, histological improvement, and decreases in alanine aminotransferase and aspartate aminotransferase levels. We will apply search strategies to search MEDLINE, Embase, Web of Science, grey literature, and trial registers. We will use Covidence® to screen the result, including citations. Individual double-data extraction will include study details and outcomes, with independent review authors resolving discrepancies. We will assess bias using the ROBINS-I tool. Meta-analyses will employ random-effects models for both dichotomous and continuous outcomes, assessing heterogeneity. Subgroup and sensitivity analyses will explore effect modifications and address missing data. Trial Sequential Analysis will control type I and type II errors. We will evaluate publication bias using funnel plots and Egger's regression test and assess certainty of evidence using GRADE.

Discussion: The findings will inform clinical decisions and benefit those affected by HCV, healthcare professionals, and policymakers.

Systematic review registration: PROSPERO: CRD42023494844.

Background: Depression and anxiety are among the most common mental health problems affecting children and adolescents worldwide. Exercise is a widely used and potentially cost-effective non-pharmacological approach that may improve mood and mental health. However, the optimal exercise modalities and doses for alleviating depressive and anxiety symptoms in children and adolescents remain uncertain. Previous evidence has primarily relied on pairwise meta-analyses or conventional network meta-analyses: the former are unable to compare multiple exercise formats simultaneously, while the latter, although capable of integrating different interventions, have not quantified dose characteristics such as intensity, frequency, and duration. Consequently, systematic dose-response evidence regarding depressive and anxiety symptoms in children and adolescents is lacking. This study aims to examine the quantitative relationship between exercise dose and changes in depressive and anxiety symptoms.

Methods: This protocol outlines a systematic review and Bayesian model-based dose-response network meta-analysis. A systematic search will be conducted of PubMed, Embase, Web of Science, the Cochrane Library, Scopus, PsycINFO, SPORTDiscus, and the China National Knowledge Infrastructure databases through May 2026. Randomized controlled trials enrolling children and adolescents aged 6-18 years with depressive or anxiety symptoms and comparing different types and doses of exercise training will be eligible for inclusion. Study quality will be appraised using the Cochrane Risk of Bias 2.0 tool. Exercise interventions will be categorized by type (e.g., aerobic, resistance, mind-body, and combined exercise-only) prior to dose-response modeling. A Bayesian model-based dose-response network meta-analysis will be performed, with exercise dose quantified as weekly metabolic equivalent of task (MET) minutes (MET-min/week) by integrating intensity, session duration, and frequency. Nonlinear dose-response curves will be fitted for distinct exercise modalities. Meta-classification and regression tree (meta-CART) analysis will be employed to identify potential effect modifiers.

Discussion: This study will systematically evaluate the nonlinear dose-response relationships between exercise dose and changes in depressive and anxiety symptoms in children and adolescents, and estimate dose ranges associated with symptom change across exercise modalities. The findings may help inform future evidence-based recommendations and provide methodological guidance for dose-response research in child and adolescent mental health.

Systematic review registration: This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD420251174947.

Background: Acute lymphoblastic leukemia (ALL) is a hematologic malignancy characterized by malignant transformation of lymphoid precursor cells. ALL prognosis differs considerably, especially between pediatric patients and adult patients, with poor response to therapy in adults. MicroRNAs (miRNAs), small non-coding RNAs that regulate the expression of genes, are possible cancer biomarkers that predict cancer prognosis. This systematic review and meta-analysis evaluates miRNAs as prognostic biomarkers in ALL and extends the findings through ceRNA network and single-cell RNA seq analyses of validated target genes.

Material and methods: We systematically searched PubMed, SCOPUS, and Web of Science (WOS) to identify studies that compared miRNA expression with the survival of ALL patients following the PRISMA guidelines. We reviewed these studies for their methodological quality, and hazard ratios (HRs) were extracted to examine miRNA expression and survival endpoints of overall survival (OS), disease-free survival (DFS), and relapse-free survival (RFS). We also applied single-cell RNA sequencing (scRNA-seq) and a competing endogenous RNA (ceRNA) network to study miRNA targets.

Results: miR-335 showed a significant protective role with a pooled HR of 0.29 (95% CI, 0.12-0.68), miR-210 with a pooled HR of 0.22 (95% CI, 0.06-0.84), and miR-125b with a pooled HR of 0.39 (95% CI, 0.16-0.95) based on 22 examined studies involving 1974 patients. These miRNAs were correlated with improved OS, DFS, and RFS. We identified potential targets, whose functions were examined within key biological pathways through a ceRNA network. In various immune cell types, comparisons of B-ALL and T-ALL with normal cells showed that 36 and 98 target genes, respectively, were upregulated, while 21 and 19 genes were downregulated. Additionally, when comparing T-ALL to B-ALL cells, 70 target genes had increased expression, and 13 genes had decreased expression. Among all analyzed lineages, leukemic blast cells exhibited the most consistent and pronounced alterations in the expression of validated miRNA target genes, suggesting that blasts are the primary population influenced by these regulatory interactions in ALL.

Conclusion: These findings support miRNAs as valuable prognostic biomarkers for ALL with potential for personalized therapy. The context-dependent role of these miRNAs highlights the need for confirmation through large, multicenter trials. The constructed ceRNA network provides useful insights into their regulatory mechanisms, opening new directions for therapeutic strategies.

Background: Human behavioural research is often clouded with the risk that study results may be contaminated by the participant's awareness that they are being observed. Direct observation by a person is associated with this phenomenon, but limited data exists evaluating this Hawthorne Effect when less invasive video recording devices are used. Here we present the first quantitative analysis to identify the extent to which this occurs, based on self-reported behavioural change when cameras are used.

Methods: Searches of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, and Google Scholar were performed on 01/12/2022. No limitations were set. The primary outcome was the proportion of participants who changed their behaviour due to awareness of being recorded. Two blinded reviewers performed screening in accordance with PRISMA guidelines. I² statistic was used to assess for heterogeneity and a random effects model was subsequently applied for the meta-analysis.

Results: Preliminary searches identified 1728 publications. After screening, twenty-eight studies were included in the final analysis involving 2586 participants. Nine publications were suitable for quantitative analysis of the primary outcome. Pooled analysis using a random-effects model demonstrated the proportion of participants who reported behavioural change because of the camera was 15% (95% CI 0.08, 0.23) [I² = 96.16%].

Conclusion: The presence of a video camera may cause behavioural change in a small proportion of study participants. Cameras may cause a much lower rate of reactivity compared to a direct human observer. The heterogeneity and high risk of bias of the publications highlight the need for further high-quality research into this subject area.

Systematic review registration: PROSPERO CRD42022370498.

Background: This study aimed to systematically identify, synthesize, and evaluate measurement properties of patient-reported outcome measures (PROMs) of eHL in adult populations.

Method: A systematic review was conducted, considering studies reporting the development or validation of eHL instruments for adult populations. Four databases and grey literature were searched from January 2000 to 2024, with additional website searches up to 2022. Quality assessment, data analysis and synthesis followed the COSMIN methodology and findings were reported according to PRISMA 2020 guidelines. The GRADE framework was used to assess evidence quality.

Results: A total of 8558 citations were identified. Seven instruments, 89 articles and 3 reports were included in this review. The HL₁₉-DIGI, DHLI, TeHLI, eHLQ, eHLA, and Lisane demonstrated sufficient ratings for aspects of content validity, albeit with varying levels of evidence, ranging from very low to high. Five instruments showed sufficient ratings for structural validity and internal consistency, but evidence on their reliability was insufficient. No information on responsiveness was mentioned in articles. The HL19-DIGI, DHLI, eHEALS, and eHLQ were the most frequently investigated instruments.

Conclusion: This review identified 17 eHL instruments, of which seven demonstrated adequate content validity. However, insufficient evidence exists regarding psychometric properties for widespread implementation. It is strongly recommended that the content of these instruments be updated to reflect patients' evolving use of eHealth services, and that further psychometrics evaluations be conducted systematically.

Systematic review registration: PROSPERO CRD42021232765.

Background: Technology-assisted cognitive interventions are increasingly used for post-stroke cognitive impairment (PSCI), but their comparative effectiveness across modalities remains unclear.

Methods: This systematic review and network meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. The Population, Intervention, Comparator, Outcome (PICO) framework was used to define the review question. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched from inception to 26 April 2025 for randomized controlled trials (RCTs) in adults with PSCI. Global cognition was assessed using the Montreal Cognitive Assessment (MoCA) and/or the Mini-Mental State Examination (MMSE). We estimated mean differences (MDs) with 95% confidence intervals (CIs) and ranked interventions using the surface under the cumulative ranking curve (SUCRA). Risk of bias was assessed using Risk of Bias 2 (RoB 2).

Results: Fourteen trials (673 participants) were included. For MoCA (9 trials; 535 participants), basic treatment plus conventional cognitive training (CT) plus virtual reality (VR) improved MoCA compared with basic treatment alone (MD = 5.70; 95% CI: 0.12 to 11.27). SUCRA suggested that basic treatment plus computerized cognitive training (CCT) plus repetitive transcranial magnetic stimulation (rTMS) ranked highest for MoCA (84.1%), followed by basic treatment plus conventional CT plus VR (74.8%). For MMSE (8 trials; 265 participants), basic treatment plus rTMS was superior to basic treatment alone (MD = 4.60; 95% CI: 0.45 to 8.75), and basic treatment plus exergaming was also superior to basic treatment alone (MD = 1.47; 95% CI: 0.04 to 2.90). SUCRA ranked basic treatment plus rTMS highest for MMSE (96.3%), followed by basic treatment plus exergaming (76.3%).

Conclusions: Technology-assisted cognitive interventions added to basic treatment may improve global cognitive function after stroke, although the current evidence remains preliminary and varies across modalities. Larger, rigorously designed RCTs are needed to confirm comparative effectiveness and guide optimal implementation in post-stroke rehabilitation.

Systematic review registration: PROSPERO CRD420251066176.

Background: Mental disorders, particularly anxiety and mood disorders, significantly impair individuals' ability to perform daily activities, potentially leading to sedentary behavior and increasing the risk of non-communicable diseases such as diabetes, cancer, and obesity. Physical activity plays a crucial role in supporting mental health, and team sports represent a promising intervention strategy. Therefore, the aim of this systematic review is to evaluate the impact of team sports practice on anxiety and mood disorders. Furthermore, it will analyze how different modalities of team sports contribute to mental health improvements and identify gaps in the current literature to guide future research directions.

Methods: This systematic review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and is registered in PROSPERO (CRD420251121611). A comprehensive search will be carried out across four electronic databases (PubMed, Embase, Web of Science, and Scopus) with no restrictions on language or publication date. Two independent reviewers will screen titles and abstracts using predefined eligibility criteria and extract data with standardized tables. A third independent reviewer will resolve any disagreements. Extracted data will include publication title, authors, year, assessment tools for anxiety and mood disorders, type of intervention, and primary outcomes related to the effects of team sports on these disorders. Risk of bias will be assessed using the Cochrane Risk of Bias tool (RoB 2.0). Data will be synthesized using a random-effects meta-analysis (DerSimonian-Laird) when at least two sufficiently homogeneous studies report the same outcome. Continuous outcomes will be pooled as mean differences (same scale) or standardized mean differences (different instruments). Statistical heterogeneity will be assessed using Cochran's Q and the I² statistic. If heterogeneity is high (I² > 75%) or if pooling is not feasible, findings will be summarized narratively, with planned subgroup and sensitivity analyses. The certainty of evidence will be assessed using GRADE.

Discussion: This systematic review is expected to provide comprehensive evidence on the potential effects of team sports participation on anxiety and mood disorders. By synthesizing findings from randomized controlled trial, the review aims to clarify the extent to which engaging in team sports may contribute to mental health promotion and symptom reduction. The results may inform clinical practice, guide the design of community-based interventions, and support policymakers in developing evidence-based strategies that use team sports as a non-pharmacological approach to improve psychological well-being.

Trial registrations: Systematic review registration: PROSPERO CRD420251121611.

Background and aims: Intestinal parasitic infections (IPIs) remain a significant public health challenge, particularly among school-aged children in low- and middle-income countries (LMICs). This systematic review and meta-analysis aimed to estimate the pooled prevalence of IPIs and identify associated risk factors in Africa and Asia.

Method: A systematic search of Medline/PubMed, Embase, Scopus, ScienceDirect, Epistemonikos, and additional searches such as Google and Google Scholar was conducted between January 2019 and April 2024. The review followed the PRISMA guidelines. Data extraction was performed using Microsoft Excel, and meta-analyses were conducted using STATA. Methodological quality was assessed using the Newcastle-Ottawa Scale. A random-effects model was used to estimate the pooled prevalence, while heterogeneity was assessed using the I² statistic. Publication bias was evaluated through funnel plots and Egger's regression test. The study protocol was registered in PROSPERO (CRD42024536604).

Results: 47 studies comprising 20,334 school-aged children were included. The pooled prevalence of at least one intestinal parasitic infection was 39% (95% CI: 33%-45%). Regional analysis showed a higher prevalence in Africa (41%) compared to Asia (35%). Protozoan infections (29%) exceeded those of helminths (19%) and mixed infections (2%). The most common parasites were Blastocystis hominis (16%), Endolimax nana (16%), Entamoeba histolytica (15%), Entamoeba coli (12%), and Ascaris lumbricoides (11%). Infections were primarily single (37%), followed by double (10%), triple (3%), and quadruple (1%). Significant risk factors included school type, socioeconomic status, larger family size, presence of domestic animals, and finger-sucking habits.

Conclusion: Intestinal parasitic infections remain a significant public health challenge among school-aged children in Africa and Asia. The findings underscore the need for sustained, school-based health programs that integrate regular deworming, hygiene education, and targeted sanitation improvements. Strengthening surveillance and addressing behavioral and environmental risk factors are essential to reducing infection burden and promoting child health.

Background: Differentiated Service Delivery (DSD) models for HIV are antiretroviral therapy (ART) mechanisms for stable people living with HIV (PLHIV) and are meant to be patient-centered to achieve treatment goals. One key element to achieve treatment goals is clients' satisfaction with DSD models. Despite extensive implementation and scale-up of DSD models in sub-Saharan Africa, satisfaction levels remain unclear. Thus far, no comprehensive systematic review and meta-analysis regarding clients' satisfaction level with DSD models and associated factors has been published. Therefore, we aim to conduct a systematic review and meta-analysis (1) to establish the level of clients' satisfaction with DSD models, (2) to determine which specific DSD models clients are most likely to be satisfied with, and (3) to identify factors associated with clients' satisfaction with DSD models.

Methods: All eligible studies reporting empirical evidence will be identified using a predetermined search strategy in several electronic databases such as EMBASE, PubMed, Scopus, Web of Science, CINAHL, and ProQuest. Observational studies that have been conducted in sub-Saharan African countries regardless of the year of publication will be included in the systematic review and meta-analysis. We will conduct this review and meta-analysis according to the guidelines by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A random effects model will be used to conduct the meta-analysis using Stata 19.5 software. Heterogeneity will be assessed by using Cochran's Q test and the I² statistic. Bias will be evaluated using Egger's and Begg's tests as well as visually by funnel plot.

Discussion: To the best of our knowledge, this review and meta-analysis will be the first to be conducted in the sub-Saharan Africa region to synthesize empirical evidence regarding clients' satisfaction with DSD models and associated factors, as well as identify common DSD models most clients are likely to be satisfied with. Collection of existing evidence will improve and guide implementation, scale-up, and adoption of different DSD models. Such knowledge can inform program managers and implementers which DSD models are likely to result in desired HIV treatment outcomes.

Systematic review registration: PROSPERO CRD420251085833.

Background: Metabolic dysfunction-associated steatohepatitis (MASH) represents a progressive form of liver disease with rising global prevalence, where sustained weight loss is essential for histological improvement. Current therapies-lifestyle modification, pharmacotherapy, and bariatric surgery-face limitations including variable efficacy, cost, invasiveness, or accessibility. Endoscopic sleeve gastroplasty (ESG) emerges as a minimally invasive alternative for moderate obesity, demonstrating promising weight loss and preliminary metabolic benefits. However, robust evidence regarding its impact on core histological outcomes remains limited and heterogeneous, necessitating a systematic evaluation to establish its therapeutic role in MASH management.

Methods and analysis: Randomized controlled trials (RCTs) and cohort studies that compare endoscopic sleeve gastroplasty and usual care in patients with metabolic dysfunction-associated steatohepatitis will be included. Literature searches will be conducted in PubMed, Web of Science, Embase, and Cochrane Library. Two reviewers will independently perform the processes of literature retrieval, screening, data extraction, and assessment of risk of bias. The primary outcome is total body weight loss (TBWL). Secondary outcomes include resolution of MASH without worsening of fibrosis, improvement in fibrosis without worsening of steatohepatitis, and incidence of adverse events. Risk of bias in included RCTs will be evaluated using Revised Cochrane risk-of-bias tool (ROB 2) for RCTs. Review Manager (RevMan) will be used for data pooling. Effect estimates will be expressed as risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). Subgroup analysis, trial sequential analysis (TSA), and sensitivity analysis will be conducted.

Ethics and dissemination: Ethical approval is not required because this study is a secondary analysis of existing data. We will disseminate the findings through peer- reviewed publications.

Systematic review registration: PROSPERO CRD420251121461.