Cochrane Database of Systematic Reviews最新文献

{"title":"Cycle regimens for endometrial preparation prior to frozen embryo transfer.","authors":"Tarek Ghobara, Tarek A Gelbaya, Reuben Olugbenga Ayeleke","doi":"10.1002/14651858.CD003414.pub4","DOIUrl":"10.1002/14651858.CD003414.pub4","url":null,"abstract":"<p><strong>Background: </strong>Frozen-thawed embryo transfer (FET) use increases the cumulative pregnancy rate, reduces cost and is relatively simple to undertake. FET is performed using different cycle regimens: spontaneous ovulatory (natural) cycles; cycles in which the endometrium is artificially prepared by oestrogen and progesterone hormones, commonly known as hormone therapy (HT) FET cycles; and cycles in which ovulation is induced by drugs (ovulation induction FET cycles). HT can be used with or without a gonadotrophin-releasing hormone agonist (GnRHa). This is an update of a Cochrane review; previous versions were published in 2008 and 2017.</p><p><strong>Objectives: </strong>To compare the effectiveness and safety of natural cycle FET, HT cycle FET and ovulation induction cycle FET, and compare subtypes of these regimens.</p><p><strong>Search methods: </strong>We used Cochrane Gynaecology and Fertility's Specialised Register, CENTRAL, MEDLINE, Embase, two other databases, four other electronic sources and two trials registers, together with reference checking, citation searching and contact with study authors to identify the studies included in the review. The latest search date was 19 December 2022.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) comparing the various cycle regimens and different methods used to prepare the endometrium during FET.</p><p><strong>Data collection and analysis: </strong>We used standard methodological procedures recommended by Cochrane. Our primary outcomes were live birth and miscarriage rates.</p><p><strong>Main results: </strong>We included 32 RCTs comparing different cycle regimens for FET in 6352 women. The certainty of the evidence was moderate to very low. The main limitations were failure to report important clinical outcomes, poor reporting of study methods and imprecision due to low event rates. Natural cycle FET comparisons Natural cycle FET versus HT FET We are uncertain of a difference in live birth rate (LBR) (odds ratio (OR) 1.18, 95% confidence interval (CI) 0.67 to 2.08; 1 study, 233 participants; low-certainty evidence), miscarriage rate (OR 0.10, 95% CI 0.01 to 1.90; 1 study, 233 participants; low-certainty evidence), ongoing pregnancy rate (OR 1.23, 95% CI 0.7 to 2.16; 1 study, 233 participants; low-certainty evidence) or multiple pregnancy rate (OR 1.26, 95% CI 0.58 to 2.75; 2 studies, 333 participants; very low-certainty evidence) between women in natural cycles and those in HT FET cycles. Natural cycle FET versus HT plus GnRHa suppression There is probably little or no difference in LBR (OR 0.89, 95% CI 0.58 to 1.36; 2 studies, 400 participants; moderate-certainty evidence) or multiple pregnancy rate (OR 1.23, 95% CI 0.60 to 2.51; 2 studies, 400 participants; moderate-certainty evidence) between women who had natural cycle FET and those who had HT FET cycles with GnRHa suppression. We are uncertain of a difference in miscarriage rate (OR 0.0","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD003414"},"PeriodicalIF":8.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207859","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":"Exercise interventions for the treatment of lower limb lymphoedema after treatment for gynaecological cancers.","authors":"Takashi Mimura, Takeshi Hasegawa, Yoshiyuki Okada, Tomomi Matsushita, Hisashi Noma, Erika Ota, Edward Barroga, Noyuri Yamaji","doi":"10.1002/14651858.CD015669","DOIUrl":"10.1002/14651858.CD015669","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of load exercise therapy with complex decongestive therapy compared with complex decongestive therapy alone for lower limb lymphoedema after gynaecological cancer treatment.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD015669"},"PeriodicalIF":8.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207860","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":"Community-based interventions for the prevention or management of dental caries in children.","authors":"Lucy O'Malley, Tanya Walsh, Anne-Marie Glenny, Philip Riley, Janet Clarkson, Laurel Graham, Roopali Kulkarni, George Kitsaras, Carly Dixon, Deborah Moore, Sharon R Lewis","doi":"10.1002/14651858.CD016145","DOIUrl":"10.1002/14651858.CD016145","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To undertake network meta-analysis (NMA) and component network meta-analysis (CNMA) to explore the comparative effectiveness of different community-based interventions, and the components within the interventions used singly or in combination, for the prevention or management of dental caries in children.  .</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016145"},"PeriodicalIF":8.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157158","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":"Fenestrated endovascular repair for abdominal aortic aneurysms.","authors":"Davina Daudu, Paris L Cai, Abhishekh Srinivas, Lawrence Mj Best, Jane Cross, Christopher J Hammond, Toby Richards","doi":"10.1002/14651858.CD014226.pub2","DOIUrl":"10.1002/14651858.CD014226.pub2","url":null,"abstract":"<p><strong>Background: </strong>Abdominal aortic aneurysms (AAAs) are abnormal dilatations of the aorta that most commonly affect its infrarenal segment, but can become more difficult to repair when they are close to or next to the renal arteries. The optimum treatment for these complex AAAs is unknown. One option is fenestrated endovascular aneurysm repair (FEVAR), which involves using fenestrations or scallops in the graft to facilitate access to the visceral arteries.</p><p><strong>Objectives: </strong>To assess the benefits and harms of complex stent-graft fenestrated endovascular aneurysm repair (FEVAR) versus open surgical repair (OSR) or conservative (non-operative) management for people with complex AAAs.</p><p><strong>Search methods: </strong>The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov without language, publication year or publication status restrictions (published, unpublished, in press or in progress) on 28 March 2023.</p><p><strong>Selection criteria: </strong>We considered all randomised controlled trials (RCTs) and quasi-RCTs, comparing treatment of complex AAA with FEVAR versus open surgical repair or conservative management in adults undergoing primary repair of complex AAA.</p><p><strong>Data collection and analysis: </strong>Two review authors independently screened studies obtained from the search for potential inclusion in the review, in accordance with the Cochrane Handbook for Systematic Review of Interventions. Primary outcomes were all-cause mortality (30 days and one year), aneurysm-related mortality at one year and length of hospital stay. Secondary outcomes were renal dysfunction at one year, reintervention rate at one year, visceral vessel patency at 30 days and one year, participant-reported health-related quality of life at one year, adverse events at one year and aneurysm-related mortality at 30 days.</p><p><strong>Main results: </strong>We found no studies fulfilling the inclusion criteria.</p><p><strong>Authors' conclusions: </strong>We did not identify eligible RCTs or quasi-RCTs that compared treatment of complex AAAs with FEVAR versus open surgical repair or conservative management. This is a difficult area in which to conduct research due to low incidence rates and aneurysm heterogeneity. Future studies could consider commissioning agreements mandating patient inclusion in studies to make the generation of high-quality evidence in this area feasible.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD014226"},"PeriodicalIF":8.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157160","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":"Selected laboratory-based biomarkers for assessing vitamin A deficiency in at-risk individuals.","authors":"Bryan M Gannon, Samantha L Huey, Neel H Mehta, Nidhi Shrestha, Lucero Lopez-Perez, Ricardo X Martinez, Lisa M Rogers, Maria Nieves Garcia-Casal, Saurabh Mehta","doi":"10.1002/14651858.CD013742.pub2","DOIUrl":"10.1002/14651858.CD013742.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Vitamin A deficiency is a highly detrimental micronutrient deficiency associated with poor growth, impaired immune responses, increased incidence of disease, ocular impairments, and maternal and child mortality. Reliable diagnostic assessment of vitamin A status is crucial to inform its clinical management. Currently, direct index measures and dose response biomarkers have been developed to provide assessments of vitamin A status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the accuracy of index tests routinely used as markers of subclinical vitamin A deficiency in individuals at risk for vitamin A deficiency. Secondary objectives are to assess covariates as sources of heterogeneity for the accuracy of index tests routinely used as markers of subclinical vitamin A deficiency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, and six other databases up to 18 August 2022, without restriction (any sex, age, pregnancy status, breastfeeding status, physiological condition, living in any country).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included any studies implementing concurrent measurement of at least one reference standard and one index test to measure vitamin A status. Eligible studies included cross-sectional or cohort-accuracy studies; longitudinal studies; and direct, indirect, and random comparison studies, in which multiple index tests with a reference standard were evaluated. Interventional studies measuring vitamin A status following supplementation or intervention were also included, while case-control studies defining cases by vitamin A status were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently screened studies and extracted data. We evaluated the methodological quality, that is, risk of bias of included studies and their applicability by using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. When meta-analysis was appropriate, we used random-effects bivariate models to obtain pooled estimates of sensitivity and specificity. We stratified all analyses by the reference standard and cutoff used, and assessed the certainty of the evidence using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 40 studies reporting 65 records. None of the studies was designed as a diagnostic test accuracy (DTA) study, limiting our analyses and assessments. Index test performance was described by 25 studies for serum or plasma retinol (SR) versus retinol isotope dilution (RID), 16 studies for SR versus liver vitamin A, eight studies for retinol-binding protein (RBP) versus retinol isotope dilution (RID), three studies for RBP versus liver vitamin A, one study for breast milk vitamin A versus RID, three studies for relative dose response (RDR) versus RID, and four studies for RDR versus liver vitamin A. No studies evaluating modified RDR were eligible for inclusion. Specificity data were available from all studies; se","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD013742"},"PeriodicalIF":8.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157162","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":"Exercise for patellar tendinopathy.","authors":"Alexandre D Lopes, Rodrigo Rn Rizzo, Luiz Hespanhol, Leonardo Op Costa, Steven J Kamper","doi":"10.1002/14651858.CD013078.pub2","DOIUrl":"10.1002/14651858.CD013078.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patellar tendinopathy is a prevalent condition that commonly affects the tendon's origin, causing pain at the front of the knee. The main treatment for patellar tendinopathy involves different types of exercise (e.g. strengthening and stretching). The most common method of strengthening exercise is eccentric (lengthening) muscle loading. Strengthening exercises can be land-based or water-based, weight-bearing or non-weight-bearing, or both. Other treatments include surgery and glucocorticoid injections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of exercise for the treatment of patellar tendinopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trials registers to 5 September 2023, with no restrictions by language.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomized controlled trials of strengthening exercise interventions compared to placebo or sham intervention; no treatment, usual care, or minimal intervention; or other active intervention. Strengthening exercises include concentric, eccentric, eccentric-concentric, and isometric exercises designed to enhance the strength and power of muscles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. Major outcomes included pain, function, participant-reported global assessment of treatment success, quality of life, return to sport, proportion of participants with adverse events, and proportion of participant withdrawals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included seven trials (211 participants with chronic patellar tendinopathy) comparing strengthening exercises with no treatment (3 trials, 93 participants), glucocorticoid injection (1 trial, 38 participants), surgery (1 trial, 40 participants), stretching exercise (1 trial, 15 participants), or pulsed ultrasound and transverse friction (1 trial, 30 participants). All trials included athletes (88% males, mean age 26 years) with a mean duration of symptoms of 41.6 months. Most trials were susceptible to bias, particularly selection bias/random sequence (57.1%), selection bias/allocation concealment (42.8%), detection bias (28.5%), attrition bias (71.4%), and selective reporting biases (28.5%). Given the nature of the intervention, neither participants nor investigators were blinded to group allocation in any trials (performance bias). We did not find any studies that compared exercise with placebo or sham intervention. Strengthening exercise versus no treatment We are very uncertain whether strengthening exercise reduces pain compared to no treatment. Mean pain with no treatment was 62.00 points on a 0 to 100 scale (0 = no pain) compared to 27.06 points with exercise (mean difference (MD) 34.94 points better, 95% confidence interval (CI","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD013078"},"PeriodicalIF":8.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149382","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":"Yoga for fatigue in people with cancer.","authors":"Sarah Messer, Annika Oeser, Carina Wagner, Andreas Wender, Nora Cryns, Roberta W Scherer, Shiraz I Mishra, Ina Monsef, Ulrike Holtkamp, Marike Andreas, Paul J Bröckelmann, Moritz Ernst, Nicole Skoetz","doi":"10.1002/14651858.CD015520","DOIUrl":"10.1002/14651858.CD015520","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cancer-related fatigue (CRF) is one of the most prevalent symptoms in individuals with cancer. Various types of exercise have shown beneficial effects. While previous systematic reviews suggest exercise may improve CRF and quality of life, evidence specifically about yoga's impact, as well as evidence on long-term effects, is limited. Previous syntheses offer promising but inconclusive findings on yoga's effectiveness. This review is one of a suite of five reviews exploring exercise for cancer-related fatigue.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of yoga versus no yoga on cancer-related fatigue in people with cancer: • before, during, and after anticancer treatment; • in the short, medium, and long term; • and effects on quality of life (QoL), adverse events, depression, and anxiety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We used CENTRAL, MEDLINE, Embase, five other databases and two trials registers, together with reference checking, citation searching and contact with study authors to identify studies that are included in the review. The latest search date was October 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing yoga to no yoga. We included studies in adults (aged 18 and older) with any type of cancer and anticancer therapy who received yoga before, during, or after anticancer therapy. We included trials evaluating at least one of the main outcomes (CRF or QoL). Yoga had to last for at least five sessions, and involve face-to-face instruction. We excluded trials with fewer than 20 participants randomised per group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;The outcomes of interest in this review are cancer-related fatigue (CRF), quality of life (QoL), adverse events, depression, and anxiety. We used standard methods expected by Cochrane. For analyses, we pooled results within the same period of outcome assessment (i.e. short, medium, and long term), and employed a random-effects model. We assessed risk of bias with the Cochrane risk of bias (RoB) 1 tool, and used GRADE to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 21 RCTs with 2041 people with cancer who received yoga during (13 studies) or after (eight studies) anticancer therapy; none examined yoga initiated before therapy. Here we present results on CRF and QoL; findings on adverse events, depression, and anxiety are in the full review. Yoga during anticancer therapy The evidence is very uncertain about the effect of yoga compared to no yoga on: short-term CRF (standardised mean difference (SMD) 0.07, 95% confidence interval (CI) -0.18 to 0.32; mean difference (MD) on Brief Fatigue Inventory (BFI; lower values mean better outcome) of 0.16, 95% CI -0.41 to 0.71; 3 studies, 253 participants); medium-term CRF (MD on Multidimensional Fatigue Inventory (MFI; lower values mean better outcome) of -1.30, 95% CI -3.50 to 0.90; 1 study","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015520"},"PeriodicalIF":8.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149419","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":"Community health worker-led interventions for hypertension.","authors":"Suning Mao, Liu Liu, Tianyi Wang, Yubin Cao","doi":"10.1002/14651858.CD016048","DOIUrl":"10.1002/14651858.CD016048","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 community health worker-led interventions on controlling blood pressure for people with hypertension.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016048"},"PeriodicalIF":8.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149379","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":"Ultrasound guidance versus anatomical landmarks for neuraxial anaesthesia in adults.","authors":"Yuto Makino, Kentaro Miyake, David Roche, Satoshi Yoshimura, Isao Nahara, Ethan Sahker, Norio Watanabe","doi":"10.1002/14651858.CD014964.pub2","DOIUrl":"10.1002/14651858.CD014964.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Neuraxial anaesthesia can be difficult to administer successfully, because the targeting space imagined by palpation of anatomical position can deviate from the actual position. Successful neuraxial anaesthesia, with as few punctures as possible, is important to reduce complications and increase patient satisfaction. Neuraxial anaesthesia by ultrasound guidance may be a useful way to increase success rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the clinical efficacy and safety of ultrasound guidance compared with anatomical landmarks for neuraxial anaesthesia in adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, Web of Science, and two trials registries, together with reference checking and citation searching, to identify studies that are included in the review. After the original search on 11 October 2022, we updated the electronic searches on 28 November 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that compared ultrasound guidance with the use of conventional anatomical landmarks for neuraxial anaesthesia in adults (≥ 18 years). We excluded studies on non-anaesthetic neuraxial procedures, such as lumbar puncture for diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were: (1) number of attempts until success or procedure termination; (2) procedure time; and (3) participant satisfaction during the procedure. Our important outcomes were: (1) first-attempt success; (2) technical failure; (3) pain during the procedure; and (4) any adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane RoB 2 tool to assess risk of bias in the included studies for the seven critical and important outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised results for each outcome, where possible, by using a random-effects analytical model. We calculated risk ratios (RR) for dichotomous outcomes, and mean differences (MD) or standardised mean difference (SMD) for continuous outcomes, each with 95% confidence intervals (CI). Where meta-analysis was not possible due to the nature of the data, we summarised the results narratively. We used GRADE to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included a total of 65 studies with 6823 participants. The studies were conducted in Africa, Asia, Europe, the Middle East, North America, and Oceania, and were published between 2001 and 2023. Thirty-two studies evaluated obstetric populations undergoing labour epidural or caesarean section (3149 participants); the remaining studies evaluated participants who received surgery under neuraxial anaesthesia. Thirty-three studies evaluated spinal anaesthesia, 15 studies evaluated lumbar epidural anaesthesia, 12 studies evaluated combined spinal and epidural anaesthesia, and the remaining four studies evaluated thoracic epidural anaesthesia. Four studies evaluated real-time","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD014964"},"PeriodicalIF":8.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149411","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":"Adjuvant epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) for the treatment of people with resected stage I to III non-small-cell lung cancer and EGFR mutation.","authors":"Mario Occhipinti, Martina Imbimbo, Roberto Ferrara, Vittorio Simeon, Giulia Fiscon, Corynne Marchal, Nicole Skoetz, Giuseppe Viscardi","doi":"10.1002/14651858.CD015140.pub2","DOIUrl":"10.1002/14651858.CD015140.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postoperative adjuvant epidermal growth factor receptor (EGFR) inhibitor osimertinib is the standard care for stage IB-IIIB non-small-cell lung cancer (NSCLC) with EGFR exon 19 deletions or exon 21 L858R mutation, following complete tumour resection, with or without prior platinum-based adjuvant chemotherapy. However, the role of EGFR tyrosine kinase inhibitors (TKIs) in this setting is debated, particularly concerning long-term curative effects versus recurrence delay. Uncertainties persist around treatment duration, harms, and effectiveness across disease stages, prior chemotherapy, or EGFR-sensitising mutation types.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effectiveness and harms of adjuvant EGFR tyrosine kinase inhibitors (TKIs) in people with resected stage I to III non-small-cell lung cancer (NSCLC) harbouring an activating EGFR mutation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched major databases (CENTRAL, MEDLINE, Embase) to 9 December 2024, along with conference proceedings (from 2019) and clinical trial registries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) reporting benefits or harms of adjuvant EGFR TKIs in adults with resected stage I-III NSCLC. Trials compared EGFR TKIs with platinum-based chemotherapy, placebo/best supportive care (BSC), or second-and/or third-generation EGFR TKIs versus first- and/or second-generation EGFR TKIs. Participants were adults with histologically confirmed stage I-III NSCLC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Three review authors independently assessed search results, resolving disagreements with a fourth author. Primary outcomes were overall survival (OS), disease-free survival (DFS), and adverse events (AEs); secondary outcomes included health-related quality of life (HRQoL), relapse risk during drug-off time, and brain relapse risk. We conducted meta-analyses using random-effects and fixed-effect models with hazard ratios (HRs) or risk ratios (RRs) and 95% confidence intervals (CIs). We assessed heterogeneity with the I² statistic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included nine RCTs involving 2603 participants, and identified six ongoing trials. Five trials compared EGFR TKIs with placebo/BSC, and four compared them with chemotherapy. We found no trials comparing second-and/or third-generation to first- and/or second-generation EGFR TKIs. Six trials had low selection bias risk; most had unclear or high risk for detection or performance bias; and four were high risk for other biases. The certainty of the evidence (GRADE) ranged from moderate to very low, depending on the outcome. First-, second-, and/or third-generation EGFR TKIs versus placebo/BSC EGFR TKIs probably improve overall survival compared to placebo/BSC (HR 0.54, 95% CI 0.40 to 0.73; 3 studies, 864 participants; moderate-certainty evidence). TKIs may improve disease-free survival compared to placebo/BSC, but the evidence ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015140"},"PeriodicalIF":8.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149376","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}