Cochrane Database of Systematic Reviews最新文献

{"title":"Phosphodiesterase type 5 inhibitor plus endothelin receptor antagonist compared to either alone for group 1 pulmonary arterial hypertension.","authors":"Yuji Oba, Tinashe Maduke, Eddie W Fakhouri, Yohannes Goite","doi":"10.1002/14651858.CD015824.pub2","DOIUrl":"10.1002/14651858.CD015824.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Pulmonary arterial hypertension (PAH), a rare disorder, causes elevated pressure in the pulmonary arteries, leading to heart failure. Untreated PAH has a poor prognosis, emphasising the need for effective intervention. Pharmacological treatment includes pulmonary vasodilators such as endothelin receptor antagonists (ERA), prostacyclin analogues, phosphodiesterase type 5 inhibitors (PDE5i), and soluble guanylate cyclase stimulators, often used together to improve symptoms and quality of life while reducing mortality and risk of hospitalisation.</p><p><strong>Objectives: </strong>To assess the benefits and harms of combination therapy involving a phosphodiesterase type 5 inhibitor (PDE5i) and an endothelin receptor antagonist (ERA) in adults and adolescents with group 1 pulmonary arterial hypertension (PAH) compared to either agent alone.</p><p><strong>Search methods: </strong>We searched Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform for randomised controlled trials (RCTs). The most recent searches were conducted on 13 March 2024.</p><p><strong>Eligibility criteria: </strong>We included published and unpublished RCTs comparing combinations of ERAs and PDE5is versus either agent alone lasting at least 12 weeks. Participants were aged 12 years or older with WHO group 1 PAH meeting specific haemodynamic criteria. We excluded cluster-, cross-over, and quasi-RCTs, and other PAH-specific medications.</p><p><strong>Outcomes: </strong>Critical outcomes were clinical worsening, mortality, and hospitalisation. Important outcomes were changes in six-minute walk distance (6MWD), WHO functional class, Borg Dyspnea Scale, serious adverse events, and withdrawal from the trial.</p><p><strong>Risk of bias: </strong>Two review authors independently assessed risk of bias using the Cochrane RoB 2 tool. We resolved disagreements through discussion or consultation. This informed GRADE ratings and summary of findings tables.</p><p><strong>Synthesis methods: </strong>We used a random-effects model to address study differences, switching to a fixed-effect model if there was variation primarily due to random error. We conducted meta-analyses if deemed meaningful, with data pooled if treatments, participants, and clinical questions were sufficiently similar.</p><p><strong>Included studies: </strong>We included nine studies with 1807 participants. The median duration of the studies was 16 weeks, ranging from 12 to 129 weeks. Treatment regimens included combinations of medications such as ambrisentan, bosentan, macitentan, tadalafil, and sildenafil.</p><p><strong>Synthesis of results: </strong>Combination therapy versus endothelin receptor antagonist Combination therapy reduces clinical worsening compared to ERA alone (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.41 to 0.68; 113 fewer per 1000 participants, 95% CI","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD015824"},"PeriodicalIF":8.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774815","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":"Aspartate aminotransferase-to-platelet ratio index (APRI) for staging of fibrosis in adults with chronic hepatitis C.","authors":"Ekaterina Dreytser, Oleg Blyuss, Anastasiya Mudrova, Taisiia Turankova, Kurinchi Selvan Gurusamy, Chavdar S Pavlov","doi":"10.1002/14651858.CD014222","DOIUrl":"10.1002/14651858.CD014222","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 the aspartate aminotransferase-to-platelet ratio index (APRI) for staging and screening fibrosis in adults with chronic hepatitis C infection when compared with liver biopsy as the reference standard. To achieve this, we will compare at least significant fibrosis (stages F2-F4) to no significant fibrosis (stages F0-F1) as this group of people is prioritised for treatment; at least advanced fibrosis (stages F3-F4) compared to no advanced fibrosis (stages F0-F2) as this group of people is at high risk for developing complications, i.e. hepatocellular carcinoma; cirrhosis (stage F4) compared to no cirrhosis (stages F0-F3) as the duration and effectiveness of treatment in these population groups of people are different. Secondary objectives We also aim to identify the pooled sensitivity and specificity of the most common cut-off values of APRI for the staging of fibrosis in adults with chronic hepatitis C. We plan to investigate heterogeneity for the following covariates if adequate data are available (Investigations of heterogeneity).</p><p><strong>Methodological quality: </strong>a) studies with high methodological quality; b) studies with low or unclear methodological quality Interval of liver biopsy and APRI: a) done in one day; b) more than one day, but less than or equal to three months Mean length of biopsy samples: a) less than 15 mm; b) mean length equal to or more than 15 mm Number of portal tracts in a biopsy sample: a) less than 11; b) number of portal tracts equal to or more than 11.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD014222"},"PeriodicalIF":8.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774813","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":"Scalp cooling for the prevention of chemotherapy-induced alopecia in women with early breast cancer.","authors":"Yasuyuki Kojima, Kanae Taruno, Ken Harada, Kazuya Inoki, Noyuri Yamaji, Hisashi Noma, Erika Ota, Takeshi Hasegawa","doi":"10.1002/14651858.CD016196","DOIUrl":"10.1002/14651858.CD016196","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 scalp cooling for the prevention of hair loss from adjuvant or neoadjuvant chemotherapy in women with early breast cancer.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD016196"},"PeriodicalIF":8.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759342","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 and endoscopic interventions in the management of idiopathic achalasia.","authors":"Michael A Scaffidi, Nauzer Forbes, Louis Huynh, Rishi Bansal, Nikko Gimpaya, Sandra McKeown, Christopher Teshima, Samir C Grover, Robert Bechara, Rishad Khan","doi":"10.1002/14651858.CD015808","DOIUrl":"10.1002/14651858.CD015808","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 endoscopic and surgical interventions for idiopathic achalasia, including pneumatic dilation, laparoscopic Heller myotomy (LHM), and per-oral endoscopic myotomy (POEM), using pairwise meta-analyses for direct comparisons and network meta-analysis for integrating direct and indirect comparisons.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD015808"},"PeriodicalIF":8.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759343","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":"Tumor necrosis factor-alpha antagonists for treatment of pediatric Crohn's disease.","authors":"Andrea Sepúlveda, Maria Jose de la Piedra Bustamante, Esther Orlanski-Meyer, Luis A Villarroel Del Pino, Maria Teresa Olivares Labbe, Juan Cristóbal Gana","doi":"10.1002/14651858.CD014497.pub2","DOIUrl":"10.1002/14651858.CD014497.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;The incidence of pediatric Crohn's disease has been steadily increasing. In this population, the disease often presents with more extensive inflammation, a tendency toward a more aggressive course, and frequently requires early immunomodulation. Anti-tumor necrosis factor (TNF) antibodies work by neutralizing pro-inflammatory effectors, thus interrupting the inflammatory cascade. There is broad consensus that biologics are effective in achieving mucosal healing in Crohn's disease. Despite this, several important questions about anti-TNF therapy in children and adolescents remain unanswered. These include determining the optimal dosing regimen for both safety and durability, identifying the ideal timing for initiating anti-TNF treatment before irreversible bowel damage occurs, and deciding whether to use a top-down or step-up approach tailored to the individual patient's disease location, behavior, and other predictors of complicated outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the efficacy and safety of TNF-alpha antagonists for induction of remission in children and adolescents with active Crohn's disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, Embase (Elsevier), LILACS (Latin American and Caribbean Health Science Information database) (BIREME), and Science Citation Index Expanded and Conference Proceedings Citation Index-Science (Web of Science). We applied no language or document type restrictions. The last update of evidence was on 1 June 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs), irrespective of publication type, publication status, and language, assessing the benefits and harms of TNF-alpha antagonist for induction of remission treatment for pediatric Crohn's disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were induction of clinical remission and incidence of serious adverse effects. Important outcomes were all-cause mortality and morbidity related to Crohn's disease, endoscopic remission, incidence of steroid withdrawal, proportion of participants in need of surgical intervention, loss of response to anti-TNF, and incidence of mild adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed risk of bias using Cochrane's RoB 1 tool. The only included trial was at overall high risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We used standard Cochrane methodology to perform this systematic review. We used the GRADE approach to assess the certainty of evidence per outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;Only one study fulfilled the inclusion criteria. The study was an open-label, multicenter RCT conducted in 12 hospitals in three European countries, and included 100 children (51 boys and 49 girls) newly diagnosed with moderate-to-severe Crohn's disease with a 52-week follow-up. Children were randomly assig","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD014497"},"PeriodicalIF":8.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759345","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":"Targeted immunosuppressive and immunomodulatory therapies for idiopathic inflammatory myopathies.","authors":"Joost Raaphorst, Nicola J Gullick, Farhad Shokraneh, Ruth Brassington, Minoesch Min, Saadia S Ali, Patrick A Gordon","doi":"10.1002/14651858.CD015854","DOIUrl":"10.1002/14651858.CD015854","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic inflammatory myopathies (IIM) are autoimmune-mediated inflammatory disorders of skeletal muscles with non-muscle involvement in some people. Treatment of IIM represents an area of unmet need; a previous Cochrane review (2012) found little or no evidence to guide treatment. Since then, potentially promising treatments targeting B and T cells and complement inhibitors have been investigated.</p><p><strong>Objectives: </strong>To assess the effects (benefits and harms) of targeted immunosuppressant and immunomodulatory treatments for the idiopathic inflammatory myopathies: dermatomyositis (DM, including juvenile dermatomyositis (JDM) and amyopathic dermatomyositis), immune-mediated necrotising myopathy (IMNM), anti-synthetase syndrome (ASS), overlap-myositis (OM), polymyositis (PM) and cancer-related myositis.</p><p><strong>Search methods: </strong>We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase and clinical trial registers until February 2023. We intended to check references and citations, and contact experts to identify additional studies, but lacked the resources.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) or quasi-RCTs of targeted immunosuppressive and immunomodulatory therapies in adults and children with IIM. Primary outcomes were improvement of function or disability and improvement of muscle strength. Secondary outcomes were achievement of definitions of improvement, cumulative corticosteroid dose, change in skin disease activity, serious adverse event and withdrawals for lack of benefit or adverse events. Our preferred follow-up was six months, although we accepted three months.</p><p><strong>Data collection and analysis: </strong>We followed standard Cochrane methodology. To assess risk of bias we used the domain-based Cochrane tool (RoB 1). We used fixed-effect models, and, when needed, random-effects models for meta-analysis. We created summary of findings tables for any comparison for which data were available, but chose in advance to prioritise comparisons of rituximab, abatacept or complement inhibitors with placebo, no treatment or standard care. We assessed the certainty of evidence using GRADE.</p><p><strong>Main results: </strong>We included 16 studies (830 participants). All studies were at risk of bias (10/16 high risk in at least one domain; four studies with unclear risk in ≥ 2 domains judged as high risk). Selective reporting was the most frequent reason for high risk of bias (37%). None of the treatments assessed showed moderate or high-certainty evidence of response compared to placebo for any of the primary or secondary outcomes. Improvement of function or disability For rituximab, function or disability improvement was not reported separately. Abatacept may have little or no effect on disability measured as change on the Health Assessment Questionnaire Disability Index (HAQ-DI) (range 0 to 3, lo","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD015854"},"PeriodicalIF":8.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759344","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":"Organised trauma systems and designated trauma centres for improving outcomes in injured patients.","authors":"Michael Mwandri, Barclay Stewart, Timothy C Hardcastle, Jemma Hudson, Andres M Rubiano, Russell L Gruen, Juan Carlos Puyana, Denise O'Connor, David Metcalfe","doi":"10.1002/14651858.CD012500.pub2","DOIUrl":"10.1002/14651858.CD012500.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Trauma systems have become the standard of care in high-income countries, but remain uncommon in low- and middle-income countries. High-quality evidence of effectiveness is needed to advocate for the development of trauma systems in low- and middle-income countries, where the burden of injury is highest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of organised trauma systems and designated trauma centres compared with usual care in injured patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and WHO ICTRP on 16 December 2023. We also searched grey literature, checked reference lists of included studies, and contacted the authors of relevant studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials, non-randomised trials, controlled before-after studies, and interrupted time series studies comparing organised trauma systems or designated trauma centres with usual care. We planned to include patients who had had major trauma (i.e. Injury Severity Score greater than 15), but made a post-hoc decision to include patients regardless of injury severity. Studies were considered for inclusion regardless of date, language, or publication status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcomes were patient outcomes (such as mortality, survival, and recovery), and adverse effects. Important outcomes were utilisation and access to trauma care services, quality of care provided, equity, and knowledge about trauma care services. Studies only reported patient outcomes (mortality, survival); there were no reports on adverse effects, utilisation and access to services, quality of care, equity, and knowledge about trauma care services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane RoB 1 tool and guidance from the Cochrane Effective Practice and Organisation of Care (EPOC) group to evaluate individual studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. We could not perform a meta-analysis due to substantial clinical heterogeneity across studies. We re-analysed data from individual studies so they could be presented in a standardised format as relative effect, change in level, and change in slope. We summarised findings using a narrative synthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;There were four interrupted time series studies (157,111 participants). Two studies (131,220 participants) compared organised trauma systems to usual care and two studies (25,891 participants) compared designated trauma centres to usual care. Two studies were conducted in the US, one in the UK, and one in Norway.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;It is very uncertain whether organised trauma systems reduce mortality compared to usual care because the certainty of the ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD012500"},"PeriodicalIF":8.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759341","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":"Advance care planning for adults with cancer.","authors":"Noyuri Yamaji, Yasuyuki Kojima, Nobuyuki Kabasawa, Edward Barroga, Hisashi Noma, Erika Ota, Takeshi Hasegawa","doi":"10.1002/14651858.CD016227","DOIUrl":"10.1002/14651858.CD016227","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 advance care planning (ACP) in people with cancer compared with standard care (without ACP).</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD016227"},"PeriodicalIF":8.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741411","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":"Topical antibiotics for treating bacterial keratitis: a network meta-analysis.","authors":"Anna Song, Yunfei Yang, Christin Henein, Catey Bunce, Riaz Qureshi, Darren SJ Ting","doi":"10.1002/14651858.CD015350.pub2","DOIUrl":"10.1002/14651858.CD015350.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Infectious keratitis, commonly known as corneal infection, is a major cause of blindness, affecting approximately six million people globally and resulting in around two million cases of monocular blindness annually. The incidence varies widely worldwide, with higher rates in low- and middle-income countries due to various risk factors, including agricultural injuries and other accidental trauma, limited access to health care, and low levels of health literacy. Bacterial keratitis (BK) is the most prevalent form in higher-income regions, contributing to significant morbidity and healthcare burden. If not diagnosed and treated promptly, BK can damage the cornea and result in corneal scarring, visual impairment and/or blindness. Broad-spectrum topical antibiotics remain the primary treatment, with regional microbiological profiles and antimicrobial resistance patterns influencing therapeutic choices. However, in view of the substantial heterogeneity in clinical practice, the optimal choice of topical antibiotics for BK remains uncertain. Addressing this unanswered question may help inform current practice and improve the clinical outcomes of BK.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the benefits and harms of topical antibiotics for treating BK and to rank interventions by performing a systematic review and network meta-analysis (NMA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registries together with reference checking and contact with study authors (where necessary). The latest search date was 8 August 2024. There were no restrictions on language or year of publication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs) in which different types of topical antibiotics (e.g. ciprofloxacin, moxifloxacin, vancomycin, etc.) and/or placebo were compared in participants with BK (diagnosed clinically or microbiologically, or both).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methodology. Our outcomes were mean days to healing, mean size of epithelial defect, mean size of infiltrate, mean corrected and uncorrected distance visual acuity, and adverse effects. We assessed risk of bias using the RoB 2 tool and the certainty of evidence using the CINeMA framework for the primary NMA results of our critical outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 23 parallel-group RCTs that enrolled 2692 participants diagnosed with BK. The studies were conducted in Australia, Canada, India, Iran, Israel, Japan, the Philippines, Serbia, Thailand, the UK, and the USA. The majority of participants were of working age, with a mean age ranging from 26 to 66 years, and 58% were male. We classified six types of interventions: fluoroquinolone monotherapy, cephalosporin monotherapy, penicillin monotherapy, dual therapy, triple therapy, and other monotherapy (povidone-iodine, honey, plac","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD015350"},"PeriodicalIF":8.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728443","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":"Desmopressin for nocturnal enuresis in children.","authors":"Deirdre Hahn, Fiona Stewart, Gayathri Raman","doi":"10.1002/14651858.CD002112.pub2","DOIUrl":"10.1002/14651858.CD002112.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Enuresis (bedwetting) affects up to 20% of five-year-old children and 2% of adults. Although spontaneous remission often occurs, the social, emotional and psychological costs can be great. Desmopressin has been used to treat bedwetting since the 1970s. This is an update of a Cochrane review first published in 2000 and last updated in 2006.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of desmopressin on treating nocturnal enuresis in children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearching of journals and conference proceedings (searched January 2023) and reference lists of relevant articles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised or quasi-randomised trials of desmopressin or desmopressin combined with another intervention for treating nocturnal enuresis in children between five and 16 years old.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Three review authors independently extracted data and assessed the risk of bias in the eligible trials. We used standard methodological procedures expected by Cochrane.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We identified 50 new studies for this review, which now includes 95 studies (8473) participants, of whom 5434 received desmopressin. In this review we continued the assessment of the effect of combination therapy involving desmopressin. The majority of the trials were in children between the ages of five to 16 years in an outpatient setting. The quality of the evidence was assessed as low or very low. The first comparison was desmopressin versus placebo. Desmopressin may reduce the mean number of wet nights per week compared with placebo (MD -1.81, 95% CI -2.24 to -1.39; participants = 1267; studies = 16; low-certainty evidence). Desmopressin probably leads to more children achieving 14 consecutive dry nights by the end of treatment compared with placebo (RR 3.18, 95% CI 1.75 to 5.80; participants = 922: studies = 11; moderate-certainty evidence). There may be little to no difference in children experiencing adverse effects with desmopressin compared to placebo (RR 1.11, 95% CI 0.81 to 1.52; participants = 269; studies = 3; low-certainty evidence). Desmopressin was compared with alarm therapy. It is uncertain if there is any difference between desmopressin compared with alarm training in reducing the number of wet nights per week (MD 0.63, 95% CI -0.49 to 1.75; participants = 285; studies = 4; I&lt;sup&gt;2&lt;/sup&gt; = 82%; very low-certainty evidence). There may be little or no difference between desmopressin and alarm therapy in the number of children achieving 14 consecutive dry nights (RR 0.98, 95% CI 0.88 to 1.09; participants = 1530; studies = 15; low-certainty evidence). There","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD002112"},"PeriodicalIF":8.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728442","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}