BACKGROUND: Venous thromboembolism is the leading cause of death in cancer patients, second only to tumor progression. The Khorana score is recommended by clinical guidelines for identifying ambulatory cancer patients at high risk of venous thromboembolism during chemotherapy. However, its predictive performance is debated among cancer patients.
OBJECTIVE: To map the applicability of the Khorana score in cancer patients and to assess its predictive performance across various cancer types, providing guidance for clinicians and nurses to use it more appropriately.
METHODS: Systematic review and meta-analysis.
METHODS: A comprehensive literature search of the electronic database was first conducted on August 30, 2023, and updated on May 20, 2024. Studies examining the Khorana score\'s predictive performance (including but not limited to the areas under the curve, C-index, and calibration plot) in cancer patients were included. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was applied to evaluate the methodological quality of the included studies. Data synthesis was achieved via random-effects meta-analysis using the R studio software. The subgroup analysis was performed according to the study design, clinical setting, cancer type, anti-cancer treatment stage, and country.
RESULTS: The review incorporated 67 studies, including 58 observational studies and nine randomized controlled trials. All included studies assessed the Khorana score\'s discrimination, with the C-index ranging from 0.40 to 0.84. The pooled C-index for randomized controlled trials was 0.61 (95 % CI 0.51-0.70), while observational studies showed a pooled C-index of 0.59 (95 % CI 0.57-0.60). Subgroup analyses revealed the pooled C-index for lung cancer, lymphoma, gastrointestinal cancer, and mixed cancer patients as 0.60 (95 % CI 0.53-0.67), 0.56 (95 % CI 0.51-0.61), 0.59 (95 % CI 0.39-0.76), and 0.60 (95 % CI 0.58-0.61), respectively. Inpatient and outpatient settings had the pooled C-index of 0.60 (95 % CI 0.58-0.63) and 0.58 (95 % CI 0.55-0.61), respectively. Calibration was assessed in only four studies. All included studies were identified to have a high risk of bias according to PROBAST.
CONCLUSIONS: The Khorana score has been widely validated in various types of cancer patients; however, it exhibited poor capability (pooled C-index<0.7) in accurately discriminating VTE risk among most types of cancer patients either in inpatient or outpatient settings. The Khorana score should be used with caution, and high-quality studies are needed to further validate its predictive performance.
BACKGROUND: The protocol for this study is registered with PROSPERO (registration number: CRD42023470320).

BACKGROUND: The screening process for systematic reviews is resource-intensive. Although previous machine learning solutions have reported reductions in workload, they risked excluding relevant papers.
OBJECTIVE: We evaluated the performance of a 3-layer screening method using GPT-3.5 and GPT-4 to streamline the title and abstract-screening process for systematic reviews. Our goal is to develop a screening method that maximizes sensitivity for identifying relevant records.
METHODS: We conducted screenings on 2 of our previous systematic reviews related to the treatment of bipolar disorder, with 1381 records from the first review and 3146 from the second. Screenings were conducted using GPT-3.5 (gpt-3.5-turbo-0125) and GPT-4 (gpt-4-0125-preview) across three layers: (1) research design, (2) target patients, and (3) interventions and controls. The 3-layer screening was conducted using prompts tailored to each study. During this process, information extraction according to each study\'s inclusion criteria and optimization for screening were carried out using a GPT-4-based flow without manual adjustments. Records were evaluated at each layer, and those meeting the inclusion criteria at all layers were subsequently judged as included.
RESULTS: On each layer, both GPT-3.5 and GPT-4 were able to process about 110 records per minute, and the total time required for screening the first and second studies was approximately 1 hour and 2 hours, respectively. In the first study, the sensitivities/specificities of the GPT-3.5 and GPT-4 were 0.900/0.709 and 0.806/0.996, respectively. Both screenings by GPT-3.5 and GPT-4 judged all 6 records used for the meta-analysis as included. In the second study, the sensitivities/specificities of the GPT-3.5 and GPT-4 were 0.958/0.116 and 0.875/0.855, respectively. The sensitivities for the relevant records align with those of human evaluators: 0.867-1.000 for the first study and 0.776-0.979 for the second study. Both screenings by GPT-3.5 and GPT-4 judged all 9 records used for the meta-analysis as included. After accounting for justifiably excluded records by GPT-4, the sensitivities/specificities of the GPT-4 screening were 0.962/0.996 in the first study and 0.943/0.855 in the second study. Further investigation indicated that the cases incorrectly excluded by GPT-3.5 were due to a lack of domain knowledge, while the cases incorrectly excluded by GPT-4 were due to misinterpretations of the inclusion criteria.
CONCLUSIONS: Our 3-layer screening method with GPT-4 demonstrated acceptable level of sensitivity and specificity that supports its practical application in systematic review screenings. Future research should aim to generalize this approach and explore its effectiveness in diverse settings, both medical and nonmedical, to fully establish its use and operational feasibility.

BACKGROUND: Current treatment paradigms recommend surgical intervention when conventional medical management proves ineffective in resolving chronic rhinosinusitis with nasal polyposis.
OBJECTIVE: To assess and compare the efficacy of dupilumab and functional endoscopic sinus surgery (FESS) for the treatment of chronic rhinosinusitis with nasal polyp (CRSwNP) over time.
METHODS: Studies comparing CRSwNP patients who received dupilumab with those who underwent FESS were included. Outcome measures included the nasal congestion score (NCS), Sino-nasal Outcome Test-22 (SNOT-22), University of Pennsylvania Smell Identification Test-40 (UPSIT-40), and nasal polyp score (NPS). The risk of bias was evaluated using the Newcastle-Ottawa Scale.
RESULTS: A total of 4 studies with 724 participants were included. The dupilumab group had a superior NCS, but an inferior NPS, compared to the FESS group during the follow-up period. The SNOT-22 score of the dupilumab group was inferior to that of the FESS group until 6 months posttreatment, but the scores were similar at around 1 year. A similar trend was observed for the UPSIT-40 score, but the score of the dupilumab group was higher at around 1 year.
CONCLUSIONS: Functional endoscopic sinus surgery was more effective than dupilumab for several months after treatment. However, at 1 year after treatment, the effects of the 2 treatments became similar, with greater olfactory improvement seen in the dupilumab group.

The use of intrathecal (IT) dexamethasone during subarachnoid block (SAB) has not been evaluated. There are no pooled data available to decide on the optimal regimen of IT dexamethasone during SAB, irrespective of the type of surgery. There is uncertainty about its dosage, effectiveness, and safety, and a need to establish clear guidelines on its use. Our objective was to evaluate the effectiveness and safety of use of IT dexamethasone during SAB. We performed a meta-analysis (PROSPERO, CRD42022304944) of trials that included patients who underwent a variety of surgical procedures under SAB. Patients received concomitant IT dexamethasone as an adjuvant to spinal local anesthetics. The analyzed outcomes included sensory and motor effects as well as adverse and/or beneficial side effects. Subgroup analysis was planned based on different doses used. Trial sequential analysis (TSA) was used to estimate the required sample size information (RIS) for each outcome. Eighteen studies (2531 participants) were included in this analysis. Addition of IT dexamethasone (4-8 mg) to heavy bupivacaine effectively prolonged the duration of sensory blockade (mean difference, MD = 63.8 minutes; [95% confidence interval, CI, 33.1-94.5], P < 0.0001), two-segment regression time (MD = 20.1[95% CI, 0.96-39.2], P = 0.04) and first rescue analgesic time (MD = 143.3 [95% CI, 90.3-196.0], P = 0.001). Subgroup analyses revealed superior effects of 8 mg dose over 4 mg for sensory and analgesic effects. The effect of dexamethasone on duration of motor blockade was inconclusive. Additionally, lower risk ratios (RRs) were recorded for spinal anesthesia-related hypotension (RR = 0.74 [95% CI, 0.6-0.9], P = 0.0003) and nausea/vomiting (RR = 0.62 [95% CI, 0.41-0.93], P = 0.02) in the dexamethasone group. For outcomes such as sensory blockade, analgesia, and hypotension, the required information size was reached during TSA. In conclusion, IT dexamethasone, used as an adjuvant to spinal local anesthetic, especially at the dose of 8 mg, increases sensory blockade duration and the time for request of the first rescue analgesic. SAB-induced side effects such as hypotension, nausea, and vomiting are lesser with the use of IT dexamethasone. However, further studies are necessary to draw meaningful conclusions on its safety profile.

Neurocysticercosis, caused by the tapeworm Taenia solium, is a neglected tropical illness that affects millions of people worldwide. The disease leads to seizures and epilepsy as the larvae invade the nervous system. Treatment with albendazole and praziquantel is common, but the comparative effectiveness of combination therapy versus monotherapy is unclear. This study evaluated the effectiveness of albendazole and praziquantel combination therapy versus albendazole monotherapy for lesion resolution in pediatric neurocysticercosis. The study aimed to assess the effectiveness of the antiparasitic combination of albendazole and praziquantel as compared with albendazole monotherapy in the treatment of neurocysticercosis in children. This study is based on a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Randomized controlled trials on pediatric patients receiving the mentioned therapies were included. The risk-of-bias tool for randomized trials assessed the study quality once data extraction and analysis were completed. This study included randomized research in neurocysticercosis pediatric patients diagnosed with neuroimaging outcomes, using albendazole and praziquantel combination therapy or albendazole monotherapy. We searched articles between September 30 and December 1, 2023. All terms followed the Medical Subject Headings (MeSH) browser, and 13 articles were found. The data was quantitatively analyzed using RevMan 5.4.1 (The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen, Denmark). We applied the relative risk (RR) for the intervention and control groups before and after treatment, obtained from prior studies on lesion result resolution. The statistical method was Mantel-Haenszel. The model analysis we used was a fixed effect model (FEM) for heterogeneity (I2) < 50% and a random effect model (REM) for I2 ≥ 50%. The impact was measured using the risk difference (RD) by study and the overall 95% confidence interval (CI). The meta-analysis indicated that combination therapy was more effective in achieving complete lesion resolution after both three months (pooled RD = 0.18, 95% CI = 0.03-0.33, p= 0.02, I2 =0%) and six months (pooled RD = 0.24, 95% CI = 0.09-0.40, p = 0.002, I2 =0%) of therapy. However, calcification outcomes were also more significant in the combination therapy group. The study demonstrates that the albendazole and praziquantel combination therapy is superior in lesion resolution in pediatric neurocysticercosis. Clinical caution is advised to prevent calcification during treatment.

UNASSIGNED: Hepatitis B Virus (HBV) can affect life quality. Monitoring and understanding the fluctuations of the HBV level of viremia related to the intricate immune activity of the host helps in the development of new treatment strategies and evaluation patterns. This meta-analysis presents the correlations between cytokines and the level of viremia in chronic HBV patients for a better comprehension of the immune mechanisms behind this infection.
UNASSIGNED: We used PRISMA guidelines for this meta-analysis. The databases assessed were PUBMED, WEB OF SCIENCE, SCOPUS, and Cochrane Library. ZOTERO and PlotDigitizer helped the systematic research process. We extracted information related to the correlations between cytokines and the HBV-DNA level. Effect measures included comparisons between standardized mean differences and correlation coefficients. We evaluated retrieved articles with the Newcastle-Ottawa Quality Assessment Scale (NOS). The R 4.2.2 software displayed the statistical calculation and graphical representations.
UNASSIGNED: From 58,169 records, we extracted 16 articles with 32 different cytokine determinations. The main interleukins included in detection panels were IL-10 and IL-21. The meta-correlation analysis comprised 1,199 chronic HBV patients. The standardized mean difference between cytokine levels in HBV patients and healthy controls was 0.82 (95% CI = [-0.19, 1.84], p = 0.11). We observed a significant, fair, pooled correlation coefficient between IL-10, IL-9, and the viral load (r = 0.52, 95% CI = [0.19, 0.85]).
UNASSIGNED: This meta-analysis brings novelty because it gives a first rigorous systematic look at multiple studies with many cytokines. Our research approaches a debatable issue and gives a possible solution for settling controversies. Future studies can arise towards understanding the immune disruption in HBV and the development of new, improved assays for prognosis.

UNASSIGNED: At present, no consensus is reached among articles that investigate the relationship of paraoxonase 1(PON1) -108C/T polymorphism with susceptibility of coronary heart disease (CHD) so far. In this regard, the present meta-analysis was conducted to comprehensively review existing articles related to the relationship of PON1 -108C/T polymorphism with CHD susceptibility. It was preregistered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY)-INPLASY202430117.
UNASSIGNED: Articles that explored the relationship between PON1 -108C/T polymorphism and CHD incidence were searched from electronic databases according to our preset study selection criteria. Thereafter, we adopted stata 12.0 software to analyze our screened studies. At the same time, odds ratios (ORs) and related 95% confidence intervals (95% CIs) were determined for evaluating association strength.
UNASSIGNED: At last, this meta-analysis selected altogether 13 case-control studies that involved 2,979 cases and 2,887 control subjects. We found that the PON1 -108C/T polymorphism displayed marked relationship with CHD susceptibility (T vs. C: OR = 1.24, 95% CI 1.07-1.45; CT vs. CC: OR = 1.33, 95% CI 1.17-1.52; TT vs. CC: OR = 1.51, 95% CI 1.09-2.09; Recessive model: OR = 1.16, 95% CI 0.93-1.45; Dominant model: OR = 1.45, 95% CI 1.16-1.81). Moreover, subgroup analysis showed that race and sample size had no impact on the results. Bioinformatics analysis showed that -108C>T polymorphism was relation to PON1 gene expression (https://gtexportal.org/home/).
UNASSIGNED: The PON1 -108T allele is identified as the possible low-penetrant risk factor of CHD, as suggested by our present meta-analysis.Systematic Review Registration: https://inplasy.com/inplasy-2024-3-0117/, Identifier INPLASY202430117.

Little is known about the effectiveness of online preventive interventions for paternal perinatal depression (PPD). This systematic review (SR) and meta-analysis (MA) of randomized controlled trials (RCTs) evaluated the effectiveness of online psychological interventions to prevent PPD in fathers and non-birthing partners. The PRISMA 2020 guidelines were followed. The search was conducted in eight electronic databases and other sources from inception to 12 May 2023. The pooled standardized mean difference (SMD) was computed using random-effect models. Seven RCTs were included in the SR and 6 were included in the MA, representing 1.042 fathers from five different countries. No trials focused on non-birthing partners were found. The pooled SMD was -0.258 [95 % confidence interval - 0.513 to -0.004; p < 0.047]. The heterogeneity was moderate (I2 = 51 %; 95%CI [0 % to 81 %]) and nonsignificant (p = 0.070). However, sensitivity analyses showed that the effectiveness was stable only when the fixed effect model and the Egger\'s g were used to estimate the pooled SMD. No publication bias was found. Only two RCTs had an overall low risk of bias assessed by using the Cochrane ROB 2.0 tool. The quality of evidence based on GRADE was very low. In conclusion, online psychological interventions may be effective for the prevention of PPD. More high-quality evidence is warranted.

UNASSIGNED: The Rearranged during Transfection (RET) gene represents a rare driver mutation in non-small cell lung cancer (NSCLC) occurring in only 1 %-2 % of cases, with implications in targeted carcinogenesis. Despite the significant efficacy demonstrated by immunotherapy in advanced NSCLC with wild-type driver genes, its validation in RET fusion-positive patients is yet to be established.
UNASSIGNED: This meta-analysis aims to systematically evaluate the effectiveness of immunotherapy in patients with RET fusion-positive NSCLC.
UNASSIGNED: and Methods: PubMed and Web of Science databases were systematically searched for relevant studies. Outcomes including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were extracted for further analysis.
UNASSIGNED: Ten real-world evidence (RWE) studies involving 7145 patients were enrolled in this meta-analysis. In terms of tumor response, the pooled ORR and DCR were 24.0 % and 61.0 %, respectively. Regarding survival analysis, the pooled median PFS and median OS were 4.17 months [95 % confidence interval (CI): 3.40-5.02) and 17.22 months (95 % CI: 11.58-23.91)], respectively. Subgroup analyses showed that immunotherapies plus chemotherapy were superior to single-immunotherapy in terms of ORR, DCR, and median PFS, which were 43 % (95 % CI: 31%-55 %) vs. 17 % (95 % CI: 11%-25 %), 74 % (95 % CI: 60%-84 %) vs. 45 % (95 % CI: 31%-59 %) and 6.69 months (95 % CI: 4.91-8.93) vs. 2.96 months (95 % CI: 2.25-3.78), respectively.
UNASSIGNED: To date, RET fusions appear to be associated with poor response to immunotherapy in NSCLC patients, and immunotherapy combined with chemotherapy seems to offer greater clinical benefits than mono-immunotherapy.

UNASSIGNED: Esophageal Squamous Cell Carcinoma (ESCC) contributes to the global burden of disease. Conventional treatments such as surgical resection and chemotherapy offer limited long-term survival rates. Recently, immunotherapies targeting PD-1 have shown promise in other cancers, but their efficacy in ESCC remains unclear.
UNASSIGNED: The 31 studies eligible for this study included a total of 10,681 patients who were subjected to immunotherapy, either alone or in combination with traditional chemotherapy. A comprehensive search was conducted on September 1, 2023, across databases including CENTRAL, PubMed, MEDLINE, Web of Science, Embase, and Scopus.
UNASSIGNED: For OSR, results indicate a significantly improved survival at different time points (6, 12, and 24 months), with an odds ratio of 0.636 (95 % CI 0.595-0.680; Z = -13.292; p < 0.00001). In terms of PFS, PD-1 inhibitors demonstrated improvements at different time points; pooled odds ratio was 0.568 (95 % CI 0.511-0.633; Z = -10.357; p < 0.00001). Regarding ORR, the pooled analysis showed an overall odds ratio of 1.724 (95 % CI 1.554-1.913; Z = 10.289; p < 0.00001), indicating improved treatment response. DCR did not suggest a significant advantage for PD-1 inhibitors over chemotherapy, with an odds ratio of 0.904 (95 % CI 0.784-1.043; Z = -1.381; p = 0.167).
UNASSIGNED: There is compelling evidence reinforcing the efficacy and safety of PD-1 inhibitors, as monotherapy or in combination with chemotherapy, for the treatment of ESCC. PD-1 inhibitors demonstrate a significant advantage in terms of OSR, PFS, and ORR.