Search Results (8,249)

Background: Indocyanine green-guided (ICG-guided) lymphadenectomy during gastrectomy for cancer has been proposed to enhance the accuracy of lymphadenectomy. The impact of ICG-guided lymphadenectomy on patient survival remains debated. Methods: The findings of the systematic review were reconstructed into an individual patient data (IDP) meta-analysis with restricted mean survival time difference (RMSTD). Overall survival (OS) and disease-free (DFS) survival were primary outcomes. RMSTD, standardized mead difference (SMD), and 95% confidence intervals (CI) were used as pooled effect size measures. Results: Three studies (6325 patients) were included; 42% of patients underwent ICG-guided lymphadenectomy. The patients’ age ranged from 47 to 72 years and 58% were males. Proximal, distal, and total gastrectomy were completed in 6.8%, 80.4%, and 12.8% of patients, respectively. The surgical approach was laparoscopic (62.3%) and robotic (37.7%). ICG-guided lymphadenectomy was associated with a higher number of harvested lymph nodes compared to non-ICG-guided lymphadenectomy (SMD 0.50; 95% CI 0.45–0.55). At the 42-month follow-up, OS and DFS estimates for ICG-guided vs. non-ICG-guided lymphadenectomy were 0.5 months (95% CI −0.01, 1.1) and 1.3 months (95% CI 0.39, 2.15), respectively. Conclusions: Our analysis suggests that ICG-guided lymphadenectomy offers equivalent long-term OS and DFS compared to non-ICG-guided lymphadenectomy. Full article

Objectives: Antibiotic exposure during pregnancy is common, accounting for over 80% of all medications prescribed. Antibiotics in pregnancy are linked to increased childhood disease risk, through direct toxicity or potentially microbiome dysbiosis. This systematic review investigated the relationship between in-utero exposure to antibiotics and childhood hearing loss. Methods: We searched Ovid Medline, Embase, and PubMed for studies examining antibiotic exposure during pregnancy and its associations with hearing loss in offspring. Studies with children whose mothers had data on antibiotic exposure during pregnancy were selected. The meta-analysis calculated (1) pooled prevalence of childhood hearing loss and (2) pooled odds ratios (ORs) for associations between in-utero exposure to antibiotics and childhood hearing loss. Results: Of 1244 studies identified, 18 met the inclusion criteria. Among 161,053 children exposed in-utero to antibiotics, 4368 developed hearing loss. The pooled prevalence of childhood hearing loss was 0.9% (95% CI 0.0–2.8%, I² = 99.6%). In-utero exposure to antibiotics was associated with an increased risk of childhood hearing loss (pooled OR 1.2, 95% CI 1.1 to 1.3, I² = 15.4%). Aminoglycoside exposure during pregnancy was associated with a higher risk of hearing loss (pooled OR 1.2, 95% CI 1.1 to 1.3, I² = 38.4%), while exposure to other antibiotic classes showed no association. Conclusions: The prevalence of childhood hearing loss among those exposed to antibiotics during pregnancy is high. Although the overall risk appears modest, aminoglycosides are linked to a significantly higher risk, suggesting maternal aminoglycoside exposure may indicate a risk for child hearing loss. Further research is needed to clarify causal pathways and long-term effects of in-utero exposure to antibiotics. Full article

Background: Tourniquet pressures used in upper limb surgery are commonly standardized at 250 mmHg. These higher tourniquet pressures have been associated with an increased risk of complications, such as neural compression injury and soft tissue damage. However, there has been limited consensus as to the use of lower tourniquet pressures and their efficacy. This systematic review and meta-analysis aims to examine the current evidence for the use of lower tourniquet pressures in upper limb surgery, comparing them to the standard tourniquet pressures of 250 mmHg and, in some cases, 300 mmHg. This study is registered on PROSPERO (CRD42024511501). The primary outcome was the adequacy and quality of the bloodless field achieved at lower pressures. Secondary outcomes were assessed when reported, including the operative time, pain, and complications. Methods: The databases Medline (via Ovid), Embase (via Ovid), Cochrane, Web of Science (Core Collection) and Scopus, ClinicalTrials.gov, EU Clinical Trials Register, and ISRCTN registry were searched from inception to January 2025. The inclusion criteria included patients undergoing upper limb surgery using regional or general anesthetic with the use of a pneumatic tourniquet. A total of 1994 studies were identified, of which 12 met the inclusion criteria for review and 8 studies were used in the meta-analysis. Risk of bias was assessed using the ROBINS-I and RoB-2 tools. Results: The sample size was 1427 patients with a mean age of 46.8 years. All studies showed a bloodless surgical field at lower tourniquet occlusion pressures. The meta-analysis showed the overall mean tourniquet inflation pressure, estimated using a random effects model, to be 169.3 mmHg with a 95% confidence interval of 144.9–193.6. However, the heterogeneity in the reported results is significant (p < 0.0001) and is a limitation to this review. Conclusions: This systematic review highlights the benefit of the use of a lower tourniquet pressure (below the standard 250 mmHg) to produce an adequate surgical field and influence procedural outcomes. Full article

Background/Objectives: Endotracheal intubation in critically ill patients presents significant challenges due to anatomical and physiological complexities, making airway management crucial. Video laryngoscopy (VL) has emerged as a promising alternative to direct laryngoscopy (DL), offering improved and higher success rates. This systematic review and meta-analysis evaluated the comparative efficacy and safety of VL versus DL in critically ill adults. Methods: A systematic search was conducted in PubMed, Embase, and Cochrane Library through August 2024 following PRISMA-2020 guidelines. Randomized controlled trials comparing VL and DL in critically ill adult patients were included. The RoB 2.0 tool assessed bias, and GRADE evaluated the certainty of evidence. The primary outcome was first-attempt success; secondary outcomes included intubation time, glottic visualization, and complications. Random effects models were used for data synthesis. Results: Fifteen studies (4582 intubations) were included. VL improved first-attempt success rates (RR 1.12; 95% CI: 1.04–1.21; I² = 87%). It also reduced esophageal intubation (RR 0.44; 95% CI: 0.26–0.75), dental injuries (RR 0.32; 95% CI: 0.16–0.67), and poor glottic visualization. No significant differences were found in hypoxemia, hypotension, or mortality. Conclusions: VL enhances intubation success and reduces specific complications, particularly in difficult airways. However, high heterogeneity and low certainty of evidence warrant further studies to clarify its impact on critical patient outcomes. Full article

Background and Objectives: Minimally invasive valve surgery (MIVS), integrated within enhanced recovery after surgery (ERAS) programs, is a pivotal advancement in modern cardiac surgery, aiming to reduce perioperative morbidity and accelerate recovery. This systematic review analyzes the integration of ERAS components into MIVS programs and evaluates their impact on perioperative outcomes and patient recovery. Materials and Methods: A systematic search of PubMed/Medline, conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, identified studies on ERAS in MIVS patients. Coronary and robotic surgery were excluded to prioritize widely adopted minimally invasive valve methods. Studies were included if they applied ERAS protocols primarily to MIVS patients, with at least five participants per study. Data on study characteristics, ERAS components, and patient outcomes were extracted for analysis. Results: Eight studies met the inclusion criteria, encompassing 1287 MIVS patients (842 ERAS, 445 non-ERAS). ERAS protocols in MIVS were heterogeneous, with studies implementing 9 to 18 of 24 ERAS measures recommended by the ERAS consensus guideline, reflecting local hospital practices and resource availability. Common elements include patient education and multidisciplinary teams, early extubation followed by mobilization, multimodal opioid-sparing pain management, and timely removal of invasive lines. Despite protocol variability, these programs were associated with reduced morbidity, shorter hospital stays (intensive care unit-stay reductions of 4–20 h to complete omission, and total length of stay by ≥1 day), and cost savings of up to EUR 1909.8 per patient without compromising safety. Conclusions: ERAS protocols and MIVS synergistically enhance recovery and reduce the length of hospital stay. Standardizing ERAS protocols for MVS could amplify these benefits and broaden adoption. Full article

Sepsis, a life-threatening condition arising from a dysregulated immune response to infection, is a significant health burden globally. Interleukin-6 (IL-6), an inflammatory cytokine produced by immune cells as a response to infection and tissue damage, plays a key role in the pathogenesis of sepsis. This systematic review and meta-analysis aimed to investigate the association of the baseline plasma levels of IL-6, and the dynamic change in these levels over a timespan of 96 h, with short-term mortality. A systematic literature search was conducted across multiple databases. Studies were included if they assessed the independent prognostic value of IL-6 in adult sepsis patients, used well-defined sepsis criteria, and reported at least one IL-6 measurement. Pooled effect estimates for the association between IL-6 and 28–30-day mortality were determined using logistic regression and AUROC analysis. Thirty-one studies, encompassing 4566 patients, were included. While baseline IL-6 levels and 96 h IL-6 clearance were not significantly associated with mortality risk (pooled OR 1.001, 95% CI 0.999–1.003 and 1.019, 95% CI 0.925–1.112, respectively), AUROC analysis indicated moderate-to-good discriminatory power for both baseline (0.701, 95% CI 0.660–0.742) and 96 h IL-6 clearance (0.828, 95% CI 0.736–0.919) in predicting 28-day mortality. While not a strong independent predictor, IL-6 demonstrates some discriminatory ability, suggesting its potential value in conjunction with other biomarkers. Full article

Background/Objectives: The effect of thoracic duct (TD) management—resection, ligation, or preservation—during esophagectomy for cancer remains controversial. This systematic review and meta-analysis aimed to assess the impact of TD management strategies on oncological outcomes and surgical morbidity. Methods: A systematic review and meta-analysis were performed following PRISMA reporting guidelines. Searches of OVID, Embase, and Web of Science identified studies comparing thoracic duct resection or TD ligation with TD preservation in esophagectomy for cancer. Outcomes included 5-year overall survival (OS), postoperative morbidity, postoperative chyle leakage, lymph node yield, and length of stay. Random-effects meta-analyses using the Hartung-Knapp-Sidik-Jonkman variance correction were conducted. Results: A total of 17 studies involving 4200 patients were included. TD resection was associated with a significantly higher lymph node yield (mean difference [MD]: 4, 95% CI: 0 to 8, p = 0.043), but also increased risk of chyle leakage (odds ratio [OR]: 2.41, 95% CI: 1.04–5.61, p = 0.044). There was no significant improvement in 5-year OS with TD resection compared to TD preservation (hazard ratio [HR]: 0.94, 95% CI: 0.76–1.17, p = 0.48). TD ligation showed no significant differences in 5-year OS (HR: 1.15, 95% CI: 0.81–1.63, p = 0.33) or morbidity compared to TD preservation. Certainty of evidence was low across outcomes. Conclusions: TD resection increases lymph node yield but is associated with higher rates of chyle leakage, without a significantly improved overall survival. TD ligation does not significantly affect oncological or surgical outcomes compared to TD preservation. A higher grade of evidence is needed to determine the definitive oncological and surgical impact of TD management strategies. Full article

Background: Men are known to have a higher incidence of acute cardiovascular events, while women are recognized for their increased mortality following diagnosis or intervention for these conditions. The aim of this study is to explore the sex differences in clinical profiles and outcomes of patients undergoing ascending aortic aneurysm (AscAA) surgery. Methods: A PRISMA compliant literature search and data extraction were conducted using PubMed, EMBASE, and SCOPUS. Observational cohort or retrospective registries that compared a defined number of male and female adults undergoing ascending aortic surgery for AscAA were included. Data analysis was conducted in compliance with Cochrane methods. Results: A total of 11 unique studies met the inclusion criteria, from which 13636 patients were included, with a distribution of 9124 males (67%) and 4512 females (33%). Overall, 91% underwent elective surgery. Male patients had significantly lower 30-day mortality, (RR: 0.68, 95% Cl [0.57, 0.81], p < 0.0001) and shorter stays in the intensive care unit, with a mean difference (MD) of −0.48 days ([−0.84, −0.13], p = 0.008). Males were significantly younger at the time of surgery (MD: −3.94 years, 95% CI [−5.58, −2.31], p < 0.00001). Male patients had significantly more frequent concomitant CABG (21% vs. 14.5%; p < 0.0001), while females had more frequent isolated supra-coronary ascending aortic replacement (22% vs. 36%; p = 0.004). Female patients who underwent AscAA surgery had significantly lower long-term survival (HR: 1.25, [1.05, 1.50], p = 0.013). Conclusions: Women undergo surgery for AscAA at older ages and face greater mortality. The disparities in preoperative age and timing of surgery between males and females can be explained by differences in comorbidity profiles and the need for concomitant surgery. Full article

Background/Objectives: The CarerQol instrument is used to measure the quality of life of informal caregivers and to assess the impact that caring for a dependent person has on them. The scale consists of two parts, CarerQol-7D, which measures the effects of informal care using two positive and five negative domains, and CarerQol-VAS, which measures happiness on a visual analog scale. Methods: In the present work, we conducted a systematic review of the instrument since its development in 2006, followed by a (convergent, clinical, and discriminative) validity analysis and a meta-analysis of the reliability of generalizing CarerQol. A total of 54 articles that used CarerQol were identified. Results: The instrument was found to have good convergent, clinical, and discriminant validity, although the average reliability coefficient was 0.67 (95% CI [0.56, 0.75]) for Cronbach’s alpha coefficients and 0.62 (95% CI [0.04, 0.89]) for test–retest reliability coefficients, with a high degree of heterogeneity between the coefficients. Conclusions: According to the psychometric theory, CarerQol is a reliable instrument and can be used for exploratory purposes in the field of research, although it should be used with caution when making decisions in clinical practice. Full article

(1) Background: Papillomaviruses are double-stranded DNA viruses, and it is essential to clarify their genotypic distribution for their effective prevention and clinical management. In this study, we aimed to evaluate the prevalence of HPV genotypes in the normal oral mucosae of HIV-positive individuals. (2) Methods: A systematic literature search was conducted across PubMed, Web of Science, Scopus, and Google Scholar to identify peer-reviewed studies published up to 13 February 2025. The inclusion criteria referred to original research studies reporting on the prevalence and genotype-specific distribution of HPV in the oral mucosae of HIV-positive individuals. Statistical analyses were conducted using the MedicReS E-PICOS AI smart biostatistics software (version 21.3, New York, NY, USA) and the MedCalc statistical software package (MedCalc Software Ltd., Ostend, Belgium). The pooled prevalence estimates were calculated using a random-effects meta-analysis model, and heterogeneity was quantified using the Cochrane Q and I² statistics. The presence of publication bias was assessed via the Begg and Mazumdar rank correlation test. (3) Results: High prevalence and heterogeneity of HPV-58 (6.23%), HPV-16 (4.326%), and HPV-66 (3.733%) were observed, indicating significant variability across populations and methodologies. This supports their association with HPV-related oropharyngeal malignancies and the need for the continuous surveillance of HIV-positive individuals. We also observed the elevated detection of LR-HPV genotypes, particularly HPV-13 (7.16%), HPV-5 (5.64%), and HPV-62 (4.24%). (4) Conclusions: These findings indicate that there is substantial heterogeneity in the prevalence of both HR-HPV and LR-HPV genotypes among HIV-positive individuals, with certain genotypes exhibiting higher detection rates across studies, emphasizing the need for targeted surveillance and preventive strategies in this vulnerable population. The application of advanced data analysis methods is essential in enhancing HPV surveillance and implementing effective control measures in this vulnerable population. Full article

Background/Objectives: Interleukin 12/23 inhibitors are a newer class of monoclonal antibodies used to induce and maintain remission for Crohn’s disease (CD), a chronic inflammatory bowel disease, when patients do not respond to conventional immunomodulatory drugs or first-line monoclonal antibody therapies. Although biologics are best administered intravenously, subcutaneous administration has been trialed, with mixed results. This research synthesized evidence on the efficacy and safety of subcutaneous compared to intravenous administration of interleukin 12/23 inhibitors for moderate to severe CD. Methods: In this systematic review and meta-analysis, we searched Cochrane, PubMed, SCOPUS, CINHAL, and preprint archives for randomized controlled trials (RCTs) that compared the efficacy and safety of subcutaneous to intravenous interleukin 12/23 inhibitors for the remission of CD. After study quality assessment, a meta-analysis was carried out using a bias-adjusted inverse variance heterogeneity model, heterogeneity was assessed using I², and publication bias was performed using Doi plots. Evidence certainty was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results: Seven RCTs, with 2179 participants, all with moderate to severe CD, were included. After meta-analysis, subcutaneous compared to intravenous administration showed similar efficacy for the induction of remission (OR 0.77, 95%CI 0.53–1.12), with no-to-low heterogeneity (I² = 0%, p = 0.97). For the maintenance of remission, only two studies had analyzable data, and they showed that subcutaneous interleukin 12/23 inhibitors were equal or better compared to intravenous administration. Further syntheses showed that subcutaneous compared to intravenous administration of interleukin 12/23 inhibitors had almost similar odds of adverse events (OR 0.91, 95%CI 0.63–1.32, I² = 39%), serious adverse events (OR 0.97, 95%CI 0.61–1.53, I² = 0%), and treatment discontinuation (OR 1.06, 95%CI 0.67–1.68, I² = 0%). Conclusions: In individuals with moderate to severe CD, subcutaneous administration has similar efficacy for inducing remission with comparable safety. More RCTs are needed to confirm these findings. Full article

Background: Cardiac involvement in sarcoidosis is often subclinical, with late manifestations associated with poorer prognosis. Speckle-tracking echocardiography (STE) is gaining attention due to its ability to detect subclinical alterations in myocardial contraction patterns and quantification of abnormal parameters. Methods: Databases, including PubMed, Cochrane Central, Embase, Scopus, and Web of Science, were searched to identify studies comparing echocardiographic parameters in sarcoidosis patients with healthy controls. Mean difference (MD) with 95% confidence intervals (CI) were pooled using the inverse-variance random-effects model in Review Manager Version 5.4.1. Statistical significance was considered at p-value <0.05. Results: Thirteen studies with 1416 participants (854—sarcoidosis; 562—healthy controls) were included. In a pooled analysis, patients with sarcoidosis demonstrated a significantly lower left ventricular global longitudinal strain (LV GLS) (Mean Difference [MD]: −3.60; 95% Confidence Interval [CI]: −4.76, −2.43; p < 0.0001) and left ventricular global circumferential strain (LV GCS) (MD: −2.52; 95% CI: −4.61, −0.43; p = 0.02), along with a significantly higher pulmonary artery systolic pressure (PASP) (MD: 4.19; 95% CI: 0.08, 8.29; p = 0.05), left ventricular end-systolic diameter (LVESD) (MD: 0.90; 95% CI: 0.10, 1.71; p = 0.03), A-wave velocity (MD: 3.36; 95% CI: 0.33, 6.39; p = 0.03), and E/E’ ratio (MD: 1.33; 95% CI: 0.42, 2.23; p = 0.004) compared to healthy controls. No significant differences were noted in left ventricular ejection fraction (LVEF), left ventricular global radial strain (LV GRS), interventricular septal thickness (IVST), tricuspid annular plane systolic excursion (TAPSE), left ventricular end-diastolic diameter (LVEDD), E-wave velocity, and E/A ratio. Conclusions: STE serves as a promising imaging modality in detecting subclinical cardiac involvement in sarcoidosis patients with no overt cardiac manifestations. A widespread cardiovascular evaluation of sarcoidosis patients with STE is recommended to detect these altered myocardial contractile patterns. The early detection of cardiac sarcoidosis is essential to prevent adverse clinical outcomes and improve mortality. Full article

Background and Objectives: Cystic fibrosis (CF), caused by CFTR gene mutations, primarily affects the respiratory and gastrointestinal systems. Microbiota modulation through probiotics, prebiotics, or synbiotics may help restore microbial diversity and reduce inflammation. This study aimed to evaluate their efficacy in CF. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2000 and 2024 was conducted in Cochrane, ScienceDirect, Web of Science, LILAC, BMC, PubMed, and SCOPUS following PRISMA guidelines. Methodological quality was assessed using the Jadad scale, and RevMan 5.4^® estimated effects on pulmonary function (FEV₁), exacerbations, hospitalizations, quality of life, and inflammatory markers. Results: Thirteen RCTs (n = 552), mostly in pediatric populations, were included. Most examined probiotics (e.g., Lactobacillus rhamnosus GG, L. reuteri), while four used synbiotics. Several studies reported reduced fecal calprotectin and proinflammatory interleukins (e.g., IL-6, IL-8), suggesting an anti-inflammatory effect. However, no significant differences were observed regarding hospitalizations or quality of life. Additionally, none of the studies documented serious adverse events associated with the intervention. The meta-analysis showed no significant decrease in exacerbations (RR = 0.81; 95% CI = 0.48–1.37; p = 0.43) or improvements in FEV₁ (MD = 4.7; 95% CI = −5.4 to 14.8; p = 0.37), even in subgroup analyses. Sensitivity analyses did not modify the effect of the intervention on pulmonary function or exacerbation frequency, supporting the robustness of the findings. Conclusions: Current evidence suggests that probiotics or synbiotics yield inconsistent clinical benefits in CF, although some reduction in inflammatory markers may occur. Larger, multicenter RCTs with longer follow-up are needed for clearer conclusions. Until more definitive evidence is available, these supplements should be considered experimental adjuncts rather than standard interventions for CF management. Full article

This study investigated the effects of compression garments on mitigating the decline in muscle strength and power resulting from exercise-induced muscle fatigue. Searches were performed in PubMed, Web of Science, EBSCO, Cochrane, and Scopus databases. The three-level restricted maximum likelihood random effects model was used to synthesize the data. Twenty-seven studies met the inclusion criteria. Compression garments had significant restorative effects on muscle strength (Hedges’s g = −0.21, p < 0.01) and power (Hedges’s g = −0.23, p < 0.01) after exercise-induced muscle fatigue. Subgroup analysis revealed that compression garments were effective in mitigating the decline in muscle strength when the rest intervals were 1–48 h and over 72 h and in mitigating the decline in power when the resting interval was 1–24 h. In addition, compression garments significantly mitigated the decline in muscle strength, during rest intervals of 1–24 h for trained individuals and over 72 h for both trained and untrained individuals, after exercise-induced muscle fatigue. In conclusion, compression garments significantly mitigated the decline in muscle strength after exercise-induced muscle fatigue. Both trained and untrained individuals could benefit from compression garments, with the effectiveness of compression garments being more pronounced in trained individuals compared to untrained ones. Full article

The role of adjuvant chemotherapy (adj-CT) in stage II colon cancer remains controversial. Circulating tumor DNA (ctDNA) is a promising biomarker for detecting minimal residual disease (MRD) and predicting recurrence. This systematic review and meta-analysis evaluated the prognostic value of ctDNA in stage II colorectal cancer (CRC), focusing on postoperative detection, post adj-CT outcomes, and dynamic surveillance. A literature search identified studies correlating ctDNA positivity in stage II CRC with recurrence risk, recurrence-free survival (RFS), and disease-free survival (DFS). Seven studies met the inclusion criteria. Postoperative ctDNA positivity significantly increased the risk of recurrence (pooled risk ratio [RR:] 3.66; 95% confidence interval [CI]: 1.25–10.72; p = 0.002). CtDNA positivity after adj-CT was strongly associated with poor survival, while dynamic ctDNA monitoring detected recurrence earlier than conventional methods, including carcinoembryonic antigen (CEA) and imaging. CtDNA is a robust prognostic biomarker in stage II CRC, enabling personalized treatment. High-risk ctDNA-positive patients may benefit from intensified therapy, while ctDNA-negative patients could avoid unnecessary treatments. However, the standardization of detection methods and large-scale validation studies are needed before integrating ctDNA into routine clinical practice as a non-invasive, dynamic tool for personalized care. Full article