Systematic Reviews最新文献

{"title":"The efficacy and safety of bivalirudin and heparin in patients with acute coronary syndrome: a systematic review and meta-analysis.","authors":"You Zhai, Hongcai Shang, Yan Li, Nan Zhang, Jisi Zhang, Shangwen Wu","doi":"10.1186/s13643-025-02782-7","DOIUrl":"10.1186/s13643-025-02782-7","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are at high risk of thrombosis. However, bleeding-related complications during antithrombotic therapy remain a major barrier to effective treatment and can often lead to adverse outcomes. This meta-analysis aimed to determine the efficacy and safety of bivalirudin and heparin in patients with ACS after PCI.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) on the efficacy and safety of bivalirudin versus heparin in patients with ACS after PCI were identified from the PubMed, Embase, Cochrane Library, CBM, CNKI, WanFang, and VIP database until August 2024. The outcomes included all-cause mortality, major adverse cardiovascular events (MACEs), incidence of recurrent myocardial infarction, stent thrombosis, short-term bleeding, revascularization, and retransfusion. Meta-analysis was performed using RevMan 5.3 and Stata 12.0 softwares. The included studies were assessed for risk of bias using the Cochrane risk-of-bias assessment tool.</p><p><strong>Results: </strong>A total of 70,199 patients from 27 randomized controlled trials (RCTs) were analyzed in this review. There were no significant differences between the bivalirudin and heparin groups in terms of all-cause mortality, major adverse cardiovascular events (MACEs), recurrent myocardial infarction, stent thrombosis within 30 days, or subacute stent thrombosis. Specifically, the incidence of short-term bleeding (P = 0.001) and retransfusion (P = 0.001) was significantly lower in the bivalirudin group compared to the heparin group. Conversely, the incidence of acute stent thrombosis (P < 0.0001) and revascularization (P = 0.009) was significantly higher in the bivalirudin group.</p><p><strong>Conclusions: </strong>Compared with heparin, bivalirudin has definite anticoagulant effect in patients with acute myocardial infarction after PCI, and the risk of bleeding and the incidence of retransfusion were lower in the bivalirudin group. This review helps doctors in PCI management choose bivalirudin or heparin more precisely based on patients' conditions for better treatment and fewer adverse events.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"39"},"PeriodicalIF":6.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of different drugs in patients with HER2-positive gastric cancer: network meta-analysis.","authors":"Jie Zhang, Chunluan Yuan, Xiao Ma","doi":"10.1186/s13643-025-02777-4","DOIUrl":"10.1186/s13643-025-02777-4","url":null,"abstract":"<p><strong>Background: </strong>In the past decade, there has been a significant advancement in targeted therapy and immunotherapy, leading to the discovery of new drugs and changes in the treatment approach for patients with HER2-positive gastric cancer. Although several drugs are available for treating these patients, there is still no consensus on their selection, and there has been limited direct or indirect comparison among them.</p><p><strong>Objective: </strong>To address this gap, a network meta-analysis was conducted to assess the efficacy and safety of different drugs used in the treatment of HER2-positive gastric cancer.</p><p><strong>Methods: </strong>By searching through databases such as PubMed, Embase, Web of Science, and Cochrane Library, we identified 16 randomized controlled trials that involved a total of 4485 patients and utilized 9 different intervention measures.</p><p><strong>Results: </strong>Based on the current evidence, compared with chemotherapy alone, the hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS) in gastric cancer patients treated with nivolumab were [hazard ratio (HR): 2.61 95%confidence interval (CI) (1.51, 4.51)] and [hazard ratio (HR): 2.01 95% confidence interval (CI) (1.18, 3.42)], respectively. Compared with chemotherapy alone, the hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS) in gastric cancer patients treated with trastuzumab deruxtecan were [hazard ratio (HR): 1.7 95% confidence interval (CI) (1.13, 2.56)] and [hazard ratio (HR): 2.13 95% confidence interval (CI) (1.42, 3.22)], respectively. It is suggested that nivolumab and trastuzumab deruxtecan can effectively prolong overall survival (OS) and progression-free survival(PFS) in patients with HER2-positive gastric cancer, while also reducing the risk of adverse events to some extent. Therefore, these two regimens, nivolumab and trastuzumab deruxtecan, are considered to be effective and safe options for the treatment of patients with HER2-positive gastric cancer.</p><p><strong>Conclusions: </strong>In previous studies, trastuzumab-based chemotherapy has been a common treatment for HER2-positive gastric cancer. To a certain extent, our study provides a reliable direction for future treatment options for HER2-positive gastric cancer.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42023420941.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"40"},"PeriodicalIF":6.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling neurogenic biomarkers for the differentiation between sepsis patients with or without encephalopathy: an updated meta-analysis.","authors":"Jiyun Hu, Wenchao Li, Shucai Xie, Ya Liao, Tao Chen, Xinrun Wang, Weiping Xia, Fang Huang, Zhaoxin Qian, Lina Zhang","doi":"10.1186/s13643-025-02784-5","DOIUrl":"10.1186/s13643-025-02784-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis-associated encephalopathy (SAE) is characterized by brain dysfunction in the context of sepsis and frequently leads to significant cognitive and neurological impairments, as well as an elevated risk of mortality. Accurate diagnosis of SAE is crucial for the timely initiation of optimal treatment and appropriate patient management. Neurogenic biomarkers hold promise as reliable serum diagnostic tools for the detection and longitudinal monitoring of SAE. This meta-analysis seeks to evaluate the diagnostic and prognostic utility of serum neurogenic biomarkers in patients with SAE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study protocol was registered in the PROSPERO database (CRD42023408312) and conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was conducted to comprehensively and critically evaluate the existing body of evidence regarding the use of serum neurogenic biomarkers: neuron-specific enolase (NSE), ubiquitin C-terminal hydrolase-L1 (UCH-L1), Tau, S100 calcium-binding protein β (S100β), and glial fibrillary acidic protein (GFAP) for the diagnosis and risk assessment of fatality in SAE. We conducted a systematic search of electronic bibliographic databases, including PubMed, Web of Science, Embase, Cochrane databases, CNKI, CQVIP, and WFSD. The quality and risk of bias of the selected studies were assessed using the QUADAS-2 tool. For biomarkers reported in two or more studies, pooled standardized mean differences and 95% confidence intervals were calculated. Heterogeneity among the included studies was examined using the I&lt;sup&gt;2&lt;/sup&gt; statistic and random-effects model was applied owing to large heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-two studies were included in our meta-analysis. The levels of serum neurogenic biomarkers were significantly higher in patients with SAE as compared to septic patients with no-encephalopathy (NE): NSE (standardized mean difference (SMD) 1.98 (95% CI 1.55-2.42), P &lt; 0.00001); UCH-L1 (SMD 1.75 (95% CI 0.90-2.59), P &lt; 0.0001); Tau (SMD 1.14 (95% CI 1.01-1.28), P &lt; 0.00001); S100β (SMD 1.82 (95% CI 1.45-2.19), P &lt; 0.00001); and GFAP (SMD 3.63 (95% CI 1.85-5.41), P &lt; 0.0001). In addition, significantly lower serum neurogenic biomarkers levels were noted in septic patients with survivors as compared to non-survivors: NSE (SMD - 1.87 (95% CI - 2.43 to - 1.32), P &lt; 0.00001); UCH-L1 (SMD - 1. 71 (95% CI - 2.24 to - 1.19), P &lt; 0.00001); Tau (SMD - 0.57 (95% CI - 0.79 to - 0.35), P &lt; 0.00001); S100β (SMD - 1.34 (95% CI - 1.88 to - 0.80), P &lt; 0.00001). However, no significant differences in serum GFAP levels [SMD -7.98 (95% CI - 22.23-6.27), P = 0.27) were found between the surviving and non-surviving groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The increased serum neurogenic biomarkers may be predictive of SAE and mortality for septic patients, which are expected to be applied as a reliable blood-based dia","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"38"},"PeriodicalIF":6.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The decision-making process and experiences of women returning to work after parental leave: a qualitative systematic review protocol.","authors":"Safiye Sahin, Sabine S Dunbar, Gurmeet Sehgal, Lisa R Roberts, Jan M Nick","doi":"10.1186/s13643-025-02778-3","DOIUrl":"10.1186/s13643-025-02778-3","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the decision-making process of women returning to work after maternity leave or parental leave and explore the influence of cultural norms and societal expectations on their choices. Additionally, we seek to understand the lived experiences of the women in this context.</p><p><strong>Introduction: </strong>Cultural norms and societal expectations significantly affect women's decisions regarding post-childbirth employment. However, a comprehensive understanding of these influences on women's experiences returning to work after parental leave is lacking.</p><p><strong>Inclusion criteria: </strong>We will include qualitative studies examining women's decision-making processes and experiences of returning to work after parental leave, with a focus on the influence of cultural norms and societal expectations. Studies from diverse cultural and geographical settings, including peer-reviewed journals and gray literature, will be considered without restrictions on publication date or language.</p><p><strong>Methods: </strong>The review will adhere to the JBI approach for qualitative systematic reviews. Major academic databases and search engines, such as CINAHL, PubMed, and Google Scholar, will be used. Study selection will involve screening titles and abstracts for relevance, followed by a full-text assessment against inclusion criteria by two independent reviewers. Critical appraisal using the JBI Critical Appraisal Checklist for Qualitative Research will evaluate study rigor. Data extraction will be conducted by two independent reviewers, using the standardized JBI data extraction tool within JBI SUMARI, to identify key themes and findings related to the women's decision-making process and lived experiences of returning to work after parental leave. The meta-aggregation approach will be utilized to synthesize findings, with confidence assessed through study quality and consistency. Any methodological deviations will be documented. Findings will be graded using the ConQual approach and presented in a summary of findings table.</p><p><strong>Discussion: </strong>By synthesizing data from different cultural contexts, this review will help bridge the gap in understanding how these factors influence women's choices. Rigor in the review will be ensured through the process of study selection, appraisal, and synthesis using the JBI approach. The findings will provide challenges faced by women and inform policies to help support their transition back to work.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42024546633.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"37"},"PeriodicalIF":6.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extent of evidence synthesis in biomedical research: a MeSH-driven analysis of neglected and well-explored areas.","authors":"Pooya Mohammadi Kazaj, Bernadette Coles, Isaac Shiri, Giovanni Baj, Christoph Gräni, Adriani Nikolakopoulou, George C M Siontis","doi":"10.1186/s13643-025-02780-9","DOIUrl":"10.1186/s13643-025-02780-9","url":null,"abstract":"","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"35"},"PeriodicalIF":6.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analysis of 5-year survival data for cancers without considering time is misleading.","authors":"Masoud Mohammadi","doi":"10.1186/s13643-025-02781-8","DOIUrl":"10.1186/s13643-025-02781-8","url":null,"abstract":"","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"36"},"PeriodicalIF":6.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive oxygenation and ventilation strategies for viral acute respiratory failure: a comprehensive systematic review and meta-analysis.","authors":"Fredy Leonardo Carreño-Hernández, Sergio Prieto, Daniela Abondando, Jairo Alejandro Gaitán, Yenny Rocío Cárdenas-Bolívar, Adriana Beltrán, Jorge Iván Alvarado-Sánchez, Joseph L Nates","doi":"10.1186/s13643-025-02775-6","DOIUrl":"10.1186/s13643-025-02775-6","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has resulted in a critical shortage of respiratory ventilators, highlighting the urgent need to explore alternative treatment options for patients with acute respiratory distress syndrome (ARDS) caused by respiratory viruses, as an alternative to invasive mechanical ventilation (IMV) in future pandemics.</p><p><strong>Objectives: </strong>The objective of this study was to assess the effectiveness of alternative noninvasive oxygenation and ventilation strategies in comparison to invasive mechanical ventilation (IMV) in patients with virus-induced acute respiratory failure (ARF). The primary outcome was the all-cause ICU mortality rate.</p><p><strong>Methods: </strong>A systematic review was conducted following the Cochrane guidelines and PRISMA reporting guidelines. The search encompassed databases such as Medline, Cochrane CENTRAL, and Embase to identify relevant indexed literature. Additionally, gray literature was included by consulting regulatory agencies. The included studies compared various oxygenation and ventilatory alternatives, such as high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), or noninvasive mechanical ventilation (NIMV) with IMV. An exploratory meta-analysis was performed by calculating the risk ratio (RR) by random effects and meta-regression to explore possible sources of heterogeneity and to compare ventilatory alternatives against IMV to reduce mortality, length of stay (LOS) days in ICU, nosocomial infection, and barotrauma.</p><p><strong>Results: </strong>A total of forty-seven studies were included in this systematic review. NIMV had an RR of 0.70 (0.58-0.85), HFNC had an RR of 0.54 (0.42-0.71), and CPAP had an RR of 0.80 (0.71-0.90), with meta-regression models that reduced heterogeneity to 0%. For LOS days in ICU, NIMV had 0.38 (- 0.69: - 0.08) lower days and HFNC 0.29 (- 0.64: 0.06) lower days with meta-regression models that reduction heterogeneity to 0% for HFNC and 50% for NIMV. Not enough studies reported nosocomial infection or barotrauma to evaluate them in a meta-analysis. The overall quality of evidence, as assessed by GRADE evaluation, was determined to be from very low to medium certainty depending on the ventilatory strategy and outcome.</p><p><strong>Conclusions: </strong>The findings of this systematic review support the use of alternative noninvasive oxygenation and ventilation strategies as viable alternatives to conventional respiratory ventilation for managing viral-induced ARF. Although it is essential to interpret these findings with caution given the overall low to medium certainty of the evidence, the integration of these modalities as part of the management strategies of these patients could help reduce the utilization of ICU beds, invasive ventilators, and costs in both developed and developing countries.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"33"},"PeriodicalIF":6.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis.","authors":"Sohini Raje, G Arun Maiya, Padmakumar R, Mukund A Prabhu, Krishnananda Nayak, Shivashankara Kn, B A Shastry, Megha Nataraj","doi":"10.1186/s13643-025-02772-9","DOIUrl":"10.1186/s13643-025-02772-9","url":null,"abstract":"<p><strong>Background: </strong>Cardiac autonomic neuropathy (CAN) is an underdiagnosed complication of type 2 diabetes mellitus (T2DM) and is associated with cardiovascular morbidity and mortality. Cardiac autonomic reflex tests (CARTs) are the gold standard; they are non-invasive and clinically feasible for screening CAN. The objective of the present meta-analysis was to examine exercise's effect on cardiac autonomic function using CARTs in T2DM.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Review and Meta-Analysis Checklist (PRISMA) was used. Electronic databases were systematically used to retrieve relevant studies after title and abstract screening. Studies utilizing exercise training with cardiac autonomic function (CARTs) outcomes in individuals with type 2 diabetes mellitus were included. The meta-analysis was conducted using RevMan 5.4.1, using the random effects model, and appropriate tests for heterogeneity. The Cohrane ROB-2 tool was used for randomized controlled trials (RCTs) and the ROBINS-I tool for non-RCT for risk of bias assessment were used.</p><p><strong>Results: </strong>Three studies were included (two for meta-analysis), considering the outcome of the E:I ratio, 30:15 ratio, and Valsalva ratio. The studies did not show any influence on the E:I and 30:15 ratio in the pooled analysis with a low risk of ineffectiveness for the exercise intervention. Exercise training significantly affected the Valsalva ratio. A different type of exercise intervention was utilized in all three studies. There was a low to moderate certainty for the evidence.</p><p><strong>Conclusion: </strong>The results indicate that further robust and high-quality randomized controlled trials utilizing cardiac autonomic reflex tests (which have clinical and physiological relevance) in type 2 diabetes mellitus are required for drawing conclusions.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42023445561.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"34"},"PeriodicalIF":6.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acupoint stimulation for postpartum breastfeeding insufficiency: a systematic review and meta-analysis.","authors":"Ya-Ching Chang, Yi-An Wang, Zi-Yu Chang, Jian-An Liao","doi":"10.1186/s13643-025-02773-8","DOIUrl":"10.1186/s13643-025-02773-8","url":null,"abstract":"<p><strong>Background: </strong>Insufficient lactation, known as hypogalactia, is an important reason for weaning. To date, no effective methods have been established to increase lactation volume. With the advantages of low cost and convenience, acupoint stimulation-defined as any stimulation applied at acupoints-is a promising option.</p><p><strong>Objectives: </strong>The aim of this systematic review was to evaluate the effectiveness of acupoint stimulation for postpartum breastfeeding insufficiency.</p><p><strong>Methods: </strong>A systematic search of seven databases (PubMed, MEDLINE, Embase, Cochrane, CNKI, Airiti Library, ClinicalTrials.gov) was performed from their inception dates to September 30, 2023. Randomized trials were included. The inclusion criteria of the intervention included acupuncture, acupressure (including tuina and massage), electroacupuncture, laser stimulation, catgut embedding, and auriculotherapy. The primary outcomes were the amount of lactation and the level of prolactin. Secondary outcomes were colostrum time and adverse effects. The risks of bias were assessed using RoB 2.0.</p><p><strong>Results: </strong>Twenty-four studies involving 3214 participants were included. When compared to the control group, the experimental group exhibited improved volume of milk production (MD = 81.30; 95% CI = 58.94-103.67) and higher prolactin levels (MD = 41.90, 95% CI = 28.57-55.22). Colostrum time was shorter in the control group ([MD = - 7.26; 95% CI = - 10.69 to - 3.83] for continuous data; [RR = 1.70; 95% CI = 1.38-2.08] for dichotomous data). Adverse effects were reported in only one trial, which included three cases of fear of acupuncture and one case of hypotension.</p><p><strong>Conclusions: </strong>Acupoint stimulation may have beneficial effects on postpartum breastfeeding insufficiency. However, the results should be interpreted with caution because of the presence of risks of bias and heterogeneity among studies.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"32"},"PeriodicalIF":6.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining outcomes of ventricular arrhythmia for SGLT2 inhibitor medication in heart failure patients: a meta-analysis of randomized controlled trials.","authors":"Miao Lin, Shiyu Zhang, Lu Zhang, Chengying Yang, Yang Luo, Yajin Peng, Xiaoqiu Tan, Qiang Wen, Xinrong Fan, Xianhong Ou","doi":"10.1186/s13643-025-02766-7","DOIUrl":"10.1186/s13643-025-02766-7","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to lower the risk of re-hospitalization and cardiovascular mortality among heart failure (HF) patients. Nevertheless, the impact of these agents on ventricular arrhythmias (VAs) has not been thoroughly investigated. To assess the beneficial impact of SGLT2 inhibitors on VAs in patients at various stages of HF, a systematic review and meta-analysis of randomized controlled trials involving SGLT2 inhibitors in this patient population was performed.</p><p><strong>Methods: </strong>A comprehensive search of the PubMed, Embase, Ovid, ProQuest, Scopus, and Cochrane databases was performed for clinical trials published up to November 21, 2024. The primary outcomes of interest were incidences of VAs and sudden cardiac death (SCD) between the groups receiving SGLT2 inhibitors and the control drugs. For the outcomes observed in the populations of the included trials and in specific subgroups, hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled and meta-analysed across the analyses.</p><p><strong>Results: </strong>A total of 23 randomized trials (22 placebo-controlled trials and 1 active-controlled trial) involving 74,380 patients (37,372 receiving SGLT2 inhibitors and 37,008 in the control group) were included. The analysed SGLT2 inhibitors included canagliflozin, dapagliflozin, empagliflozin, bexagliflozin, sotagliflozin, and ertugliflozin. The participants were non-advanced HF patients, including at-risk for HF, pre-HF, and symptomatic HF, with follow-up duration ranging from 12 to 296 weeks. Compared with the control, treatment with SGLT2 inhibitors was associated with significantly reduced risk of VAs (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.74-0.98; P = 0.02) and SCD (RR 0.79, 95% CI 0.64-0.98; P = 0.03). Subgroup analyses indicated that longer follow-up (≥ 1 year) taking SGLT2 inhibitors can still reduce the risk of VAs (RR 0.79, 95% CI 0.65-0.96; P = 0.02) and SCD (RR 0.80, 95% CI 0.65-0.99; P = 0.04).</p><p><strong>Conclusion: </strong>SGLT2 inhibitors have beneficial effects on lowering risks of VAs and SCD in patients with type 2 diabetes, cardiovascular diseases, heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and heart failure with mildly reduced ejection fraction (HFmrEF), with longer follow-up duration reinforcing these findings. However, future prospective trials are needed to verify the effects of SGLT2 inhibitors on VAs and SCD.</p><p><strong>Systematic review registration: </strong>PROSPERO (CRD42024601914).</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"31"},"PeriodicalIF":6.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}