Cochrane Database of Systematic Reviews最新文献

{"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":"<p><strong>Rationale: </strong>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.</p><p><strong>Objectives: </strong>To assess the efficacy and safety of TNF-alpha antagonists for induction of remission in children and adolescents with active Crohn's disease.</p><p><strong>Search methods: </strong>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.</p><p><strong>Eligibility criteria: </strong>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.</p><p><strong>Outcomes: </strong>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.</p><p><strong>Risk of bias: </strong>We assessed risk of bias using Cochrane's RoB 1 tool. The only included trial was at overall high risk of bias.</p><p><strong>Synthesis methods: </strong>We used standard Cochrane methodology to perform this systematic review. We used the GRADE approach to assess the certainty of evidence per outcome.</p><p><strong>Included studies: </strong>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}

{"title":"Xpert MTB/RIF Ultra assay for pulmonary tuberculosis and rifampicin resistance in adults and adolescents.","authors":"David J Horne, Jerry S Zifodya, Adrienne E Shapiro, Elizabeth Chandler Church, Jonah S Kreniske, Alexander W Kay, Katie Scandrett, Karen R Steingart, Yemisi Takwoingi","doi":"10.1002/14651858.CD009593.pub6","DOIUrl":"10.1002/14651858.CD009593.pub6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Xpert MTB/RIF Ultra (Xpert Ultra) is a molecular World Health Organization (WHO)-recommended rapid diagnostic test that simultaneously detects tuberculosis and rifampicin resistance. This review updates a comparative accuracy Cochrane review of Xpert MTB/RIF and Xpert Ultra as Xpert Ultra has replaced Xpert MTB/RIF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the diagnostic accuracy of Xpert MTB/RIF Ultra (Xpert Ultra) for detecting pulmonary tuberculosis and rifampicin resistance in adults and adolescents with presumptive tuberculosis based on signs or symptoms or with an abnormal chest x-ray suggestive of tuberculosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched seven databases including CENTRAL, MEDLINE, and Embase, plus two trial registers (ClinicalTrials.gov and the WHO ICTRP) to 16 October 2023 without language restrictions. A WHO Public Call for ongoing and unpublished studies was made between 30 November 2023 and 15 February 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included cross-sectional studies, cohort studies, and randomised controlled trials that provided data on the diagnostic accuracy of Xpert Ultra using respiratory specimens in adolescents (aged 10 to 14 years) and adults (aged 15 years and older) with presumptive pulmonary tuberculosis. For pulmonary tuberculosis detection, the reference standards were culture and a composite reference standard. For rifampicin resistance, the reference standards were culture-based phenotypic drug susceptibility testing with or without whole genome sequencing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently extracted data using a standardised form. We assessed risk of bias using QUADAS-2. We performed meta-analyses using a bivariate model to produce summary sensitivities and specificities, separately for pulmonary tuberculosis detection and rifampicin resistance detection. We performed subgroup analyses by smear status, HIV status, and history of tuberculosis. We summarised Xpert Ultra trace-positive results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;Pulmonary tuberculosis detection For detection of pulmonary tuberculosis, Xpert Ultra summary sensitivity and specificity against culture were 90.7% (95% confidence interval (CI) 88.2 to 92.7) and 94.8% (95% CI 92.8 to 96.3) (32 studies, 12,529 participants; high-certainty evidence). Most studies had low risk of bias in all QUADAS-2 domains. If the point estimates for Xpert Ultra are applied to a hypothetical cohort of 1000 people, where 100 of those presenting with symptoms have pulmonary tuberculosis, Xpert Ultra will miss nine cases. The number of people wrongly diagnosed with pulmonary tuberculosis would be 47. In people living with HIV, Xpert Ultra summary sensitivity and specificity were 87.7% (82.0 to 91.7) and 95.3% (92.2 to 97.2) (11 studies, 1164 participants). Amongst people with smear-negative, culture-positive pulmonary tuberculosis, Xpert Ultra summar","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD009593"},"PeriodicalIF":8.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728444","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":"Vaginal lasers for treating stress urinary incontinence in women.","authors":"Giulia M Ippolito, Irene M Crescenze, Hannah Sitto, Rita R Palanjian, Daniel Raza, Paholo Barboglio Romo, Sheila A Wallace, Giovany Orozco Leal, J Quentin Clemens, Philipp Dahm, Priyanka Gupta","doi":"10.1002/14651858.CD013643.pub2","DOIUrl":"10.1002/14651858.CD013643.pub2","url":null,"abstract":"<p><strong>Background: </strong>Stress urinary incontinence (SUI) in women is common and can have a profound impact on an individual's quality of life. Vaginal lasers, designed for treating vulvovaginal atrophy, have been explored as a clinic-based option for treating SUI. However, the effect of vaginal lasers on SUI remains unclear.</p><p><strong>Objectives: </strong>To assess the effects of vaginal lasers for treating SUI in women and to summarise the principal findings of relevant economic evaluations.</p><p><strong>Search methods: </strong>We performed a comprehensive search using the Cochrane Incontinence Specialised Register (searched 29 April 2024). The Register contains trials identified from multiple databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, and WHO ICTRP (all within the Register). We also handsearched journals and conference proceedings and searched the reference lists of relevant articles. We identified published reports of relevant economic evaluations through electronic literature searches, and performed a literature search for a brief economic commentary (BEC), but found no studies of economic evaluations that compare vaginal lasers with other treatments.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials of women with SUI assessing therapy with a vaginal laser versus sham or control treatments or topical treatments.</p><p><strong>Data collection and analysis: </strong>Two review authors independently performed study selection, data extraction, and risk of bias assessment, with arbitration from a third review author as needed. We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to the GRADE approach.</p><p><strong>Main results: </strong>We screened 227 references and included nine studies that reported outcomes on 689 women with SUI. The studies were conducted in Europe, North America, and South America. Five studies utilised CO₂ laser and four utilised Er:YAG laser therapy, delivered from one to three treatments occurring 28 to 45 days apart. The studies compared laser therapy to sham or topical therapy; two studies had three comparator arms. The time points for all the reported outcomes ranged from three to 12 months and were therefore considered either short term (less than one year) or medium term (one to five years). Generally, the certainty of evidence was downgraded due to concerns of risk of bias and imprecision and judged to be very low. Vaginal lasers versus sham or control treatments (such as topical lubricant) All nine studies, reporting outcomes for 689 women, investigated this comparison. There may be no difference in the number of continent women between women who underwent vaginal laser compared to those who underwent sham or control treatments in the short term; however, the CI is sufficiently wide enough to in","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD013643"},"PeriodicalIF":8.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12291154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706591","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":"Transcranial laser therapy for acute ischaemic stroke.","authors":"Haoyang He, Zhimeng Zhang, Hengshu Chen, Zhixuan Jiang, Yanan Wang, Xindi Song, Junfeng Liu, Simiao Wu","doi":"10.1002/14651858.CD012426.pub2","DOIUrl":"10.1002/14651858.CD012426.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Ischaemic stroke is a leading cause of disability and death worldwide, but limited treatment options are available to improve its outcomes. Some studies have explored transcranial laser therapy in people with acute ischaemic stroke, but the benefits and harms of this treatment are unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The primary objective was to assess the benefits and harms of transcranial laser therapy for improving functional outcomes after acute ischaemic stroke. The secondary objective was to assess the equity of transcranial laser therapy in people with acute ischaemic stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, ISI Science Citation Index, CINAHL, PEDro (Physiotherapy Evidence Database), REHABDATA, and four ongoing trials registries. We also searched reference lists and databases of conference abstracts for other studies, including any that are ongoing or unpublished. The latest search date was 3 August 2024 for all databases except CenterWatch, which we searched on 1 November 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing transcranial laser therapy with sham treatment or no treatment in people with acute ischaemic stroke, with or without standard treatment in both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcomes were unfavourable functional outcome, defined as a score of 3 to 6 on the modified Rankin Scale (mRS), and all-cause mortality. The important outcomes were improvement of stroke severity measured on the National Institutes of Health Stroke Scale (NIHSS), serious adverse events, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane risk of bias tool (RoB 2) to assess the risk of bias for all outcomes in all RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We planned to use risk ratios (RRs) with 95% confidence intervals (CIs) to compare all outcomes. However, for improvement of stroke severity, we extracted odds ratios (ORs) and 95% CIs from the original studies because the raw data were unavailable. Our meta-analyses used fixed-effect modelling. To assess statistical heterogeneity, we used the I&lt;sup&gt;2&lt;/sup&gt; statistic. We used the GRADE approach to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included four RCTs enrolling a total of 1420 people with acute ischaemic stroke. The studies were published between 2007 and 2014. All were multicentre studies, based in Europe, North America, South America, Asia, or more than one of these continents. All studies included people older than 40 years (mean age 68.3 years), and 59.6% of participants were men. All studies enrolled participants within 24 hours after onset of stroke symptoms, all used a transcranial laser of 808-nm wavelength, and all compared transcranial laser therapy with sham treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Critical outcomes Transcranial laser t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD012426"},"PeriodicalIF":8.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697811","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":"Corticosteroids for treatment of leptospirosis.","authors":"Nathaniel Lee, Su Myat Han, Patrick Mukadi, Tansy Edwards, Hsu Thinzar Maung, Chris Smith, Tin Zar Win","doi":"10.1002/14651858.CD014935.pub2","DOIUrl":"10.1002/14651858.CD014935.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Leptospirosis is a bacterial disease caused by Leptospira spp, a zoonotic pathogen spread via contaminated soil and water. Corticosteroids have been used for the treatment or prevention of severe manifestations of disease, but the indications for their use and treatment efficacy remain uncertain. This review evaluates the existing evidence for the use of corticosteroids in leptospirosis from randomised trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of corticosteroids versus no intervention, no intervention beyond standard of care, or placebo for the treatment of people with leptospirosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;Electronic searches in the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, and other resources were conducted. We searched online clinical trial registries to identify unpublished or ongoing trials, and reviewed reference lists from the identified publications for potential trials. We contacted authors of identified trials, relevant individuals, and organisations for additional information. The last search date was 10 April 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We considered the inclusion of randomised clinical trials of any trial design which assessed corticosteroids for the treatment of leptospirosis. We imposed no restrictions on age, sex, occupation, comorbidity of trial participants, or outcomes reported. We looked for trials assessing corticosteroids irrespective of type, route of administration, dosage, and schedule versus no intervention, placebo, or no intervention beyond standard care. We included trials meeting any of these criteria, irrespective of the manuscript's primary language.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We adhered to Cochrane methodology. Data entry and analysis were facilitated by the use of the Review Manager. The primary outcomes were all-cause mortality and the proportion of individuals experiencing serious adverse events. The secondary outcomes were quality of life, the proportion of individuals experiencing non-serious adverse events, days of hospitalisation, and the proportion of individuals experiencing Jarisch-Herxheimer reactions. We employed the risk of bias 2 tool (RoB 2) to assess the bias risk of included trials. We used the GRADEPro software to evaluate the certainty of evidence. We presented dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD), both accompanied by their corresponding 95% confidence intervals (CI). We applied a random-effects meta-analysis for the primary analysis and a fixed-effect model for the sensitivity analyses. Our primary outcome analyses included trial data at the longest follow-up. We analysed the outcome data regardless of the risk of bias.&lt;/p&gt;&lt;p","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD014935"},"PeriodicalIF":8.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697810","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}