Objectives: This meta-analysis aims to compare the safety and efficacy of radiofrequency ablation (RFA) and surgical resection (SR) in patients with small hepatocellular carcinoma (HCC).
Methods: A systematic literature search was conducted across four databases (PubMed, Web of Science, Cochrane Library, and Embase) for studies published between January 2020 and June 2024. The included studies reported comparative outcomes of SR and RFA in patients with small HCC (≤ 3 cm), including survival, oncological, and perioperative endpoints.
Results: A total of 25 studies involving 10,322 patients were included in the analysis. Compared with RFA, SR was associated with superior survival outcomes, including three-year overall survival (OS) (HR: 0.73; 95% CI: 0.66-0.80), five-year OS (HR: 0.70; 95% CI: 0.62-0.79), one-year recurrence-free survival (RFS) (HR: 0.55; 95% CI: 0.47-0.65), three-year RFS (HR: 0.66; 95% CI: 0.59-0.73), and five-year RFS (HR: 0.76; 95% CI: 0.68-0.85). Although SR was linked to longer operative times, prolonged hospitalization, and higher complication rates, it provided significantly better local tumor control, as reflected by a markedly reduced local recurrence rate. In patients with multiple tumors or those measuring ≤ 2 cm, the three- and five-year RFS rates were comparable between the SR and RFA groups. The three-year OS was also similar between the two treatments for tumors ≤ 2 cm.
Conclusion: These findings indicate that, compared with RFA, SR offers improved survival and lower recurrence rates in patients with small HCC. However, for individuals with tumors ≤ 2 cm or multiple HCC lesions, long-term survival outcomes are comparable between the two modalities, suggesting that treatment decisions should be individualized on the basis of tumor characteristics and patient risk-benefit profiles.
Background: Chemotherapy-induced diarrhea (CID) is a common complication among colorectal cancer patients receiving chemotherapeutic treatment. This condition adversely affects therapeutic outcomes and potentially increases mortality risks. Acupuncture, an integral component of traditional Chinese medicine, has gained widespread use in China's clinical settings. Recent findings suggest that this non-drug approach may provide therapeutic advantages for managing CID. This warrants further research into its clinical application.
Methods: A comprehensive systematic review will be performed to find randomized controlled trials (RCTs) that examine the therapeutic effectiveness and safety of acupuncture treatments for managing CID in patients with colorectal cancer. The search strategy includes eight major electronic repositories: PubMed, Web of Science, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Biomedical Database (CBM), and China Scientific Journal Database (VIP), with no language restrictions. Primary endpoints focused on clinical improvements quantified through two key parameters: alterations in diarrhea severity according to the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) classifications, and modifications in episode duration. Secondary endpoints encompassed safety assessments of acupuncture-related adverse reactions and comprehensive evaluation of quality-of-life indicators using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Two reviewers will independently assess the risk of bias for all primary outcomes via the Cochrane Risk of Bias tool (RoB2). Disagreements will be resolved through discussion or third-party adjudication. For data synthesis and meta-analysis, all statistical analyses will utilize Review Manager software version 5.3 from the Cochrane Collaboration.
Conclusion: This systematic review will synthesize existing evidence to evaluate the therapeutic efficacy and safety of acupuncture in managing CID among colorectal cancer patients. The findings aim to inform clinical practice by assessing whether acupuncture represents a viable adjunctive therapy within evidence-based treatment protocols.
Systematic trial registration: PROSPERO CRD420251045610.
Background: Health-related quality of life (HRQoL) measures are widely used in research and clinical practice; however, their application among children and adolescents in low- and middle-income countries (LMICs), where most of the world's youth reside remains underexplored. This scoping review aims to identify generic HRQoL instruments used in LMICs and describe their applications and reported psychometric properties.
Method: Guided by Arksey and O'Malley's framework, a search for peer-reviewed papers published between 2000 and 2024 was conducted in six databases (Medline, Embase, PubMed, Scopus, CINAHL, and Web of Science). The review included papers reporting the use of generic HRQoL instruments among individuals aged 0-19 years in LMICs.
Results: A total of 152 papers originating from 22 (of 75) LMICs were included. Nearly half of the papers were from India 50 (32.9%) and Egypt 25 (16.5%). Eight generic HRQoL instruments (PedsQL 4.0 GCS, KIDSCREEN-10/27/52, HUI-2/3, EQ-5D-Y-3L/5L, PROMIS-25, PedsQL Short Form (15-items), EQ-5D-3L/5L, and SF-36) were identified. Of these, PedsQL 4.0 GCS was reported in 78% of papers. Only 11 (7.2%) papers reported use of the instruments in the general population, and only one generated population norms. Very few studies 2 (1.3%) included children ≤ 4 years. One-third (34.9%) of the studies included both self- and proxy-reported HRQoL data. Most of the instruments were used for general health assessment (77.6%); only 9.9% of studies evaluated treatment or intervention outcomes, and 12.5% were psychometric studies. None of the psychometric studies assessed all nine measurement properties recommended by COSMIN.
Conclusion: The use of generic HRQoL instruments in studies of children and adolescents in LMICs, mainly with PedsQL, has increased in recent years, though almost half of the studies identified were carried out in only two countries. Despite their growing use, gaps remain in population coverage, psychometric evidence, and the geographic distribution of research in LMICs using generic HRQoL instruments.
Scoping review registration: The protocol was submitted to Open Science Framework on 24 January 2025. Registration DOI: https://doi.org/10.17605/OSF.IO/MVG62.
Background: In China, 6:2 chlorinated polyfluoroalkyl ether sulfonic acid (6:2 Cl-PFESA), commercially designated as F-53B, has been predominantly implemented as the perfluorooctane sulfonate (PFOS) substitute, with its 8:2 derivative showing negligible relevance to population exposure. Previous studies have found that 6:2 Cl-PFESA is closely related to dyslipidemia and disrupted glucose homeostasis, though results remain inconsistent.
Methods: Our study aimed to separately investigate the potential associations of 6:2 and 8:2 Cl-PFESA with glucolipid metabolism indicators in Chinese adults. A comprehensive systematic literature search was conducted across three major databases-PubMed, Embase, and Web of Science-by 23 September 2024. Random effects models were employed to estimate changes in blood lipid and glucose parameters with one interquartile range (IQR) increment in mean blood concentration of 6:2 and 8:2 Cl-PFESA. Subgroup analyses were performed based on different populations and types of diabetes. A Bayesian random-effects meta-regression model was conducted to attribute differences apparent between individual empirical estimates to mean 6:2 Cl-PFESA concentration.
Results: The analysis included 17 publications with more than 17, 000 participants. Meta-analyses revealed that each IQR increase of 6:2 Cl-PFESA exhibited significantly positive correlations with a 3.90 mg/dl change in total cholesterol (TC) (95% CI: 1.97, 5.83), and a 2.94 mg/dl change in low-density lipoprotein cholesterol (LDL-C) (95% CI: 1.47, 4.41) among the general adult population. The odds ratio (OR) for gestational diabetes mellitus (GDM) among pregnant women exposed to 6:2 Cl-PFESA was 1.61 (95% CI: 1.15, 2.27). Studies on 8:2 Cl-PFESA were insufficient.
Conclusion: The results demonstrated that 6:2 Cl-PFESA was significantly related to TC, LDL-C, as well as the risk of GDM. These findings challenge the current industrial designation of 6:2 Cl-PFESA as a safer alternative, necessitating explicit regulatory re-evaluation pending comprehensive mechanistic evidence that elucidates its biological interactions.
Systematic review registration: PROSPERO CRD42024581843.
Background: Postoperative pulmonary complications (PPCs) are common following abdominal surgery, contributing significantly to perioperative morbidity and mortality, prolonged hospitalization, and increased healthcare costs. Although various non-pharmacological strategies are frequently recommended in perioperative care, their comparative clinical effectiveness remains unclear. A rigorous synthesis of the available evidence is urgently needed to inform clinical guidelines and optimize patient outcomes.
Methods: A comprehensive literature search will be conducted in Ovid MEDLINE, Embase, and Web of Science from inception to January 2025, without language restrictions. We will include randomized controlled trials (RCTs) that evaluate structured single non-pharmacological perioperative interventions in adult patients undergoing elective abdominal surgery under general anesthesia. Only studies that clearly define PPCs will be included. The primary outcome is the proportion of patients developing composite PPCs. Secondary outcomes include each PPC subtype based on European Perioperative Clinical Outcome (EPCO) criteria (e.g., respiratory infection, respiratory failure, pleural effusion, atelectasis, or pneumothorax), hospital length of stay, and all-cause mortality. Two reviewers will independently screen studies, extract data, and assess risk of bias using the Cochrane RoB 2.0 tool. Pairwise random-effects meta-analyses using the Restricted Maximum Likelihood (REML) estimator will be performed, supplemented by trial sequential analysis to assess evidence robustness. Between-study heterogeneity will be quantified using I2. Publication bias will be evaluated through funnel plots and Egger's test. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be applied to assess the quality of the published literature.
Discussion: This systematic review and meta-analysis aims to provide an updated and focused synthesis of non-pharmacological interventions for preventing PPCs in adult patients undergoing abdominal surgery. By incorporating recent high-quality RCTs and applying rigorous evaluation methods, the review is expected to generate evidence directly applicable to perioperative practice, enhance clinical decision-making, support guideline development, and highlight critical areas for future research.
Systematic review registration: PROSPERO CRD42025637449.
Background: There is robust evidence reflecting that individuals with PTSD are significantly more at risk of engaging in self-harm and suicidal behaviours. Trauma-focused interventions for PTSD, however, predominantly focus on PTSD symptomology-related outcomes. Therefore, there is a dearth of knowledge regarding the treatment effects of psychological interventions in individuals with PTSD examining self-harm-related outcomes. This evidence synthesis will identify studies that investigate interventional effects on self-harm, non-suicidal self-injury (NSSI), and suicide attempts.
Methods: A comprehensive bibliographic search will be conducted to identify eligible randomised controlled trials (RCTs) and non-RCT evaluation studies indexed in Ovid MEDLINE, Embase (Ovid), PTSDPubs (ProQuest), APA PsycInfo (Ovid), PubMed (NOT MEDLINE[SB]), Web of Science Core Collection (CPCI-SSH), CENTRAL, WHO ICTRP, and ClinicalTrials.gov from inception to present day. A range of supplementary search techniques will also be employed to reduce the file drawer effect. Two independent reviewers will screen records at a title/abstract and full-text level, with 50% extracted data being cross-checked by an independent reviewer. Eligible studies will be assessed for risk-of-bias (RoB) using Cochrane's RoB 2.0 for RCTs and ROBINS-I for non-RCTs. A combination of random- and fixed-effects meta-analytic models will be performed separately for RCTs and non-RCTs, and for post-intervention and follow-up periods for self-harm, NSSI, and suicide attempts separately and in aggregate, using d-family effect sizes (including Hedges' g) and risk ratio/odds ratio for continuous and binary outcome data, respectively, with associated 95% confidence intervals. Sensitivity analyses will be performed to examine if methodological decisions impact on summary effects. Potential sources of heterogeneity will be examined as moderators (e.g. adults versus non-adults, intervention delivery, and complex PTSD versus PTSD) using mixed-effect meta-regression models. The evaluation of certainty of evidence of all main outcomes will be conducted using the GRADE approach. The review will be reported in accordance with PRISMA-S and PRISMA 2020 guidelines.
Discussion: This systematic review and meta-analysis of RCTs and non-RCTs will provide a comprehensive synthesis of treatment effects of psychological interventions on self-harm related outcomes among individuals with PTSD. The results may increase a better understanding of which interventions are best suited to targeting self-harm outcomes in this population. The completed review will be published in a peer-reviewed journal.
Systematic review registration: PROSPERO CRD42024598594.
Background: Experiencing stress is a normative part of human life. Due to its major impact on health and longevity, effort has been put into understanding underlying determinants and consequences. For stress measurement, a vast number of different methods, including physiological, subjective, and behavioral assessments, can be used. Previous measurement methods have already provided valuable insights into the role of the stress systems. However, their application has some drawbacks, highlighting the need for more convenient, less expensive, less intrusive, and continuous methods. A promising alternative could be the assessment of macroscopic body movements, which we define as body movements that are actively, consciously, or unconsciously, initiated by the muscular system.
Methods: The study protocol was registered with PROSPERO, and PRISMA-P guidelines were followed. We will screen MEDLINE, PsycInfo, Web of Science, Embase, and Google Scholar for suitable studies in German or English with no restrictions towards the publication date. To do so, an a priori defined search strategy will be employed. Furthermore, we will carry out backward and forward citation searches. Inclusion criteria comprise studies examining macroscopic body movements in response to stress or related psychological constructs induced by standardized protocols. Exclusion criteria include studies on non-human populations as well as studies that do not report on a control group/condition nor pre-/post-comparisons nor traditional stress markers. The search, selection, and data extraction processes will be performed by two reviewers independently, while a third reviewer will be consulted in case of discrepancy. We will assess Risk of Bias using the revised Cochrane Risk of Bias tool or ROBINS-I, as appropriate. We will conduct random-effects meta-analyses where feasible. The quality of evidence will be evaluated using the GRADE approach. Furthermore, results will undergo critical examination towards meta-biases.
Discussion: Due to the growing number of studies assessing macroscopic movements in the context of stress, the field is becoming complex, highlighting the need for a summary of current findings. Thus, here we outline a study protocol for a systematic review and meta-analysis on macroscopic movements as a potential novel marker for stress.
Systematic review registration: PROSPERO CRD42024539659.
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