Cochrane Database of Systematic Reviews最新文献

{"title":"Vitamin B₁₂ supplementation for anaemia, vitamin B₁₂ status, and health outcomes in women of reproductive age.","authors":"Erin G Sley, Amy Fothergill, Lili B Steel, Doreen Y Larvie, Dripta Roy Choudhury, Jo Weeks, Julia L Finkelstein","doi":"10.1002/14651858.CD016233","DOIUrl":"https://doi.org/10.1002/14651858.CD016233","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of oral vitamin B₁₂ supplementation on vitamin B₁₂ status, anaemia, and health outcomes in women of reproductive age.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016233"},"PeriodicalIF":8.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CFTR modulator monotherapy for people with cystic fibrosis with class II CFTR gene variants (most commonly F508del).","authors":"Matthew Heneghan, Sherie Smith, Nikki Jahnke, Sarah Nevitt, Kevin W Southern","doi":"10.1002/14651858.CD016290","DOIUrl":"10.1002/14651858.CD016290","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Cystic fibrosis (CF) is a common, life-shortening genetic condition caused by a variant in the cystic fibrosis transmembrane conductance regulator (CFTR) protein. A class II CFTR gene variant, F508del, is the commonest CF-causing variant (found in up to 90% of people with CF (pwCF) in some populations). The F508del variant lacks meaningful CFTR function: the faulty protein is degraded before reaching the cell membrane, where it would normally transport salt across the epithelial membrane. Corrective therapy with CFTR modulators could benefit many pwCF. This review evaluates treatment with single modulators (monotherapy).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the clinically important benefits and harms of CFTR modulator monotherapy in people of any age with cystic fibrosis with class II CFTR gene variants (most commonly F508del).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We last searched the Cochrane CF Trials Register and online trials registries on 27 June 2025. We also checked the reference lists of relevant articles for additional studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included parallel-group randomised controlled trials (RCTs) comparing any single CFTR modulator to placebo or any other single CFTR modulator in pwCF of any age or disease severity with class II variants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were survival, quality of life (total score and respiratory domain), and forced expiratory volume in one second (FEV&lt;sub&gt;1&lt;/sub&gt; % predicted; relative and absolute change from baseline). Our important outcomes included adverse effects and time to first pulmonary exacerbation. We planned to assess outcomes in the immediate term, short term, and longer term.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed risk of bias using the original Cochrane tool (RoB 1).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We analysed available data with RevMan using a fixed-effect model. We reported odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. For adverse events, we reported 99% confidence intervals (CIs); for all other outcomes, we reported 95% CIs. Where we were unable to analyse data, we reported the results narratively. We used GRADE to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 10 early-phase placebo-controlled RCTs (424 participants) assessing eight different drugs (4PBA, CPX, N6022, cavosonstat, lumacaftor, FDL169, GLPG2222, and riociguat) in adults; one 4PBA study additionally included adolescents (age ≥ 14 years). All participants were homozygous for F508del. The longest study lasted just 29 days, so we could only assess immediate-term outcomes. Only two studies received no funding from pharmaceutical companies. Our main results are for lumacaftor and cavosonstat, which were the only drugs selected for further investigation in subsequent studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/str","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016290"},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for preventing unintended pregnancies among adolescents.","authors":"Chioma Oringanje, Martin M Meremikwu, Heidi Arth, Ekpereonne Esu, Anne Meremikwu, John E Ehiri","doi":"10.1002/14651858.CD016356","DOIUrl":"10.1002/14651858.CD016356","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of primary prevention interventions (school-based, community/home-based, clinic-based, and faith-based) on unintended pregnancies among adolescents.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016356"},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Singing for adults with chronic respiratory disease.","authors":"Mette Kaasgaard, Stephen Clift, Camilla Hansen Nejstgaard, Kirsten Buch Rasmussen, Katarzyna Grebosz-Haring, Helene Louise Hartmeyer, Morten Hostrup, Arne Bathke, J Matt McCrary","doi":"10.1002/14651858.CD016265","DOIUrl":"10.1002/14651858.CD016265","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of singing for chronic respiratory diseases in adults compared to all studied comparison groups.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016265"},"PeriodicalIF":8.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olfactory stimulation for promoting development and preventing morbidity in preterm infants.","authors":"Mikaela Lenells, Marcus G Prescott, Katarzyna Wróblewska-Seniuk, Michelle Fiander, Roger F Soll, Matteo Bruschettini","doi":"10.1002/14651858.CD016074.pub2","DOIUrl":"10.1002/14651858.CD016074.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Preterm infants, often gavage-fed due to immaturity, may benefit from interventions that hasten the move to breastfeeding. Olfactory stimulation may increase appetite and speed up the transition to full oral feeding, potentially shortening hospital stay and improving outcomes for both infants and families.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of olfactory stimulation for reducing morbidity and promoting development in hospitalized preterm infants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched MEDLINE, Embase, CENTRAL, CINAHL, Epistemonikos, two trial registries, and conference abstracts up to 2 April 2025. We checked the reference lists of included studies and systematic reviews on olfactory or sensory stimulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs) and quasi-RCTs evaluating olfactory stimulation with different odorants (maternal breast milk, food-associated odors, or non-food-associated odors) in preterm infants (born before 37 weeks' gestation). Eligible controls were no intervention, placebo, or standard care (considered together) or another odorant. We excluded studies combining olfactory stimulation with taste, as another review will focus on combined sensory stimulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were apnea, intermittent hypoxemia, duration of hospital stay, time to full oral feeding, and exclusive breastfeeding. Our important outcomes included blindness and sensorineural deafness requiring amplification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane risk of bias tool (RoB 2) to assess risk of bias in the included studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We conducted meta-analyses using fixed-effect models to calculate risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data, each with its 95% confidence interval (CI). We assessed the certainty of evidence using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 14 trials enrolling 1087 neonates. The types of olfactory stimulation under investigation were maternal breast milk (9 studies); food-associated odors such as cinnamon, vanilla, or anise (5 studies); and non-food-associated odors such as rose or parents' scent (3 studies). Three studies evaluated two different odorants. Gestational age and bodyweight varied widely. The comparators were placebo, no intervention, and standard care. Eleven studies aimed to assess the effect of olfactory stimulation on infant feeding outcomes such as time to full oral feeding, weight gain, length of hospital stay, or a combination of these outcomes. Three studies aimed to assess the effect of olfactory stimulation on apnea prevention, oxygen saturation, or both. We identified five ongoing trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;No studies reported apnea as a dichotomous outcome, intermittent hypoxemia, exclusive breastfeeding, o","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016074"},"PeriodicalIF":8.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-D administration after childbirth for preventing Rhesus alloimmunisation for subsequent pregnancies.","authors":"Nimisha Kumar, Morteza A Khafaie, Shayesteh Jahanfar, Anthony L Shanks","doi":"10.1002/14651858.CD014729","DOIUrl":"https://doi.org/10.1002/14651858.CD014729","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of various doses and timings of anti-D administration for prevention of Rhesus (Rh) alloimmunisation after childbirth in Rh-negative women with an Rh-positive baby.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD014729"},"PeriodicalIF":8.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for preventing falls in older people in hospitals.","authors":"Charlotte McLennan, Suzanne M Dyer, Wing S Kwok, Jenni Suen, Tania S Marin, Melanie Haley, Geoffrey R Murray, Katy Sutcliffe, Dylan Kneale, Catherine Sherrington, Ian D Cameron","doi":"10.1002/14651858.CD016065","DOIUrl":"https://doi.org/10.1002/14651858.CD016065","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Falls in hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of the hospital components of a review of interventions in hospitals and care facilities first published in 2010 and updated in 2012 and 2018.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of interventions designed to reduce the incidence of falls in older people in hospitals, including inpatient rehabilitation facilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, CINAHL, and trial registers to 28 October 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Randomised controlled trials of any interventions for preventing falls in older people (aged 65 years and over) in hospitals, excluding trials where falls were recorded as adverse events of the intervention and those recruiting participants post-stroke or living with Parkinson's disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes were rate of falls (number of falls per unit time) and risk of falling (number of fallers). Important outcomes were risk of fracture, adverse events, and economic outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We evaluated risk of bias in the included trials against nine items (seven in the Cochrane RoB 1 tool, plus method of ascertaining falls and baseline imbalance).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently performed study selection, risk of bias assessment, and data extraction. We calculated rate ratios (RaR) for rate of falls and risk ratios (RRs) for risk of falling and risk of fracture, with 95% confidence intervals (CIs). We adjusted for clustering if not undertaken by the trial authors. We pooled results where appropriate using the generic inverse variance method in RevMan. We conducted subgroup analyses according to intervention type, cognitive status, setting, and informed by an intervention component analysis. Where pooling was precluded by the nature of the data, we presented trial data in tables for illustrative purposes. We recategorised one trial considered as multifactorial in 2018 to multicomponent education for consistency within the group of trials considered as multifactorial. We used GRADE to assess the certainty of evidence for each outcome for the main comparisons. GRADE ratings of risk of bias were based on sensitivity analyses excluding trials at high risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 32 new trials (35,235 participants) in this update, for a total of 55 trials (104,474 participants; mean age 79 years; 45% women). The majority of trials were at high risk of bias in one or more domains, mostly due to lack of blinding, which is not typically feasible for hospital fall prevention interventions. With few exceptions, the certainty of evidence for the critical outcomes of falls for individual interventions was rated as low or very low. We have reported outcomes for the main compa","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016065"},"PeriodicalIF":8.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual tubal patency tests for tubal occlusion and hydrosalpinx.","authors":"Rachel Tros, Danah Kamphuis, Kimmy Rosielle, Carolien Koks, Velja Mijatovic, Marlies Y Bongers, Ben Willem J Mol, Rui Wang","doi":"10.1002/14651858.CD014968.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD014968.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Around 18% to 33% of couples with infertility present with tubal occlusion (blocked or damaged fallopian tubes) or hydrosalpinx (fluid-filled tubes). Diagnostic laparoscopy (keyhole surgery) with chromopertubation (methylene blue dye tubal patency testing) is considered the reference standard for ruling out tubal occlusion and hydrosalpinx. However, due to its invasiveness and high costs, alternative, less invasive tests have been carried out using imaging techniques. They include sono-hysterosalpingography (sono-HSG), hysterosalpingography (HSG), outpatient transvaginal hydrolaparoscopy (THL), and magnetic resonance hysterosalpingography (MR-HSG). The choice of test varies in different settings; the choice of contrast, operator skill and test technology are factors that can influence diagnostic quality. Furthermore, the performance of the visual tubal patency tests can vary in different populations, depending on whether the test is carried out in an unselected group or in one classified as high or low risk for having tubal pathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine and compare the diagnostic accuracy of visual tubal patency tests (sono-HSG, HSG, THL, and MR-HSG) for the diagnosis of tubal occlusion. Secondary objectives are to determine and compare the diagnostic accuracy of visual tubal patency tests (sono-HSG, HSG, THL, and MR-HSG) for the diagnosis of hydrosalpinx and to evaluate heterogeneity concerning population characteristics (population risk stratification) and index test characteristics (contrast media, technology, operator skills).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase and CINAHL, and two trials registers. We also contacted experts in the field for any additional studies (last date of search: 6 November 2023).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included studies on the diagnostic accuracy of a single index test and studies on the comparative diagnostic accuracy of two or more index tests. Index tests included were: sono-HSG, HSG, THL, and MR-HSG. Laparoscopy with methylene blue dye tubal patency testing was the reference standard. We included participants who had been trying to conceive for at least one year. All participants in the included studies should have undergone this reference standard. Target conditions were bilateral tubal occlusion, at least one-sided tubal occlusion, tubal occlusion by tube, and hydrosalpinx.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently extracted data. We performed random-effects meta-analysis in a bivariate model. For each index test, we presented pairs of sensitivity and specificity with their 95% confidence intervals (CIs) for each study, as well as the pooled sensitivity and specificity in a forest plot. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool for risk of bias assessments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We identified 11,787","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD014968"},"PeriodicalIF":8.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early versus late surgical start times for on-pump cardiac surgery.","authors":"Zhengyang Liu, Jahan C Penny-Dimri, Matthew Nagel, Mark Plummer, Reny Segal, Peter T Morley, Julian Smith, Luke A Perry","doi":"10.1002/14651858.CD014901.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD014901.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Circadian rhythms affect cardiovascular function, and the timing and severity of stroke and myocardial infarction (commonly known as a heart attack). Afternoon cardiac surgery may improve outcomes by reducing ischaemia-reperfusion injury (i.e. reducing tissue damage caused when blood supply returns to tissue (reperfusion) after a period of oxygen deprivation (ischaemia)). However, the evidence is conflicting. This systematic review assessed the impact of surgical timing on clinical outcomes after cardiac surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of early versus late surgical start times for on-pump cardiac surgery on mortality, cardiac outcomes, and quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, and Web of Science Conference Proceedings Citation Index - Science, along with ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform trials registers. We also conducted reference checking, citation searching, and contacted study authors to identify studies for inclusion. The latest search date was 26 January 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) in adults undergoing cardiac surgery comparing late with early surgical start times. We excluded non-randomised studies and studies in children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were short-term mortality (≤ 30 days postoperative), long-term mortality (&gt; 30 days postoperative), and perioperative myocardial infarction. Other important outcomes were perioperative myocardial injury, postoperative atrial fibrillation, left ventricular ejection fraction, lengths of intensive care unit (ICU) and hospital stays, and quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane Risk of Bias 2 tool to assess bias in the included RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;As only one study met the inclusion criteria, we did not perform meta-analysis. We synthesised results descriptively, and used GRADE to assess the certainty of the evidence for specified outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included one study with 88 participants. The included study was conducted in France, and reported on differences in outcomes between morning and afternoon on-pump elective aortic valve replacement in adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Critical outcomes No study reported short-term or long-term mortality data for early versus late surgical start times for on-pump cardiac surgery. In the included study, there was no evidence of a difference regarding in-hospital mortality between groups, with no deaths in both groups (risk ratio (RR) and 95% confidence interval (CI) not estimable; 1 study, 88 participants). The evidence is very uncertain about the effect of early versus late surgery on perioperative myocardial infarction (RR 0.29, 95% CI 0.06 to 1.30; 1 study,","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD014901"},"PeriodicalIF":8.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver support systems for adults with acute liver failure.","authors":"Arturo J Martí-Carvajal, Buddheera Bandara Wm Kumburegama, Dimitrinka Nikolova, Chavdar S Pavlov, Ezequiel Mauro, Lise Lotte Gluud, Diana Monge Martín, Jian Ping Liu, Susana Nicola, Gabriella Comunián-Carrasco, Mario A Gemmato-Valecillos, Christian Gluud","doi":"10.1002/14651858.CD015059.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD015059.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Acute liver failure (ALF) is a life-threatening condition, characterised by serious damage to the liver cells and function. The aetiology of ALF determines the prognosis, and without immediate care or liver transplantation, people with ALF will develop life-threatening complications and die. Liver support systems are used as a bridge therapy to provide detoxification and restore liver function until either functional recovery occurs or a liver becomes available for transplantation. Liver support systems have continued to be used despite conflicting results of randomised clinical trials (RCTs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of liver support systems plus standard medical care versus standard medical care for adults with acute liver failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We identified trials through manual and electronic searches in The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, LILACS, Science Citation Index Expanded, and Conference Proceedings Citation Index - Science. We also searched reference lists, trials registers, other sources, and contacted trial authors to identify trials for inclusion in the review. The latest search date was 10 July 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included RCTs (published as abstracts or full-text articles) with a parallel-group design. We included the trials irrespective of the publication language and year, country of performance, or reported outcomes. The trials compared liver support systems plus standard medical care versus standard medical care. We included trials in adults ≥ 18 years old, of any sex, ethnicity, or race, diagnosed with ALF (including previous definitions) and irrespective of aetiology. We excluded trials with mixed populations where participants with ALF were &lt; 10 % of the total number of participants; quasi-randomised trials and other observational studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes were: all-cause mortality by day 28, all-cause mortality, serious adverse events (measured by the total number of people with one or more events), and the proportion of people with liver transplantation. Important outcomes included health-related quality of life, hepatic encephalopathy, and multi-organ failure (measured by the total number of events, including people who needed liver transplantation). Except for all-cause mortality by day 28, we planned to assess the remaining outcomes at their maximal follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias with the outcome-based RoB 2 tool. We judged the overall bias risk of each outcome result using the intention-to-treat principle. We resolved disagreements through discussion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We followed the Methodological Expectations for Cochrane Intervention Reviews when conducting the review, and PRISMA 2020 f","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD015059"},"PeriodicalIF":8.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}