Cochrane Database of Systematic Reviews最新文献

{"title":"Low-intensity shockwave therapy for erectile dysfunction.","authors":"Onuralp Ergun, Kwangmin Kim, Myung Ha Kim, Eu Chang Hwang, Yooni Blair, Ahmet Gudeloglu, Sijo Parekattil, Philipp Dahm","doi":"10.1002/14651858.CD013166.pub3","DOIUrl":"https://doi.org/10.1002/14651858.CD013166.pub3","url":null,"abstract":"<p><strong>Rationale: </strong>Low-intensity shockwave therapy (LiSWT) is a new way of treating erectile dysfunction using sound waves to help improve blood flow to the penis. No existing systematic reviews comparing LiSWT to placebo or other therapies for treating erectile dysfunction have used rigorous Cochrane methodology. Many existing studies appear to be of poor methodological quality, and several trials are ongoing, reflecting an evolving evidence base. Therefore, it is unclear whether LiSWT truly helps men who have erectile dysfunction. Furthermore, there is very limited focus on patient-important outcomes in the existing systematic reviews. In this comprehensive Cochrane review, we compared LiSWT to sham therapy to evaluate its efficacy and safety.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of low-intensity shockwave therapy for erectile dysfunction in men compared to sham treatment.</p><p><strong>Search methods: </strong>We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, Scopus, and two trial registries up to 7 July 2024. We applied no restrictions on publication status or language.</p><p><strong>Eligibility criteria: </strong>We included randomized controlled trials (RCTs) that compared LiSWT to either sham or no treatment. We excluded trials involving people with prior kidney transplants or who had surgical procedures to remove the prostate gland (i.e. radical prostatectomy).</p><p><strong>Outcomes: </strong>Critical outcomes were erectile function, discontinuation from treatment, and treatment-related adverse events; important outcomes were patient/partner satisfaction, penile rigidity, and quality of sexual life. We assessed all outcomes in the short term (≤ 3 months) and long term (> 3 months).</p><p><strong>Risk of bias: </strong>We assessed the risk of bias using Cochrane's risk of bias assessment tool (RoB1).</p><p><strong>Synthesis methods: </strong>We performed statistical analyses following Cochrane Handbook of Systematic Reviews of Interventions guidance. We synthesized results for each outcome using meta-analysis using a random-effects model. We used GRADE to assess the certainty of evidence.</p><p><strong>Included studies: </strong>We focused on RCTs that applied LiSWT treatment utilizing electrohydraulic, electromagnetic, or piezoelectric energy. We included 21 RCTs, including 1357 randomized participants (men aged 39 to 65 years old with erectile dysfunction between 3 and 68 months); 16 were published in full text, and the rest as abstract proceedings. The baseline International Index of Erectile Function-Erectile Function domain (IIEF-EF) scores of participants in these studies ranged from seven to 20. Based on this scale, most men had mild-to-moderate (12 to 16) and mild (17 to 21) erectile dysfunction.</p><p><strong>Synthesis of results: </strong>We included 21 RCTs that randomized 1357 participants. The certainty of the evidence for reported outcomes was low, most","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD013166"},"PeriodicalIF":8.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625499","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":"Skin cleansers and leave-on product interventions for preventing incontinence-associated dermatitis in adults.","authors":"Tanya Graham, Dimitri Beeckman, Jan Kottner, Mandy Fader, Francesca Fiorentino, Joanne M Fitzpatrick, Mikel Gray, Ruth G Harris, Sangeeta Sooriah, Sheila A Wallace, Peter R Worsley, Sue Woodward","doi":"10.1002/14651858.CD011627.pub3","DOIUrl":"10.1002/14651858.CD011627.pub3","url":null,"abstract":"<p><strong>Background: </strong>Incontinence-associated dermatitis (IAD) is a common skin problem in adults with urinary incontinence, faecal incontinence, or both. Prevention involves skin care interventions such as skin cleansing and the application of skin protectants/barriers (leave-on products).</p><p><strong>Objectives: </strong>To assess the effects of skin care cleansers, leave-on products, and procedures for preventing incontinence-associated dermatitis in adults.</p><p><strong>Search methods: </strong>On 29 April 2024, we searched the Cochrane Incontinence Specialised Register - which includes searches of CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, and WHO ICTRP - and hand-searched journals and conference proceedings. We searched reference lists of included studies to identify additional studies.</p><p><strong>Selection criteria: </strong>We selected randomised controlled trials (RCTs) and quasi-RCTs conducted in any healthcare setting and involving participants aged over 18 years without IAD at baseline. We included trials comparing the effectiveness of skin cleansing interventions and leave-on products or combinations of interventions/leave-on products.</p><p><strong>Data collection and analysis: </strong>Three review authors independently screened the titles, abstracts, and full-text articles. Four review authors independently extracted data and assessed risk of bias. Data from studies not published in English were translated and extracted by volunteers from Cochrane Engage and the review authors' networks. Primary outcomes were: number of participants with IAD and adverse effects related to the intervention (pain, skin rash, itching, and other serious adverse effects). Secondary outcomes were: number of participants satisfied with skin care products or procedures, adherence to the protocol throughout the intervention, and quality of life (condition-specific or generic). We used GRADE to assess the certainty of the evidence.</p><p><strong>Main results: </strong>We included 15 trials with 1020 participants in a qualitative synthesis (41 participants from nursing homes; 65 from both care homes and hospital, and 914 from hospital settings). Participants had urinary incontinence, faecal incontinence, or both. Thirteen trials had small sample sizes and two trials had 180 and 174 participants. Six trials assessed outcomes in the short term (≤ 7 days), four in the medium term (8 days-1 month), and one in the long term (> 1 month-3 months). In the remaining studies, the timing of assessment was unclear. The overall risk of bias in the included studies was high. Substantial heterogeneity (in study populations, skin care products, skin care procedures, outcomes, and measurement tools) precluded meta-analysis. Three trials compared skin cleansing interventions, and five trials compared leave-on products or a combination of leave-on products. Seven trials compared a combination of skin cleansers and lea","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD011627"},"PeriodicalIF":8.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607718","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":"Postextubation use of non-invasive respiratory support in preterm infants: a network meta-analysis.","authors":"Abdul Razak, Prakeshkumar S Shah, Madhura Kadam, Sayem Borhan, Amit Mukerji","doi":"10.1002/14651858.CD014509.pub2","DOIUrl":"10.1002/14651858.CD014509.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Several non-invasive respiratory support modes are available to reduce extubation failure in preterm infants. However, their relative efficacy is unclear.</p><p><strong>Objectives: </strong>To assess the benefits and harms of non-invasive respiratory support modes for postextubation support in preterm infants.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science to January 2024.</p><p><strong>Eligibility criteria: </strong>Randomised, quasi-randomised, and cluster-randomised controlled trials comparing non-invasive respiratory support modes for preterm infants postextubation.</p><p><strong>Outcomes: </strong>Critical outcomes included treatment failure, endotracheal ventilation, and moderate-severe chronic lung disease (CLD). Important outcomes included any CLD, death, death or moderate-severe CLD, pulmonary air leak syndrome, intestinal perforation, and moderate to severe neurodevelopmental impairment.</p><p><strong>Risk of bias: </strong>We assessed risk of bias using the Cochrane RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We evaluated seven non-invasive respiratory support modes: nasal continuous positive airway pressure (CPAP); non-invasive positive pressure ventilation (NIPPV); biphasic positive airway pressure (BiPAP); high-flow nasal cannula (HFNC); non-invasive high-frequency oscillatory ventilation (NIHFV); non-invasive neurally adjusted ventilatory assist (NIV-NAVA); high nasal continuous positive airway pressure (H-CPAP). We used random-effects pairwise meta-analysis for direct comparisons and a Bayesian network meta-analysis to estimate network risk ratio (nRR) and 95% credible interval (95% CrI) for indirect and mixed comparisons across seven non-invasive respiratory support modes. We assessed the certainty of evidence using Confidence In Network Meta-Analysis specifically developed for network meta-analysis.</p><p><strong>Included studies: </strong>We included 54 studies involving 6995 preterm infants.</p><p><strong>Synthesis of results: </strong>Treatment failure (48 studies, 6652 infants). NIPPV may result in a large reduction in treatment failure compared to CPAP (nRR 0.48, 95% CrI 0.36 to 0.62; low-certainty evidence) and HFNC (nRR 0.39, 95% CrI 0.26 to 0.57; low-certainty evidence). NIHFV likely results in a large reduction in treatment failure compared to CPAP (nRR 0.39, 95% CrI 0.26 to 0.58; moderate-certainty evidence) and may result in a large reduction in treatment failure compared to HFNC (nRR 0.32, 95% CrI 0.19 to 0.52; low-certainty evidence). For other comparisons, the evidence was very uncertain or there may have been little to no difference. Endotracheal ventilation (47 studies, 6459 infants). NIPPV may result in a large reduction in endotracheal ventilation compared to CPAP (nRR 0.51, 95% CrI 0.38 to 0.65; low-certainty evidence). NIHFV likely results in a large reduction in endotracheal ventilation compared to CPAP (nRR 0.3","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD014509"},"PeriodicalIF":8.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12248292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607717","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":"Virtual reality for stroke rehabilitation: time to rethink? Lessons from a Cochrane review.","authors":"Derick T Wade","doi":"10.1002/14651858.ED000174","DOIUrl":"10.1002/14651858.ED000174","url":null,"abstract":"","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"ED000174"},"PeriodicalIF":8.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607719","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":"Digital health, technology-driven or technology-assisted interventions for the management of obesity in children and adolescents.","authors":"Cristina Palacios, Jacqueline Hernandez, Ajmal Ajmal, Andres J Rodriguez, Alhassan Yosri Ibrahim Hassan, Maria-Inti Metzendorf, Jessica C Ramella-Roman","doi":"10.1002/14651858.CD015968","DOIUrl":"10.1002/14651858.CD015968","url":null,"abstract":"<p><strong>Background: </strong>Childhood obesity is a worldwide public health problem that increases the risk of chronic diseases. In 2016, more than 340 million children and adolescents aged 5 to 19 years were living with overweight or obesity.</p><p><strong>Objectives: </strong>To assess the effects and safety of interventions using digital technology - that is, interventions applied to achieve health objectives implemented within any digital application, communication, or system - for the integrated management of obesity in children and adolescents. Specifically, to assess the effects of digital interventions in the management of obesity in children and adolescents when used: - in combination with conventional care compared to conventional care alone; and - alone compared to conventional care alone.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and two major trials registers to identify the studies included in this review. The date of the last search was 14 April 2025. We did not apply any language restrictions.</p><p><strong>Selection criteria: </strong>We included randomized controlled trials conducted in children (0 to 9 years old) and adolescents (10 to 19 years old) living with obesity, as defined by World Health Organization (WHO) Growth References. We included trials using the following digital health interventions for managing obesity: 'wearable' or implantable devices, web-based interventions, text messages, mobile phone or tablet applications, 'exergaming' or active video gaming, and telehealth. Participants in the comparison groups received conventional care or an intervention without a digital/technological component.</p><p><strong>Data collection and analysis: </strong>Working independently, two review authors extracted data, assessed the studies' risk of bias using Cochrane's original risk of bias tool, and evaluated the certainty of the evidence using GRADE criteria. The following outcomes were extracted: anthropometry (body mass index [BMI], weight, skinfolds, waist-to-hip ratio, waist circumference), adiposity, physical activity, physical and mental well-being, quality of life, blood pressure, adverse events associated with the interventions, presence of obesity co-existing complications, obesity-associated disability, hyperinsulinemia, insulin resistance, glycemia, lipid metabolism or adipogenesis, lipid hormones, alterations in hunger or satiety, reduced disability in any of the functionality domains, mortality, prevalence of obesity in adulthood, and access to health services.</p><p><strong>Main results: </strong>We included 15 studies involving 911 participants, conducted in the USA (five studies), Sweden (three studies), and one each in Canada, China, Ireland, Italy, South Korea, Switzerland, and Thailand. All studies involved participants aged 10 to 19 years old, with 10 exclusively focusing on this age group. Five studies also","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD015968"},"PeriodicalIF":8.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599648","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":"Gut microbiome-based interventions for the management of obesity in children and adolescents aged up to 19 years.","authors":"Shah Mohammad Fahim, Samantha L Huey, Ximena E Palma Molina, Nikita Agarwal, Pratiwi Ridwan, Naiwen Ji, Matthew Kibbee, Rebecca Kuriyan, Julia L Finkelstein, Saurabh Mehta","doi":"10.1002/14651858.CD015875","DOIUrl":"10.1002/14651858.CD015875","url":null,"abstract":"<p><strong>Background: </strong>The epidemic of overweight and obesity affects more than 390 million children and adolescents aged 5 to 19 years and 37 million children under five years of age. Overweight and obesity are associated with both short- and long-term consequences, including chronic inflammation, metabolic diseases, as well as alterations in the gut microbiome composition. Gut microbiome-based approaches may impact microbiome-related metrics such as diversity or the abundance of intestinal bacteria, which may be linked to obesity-related outcomes. However, evidence regarding the effect of gut microbiome-based interventions for the management of obesity is limited.</p><p><strong>Objectives: </strong>To assess the effects of gut microbiome-based interventions in the management of overweight or obesity in children and adolescents in all their diversity aged 0 to 19 years.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, CINAHL, Web of Science Core Collection, BIOSIS Previews, Global Index Medicus (all regions), IBECS, SciELO, PAHO, PAHO IRIS, WHO IRIS, WHOLIS, Bibliomap, TRoPHI as well as ICTRP Search Portal and ClinicalTrials.gov. The date of the last search for all databases was 24 January 2025. We did not apply any language restrictions.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials that evaluated gut microbiome-based interventions [i.e. prebiotics, probiotics, synbiotics, short-chain fatty acids (SCFAs), and faecal microbiota transplantation (FMT)] compared to standard-of-care, placebo, or control interventions in children and adolescents aged 0 to 19 years with overweight or obesity.</p><p><strong>Data collection and analysis: </strong>Two review authors independently screened titles and abstracts and full texts, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias 2 tool and certainty of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE), a framework for assessing the certainty of evidence and making recommendations in systematic reviews. Random-effects meta-analyses were performed unless only one study per outcome was available, for which fixed-effect analyses were performed.</p><p><strong>Main results: </strong>We found 17 studies (838 participants) from various countries, evaluating the effects of prebiotics, probiotics, synbiotics, SCFAs, and FMT on body mass index (BMI), body weight, waist circumference, total body fat percentage (%TBF), systolic and diastolic blood pressure, and adverse events. Of the 17 studies included, five studies were in adolescents aged 10 to 19 years, and 12 studies were in children and adolescents spanning both age groups, 0 to 19 years. Upon contacting authors for data grouped by age of the participants, no studies provided separate outcomes data for children and adolescents. The included studies were funded by either academic funding sources or grants from the public and privat","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD015875"},"PeriodicalIF":8.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599649","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":"Complement inhibitors for myasthenia gravis in adults.","authors":"Laura M White, Fiona J Clay, Anne-Marie Forbes, Ryan Yann Shern Keh, James B Lilleker, Jennifer Spillane, Karen Storms, Jon Sussman, Katherine C Dodd","doi":"10.1002/14651858.CD016098","DOIUrl":"10.1002/14651858.CD016098","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 complement inhibitors for treating myasthenia gravis in adults compared with control treatment (placebo or standard care).</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD016098"},"PeriodicalIF":8.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583270","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":"The diagnostic test accuracy of bone sound conduction testing for the diagnosis of fractures of the upper and lower limbs and ribcage.","authors":"Michael Schmidt, Lena Valeria Sardo, Stephan Kirchner","doi":"10.1002/14651858.CD016128","DOIUrl":"10.1002/14651858.CD016128","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the diagnostic accuracy of bone sound conduction testing (BSCT) for the screening of limb or ribcage fractures in people of all ages. Secondary objectives To investigate potential sources of heterogeneity in the diagnostic accuracy of BSCT due to the following factors: source of sound generation, age, gender, prevalence of fracture, type of fracture, body region, body mass index and bone disease, geographical location, experience of investigator, and presence of bone or joint implants.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD016128"},"PeriodicalIF":8.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583273","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":"Surgical versus medical methods for second-trimester induced abortion.","authors":"Jessica M Atrio, Sarita Sonalkar, Helena Kopp Kallner, Rachel B Rapkin, Kristina Gemzell-Danielsson, Patricia A Lohr","doi":"10.1002/14651858.CD006714.pub3","DOIUrl":"10.1002/14651858.CD006714.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Understanding the relative benefits and harms of surgical versus medical methods for second-trimester abortion is essential for guiding clinical practice across diverse settings and patient populations. This review evaluates differences in outcomes and patient experiences to support informed counseling and care. It updates a previous version published in 2008.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the benefits and harms of surgical and medical methods of induced abortion in the second trimester (i.e. at or after 13 weeks' gestation).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We identified trials using CENTRAL (Ovid EBM Reviews), MEDLINE ALL (Ovid), Embase.com, LILACS, Scopus, and Google Scholar on 29 November 2023. We also searched the reference lists of identified studies, relevant review articles, book chapters, and conference proceedings for additional, previously unidentified studies. We contacted experts in the field for information on other published or unpublished research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Randomized trials comparing surgical abortion by vacuum aspiration or dilation and evacuation (D&E) to medical abortion with mifepristone and misoprostol in the second trimester of pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We assessed the validity of each study using Cochrane methods. We contacted investigators for additional information regarding trial conduct or outcomes as required. Some outcomes were consistently reported across multiple studies and could be combined for meta-analysis. The primary outcome of interest was abortion completed with the intended method (defined as fetal expulsion).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included three studies (281 participants). The studies were conducted in Nepal (n randomized = 141), England (n randomized = 122), and the United States (n randomized = 18) and included participants with pregnancy durations ranging from 12 weeks to 19 weeks and 6 days. We used GRADE to assess the certainty of evidence. Abortion completed with the intended method (defined as fetal expulsion) occurred for nearly all trial participants. There may be no difference between surgical and medical methods, although the evidence for this outcome is very uncertain (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.96 to 1.02; 3 trials; 269 participants). Incomplete abortion requiring an additional procedure or intervention (immediate or delayed) may occur less often with surgical abortion (RR 0.19, 95% CI 0.07 to 0.53; 3 trials; 269 participants), but the evidence is very uncertain. Hemorrhage requiring blood transfusion may occur less often with surgical abortion, but the evidence is very uncertain as the outcome occurred infrequently (RR 0.29, 95% CI 0.07 to 1.12; 3 trials; 269 participants). There may be less bleeding with surgical abortion than with medical abortion based on a measure of total blood loss (difference in mean estimated blood l","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD006714"},"PeriodicalIF":8.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583272","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":"Fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer.","authors":"Maria-Eulalia Fernandez-Montoli, Jordi Sabadell, Nayanar Adela Contreras Perez, Paula Verdaguer Menéndez-Arango, Carla Julia Torres, Judith Lleberia","doi":"10.1002/14651858.CD013111.pub2","DOIUrl":"10.1002/14651858.CD013111.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Endometrial cancer is the sixth most common cancer in women worldwide, and the fourth most common in high-income countries, where its incidence is increasing. Atypical endometrial hyperplasia (AEH) is an overgrowth of the womb lining and can be a precursor of endometrial cancer. Between 14% and 25% of cases of endometrial cancer are diagnosed in premenopausal women. Due to delays in childbearing age and increasing obesity rates, a growing number of women wish to explore fertility-sparing management of endometrial cancer or AEH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the effectiveness and safety of fertility-sparing treatments, including pharmacological interventions (e.g. oral progestin, levonorgestrel intrauterine system (IUS), metformin) and bariatric or hysteroscopic surgery, for AEH and presumed stage IA grade 1 endometrioid endometrial cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the following electronic databases to 3 February 2025: CENTRAL; Ovid MEDLINE; and Ovid Embase. We also searched five trials registers and conference proceedings and abstracts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that compared fertility-sparing therapy for presumed stage IA grade 1 endometrioid endometrial cancer or AEH with oral progestin compared to levonorgestrel IUS or metformin or other pharmacological interventions, or bariatric or hysteroscopic surgery (any comparison); or any of these interventions with the usual treatment (surgery). Other comparative non-randomised studies were also eligible for inclusion (quasi-randomised trials, non-randomised studies (NRS), and prospective and retrospective cohort studies).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently extracted data and assessed the methodological quality of the studies. We used standard Cochrane methodological procedures. Where possible, we pooled data from RCTs in a meta-analysis. Otherwise, we provided a narrative description of the results. Primary outcomes are overall survival and live birth rate. Secondary outcomes are progression-free survival, complete pathological response rate (CR), severe adverse events, psychological symptoms, quality of life, pregnancy rate, and surgery for persistent/progressive disease. We assessed the certainty of the evidence using GRADE. We assessed the risk of bias only in RCTs, using the Cochrane risk of bias tool, RoB 1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 12 studies with 904 participants; six RCTs and six NRSs. Four studies included women with AEH, two, women with endometrial cancer, and six, both AEH and endometrial cancer. We judged the studies at high risk of overall bias. We pooled two RCTs into one meta-analysis and described the remaining comparisons narratively. None of the included studies provided evidence for overall survival, progression-free survival or quality of life for any comparison. Metform","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD013111"},"PeriodicalIF":8.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583271","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}