• MeSH
• Diabetes Mellitus, Type 2 MeSH
• Quality of Health Care statistics & numerical data   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Comparative Study MeSH

OBJECTIVE: The main aim was to determine the overall vaccine effectiveness (VE) against recurrent cervical intraepithelial neoplasia grade 2 or worse (CIN2+) including specific VE associated with timing of human papillomavirus (HPV) vaccination using data from published studies. DESIGN: Meta-analysis and meta-regression. DATA SOURCES: A computerised literature search was undertaken using the MEDLINE, EMBASE, International Pharmaceutical Abstracts, Derwent Drug File, ProQuest Science and Technology, Cochrane and MedRxiv databases. To be eligible, the studies, with no language restrictions, had to be published between 1 January 2001 and 25 May 2023. REVIEW METHODS: Included were studies with an unvaccinated reference group that assessed CIN2+ recurrence irrespective of the HPV genotype in women undergoing conisation provided. The present study was carried out in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines. The risk of study bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to assess the strength of evidence for the primary outcome. Data synthesis was conducted using meta-analysis and meta-regression. RESULTS: Out of a total of 14 322 publications, 20 studies with a total of 21 estimates were included. The overall VE against recurrent CIN2+ irrespective of the HPV genotype achieved 69.5% (95% CI: 54.7% to 79.5%). While the HPV vaccine valency, follow-up duration, type of study including its risk of bias had no effect on VE, the highest VE of 78.1% (95% CI: 68.7% to 84.7%) was reported for women receiving their first dose not earlier than the day of excision. This outcome was supported by additional analyses and a VE prediction interval ranging from 67.1% to 85.4%. CONCLUSIONS: The outcome of this meta-analysis and meta-regression convincingly showed the beneficial effect of post-excisional HPV vaccination against CIN2+ recurrence. Studies published to date have been unable to determine whether or not vaccination, completed or initiated before conisation, would be associated with more favourable results. PROSPERO REGISTRATION NUMBER: CRD42022353530.

• MeSH
• Uterine Cervical Dysplasia * MeSH
• Papillomavirus Infections * MeSH
• Humans MeSH
• Uterine Cervical Neoplasms * prevention & control   surgery   MeSH
• Vaccination MeSH
• Papillomavirus Vaccines * MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH

OBJECTIVE: Pelvic exenteration is a radical surgery for advanced or recurrent pelvic tumors, requiring careful patient selection and a multi-disciplinary approach. Despite advancements, it remains high-risk, with limited data on outcomes. The present meta-analysis evaluates survival, mortality, and trends to clarify its role in gynecologic oncology. METHODS: A systematic search was conducted in January 2025 to identify studies on pelvic exenteration outcomes for gynecologic malignancies. Studies with at least 10 patients reporting 5-year overall survival or 30-day mortality were included. Data extracted included patient and surgical characteristics, and a scoring system based on study design, sample size, and center volume was used to include high-quality studies (score ≥3). Poisson regression models were used to analyze the associations between predictors and outcomes, with results expressed as incidence rate ratios and a 95% CI. RESULTS: A total of 46 studies involving 4417 patients met the inclusion criteria. Most patients underwent pelvic exenteration for cervical cancer (N = 3183). Positive pelvic and aortic nodal involvement were key predictors of reduced 5-year overall survival, decreasing by 3.9% and 5.9% per 1% increase in nodal positivity, respectively. Pelvic wall involvement also significantly reduced survival by 15.9%. The 30-day mortality rate was 5.1%, with sepsis (27.2%) being the leading cause of death. Peri-operative mortality decreased significantly over time, with each year of publication associated with a 2.6% decrease in incidence rate. However, pelvic sidewall involvement and total exenteration increased 30-day mortality by 11.5% and 0.7%, respectively. CONCLUSIONS: Pelvic exenteration remains a viable but high-risk option for select patients with advanced gynecologic malignancies. Pre-operative assessment and multi-disciplinary planning are essential for optimizing outcomes.

• MeSH
• Pelvic Exenteration * mortality   methods   MeSH
• Humans MeSH
• Genital Neoplasms, Female * surgery   mortality   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH

This systematic literature review (SLR) aimed to comprehensively synthesize existing studies that have reported on TMG-derived parameters of lower extremities in soccer players. The PubMed, Web of Science, and EBSCOHost (including MEDLINE, SPORTDiscuss, ERIC, DOAJ, and SCOPUS) databases were searched from inception to the 31st of August, 2023. Reports were eligible if they satisfied the following criteria: recruited active soccer players, with no restriction on race, sex, age, level of expertise, or health status; studies utilizing TMG for measuring muscle contractile properties. In total, 25 published journal articles from 22 original studies were included in the current review, encompassing a total of 1224 participants (4% females). The analysis considered various muscles, with the biceps femoris (BF), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), semitendinosus (ST), gastrocnemius lateralis (GL), and gastrocnemius medialis (GM) being investigated. Significant variations were observed in TMG parameters across different muscles, age categories, and levels of play. The quality of evidence varied from low to moderate for all analyses. The meta-regression analysis indicated that age moderated several TMG-derived parameters in lower limb muscles including BF Vc, RF Td and Vc, ST Dm and sustain time, VL Dm, Tc, Td and relaxation time (Tr), and VM Tc, Td and Tr, respectively. In conclusion, the current review illuminated the multifaceted applications of TMG in assessing lower extremity muscles in soccer players. Beyond evaluating muscle contractile properties in various superficial muscles of the lower limbs in soccer players, TMG-derived parameters may serve as potentially valuable markers in identifying neuromuscular risk factors for anterior cruciate ligament injuries and predicting hamstring-related injuries.

• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND: Observational studies made it possible to assess the impact of risk factors on the long-term effectiveness of mRNA and adenoviral vector (AdV) vaccines against COVID-19. METHODS: A computerized literature search was undertaken using the MEDLINE, EMBASE, and MedRxiv databases to identify eligible studies, with no language restrictions, published up to 28 February 2022. Eligible were observational studies assessing vaccine effectiveness (VE) by disease severity with reference groups of unvaccinated participants or participants immunized with one, two, or three vaccine doses. Our study was carried out in compliance with the PRISMA and MOOSE guidelines. The risk of study bias was identified using the Newcastle-Ottawa Quality Assessment Scale. The GRADE guidelines were applied to assess the strength of evidence for the primary outcome. The synthesis was conducted using a meta-analysis and meta-regression. RESULTS: Out of a total of 14,155 publications, 290 studies were included. Early VE of full vaccination against COVID-19 of any symptomatology and severity decreased from 96% (95% CI, 95-96%) for mRNA and from 86% (95% CI, 83-89%) for AdV vaccines to 67% for both vaccine types in the last 2 months of 2021. A similar 1-year decline from 98 to 86% was found for severe COVID-19 after full immunization with mRNA, but not with AdV vaccines providing persistent 82-87% effectiveness. Variant-reduced VE was only associated with Omicron regardless of disease severity, vaccine type, or vaccination completeness. The level of protection was reduced in participants aged >65 years, with a comorbidity or those in long-term care or residential homes independently of the number of doses received. The booster effect of the third mRNA dose was unclear because incompletely restored effectiveness, regardless of disease severity, declined within a short-term interval of 4 months. CONCLUSIONS: Full vaccination provided an early high, yet waning level of protection against COVID-19 of any severity with a strong impact on the high-risk population. Moreover, the potential risk of new antigenically distinct variants should not be underestimated, and any future immunization strategy should include variant-updated vaccines.

• MeSH
• COVID-19 * prevention & control   MeSH
• Humans MeSH
• RNA, Messenger MeSH
• Risk Factors MeSH
• Vaccine Efficacy MeSH
• COVID-19 Vaccines * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

BACKGROUND: In the last three decades, both medical and sports science professionals have recognized the considerable potential of digital-based interventions (DBI) to enhance the health-related outcomes of their practitioners. OBJECTIVES: This study aimed to investigate the effectiveness and potential moderators of DBI on measures of muscular strength. METHODS: Six databases (PubMed/MEDLINE, Web of Science, SportDiscus, Embase, Cochrane Register of Controlled Trials and Google Scholar) were searched for eligible studies up to June 2022. The GRADE, PEDRO, and TIDieR checklists were used to assess the quality of evidence, methodology, and completeness of intervention descriptions, respectively. RESULTS: A total of 56 studies were included in the meta-analysis (n = 2346), and participants were classified as healthy (n = 918), stroke survivors (n = 572), diagnosed with other neurological disorders (n = 683), and frail (n = 173). The DBI showed a small effect (standardized mean difference [SMD] = 0.28, 95% CI 0.21 to 0.31; p < 0.001) on strength, regardless of the type of intervention, control group, or tested body part. More specifically, while splitting the studies into different subgroups, a meta-analysis of 19 studies (n = 918) showed a small effect (SMD = 0.38, 95% CI 0.12 to 0.63; p = 0.003) on strength in the asymptomatic population. Similarly, small but positive effects of DBI were observed for stroke survivors (SMD = 0.34, 95% CI 0.13 to 0.56; p = 0.002), patients diagnosed with other neurological disorders (SMD = 0.17, 95% CI 0.03 to 0.32; p = 0.021), and the frail population (SMD = 0.25, 95% CI 0.0 to 0.5; p = 0.051). Sub-group analysis and meta-regression revealed that neither variable modified the effects of the DBI on measures of strength. CONCLUSIONS: Overall, DBI may serve as an effective method to improve measures of strength in adults, regardless of their health status as well as the type of digital device, the presence of human-computer interaction, and the age of participants. In addition, the DBI was found to be more effective than traditional training or rehabilitation methods.KEY MESSAGESDigital-based intervention (DBI) is effective in improving measures of muscular strength in adults regardless of participants' health statusDBIs were equally effective for strength improvements in lower and upper limbsAlthough, DBIs were found to be effective in improving muscular strength, most studies did not follow strength training guidelines when prescribing the interventions.

• MeSH
• Stroke * MeSH
• Adult MeSH
• Humans MeSH
• Randomized Controlled Trials as Topic MeSH
• Stroke Rehabilitation * methods   MeSH
• Muscle Strength MeSH
• Health Status MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Review MeSH
• Systematic Review MeSH

This study aimed to investigate the effect of lifestyle intervention (LSI) on diagnosed infertility in overweight and obese women. A systematic review and meta-analysis were conducted. A literature search was performed on the following databases from September 2022 to December 2022: PubMed, Web of Science, and SPORTDiscus. The inclusion criteria were the following: women between 18 and 45 years of age, BMI over 25.0 kg/m2, diagnosed with infertility, a weight loss intervention, and control group part of RCTs. In total, 15 studies were identified and included. The meta-analysis shows a beneficial effect of LSI on reducing weight, waist circumference, and BMI and increasing infertility. A significantly beneficial effect of lifestyle intervention on weight reduction was observed for participants who initially had a higher BMI, while a non-significant effect was observed for individuals with a BMI above 35 kg/m2. The meta-analysis showed a beneficial effect of lifestyle intervention on ovulation incidence and sex hormone-binding globulin. The lifestyle intervention group had 11.23 times more ovulatory incidence than the control group, which in turn increased the ability to conceive. As robust evidence for the effect of lifestyle interventions on infertility in obese and overweight women was found, it is advised to integrate similar interventions into future infertility treatment processes.

• Publication type
• Systematic Review MeSH

OBJECTIVES: To verify whether transradial (TRA) compared to transfemoral (TFA) cardiac catheterization reduces the risk of periprocedural stroke (PS). METHODS: We reviewed (CRD42021277918) published real-world cohorts reporting the incidence of PS within 3 days following diagnostic or interventional catheterization. Meta-analyses and meta-regressions of odds ratios (OR) performed using the DerSimonian and Laird method were checked for publication bias (Egger test) and adjusted for false-positive results (study sequential analysis SSA). RESULTS: The pooled incidence of PS from 2,188,047 catheterizations (14 cohorts), was 193 (105 to 355) per 100,000. Meta-analyses of adjusted estimates (OR = 0.66 (0.49 to 0.89); p = 0.007; I2 = 90%), unadjusted estimates (OR = 0.63 (0.51 to 0.77; I2 = 74%; p = 0.000)), and a sub-group of prospective cohorts (OR = 0.67 (0.48 to 0.94; p = 0.022; I2 = 16%)) had a lower risk of PS in TRA (without indication of publication bias). SSA confirmed the pooled sample size was sufficient to support these conclusions. Meta-regression decreased the unexplained heterogeneity but did not identify any independent predictor of PS nor any effect modifier. CONCLUSION: Periprocedural stroke remains a rare and hard-to-predict adverse event associated with cardiac catheterization. TRA is associated with a 20% to 30% lower risk of PS in real-world/common practice settings. Future studies are unlikely to change our conclusion.

• MeSH
• Femoral Artery MeSH
• Radial Artery MeSH
• Stroke * epidemiology   etiology   prevention & control   MeSH
• Percutaneous Coronary Intervention * methods   MeSH
• Humans MeSH
• Catheterization, Peripheral * methods   MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Cardiac Catheterization adverse effects   methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH

Background. The two newer oral P2Y12 inhibitors prasugrel and ticagrelor have proven superior to clopidogrel in the treatment of acute coronary syndrome (ACS). The extent to which the reduction in mortality seen with ticagrelor is confined to this particular agent is hard to judge by simply looking at the overall study results as the study populations were composed of different cohorts at substantially different risk of death. Method.s A meta-regression technique was applied to 12 distinctive patient cohorts, six for each of prasugrel and ticagrelor, to investigate differential effects on mortality of P2Y12 inhibitors. Results. Data for the analysis cohorts, totalling 37,372 patients, were extracted from publications and cover a widely comparable spectrum of patient types, defined by the type of ACS and treatment strategy. The meta-regression lines for cardiovascular mortality with prasugrel or ticagrelor (each versus clopidogrel), as well as for both agents pooled, indicate a linear relationship with increasing benefit seen with higher underlying risk (p = 0.007, 0.021 and 0.003, and R2 = 0.87, 0.77 and 0.62, respectively). Conclusions. In the ACS patients studied, we found a mortality benefit with the two newer oral P2Y12 inhibitors prasugrel and ticagrelor when compared with clopidogrel, which increases progressively as the underlying risk of death increases. This appears to be a class effect for these two newer agents.

• MeSH
• Acute Coronary Syndrome drug therapy   mortality   MeSH
• Purinergic P2Y Receptor Antagonists * therapeutic use   MeSH
• Fatal Outcome MeSH
• Cardiovascular Diseases mortality   MeSH
• Clopidogrel therapeutic use   MeSH
• Humans MeSH
• Regression Analysis MeSH
• Risk MeSH
• Statistics as Topic MeSH
• Ticagrelor therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVES: The COVID-19 pandemic required rapid development of vaccines within a short period of time which did not allow to assess vaccine effectiveness (VE) in the long-term. METHODS: A computerized literature search was undertaken to identify eligible studies, with no language restrictions, published between 1 December 2020 and 30 June 2023. RESULTS: Out of a total of 27,597 publications, 761 studies were included. Early VE of 87.2% decreased to 55.1% after 9 months among populations fully immunized not only with mRNA (proxy mRNA) vaccines, and 66.3% decreased to 23.5% in populations immunized exclusively with non-mRNA vaccines. Protection against severe COVID-19 declined to 80.9% for proxy mRNA vaccines and 67.2% for non-mRNA vaccines. Omicron variants significantly diminished VE. Within 6-8 months of receiving a single booster of an mRNA vaccine, VE declined to 14.0% and 67.7% for any and severe COVID-19, respectively. Multiple mRNA booster doses restored protection that declined to 29.5% and 70.6% for any and severe COVID-19, respectively, within 5-7 months. CONCLUSION: Outcomes of this meta-regression underscore the evolving nature of COVID-19 in response to vaccination, dosing schedules, and emerging variants, and provide crucial insights for public health interventions and vaccination strategies.

• MeSH
• COVID-19 * epidemiology   prevention & control   MeSH
• Humans MeSH
• RNA, Messenger MeSH
• Pandemics MeSH
• SARS-CoV-2 genetics   MeSH
• Vaccine Efficacy MeSH
• Vaccination MeSH
• Vaccines * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH