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Pharmacologic prophylaxis of postoperative delirium in elderly patients: A network meta-analysis of randomized controlled trials.
Liu, TH, Lin, YT, Wu, JY, Huang, PY, Tsai, WW, Lai, CC, Kao, PH, Su, KP
Journal of psychiatric research. 2025;:169-178
Abstract
BACKGROUND The high incidence and mortality rates of postoperative delirium (POD) among elderly patients highlights the pressing need for tailored prophylactic strategies. Despite various pharmacologic prophylactic strategies have been reported effective, their overall benefit and safety remain unclear in the geriatric population. Our network meta-analysis (NMA) aimed to systematically evaluate and rank the effectiveness of various pharmacological interventions in preventing POD in elderly patients. METHODS We conducted an extensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Google Scholar for randomized controlled trials (RCTs) published up to August 1, 2023. We included RCTs examining pharmacological prophylactic effects of POD in elderly patients. To extract data in alignment with predefined areas of interest, we employed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The primary outcome was the incidence of POD. For secondary outcomes, we evaluated tolerability through all-cause discontinuation or drop-out rates, as well as all-cause mortality. RESULTS Our analysis encompassed a total of 44 RCTs involving 11,178 patients. Out of these, 26 RCTs involved comparisons with placebo only. For delirium prevention, the treatment groups receiving atypical antipsychotics (odds ratio (OR) of 0.27 and 95% confidence interval (CI) of 0.12-0.58), haloperidol (OR of 0.42; 95% CI of 0.25-0.71), dexmedetomidine (OR of 0.51 and 95% CI of 0.37-0.71 and melatonergic agents (MMA) (OR of 0.57 and 95% CI of 0.33-0.98) had significantly lower rates of delirium compared to the placebo group. Notably, the atypical antipsychotics ranked as the most effective treatment. For tolerability, no statistically differences in rates of dropout discontinuation and all-cause mortality among groups allocated to the placebo or individual pharmacological treatments. CONCLUSIONS Based on indirect evidence, our network meta-analysis identified atypical antipsychotics, dexmedetomidine, MMA, and haloperidol as effective in preventing POD in the elderly, with atypical antipsychotics ranking highest. However, it is essential to note that these findings should be confirmed through further RCTs.
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Comparative effectiveness of massage combined with lifestyle intervention and lifestyle intervention alone for simple obesity: A systematic review and meta-analysis.
Wang, G, Ju, H, Zhang, Z, Wu, X, Niu, H, Zhang, L, Chen, L, Lou, H, Yang, Y
Medicine. 2025;(2):e41074
Abstract
BACKGROUND This study aimed to assess the comparative effectiveness of massage combined with lifestyle intervention and lifestyle intervention alone in patients with simple obesity. METHODS The PubMed, Embase, Cochrane Library, CNKI, VIP Database, and Wanfang Data were searched. Meta-analysis was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Primary outcomes were body weight (BW) and body mass index (BMI). Secondary outcomes were waist circumference (WC), hip circumference (HC), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting insulin (FINS), and homeostasis model assessment-insulin resistance (HOMA-IR) and adverse events. RESULTS Thirteen randomized controlled trials were included. The meta-analysis showed that massage combined with lifestyle intervention significantly decreased BW (mean difference [MD]: -4.85; 95% confidence interval [CI]: -8.25 to -1.46; P = .005), BMI (MD: -2.65; 95% CI: -4.05 to -1.24; P = .0002), WC (MD: -3.63; 95% CI: -6.28 to -0.98; P = .007), TC (MD: -0.52; 95% CI: -0.84 to -0.20; P = .001), TG (MD: -0.23; 95% CI: -0.45 to -0.02; P = .003), LDL-C (MD: -0.48; 95% CI: -0.54 to -0.42; P < .00001), HDL-C (MD: -0.11; 95% CI: -0.17 to -0.05; P = .0004), FINS (MD: -1.64; 95% CI: -3.16 to -0.12; P = .03), and HOMA-IR (MD: -0.42; 95% CI: -0.65 to -0.18; P = .0005) compared with lifestyle intervention alone. In subgroup analyses, more obvious reduction in BMI (P = .02, I2 = 80.3%) for the children and adolescents subgroup, more obvious reduction in HC (P = .04, I2 = 76.1%) for the adults subgroup, more significant reduction in TC (P < .00001, I2 = 98.3%), LDL-C (P < .00001, I2 = 95.6%), and HDL-C (P < .0001, I2 = 94.1%) for intermittent treatment subgroup and more significant reduction in TC (P < .00001, I2 = 95.9%) and HDL-C (P < .0001, I2 = 94.1%) for treatment times ≤30 subgroup were detected. CONCLUSIONS Compared with lifestyle intervention alone, massage combined with lifestyle intervention significantly decreased BW, BMI, WC, TC, TG, LDL-C, FINS, and HOMA-IR, but produced less effect in increasing HDL-C. And different ages, treatment intervals, and treatment times can all affect treatment outcomes.
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Effect of Astragalus injection treatment for viral myocarditis: a systematic review and meta-analysis.
Jialiken, D, Qian, L, Wen, S, Ren, S, Fan, Y, Dong, YX, Zou, C
European journal of medical research. 2025;(1):1
Abstract
BACKGROUND Astragalus injection has been utilized in traditional Chinese medicine to treat a variety of diseases. The purpose of this systematic review was to evaluate the effectiveness of Astragalus injection in the treatment of viral myocarditis. METHODS English databases such as PubMed, Cochrane Library, and EMBASE, and Chinese databases of Sino Med, China National Knowledge Infrastructure (CNKI), the VIP Information Resource Integration Service Platform, and Wanfang Data Information Site, were searched from their inception until May 1, 2024. The outcome measures of this study included the effectiveness rate, creatine kinase (CK), aspartate aminotransferase (AST), creatine kinase Isoenzyme (CK-MB), lactate dehydrogenase (LDH), cardiac troponin I (cTnI), and electrocardiogram (ECG). RESULTS Twenty-six studies were included in this analysis, comprising a total of 2793 patients. Meta-analyses indicated that, compared to standard treatment alone, the Astragalus injection group demonstrated significant advantages, achieving an effectiveness rate of 92.79% (1094 cases). In contrast, the control group, which included 1108 cases, had an effectiveness rate of 77.71% (861 cases). Additionally, the Astragalus injection group exhibited the following benefits for patients affected by viral myocarditis: decreasing ∆AST [weighted mean difference (WMD) = - 14.23, 95% confidence interval (CI) (- 24.17, - 4.30), P < 0.05]; ∆CK [weighted mean difference (WMD) = - 34.84, 95% confidence interval (CI) (- 48.03, - 21.65), P < 0.05], lowering ∆CK-MB [WMD = - 7.64, 95% CI (- 9.30, - 5.99), P < 0.001], ∆cTnl [WMD = - 0.18, 95% CI (- 0.27, - 0.10), P < 0.001], ∆LDH [WMD = -41.93, 95% CI (- 55.97, - 27.90), P < 0.05], and ∆cTnI [WMD = - 0.18, 95% CI (- 0.28, - 0.08), P < 0.05]. CONCLUSION Astragalus injection may have a therapeutic effect in patients with viral myocarditis by reducing levels of AST, CK, CK-MB, LDH, and cTnI, improving ECG results, and increasing the overall effectiveness rate for those affected by this condition. TRIAL REGISTRATION This study registered with PROSPERO before conducting the systematic review. The registration number is CRD42021239660.
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Prevalence of successful aging in older adults: A systematic review and meta-analysis.
Zhou, Y, Sun, Y, Pan, Y, Dai, Y, Xiao, Y, Yu, Y
Archives of gerontology and geriatrics. 2025;:105604
Abstract
BACKGROUND Successful aging (SA) describes the multidimensional aspects of achieving optimal physical and mental health and social well-being combinations in old age. Recent years have seen increasing interest in understanding SA prevalence. This study systematically evaluates the current state of SA globally, defined as multidimensional outcomes. OBJECTIVE To systematically evaluate the global prevalence of SA in older adults. METHODS We searched PubMed, Embase, Web of Science, Cochrane Library, China Biomedical Database, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and Weipu Database from inception to February 14, 2024. Two researchers independently conducted literature screening, data extraction, and quality evaluation. Meta-analysis was performed using Stata 16.0. RESULTS Thirty studies comprising 250,460 older adults were included. Meta-analysis showed the overall global prevalence of SA was 24.0 % [95 % CI (20.7 %, 27.3 %)]. Prevalence rates were 25.1 % in Asia, 21.5 % in Europe, 20.6 % in the Americas; 16.8 % in developed and 27.1 % in developing countries. Subgroup analyses indicated higher SA rates among male older adults, married/cohabiting, living in urban areas, and having higher education levels. CONCLUSIONS The global prevalence of SA among older adults is low, with variations across age groups, regions, and education levels. Due to the limitations of the included studies, further high-quality research is needed to validate these findings.
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Energy and protein nutrition adequacy in general wards among intensive care unit survivors: A systematic review and meta-analysis.
Rosseel, Z, Cortoos, PJ, Leemans, L, van Zanten, ARH, Ligneel, C, De Waele, E
JPEN. Journal of parenteral and enteral nutrition. 2025;(1):18-32
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BACKGROUND Adequate energy and protein provision is mandatory to optimize survival chances in critical illness, prevent loss of muscle mass, and reduce length of stay. Data are available concerning feeding adequacy in intensive care unit (ICU) participants, but little is known about the adequacy in post-ICU participants. This systematic review aimed to evaluate feeding adequacy in post-ICU participants and addressed causes of feeding interruption leading to suboptimal adequacy. METHODS For this systematic review, a bibliographic search was performed in PubMed, Scopus, and Web of Science. Randomized controlled studies, non-randomized controlled studies, and observational studies conducted between January 1990 and November 2023 fulfilling the inclusion criteria were withheld. RESULTS Eight studies were included. Outcomes reported were energy and protein adequacy, barriers, and feeding routes. Energy and protein requirements were determined in various ways, including indirect calorimetry and standardized and weight-based formulas. Energy adequacy ranged from 52% to 102% and protein adequacy between 63% and 86%. Participants were mainly fed with enteral nutrition (EN) or a combination of oral nutrition and EN. The main barrier reported for inadequate nutrition intake was feeding tube removal. CONCLUSION Next to different ways in calculating targets and reporting results, a wide range in energy and protein adequacy was observed, but with constant protein underfeeding. Participants fed with EN or a combination of EN and oral nutrition had the best adequacy; inappropriate tube removal is a common barrier leading to inadequate therapy. Standardized reporting and larger studies are needed to guide nutrition care for post-ICU participants.
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Medical Therapies for Prevention and Treatment of Inflammatory Pouch Disorders-A Systematic Review and Meta-Analysis.
Syal, G, Barnes, E, Raffals, L, Al Kazzi, E, Haydek, J, Agarwal, M, Singh, S
The American journal of gastroenterology. 2025;(1):135-150
Abstract
INTRODUCTION Pouchitis and Crohn's-like disease of the pouch (CLDP) are common in patients who undergo ileal pouch anal anastomosis for ulcerative colitis. We conducted separate systematic reviews to evaluate the effectiveness of available interventions to prevent and treat pouchitis and CLDP. METHODS Through systematic literature reviews, we identified studies that evaluated the effectiveness of probiotics, antibiotics, 5-aminosalicylates, nonsystemic oral corticosteroids, and advanced therapies for prevention and treatment of pouchitis and CLDP for meta-analysis. Primary outcomes were occurrence of pouchitis for pouchitis prevention and clinical response for pouchitis and CLDP treatment. We estimated the relative effectiveness of these interventions using the existing placebo response rates or hypothetical spontaneous improvement rates derived from clinical trials of pouchitis, ulcerative colitis, and Crohn's disease. RESULTS Probiotics were effective for primary (relative risk [RR] 0.18; 95% confidence interval [CI] 0.05-0.62) and secondary prevention (RR 0.17; 95% CI 0.09-0.34) of pouchitis. Antibiotics were effective for treatment of acute and chronic pouchitis (12 cohorts; RR 1.67; 95% CI 1.34-2.01; response rate 65%; 95% CI 52-75) with ciprofloxacin and metronidazole-based regimens being more effective than rifaximin. Advanced therapies were effective for treatment of chronic antibiotic-refractory pouchitis (31 cohorts; RR 1.71; 95% CI 1.28-2.56; response rate 50%; 95% CI 43-57) and CLDP (10 cohorts; RR 2.49; 95% CI 1.87-3.73; response rate 74%; 95% CI 68-79) without significant difference between classes. DISCUSSION Multiple medical interventions are effective for prevention and treatment of pouchitis and CLDP. Given the overall low quality of data, further research is needed to confirm these findings.
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Interventions for the prevention of weight gain during festive and holiday periods in children and adults: A systematic review.
Guerrero-Magaña, DE, Urquijo-Ruiz, LG, Ruelas-Yanes, AL, Martínez-Contreras, TJ, Díaz-Zavala, RG, Candia-Plata, MDC, Esparza-Romero, J, Haby, MM
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2025;26(1):e13836
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Festive and holiday periods are often associated with weight gain due to changes in eating and activity patterns. For example, it has been suggested that there may be an accelerated gain in weight in children and adolescents during the summer school holidays and that this may especially affect high-risk groups, such as certain racial populations (black, Hispanic) and those with overweight or obesity. The aim of this study was to assess the impact of interventions designed to prevent weight gain during festive and holiday periods in children and adults. This study was a systematic review of twelve studies - randomised controlled trials (RCTs), cluster-RCTs, and non-RCTs. Results showed that the evidence for interventions targeting prevention of BMI increases in children during summer showed positive results, while interventions to prevent weight gain in adults during December holiday periods also showed consistent positive effects. Authors concluded by highlighting potential interventions that may help prevent weight gain during holiday periods. However, the evidence quality is generally low, and further research is needed to improve the robustness of these findings and extend them to more diverse populations.
Abstract
Some periods during the year, such as festive and summer holiday periods, have been associated with weight gain. We aimed to assess the effect of interventions for the prevention of body weight gain during festive and holiday periods in children and adults. A systematic search was conducted in six databases and supplementary sources until January 4, 2023. We included randomized controlled trials (RCTs), cluster-RCTs, and non-RCTs. Our primary outcome measure was the change in body weight in adults or the change in BMI z-score or BMI percentile in children and adolescents. From 4216 records, 12 primary studies (from 22 reports) met the inclusion criteria-10 from the United States, one from the United Kingdom, and one from Chile. Two studies had a low risk of bias, two moderate, seven high, and one critical risk of bias. The meta-analysis in children included four of seven studies during the summer holidays (six interventions) and showed a mean difference in BMI z-score favoring the intervention group (-0.06 [95% CI -0.10, -0.01], p = 0.01, I2 = 0%, very low certainty evidence). The meta-analysis in adults included five studies during festive periods with a mean difference in weight favoring the intervention group (-0.99 kg [95% CI -2.15, 0.18], p = 0.10, I2 = 89%, very low certainty evidence). This review has highlighted potential interventions to prevent the increase in body weight during holiday periods. More work is needed to improve the quality of the evidence and to extend it to countries outside of the United States and United Kingdom and to the adolescent population.
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Association between triglyceride to HDL cholesterol ratio and a risk of diabetes mellitus: a systematic review and meta-analysis.
Zhong, H, Luo, L, Wang, X, Xiao, Y
Laboratory medicine. 2025;(1):1-6
Abstract
OBJECTIVE The aim of this study was to investigate the link between the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) and the occurrence of type 2 diabetes mellitus (T2DM). METHODS PubMed, Embase, and Scopus databases were searched for cohort and case-control studies that reported on the link between TG/HDL-C and a risk of T2DM, with no restrictions on criteria used for the definition and categorization of low and high TG/HDL-C ratios. RESULTS A total of 20 studies were included. There was considerable variability in terms of categorization of low or normal and higher TG/HDL-C ratio among the studies. Patients with high TG/HDL-C ratio had markedly higher risk of developing T2DM compared with patients with low or normal TG/HDL-C. Each unit increase in the ratio correlated with the increased risk of diabetes. Subgroup analysis based on sex showed an increased risk of T2DM in males and females with a high ratio compared with the group with a low/normal ratio. CONCLUSION Higher TG/HDL-C ratio correlates with increased risk of T2DM. Despite limitations, the study demonstrates a possible value of using TG/HDL-C ratio as a biomarker for diabetes risk.
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Elective high frequency oscillatory ventilation versus conventional mechanical ventilation on the chronic lung disease or death in preterm infants administered surfactant: a systematic review and meta-analysis.
Yu, X, Tan, Q, Li, J, Shi, Y, Chen, L
Journal of perinatology : official journal of the California Perinatal Association. 2025;(1):77-84
Abstract
BACKGROUND Use of elective high frequency oscillatory ventilation (HFOV) compared with conventional mechanical ventilation (CMV) results in a small reduction in the risk of chronic lung disease (CLD) or death, but the evidence is weak. Our objective was to explore whether elective HFOV was associated with less CLD or death as compared with CMV in preterm infants administered surfactant. METHODS We conducted a systematic review and meta-analysis, including 1835 ventilated participants from 11 randomized controlled trials comparing elective HFOV with CMV between February 1993 and February 2014. The primary outcome was the incidence of CLD or death. RESULTS Compared with CMV, elective HFOV was associated with less CLD or death (relative risk (RR) 0.76, 95% confidence interval (CI) 0.61-0.94, p = 0.01) (p = 0.01, I2 = 55%), CLD (RR 0.71, 95%CI 0.53-0.93, p = 0.01) (p = 0.03, I2 = 50%), and ≥2nd stages of retinopathy of prematurity (RR 0.77, 95%CI 0.62-0.94, p = 0.01) (p = 0.42, I2 = 0%). In the subgroup of > 1 dose of surfactant, compared with CMV, elective HFOV was also related to less CLD or death (RR 0.87, 95%CI 0.77-0.98, p = 0.02) (p = 0.10, I2 = 42%). No differences were found in the incidences of death, grade 3 or 4 of intraventricular hemorrhage, periventricular leukomalacia, airleak and necrotizing enterocolitis between the two groups. CONCLUSION Elective HFOV is superior to CMV in reducing the incidence of CLD or death in ventilated preterm infants administered surfactant, especially in the subgroup of >1 dose of surfactant. TRIAL REGISTRY International Prospective Register of Systematic Reviews: No.: CRD42022301033; URL: https://www.crd.york.ac.uk/PROSPERO/ .
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Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia: A Systematic Review and Meta-Analysis.
Ayus, JC, Moritz, ML, Fuentes, NA, Mejia, JR, Alfonso, JM, Shin, S, Fralick, M, Ciapponi, A
JAMA internal medicine. 2025;(1):38-51
Abstract
IMPORTANCE Hyponatremia treatment guidelines recommend limiting the correction of severe hyponatremia during the first 24 hours to prevent osmotic demyelination syndrome (ODS). Recent evidence suggests that slower rates of correction are associated with increased mortality. OBJECTIVE To evaluate the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia. DATA SOURCES We searched MEDLINE, Embase, the Cochrane Library, LILACS, Web of Science, CINAHL, and international congress proceedings for studies published between January 2013 and October 2023. STUDY SELECTION Comparative studies assessing rapid (≥8-10 mEq/L per 24 hours) vs slow (<8 or 6-10 mEq/L per 24 hours) and very slow (<4-6 mEq/L per 24 hours) correction of severe hyponatremia (serum sodium <120 mEq/L or <125 mEq/L plus severe symptoms) in hospitalized patients. DATA EXTRACTION AND SYNTHESIS Pairs of reviewers (N.A.F., J.R.M., J.M.A., A.C.) independently reviewed studies, extracted data, and assessed each included study's risk of bias using ROBINS-I. Cochrane methods, PRISMA reporting guidelines, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to rate the certainty of evidence were followed. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Primary outcomes were in-hospital and 30-day mortality, and secondary outcomes were hospital length of stay (LOS) and ODS. RESULTS Sixteen cohort studies involving a total of 11 811 patients with severe hyponatremia were included (mean [SD] age, 68.22 [6.88] years; 56.7% female across 15 studies reporting sex). Moderate-certainty evidence showed that rapid correction was associated with 32 (odds ratio, 0.67; 95% CI, 0.55-0.82) and 221 (odds ratio, 0.29; 95% CI, 0.11-0.79) fewer in-hospital deaths per 1000 treated patients compared with slow and very slow correction, respectively. Low-certainty evidence suggested that rapid correction was associated with 61 (risk ratio, 0.55; 95% CI, 0.45-0.67) and 134 (risk ratio, 0.35; 95% CI, 0.28-0.44) fewer deaths per 1000 treated patients at 30 days and with a reduction in LOS of 1.20 (95% CI, 0.51-1.89) and 3.09 (95% CI, 1.21-4.94) days, compared with slow and very slow correction, respectively. Rapid correction was not associated with a statistically significant increased risk of ODS. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, slow correction and very slow correction of severe hyponatremia were associated with an increased risk of mortality and hospital LOS compared to rapid correction.
