Systematic Reviews最新文献

{"title":"Female genital schistosomiasis-related infertility and gynecological manifestations among women living in countries endemic for urogenital schistosomiasis in Africa: systematic review and meta-analysis protocol.","authors":"Francisca Happy Ametor, Morrison Asiamah, David Owiredu, Kwadwo Owusu Akuffo, Mercy Monde Imakando, Anthony Danso-Appiah","doi":"10.1186/s13643-026-03214-w","DOIUrl":"10.1186/s13643-026-03214-w","url":null,"abstract":"<p><strong>Introduction: </strong>Female genital schistosomiasis (FGS), affecting over 56 million women and girls, is a neglected tropical disease with substantial public health implications. Existing evidence on its impact on reproductive health, particularly infertility, is limited and, in most cases, inconclusive. This systematic review aims to gather evidence on the magnitude of FGS-related gynecological manifestations and infertility among females of reproductive age living in countries across Africa.</p><p><strong>Methods: </strong>We will search PubMed, CINAHL, LILACS, Google Scholar, Web of Science, and African Journals Online (AJOL) from inception to 31st August 2026, without language restrictions, using terms such as \"female genital schistosomiasis\", \"FGS\", and \"infertility\" together with all applicable alternative terms nested with the appropriate Boolean operators. We will also search gray sources such as conference proceedings, dissertations, WHO databases, and preprint repositories for studies. The reference lists of relevant studies will be hand-searched for additional studies potentially missed by our searches. Retrieved studies will be collated and deduplicated using EndNote and exported to Rayyan QCRI for screening. At least two reviewers will independently select studies, extract data, and assess the quality of the included studies using validated tools, resolving disagreements through discussion. We will use pooled proportions for non-comparative studies and odds ratios or risk ratios for comparative studies reporting categorical data, while mean and mean difference (MD) will be used to summarize continuous data. All estimates will be reported with their corresponding 95% confidence intervals (CIs). Random-effects or fixed-effect meta-analysis models will be employed, depending on the extent of heterogeneity between studies. The heterogeneity will be assessed graphically for overlapping CIs and statistically using the I² statistic. We will conduct sub-group analyses when there is significant heterogeneity, and sensitivity analyses to assess the robustness of pooled estimates.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42023449271.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219762","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":"National and regional challenges of antibiotic prescribing patterns in pediatric populations across Africa: a systematic review and meta-analysis.","authors":"Sancho Pedro Xavier, Ana Raquel Ernesto Manuel Gotine, Melsequisete Daniel Vasco, Nerys Wendy Antonieta Alfane, Nelson Domingos Cote, Audêncio Victor","doi":"10.1186/s13643-026-03223-9","DOIUrl":"10.1186/s13643-026-03223-9","url":null,"abstract":"<p><strong>Background: </strong>Excessive and inappropriate use of antibiotics represents a major concern directly associated with the emergence of resistant microorganisms, posing a global public health threat. Inappropriate prescribing patterns are particularly frequent in pediatric populations, leading to significant clinical and epidemiological consequences. Improving the quality of antibiotic prescribing is a rational and necessary strategy to strengthen the AWaRe framework (Access, Watch, and Reserve), proposed by the World Health Organization (WHO) to guide rational antibiotic use. This study aimed to systematically review and conduct a meta-analysis on antibiotic prescribing patterns in pediatric patients across Africa.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, SciElo, Scopus, Web of Science, and the WHO Global Index Medicus on 23 May 2025. Eligible studies reported antibiotic prescribing patterns among pediatric patients in Africa, including types of prescribed antibiotics, route of administration, and AWaRe classification. Methodological quality was assessed using the National Institutes of Health (NIH) tools. Pooled prevalence estimates were calculated using random-effects meta-analysis based on the Freeman-Tukey double arcsine transformation.</p><p><strong>Results: </strong>The pooled prevalence of antibiotic prescribing among pediatric patients in Africa was 76.0% (95% CI, 68.0-82.0; I² = 99.8%). Approximately 78.0% received at least one antibiotic parenterally, with a mean of 1.55 antibiotics per patient (95% CI, 1.36-1.74). The highest prescribing prevalence was observed in Central Africa (85.0%), followed by Western (83.0%), while Eastern and Southern regions reported a prevalence of 64.0%. By AWaRe classification, Access antibiotics accounted for 65.0% of prescriptions, Watch for 27.0%, and Reserve for 3.0% (reported only in South Africa). The most prescribed antibiotics included amoxicillin (54.1%), amikacin (47.5%), gentamicin (41.2%), and ampicillin (38.0%) in the Access group; ceftriaxone (48.3%), cefuroxime (42.0%), and imipenem/meropenem (32.9%) in the Watch group; and ampicillin combined with cloxacillin (28.0%) in the not-recommended group.</p><p><strong>Conclusions: </strong>These findings provide a descriptive overview of antibiotic prescribing patterns among pediatric patients in Africa. Given the variability across studies, the results underscore the importance of strengthening antimicrobial stewardship initiatives and promoting the rational use of antibiotics, particularly within the AWaRe framework, to support efforts aimed at mitigating antimicrobial resistance.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219832","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 effectiveness of education-based interventions on iodine knowledge, attitude, behaviour, and status: a systematic review protocol.","authors":"Jhama Malla, Benjamin Gardner, Jayne V Woodside, Sarah C Bath","doi":"10.1186/s13643-026-03236-4","DOIUrl":"10.1186/s13643-026-03236-4","url":null,"abstract":"<p><strong>Background: </strong>Iodine deficiency remains a significant public health issue, further highlighted by the concern of its re-emergence in multiple countries. The health burden of iodine deficiency is high, especially in those who are vulnerable to the effects of iodine deficiency, such as pregnant women, infants, and children. Studies have shown that the public has low awareness and misconceptions regarding iodine. Increasing the understanding of the importance of iodine and its sources are crucial steps in controlling iodine deficiency in populations. This proposed systematic review aims to evaluate the effectiveness of education-based interventions and identify effective strategies that are associated with improved iodine knowledge, attitude, behaviour, and/or status, which could assist in improving iodine intake and combatting iodine deficiency.</p><p><strong>Methods: </strong>This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines. The electronic databases that will be used to search for relevant studies are PubMed/MEDLINE, Web of Science, ScienceDirect, Scopus, and EMBASE, with no restriction on population and date. We will also explore Google Scholar to identify relevant studies. Two reviewers will perform the screening and data extraction, and disagreements will be solved by discussion or a third reviewer. We will synthesise the findings using meta-analyses where possible or otherwise via a narrative synthesis.</p><p><strong>Discussion: </strong>The findings of the review will help to inform and guide the development and implementation of education programmes and evidence-based health interventions aimed at preventing iodine deficiency, with potential applicability to wider public health strategies.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42025065136.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219747","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":"Automated insulin delivery in type 2 diabetes: a meta-analysis of randomized trials protocol.","authors":"Luis Gordillo-Rosas, Cindy Lee Cajachagua-Pucuhuaranga, Julián Santa Cruz-Venegas, Luis Mateus Urrutia-Osorio, Samir Pantoja, Jimena Lozano-Núñez, Oriana Rivera-Lozada, Cesar Bonilla-Asalde, Joshuan J Barboza","doi":"10.1186/s13643-026-03206-w","DOIUrl":"10.1186/s13643-026-03206-w","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic metabolic disorder, and a substantial proportion of patients eventually require insulin therapy, which is frequently complicated by therapeutic inertia, hypoglycemia and glycemic variability. Automated insulin delivery (AID) systems combine continuous glucose monitoring with algorithm-driven insulin delivery, but their efficacy and safety in adults with T2DM remain uncertain. The objective of this systematic review and meta-analysis is to evaluate the efficacy and safety of AID systems compared with conventional insulin-based strategies in adults with T2DM.</p><p><strong>Methods: </strong>The conduct of this review will follow the Cochrane Handbook for Systematic Reviews of Interventions (version 6.5) and reporting will adhere to the PRISMA 2020 and PRISMA-P 2015 statements. Randomized controlled trials (parallel-group and cross-over) evaluating AID systems in adults with T2DM will be identified through a systematic search of MEDLINE (via PubMed), EMBASE, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception to 30 November 2025, without language restrictions. The strategy will combine controlled vocabulary, free-text terms, and the Cochrane Highly Sensitive Search Strategy for identifying RCTs; will be developed with input from an expert health-sciences librarian; and will be peer-reviewed using the PRESS 2015 checklist. Two reviewers will independently screen, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Pooled estimates will be calculated using random-effects inverse-variance meta-analysis; certainty of evidence will be rated with GRADE.</p><p><strong>Discussion: </strong>This review will provide a comprehensive synthesis of randomized evidence on AID systems in T2DM and will inform clinicians, patients, guideline developers, and policymakers about the magnitude of benefit and the safety profile of this technology in routine practice.</p><p><strong>Systematic review registration: </strong>PROSPERO (CRD420261302666).</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212638","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":"Effects of curcuminoids on allergic rhinitis diseases: a systematic review and meta-analysis of animal and human studies.","authors":"Ratchanon Inpan, Kornvipa Settakorn, Nutthiya Hanprasertpong, Mingkwan Na Takuathung, Nut Koonrungsesomboon","doi":"10.1186/s13643-026-03225-7","DOIUrl":"10.1186/s13643-026-03225-7","url":null,"abstract":"<p><strong>Background: </strong>Allergic rhinitis is a chronic inflammatory condition triggered by allergens. Curcuminoids, known for their anti-inflammatory and immunomodulatory properties, show potential as alternative treatments for allergic rhinitis. This systematic review and meta-analysis evaluated the efficacy of curcuminoids in managing allergic rhinitis symptoms and related biological markers in both animal and human studies.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Scopus, and Cochrane Library was conducted to identify eligible animal and human studies. Data extraction included allergic rhinitis symptom scores (rubbing, sneezing, itching, nasal congestion, and runny nose) and related biological markers (i.e., IL-4 and IgE). The risk of bias was assessed using SYRCLE's tool for animal studies and RoB2 for human studies. Meta-analyses employed a random-effects model and reported standardized mean difference (SMD) with 95% confidence intervals (CIs). Certainty of evidence was evaluated with the GRADE approach.</p><p><strong>Results: </strong>Seven animal studies (n = 189) and three human studies (n = 371) were included in the meta-analysis. Animal studies showed significant reductions in two symptom scores and one related biological marker: rubbing (SMD = - 2.2013, 95% CI - 3.8027 to - 0.5998, p = 0.0071); sneezing (SMD = - 2.3844, 95% CI - 3.6940 to - 1.0747, p = 0.0004); and IL-4 (SMD = - 0.9416, 95% CI - 1.8130 to - 0.0702, p = 0.0342). Symptom scores in humans showed a trend toward reduction, although the change was not statistically significant.</p><p><strong>Conclusions: </strong>Curcuminoids showed beneficial effects in animal models of allergic rhinitis, while current human evidence is limited and inconclusive. Further well-designed clinical trials are needed to clarify their therapeutic potential in humans.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42025640405.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212629","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":"Comparing supervised machine learning and large language models in title-abstract screening.","authors":"Marco F Aigner, Matthias Ganzinger, Pascal Probst, Moritz Rinckens, Thomas M Pausch","doi":"10.1186/s13643-026-03199-6","DOIUrl":"10.1186/s13643-026-03199-6","url":null,"abstract":"<p><strong>Background: </strong>Systematic reviews require reviewers to decide on the eligibility of large numbers of articles derived from database searches. To accelerate review conduct while continuously more literature gets published, past studies proposed automating the title/abstract-screening step by either supervised machine learning or large language models. Because prior studies mainly compared results within the same model family, we directly compared common TF-IDF-based supervised baselines and a zero-shot, criteria-prompted, and open-weight large language model on the same data to discuss whether, and in which scenarios, they are feasible for review screening automation.</p><p><strong>Methods: </strong>We predicted the eligibility of labeled articles by four supervised machine learning models (Naïve Bayes, support vector machine, random forest, logistic regression) and one large language model (Llama-3.1-8B-Instruct). Articles were labeled with eligibility as decided by human reviewers in six systematic reviews. We evaluated the performance by binary confusion matrices and calculated recall, specificity, precision, F1-score, and accuracy over a thousand bootstrap samples each. We compared these results to a reported performance of 0.86 (recall) and 0.79 (specificity) in single human reviewers.</p><p><strong>Results: </strong>Model performance varies greatly between the data sets. Except for Naïve Bayes, recall and specificity are closer aligned in the supervised machine learning models compared to llama. Averaged across all datasets, llama matches human recall and the Naïve Bayes classifier exceeds it, while both fall behind human specificity. Conversely, logistic regression, random forest and support vector machine fall behind human recall while all three exceed human specificity.</p><p><strong>Conclusions: </strong>Both supervised machine learning and large language models achieve recalls close to or above those of human reviewers. The supervised machine learning models achieve a higher harmonic mean of recall and specificity, while the llama model is more sensitive. Considering the reliance on training data and the all-or-nothing automation with supervised machine learning, this study's results warrant their use in the extension of pre-existing, non-critical, systematic reviews. Contrarily, as large language models decide on articles individually and as they provide comprehensive, discussable, reasoning they may be used in tandem with human reviewers while the performance of ensembles of large language models is yet to be analyzed.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"15 1","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206277","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":"Current evidence and future perspectives in the treatment of head and neck vagal paragangliomas: a systematic review.","authors":"Lara Valentina Comini, Andrea Rampi, Emilio Salerno, Paola Lovino Camerino, Alex Finco, Gabriele Redaelli, Davide Di Santo, Stefano Bondi","doi":"10.1186/s13643-026-03212-y","DOIUrl":"10.1186/s13643-026-03212-y","url":null,"abstract":"<p><strong>Background: </strong>Vagal paragangliomas (VPGs) are rare neuroendocrine tumors, typically benign but with unpredictable growth and local invasiveness. Their management is debated, particularly in asymptomatic or elderly patients, due to the lack of clear predictive indicators for progression and treatment response. This systematic review aimed to assess the clinical features and treatment outcomes of VPGs.</p><p><strong>Methods: </strong>We conducted a systematic review of the literature, screening studies at multiple levels. A total of 41 articles were included, comprising data from 501 patients. Treatments were categorized as surgery, radiotherapy (RT), both, or observation (wait-and-scan). Due to study heterogeneity and generally low evidence levels, a statistical comparison between treatment modalities was not feasible.</p><p><strong>Results: </strong>Among 501 patients, 325 underwent surgery, 101 received RT, 9 had combined treatment, and 66 were managed conservatively. Surgical resection achieved effective tumor removal and long-term control but was almost always associated with vagal nerve injury, leading to dysphonia and dysphagia. There was a 2.6-fold increase in postoperative impairment of at least one additional cranial nerve (IX, XII) or the sympathetic chain compared to preoperative status. RT and stereotactic radiosurgery (SRS) offered high tumor control rates with generally mild side effects, though long-term radiation risks-especially in younger patients-remain a concern. These modalities were often preferred for small, non-secreting tumors with preserved nerve function. The wait-and-scan approach was mainly used in elderly patients with asymptomatic or slow-growing tumors. No definitive predictors of tumor growth or treatment complications emerged from the literature.</p><p><strong>Conclusions: </strong>Surgery offers curative resection but carries a high risk of cranial nerve morbidity. RT and SRS are effective, less invasive alternatives with favorable safety profiles, particularly suitable for small, stable tumors. While observation remains appropriate in select cases, emerging options such as proton therapy, partial resection, and theranostics require further research to clarify their roles. The overall quality of evidence remains low, highlighting the need for prospective, comparative studies.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212656","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":"Caffeine treatment for apnea in infants and children: protocol for a systematic review and meta-analysis.","authors":"Michelle Yu, Hana Sharifi, Sofia Quon, Kaitryn Campbell, Bram Rochwerg, David J Zorko, Melissa J Parker","doi":"10.1186/s13643-026-03222-w","DOIUrl":"10.1186/s13643-026-03222-w","url":null,"abstract":"<p><strong>Background: </strong>Caffeine citrate is recommended to treat apnea of prematurity in premature neonates based on high-quality evidence demonstrating improved outcomes. In contrast, the prescription of caffeine for mature neonates and infants hospitalized with apnea is based on a paucity of evidence. We present here our protocol for a systematic review to synthesize existing data on the safety and effectiveness of caffeine treatment for apnea in hospitalized pediatric patients, with findings expected to focus on mature neonates and infants.</p><p><strong>Methods: </strong>We developed this systematic review protocol in accordance with the PRISMA guidelines and PRISMA-P checklist. The search strategy was developed with the assistance of an information specialist. Information sources will include MEDLINE, Embase, CINAHL, and CENTRAL databases, as well as unpublished literature sources. Eligible studies will include randomized controlled trials, non-randomized trials, and observational studies investigating caffeine (of any formulation, administered by any route, of any duration) versus placebo, usual care, or non-methylxanthine comparator. The population of interest is children aged 0-17 years with apnea presenting to emergency, critical care, or in-patient settings; studies of premature babies receiving treatment for apnea of prematurity will be excluded. Critical outcomes include total duration of respiratory support, ventilator-free days, duration of invasive mechanical ventilation, duration of non-invasive respiratory support, time to apnea cessation, and serious adverse events. Two authors will independently screen identified studies against prespecified eligibility criteria. Data from included studies will be abstracted in duplicate and entered into our data abstraction form. Risk of bias for each included study will be independently assessed by two reviewers using the appropriate risk of bias tool. If appropriate, we will perform a meta-analysis. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, with results presented in a summary of findings table.</p><p><strong>Discussion: </strong>We will undertake the first rigorous evidence synthesis examining the safety and efficacy of caffeine treatment for apnea in hospitalized pediatric patients, where studies of premature babies with apnea of prematurity will be specifically excluded. We aim to fill the identified knowledge gap with this systematic review.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420251146484.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206202","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":"Prophylactic C4/5 foraminotomy for the prevention of C5 palsy following posterior cervical decompression: a systematic review and meta-analysis.","authors":"Qing Fang, Jianbin Guan, Bo Dong, Kaitan Yang, Haohao Liang","doi":"10.1186/s13643-026-03224-8","DOIUrl":"10.1186/s13643-026-03224-8","url":null,"abstract":"<p><strong>Background: </strong>C5 palsy is a common and disabling complication of posterior cervical decompression, impairing shoulder function, prolonging rehabilitation, and reducing patient satisfaction. Prophylactic C4/5 foraminotomy has been proposed as a preventive strategy, but its effectiveness and safety remain uncertain.</p><p><strong>Objective: </strong>To systematically assess the impact of prophylactic C4/5 foraminotomy on the incidence of C5 palsy and postoperative outcomes.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of 12 comparative cohort studies (n = 2,023) following PRISMA guidelines. The primary outcome was incidence of postoperative C5 palsy. Secondary outcomes included functional scores, sagittal alignment, and perioperative parameters.</p><p><strong>Results: </strong>Prophylactic foraminotomy significantly reduced C5 palsy risk by 67% (RR = 0.33, 95% CI: 0.21-0.52; p < 0.0001) with consistent effects across surgical techniques (I² = 0%). Modest improvements in JOA (SMD = + 0.14, p = 0.028) and NDI (SMD = -0.15, p = 0.032) were observed, without adverse effects on sagittal alignment or blood loss. Operative time increased moderately (SMD = + 0.47, p = 0.0003).</p><p><strong>Conclusions: </strong>Prophylactic C4/5 foraminotomy is associated with a substantial reduction in the risk of postoperative C5 palsy, with moderate-certainty evidence supporting its clinical effectiveness. Future randomized studies may be valuable to refine patient selection and confirm generalizability across broader populations.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206240","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":"Safety of anti-infective agents use during pregnancy on offspring: protocol for an umbrella review incorporating a novel three-stage data extraction strategy.","authors":"Wenling Wang, Long Ge, Yiquan Xiong, Jingwen Chen, Chen Chen, Yan Ren, Lehana Thabane, Xin Sun, Jing Tan","doi":"10.1186/s13643-026-03235-5","DOIUrl":"10.1186/s13643-026-03235-5","url":null,"abstract":"<p><strong>Background: </strong>Anti-infective agents are widely used during pregnancy to prevent, treat, and mitigate the transmission of infections, and their utilisation has significantly increased over the past decade. However, concerns persist regarding their potential embryotoxicity, compounded by inconsistencies in safety data that complicate medication decision-making. This protocol details an umbrella review that aims to provide a comprehensive and methodologically sound synthesis of evidence from systematic reviews (SRs) on the adverse effects of prenatal anti-infective exposure on offspring. The review will incorporate a standardised, three-stage data extraction strategy and an R-based algorithm to efficiently identify and manage overlapping evidence.</p><p><strong>Methods: </strong>We will conduct a comprehensive search across six databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Epistemonikos) from inception to June 22, 2024. The search will cover three key concepts-pregnant women, anti-infective agents, and systematic reviews-without restrictions on controls or outcomes. We will include SRs, with or without meta-analyses, that evaluate the adverse effects of prenatal anti-infective exposure and report either neonatal outcomes (e.g. birth defects) or long-term offspring outcomes (e.g. neurodevelopmental disorders). To address overlapping evidence, a structured three-stage data extraction process, supported by an R-based algorithm, will be implemented, sequentially handling PICO definition extraction, overlapping evidence management, and quantitative data extraction. At least two independent reviewers will screen studies, extract data, and assess methodological quality and evidence strength using AMSTAR-2 and GRADE, respectively. Evidence synthesis will be conducted narratively, drawing on meta-analytic associations from direct comparative analyses and organising findings by anti-infective agents, indications, outcomes, effect estimates, certainty of evidence, and methodological quality. Anti-infectives with safety concerns will be summarised in tables and evidence maps.</p><p><strong>Discussion: </strong>By adopting a standardised process that incorporates an automated algorithm for managing overlapping evidence, the planned umbrella review will provide a comprehensive synthesis of existing evidence on the adverse effects of anti-infective use during pregnancy. The findings are expected to inform clinical practice, guide policy decisions, and support infection management in pregnant patients. Furthermore, the review will identify key knowledge gaps, help prioritise future research, and ultimately contribute to improving maternal and offspring health outcomes.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42024577013.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206164","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}