Systematic Reviews最新文献

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.

Background: Human Papillomavirus (HPV) E6/E7 mRNA testing has been proposed as a potential improvement over HPV DNA testing for predicting cervical lesion progression. This systematic review and meta-analysis evaluated the diagnostic performance of HPV E6/E7 mRNA testing across various clinical scenarios.

Methods: A comprehensive search was conducted in Medline, Embase, Cochrane, Web of Science, and other databases. Two clinical scenarios were analyzed: triage of atypical squamous cells of undetermined significance (ASCUS), prediction of post-conization recurrence.. Diagnostic accuracy was assessed using standardized quality appraisal tools, with results synthesized through forest plots and Summary Receiver Operating Characteristic (SROC) curves.

Results: In ASCUS triage, all mRNA methods, including PreTect, APTIMA, and QuantiVirus, achieved comparable sensitivity but significantly higher specificity than DNA testing, with PreTect showing the strongest performance. For post-conization recurrence prediction, QuantiVirus and PreTect assays provided similar sensitivity but greater specificity compared to HPV DNA testing.

Conclusion: HPV E6/E7 mRNA testing offers higher specificity while maintaining comparable sensitivity to HPV DNA testing across multiple clinical scenarios. For ASCUS triage, PreTect demonstrates superior performance with the highest specificity and should be prioritized for clinical implementation in this setting. For post-conization recurrence prediction, QuantiVirus provides optimal diagnostic accuracy and represents the preferred choice for surveillance following cervical conization.

Systematic review registration: PROSPERO: CRD42023473415.

Background: Early outcome prediction after spontaneous intracerebral hemorrhage (ICH) is critical for patient management and counseling. Although machine learning (ML) models are increasingly applied, their comparative performance and explainability relative to traditional statistical models remain unclear.

Objectives: To systematically compare the predictive performance, calibration, and explainability of ML versus traditional models for early outcomes after ICH.

Methods: Following PRISMA-P guidelines and registered in PROSPERO (CRD420251166996), this systematic review and meta-analysis will include studies developing, validating, or comparing ML and traditional models for predicting early mortality or poor functional outcome (mRS ≥ 3 or GOS ≤ 3) after ICH. Data sources will include PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, IEEE Xplore, and major Chinese databases (CNKI, Wanfang, VIP, CBM). Two reviewers will independently screen studies, extract data, and assess risk of bias using the PROBAST + AI tool, which extends and replaces the original PROBAST framework for prediction models incorporating machine learning. Pooled analyses will employ random-effects models; confidence in the body of evidence will be summarized using an adapted approach informed by GRADE principles for prognosis evidence.

Expected results: This review will explore whether ML-based models demonstrate differences in discrimination, calibration, and explainability compared with traditional models.

Conclusions: This review will provide a comprehensive, evidence-based assessment of prognostic modeling for ICH, guiding future model design, validation, and clinical application.

Systematic review registration: PROSPERO CRD420251166996.

Background: Sweet solutions are widely used to reduce procedural pain in preterm infants, but their comparative efficacy and safety remain unclear.

Methods: We searched CINAHL, MEDLINE, Embase, CENTRAL, Scopus, and ProQuest for randomized controlled trials comparing glucose, sucrose, or expressed breast milk with control or with each other in preterm infants. We performed a random-effects frequentist network meta-analysis across three pain time points (reactivity, regulation, recovery). Pain level served as the primary outcome, while heart rate, oxygen saturation, respiratory rate, crying time, and adverse events were designated as secondary outcomes. Treatment efficacy was subsequently ranked using P-scores and a beading plot.

Results: We screened 10,043 records, included 42 RCTs (2733 infants), and analyzed 38 RCTs (2367 infants) in the network meta-analysis. Compared to the controls alone, glucose (standardized mean difference [SMD], -0.72; 95% confidence interval [CI], -1.19 to -0.25) and sucrose (SMD, -0.56; 95% CI, -1.04 to -0.07) were associated with lower pain responses in the reaction phase. In the regulation and recovery phases, pain reduction was consistently linked to glucose, sucrose, and expressed breast milk. Those interventions were supported by results of P-scores that ranged from 0.877 to 0.917 showing glucose's superiority in the three phases. Glucose was associated with a higher risk of adverse events. Half of the 38 trials in the network meta-analysis had a low risk of bias. The evidence certainty for the primary outcome was moderate to very low, while the certainty for the secondary outcomes spanned a range from high to very low.

Conclusions: Glucose ranked most effective for reducing procedural pain in preterm infants, followed by sucrose and expressed breast milk. Future trials should evaluate optimal dosing, repeated administration, and combinations with other non-pharmacological pain-management strategies to maximize efficacy and safety.

Systematic review registration: PROSPERO CRD42023389288 Glucose is the most effective sweet solution in alleviating pain scores in preterm infants, followed by sucrose and expressed breast milk.

Background: Emerging viral threats such as coronavirus, influenza, Lassa fever, Mpox, and Nipah virus continue to pose significant global health challenges. The development and deployment of effective vaccines are essential for outbreak control and pandemic preparedness. This protocol describes a systematic review that will synthesize evidence on vaccine candidates targeting high-priority viral threats and major vaccine platforms.

Methods: We will include randomised controlled trials (RCTs) assessing vaccine candidates for specified viruses (coronavirus, Lassa fever, Nipah virus, and Mpox) and platforms (protein-based, viral vector, and RNA) in the human populations. To encompass the full vaccine development landscape, exploratory and preclinical studies may also be included (any type of original research). Data sources will include MEDLINE Ovid, Embase Ovid (including ClinicalTrials.gov), and Cochrane Library (including CENTRAL), and grey literature (including conference proceedings, dissertations, trial registries, and company websites). Risk of bias will be assessed using Cochrane revised tool for assessing risk of bias in randomised trials (RoB-2) and Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), and certainty of evidence will be evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The primary outcomes are safety, immunogenicity, and vaccine efficacy or effectiveness, prioritised for their critical role in outbreak management and in guiding regulatory approval, public health policy, and clinical decision-making. Meta-analyses will be conducted where appropriate, using both fixed- and random-effects models. Subgroup analyses will be performed to explore heterogeneity based on virus type, vaccine platform, and outcome measures, where appropriate.

Discussion: This review will provide a comprehensive synthesis of vaccine development efforts across multiple platforms and pathogens with epidemic or pandemic potential. It will inform future research, policy, and investment decisions in global health preparedness.

Systematic review registration: PROSPERO 2025 CRD420251082338 on 6 October 2025.

Introduction: HER2-positive breast cancer is an aggressive subtype that benefits from targeted therapies. According to the Chinese Society of Clinical Oncology (CSCO) guidelines and the National Comprehensive Cancer Network (NCCN), the combination of trastuzumab (H) with pertuzumab (P) and neoadjuvant chemotherapy has become the standard treatment for patients with HER2-positive breast cancer in the neoadjuvant setting. Nevertheless, the long-term survival benefits of neoadjuvant dual HER2 blockade (P + H) remain unaddressed by comprehensive meta-analyses to date. This study is the first systematic review and meta-analysis to directly compare the long-term efficacy of P + H vs. H (excluding trastuzumab-derived or similar drugs, such as T-DM1, T-DXd, and so on) in the neoadjuvant treatment of HER2-positive breast cancer.

Methods: We conducted a systematic literature search in PubMed, Embase, the Cochrane Library, CNKI, Wan Fang, and VIP databases for relevant studies published up to June 1, 2025. RCTs with HER2-positive breast cancer patients who had not received breast cancer-related treatments previously were included. Treatment of P + H or H arms with chemotherapy combined with pertuzumab plus trastuzumab or trastuzumab as neoadjuvant treatment. The primary outcome was the event-free survival (EFS), disease-free survival (DFS), and overall survival (OS), and secondary outcomes included total pathological complete response (tpCR), objective response rate (ORR), and grade ≥ 3 adverse effects (AEs). The quality of evidence was assessed using the GRADE.

Results: A total of six RCTs involving 803 patients were included. In long-term efficacy, the P + H arm showed significant improvements in 3-year EFS rate (RR 1.08, 95% CI 1.00-1.16, p = 0.04), 5-year EFS rate (RR 1.10, 95% CI 1.01-1.20, p = 0.03), 5-year EFS (HR 0.58, 95% CI 0.38-0.87, p = 0.009), 5-year DFS rate (RR 1.09, 95% CI 0.99-1.20), and 5-year DFS (HR 0.55, 95% CI 0.35-0.84), compared to the H arm. In short-term efficacy, the P + H arm showed significant improvements in tpCR (RR 1.76, 95% CI 1.39-2.23, p < 0.001) and ORR (RR 1.18, 95% CI 1.09-1.27, p < 0.001) compared to the H arm. The outcome of 5-year DFS rate had moderate-quality evidence, and the outcome of 3-year EFS rate, 5-year EFS rate, 5-year EFS (HR), 5-year DFS (HR), tpCR had high-quality evidence.

Conclusions: Dual HER2 blockade with pertuzumab and trastuzumab demonstrated superior short- and long-term efficacy compared with trastuzumab alone, with each treatment showing a distinct but manageable safety profile.

Systematic review registration: PROSPERO CRD42021286130.

Background: Bulimia nervosa is a severe mental disorder associated with several physical and mental health complications. The aim of this review is to provide an overview of existing theoretical models regarding the development and maintenance of bulimia nervosa. A second aim is to develop a synthesis to allow for a more complete understanding of bulimia nervosa, which may help to develop and refine interventions in the future.

Methods: PsycInfo, PubMed, PSYNDEX, Scopus, and Google Scholar will be searched for studies presenting models of bulimia nervosa. Topic modeling will be used to gain initial insights into related factors. Additionally, two independent expert reviewers will screen the literature and select models of bulimia nervosa as well as associated datasets for additional empirical analyses. In the case of discrepancies, a third reviewer will be consulted. The similarities between the identified models of bulimia nervosa will be summarized in a narrative synthesis. Depending on the number of identified models and available datasets, models will be tested using existing datasets.

Discussion: The review seeks to summarize existing models regarding the development and maintenance of BN. The results could be used as a starting point for developing adequate models, testing these models, and subsequently using them to inform evidence-based intervention programs in the future.

Systematic review registration: This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 30.09.2024 (CRD42024581179).