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BackgroundCatheter-directed therapies (CDT) are an alternative to systemic thrombolysis (ST) in pulmonary embolism (PE) patients, but the mortality benefit of CDT is unclear.ObjectiveWe conducted a systematic review with meta-analysis to compare the efficacy and safety of CDT and ST in intermediate-high and high-risk PE.MethodsWe included (P) participants, adult PE patients; (I) intervention, CDT; (C) comparison, ST; (O) outcomes, mortality, complications, in-hospital treatment, and length of hospital stay; (S) study design, randomized controlled trials (RCTs), or cohort comparing CDT and ST. The primary endpoint was 30-day mortality. Secondary outcomes included treatment-related complications including bleeding, the use of hospital resources, and length of hospital stay.ResultsEleven studies including 65,589 patients met the inclusion criteria. Thirty-day mortality was lower in the CDT group, compared to ST group [7.3 vs. 13.6%; odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.38–0.69, p < 0.001]. The rates of myocardial injury, cardiac arrest, and stroke were lower in CDT group, compared to ST group (p < 0.001 for all). The rates of any major bleeding, intracranial hemorrhage, hemoptysis, and red blood cell transfusion were lower in patients treated with CDT, compared to ST (p ≤ 0.01 for all). Extracorporeal life support was used more often in patients treated with CDT, compared to ST (0.5 vs. 0.2%, OR = 2.52, 95% CI 1.88–3.39, p < 0.001). The use of hospital resources and length of hospital stay were comparable in both groups.ConclusionCDT might decrease mortality in patients with intermediate-high and high-risk PE and were associated with fewer complications, including major bleeding.

Introduction: Given the increasing prevalence of hip dysfunction and the consequent rise in total hip arthroplasty procedures, our research aims to elucidate the optimal administration route of tranexamic acid to minimize perioperative complications and enhance patient. Methods: The BioMedCentral, PubMed, EMBASE, Scopus, and Cochrane Central Register databases were searched for pertinent studies published up until January 12, 2024. Randomized and quasi-randomized clinical trials comparing intravenous versus intra-articular tranexamic acid in adult patients under total hip arthroplasty were included. Pooled analysis was conducted using Review Manager v. 5.4 software (RevMan). The level of statistical significance was set at p < 0.05. Results: Nineteen trials were included in the meta-analysis. Hemoglobin drops after IV-TXA compared to IA-TXA showed no statistically significant differences (SMD = -0.08; 95%CI: -0.41 to 0.24; p=0.61). The situation was similar for hemoglobin drop (SMD = 0.03; 95%CI: -0.10 to 0.17; p=0.62). Total blood loss for IV-TXA was 935 ± 527 mL, compared to 962 ± 519 mL for IA-TXA (SMD = -0.07; 95%CI: -0.19 to 0.05; p=0.23; Figure 6). The need for blood transfusion was noted in 8.1% of IV-TXA-treated patients and 8.3% of IA-TXA-treated patients (OR = 0.95; 95%CI: 0.66 to 1.38; p=0.79). Discussion and Conclusions: Both the intravenous and intra-articular tranexamic acid administration showed the same level of effectiveness in limiting blood loss, lowering post-operative complications, and minimizing overall adverse events in total hip arthroplasty. These approaches may be used interchangeably at the clinician's discretion without determining the superiority of any method. Moreover, it is vital to include tranexamic acid in the guidelines since it should be frequently used in any operation of this kind.

Introduction: This study investigates the diagnostic and prognostic potential of Surfactant Protein D (SP-D), in distinguishing COVID-19 patients from healthy controls and predicting outcomes in infected individuals. Through a comprehensive systematic review and meta-analysis, we aim to elucidate the role of SP-D in the clinical management of COVID-19, addressing a crucial gap in current biomarker research. Methods: We searched PubMed, Embase, Web of Science, and Scopus, for articles published in English up to January 21, 2024. We employed a systematic review and meta-analysis approach, searching multiple databases for studies that measured SP-D levels in COVID-19 patients and healthy controls. The inclusion criteria were strictly defined to ensure the selection of studies with high-quality data, and statistical analyses were performed to assess the diagnostic and prognostic value of SP-D in the context of COVID-19. Results: Twelve studies were included in this systematic review and meta-analysis. Pooled analysis showed that SP-D levels among those groups of patients varied and amounted to 44.38±74.71 vs. 21.29±31.8, respectively (SMD = 1.39; 95%CI: 0.35 to 2.43; p=0.009). Pooled analysis of SP-D values among severe and non-severe COVID-19 patients was 58.28±101.8 and 94.69±114.22 respectively (SMD = 0.44; 95%CI: -0.78 to 1.66; p=0.48). SP-D levels also did not detect statistically significant differences in COVID-19 patients who survived and died in the hospital (27.18±16.4 vs. 29.12±14.14; SMD = 0.07; 95%CI: -0.28 to 0.42; p=0.70). Conclusions: Results of the current systematic review and meta-analysis indicated that SP-D may be a good marker for differentiating patients with COVID-19 from healthy patients, but it does not provide prognostic value among patients with COVID-19. Further studies are needed to confirm the results

BackgroundAnkle instability results in sensory and motor impairments. Typically, health professionals recommend conservative treatment as the initial approach for individuals with this condition. One such treatment option is Electrical Stimulation (ES). This systematic review assesses the effects of ES techniques on postural control measures in cases of ankle instability.MethodWe systematically searched five electronic databases: ClinicalTrials.gov, PubMed, Scopus, SPORTDiscus, and Web of Science. To evaluate the quality of the included articles, we utilized the PEDro checklist. We extracted data on population, intervention, and outcomes and synthesized them narratively.ResultES decreased the time needed to stabilize the center of pressure, velocity, displacement, and area, thereby enhancing the performance of clinical tests. While postural stability indexes remained unaffected, the gait inversion angle increased with electrical stimulation.ConclusionThese results suggest that ES interventions are crucial in enhancing postural control in subjects with ankle instability compared to coordination exercises therapy alone. Stochastic resonance reduced A/P and M/L TTS, COP velocity, COP displacement, and COP area, resulting in enhanced postural control.

The Visceral Sensitivity Index (VSI) represents a significant advancement in the assessment of gastrointestinal-specific anxiety among patients with irritable bowel syndrome (IBS) and chronic inflammatory bowel diseases (IBD)—such as ulcerative colitis and Crohn’s disease. However, an Italian version of the instrument is not yet available for the Italian-speaking population. This study utilized a national sample of 500 individuals divided into four groups: (a) patients with Crohn’s disease, (b) patients with ulcerative colitis, (c) patients with IBS, and (d) healthy controls (individuals without any diagnoses) to test the validity and reliability of the Italian VSI. Using back-translation methodology to ensure translation fidelity, this research applied a questionnaire and the VSI through an online format to 500 participants. Confirmatory Factor Analysis (CFA) revealed that the Italian VSI had excellent psychometric properties, demonstrating high internal consistency (Cronbach’s α = 0.949) and construct validity. The scale proved sensitive in detecting significant differences in visceral sensitivity among groups, highlighting its utility as a clinical and research assessment tool. Specifically, the Italian VSI exhibited a unidimensional factorial structure and maintained a strong correlation with interoceptive awareness, type of disease, and gastrointestinal symptom severity, confirming its role in enhancing the understanding and management of IBD and IBS in Italy.

Aim: The goal of this meta-analysis is to evaluate and compare the effectiveness of endotracheal intubation (ETI) and supraglottic airway (SGA) devices in airway management during out-of-hospital cardiac arrest events. Materials and Methods: Study was designed as a systematic review and meta-analysis and was conducted according to the 2020 PRISMA guidelines. Relevant studies published up to January 2024 were searched systematically using the following databases: PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library. Pooled effect sizes were calculated using a random-effects model and reported as the odds ratios and 95% confidence intervals. Results: Out of 4218 records initially identified, 25 eligible studies were selected for inclusion in a meta-analysis. Survival to hospital admission was 26.8% for ETI and 14.5% for SGA (p

The disruption of homeostasis in the tissue microenvironment following skin injury necessitates the provision of a supportive niche for cells to facilitate the restoration of functional tissue. A meticulously engineered cell-scaffold biointerface is essential for eliciting the desired cellular responses that underpin therapeutic efficacy. To address this, we fabricated an electrospun poly-(L-lactide) (PLLA) cell scaffold enriched with graphene oxide (GO) and gold nanoparticles (AuNPs). Comprehensive characterization assessed the scaffolds’ microstructural, elemental, thermal, and mechanical properties. In vitro investigations evaluated the biocompatibility, adhesive and regenerative capabilities of the scaffolds utilizing human keratinocytes (HEKa), fibroblasts (HFFF2), and reconstructed epidermis (EpiDerm™) models. The results demonstrated that the incorporation of the GO-Au composite substantially altered the nanotopography and mechanical properties of the PLLA fibers. Cells effectively colonized the PLLA + GO-Au scaffold while preserving their structural morphology. Furthermore, PLLA + GO-Au treatment resulted in increased epidermal thickness and reduced tissue porosity. The scaffold exerted a significant influence on actin cytoskeleton architecture, facilitating cell adhesion through the upregulation of integrins, E-cadherin, and β-catenin. Keratinocytes exhibited enhanced secretion of growth factors (AREG, bFGF, EGF, EGF R), while fibroblast secretion remained stable. These findings endorse the scaffold’s potential for regulating cellular fate and preventing hypertrophic tissue formation in skin tissue engineering.

Aim: This meta-analysis presented the impact of pandemic Coronavirus disease-2019 on the use of the public access defibrillation (PAD) system for adult patients with out-of-hospital cardiac arrest. Materials and Methods: This study was designed as a systematic review and meta-analysis and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We systematically searched PubMed, Medline, Embase, and the Cochrane Central Register of Controlled Trials databases until January 2024. Results: This meta-analysis included 30 analyzed studies. Pooled analysis showed that activation of PAD among those two periods varied and amounted to 3.8% vs. 3.9%, respectively [odds ratio (OR)=0.77; 95% confidence interval (CI): 0.66 to 0.89; p

Objectives: Ankle orthoses are one of the interventions used to prevent first and repeated lateral ankle sprains. We conducted this systematic review of the literature to investigate the effect of ankle orthoses on postural control in individuals with acute, chronic, or functional ankle sprains. Methods: Three electronic databases (Scopus, PubMed, and Web of Science) were searched for experimental studies using predefined keywords. We used the PRISMA method to select articles. Initially, the articles were examined for inclusion criteria and then assessed for their quality based on the physiotherapy evidence database scale. Results: In the initial search, we retrieved 156 articles. After following the steps of the PRISMA flowchart and reviewing the entire text, only 14 reports met the inclusion criteria of this study. We extracted data from population, intervention, and outcome measures. Discussion: Overall, ankle orthoses were effective in improving the static postural control of patients with lateral ankle sprains; however, the dynamic postural control results were unclear. Since most people who experience lateral ankle sprains have both functional and mechanical instability, ankle orthoses may affect both types of instability and thereby improve postural control.

AbstractBackground Mid-regional pro-adrenomedullin (MR-proADM) is useful for risk stratification in patients with sepsis and respiratory infections. The study’s purpose was to assess the available data and determine the association between MR-proADM levels and mortality in COVID-19 participants.Methods A comprehensive literature search of medical electronic databases was performed including PubMed, Web of Science, Scopus, Cochrane, and grey literature for relevant data published from 1 January 2020, to 20 November 2022. Mean differences (MD) with 95% confidence intervals (CI) were calculated.Results Fourteen studies reported MR-proADM levels in survivors vs. non-survivors of COVID-19 patients. Pooled analysis showed that MR-proADM level in the survivor group was 0.841 ± 0.295 nmol/L for patients who survive COVID-19, compared to 1.692 ± 0.761 nmol/L for non-survivors (MD = −0.78; 95%CI: −0.92 to −0.64; p

Introduction: Galectin-3 is a β-galactoside-binding lectin with several roles in the immune- inflammatory response. The aim of this systematic review and meta-analysis was to explain the prognostic value of Galectin-3 on COVID-19 severity and mortality from the existing literature. Methods: PubMed/MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were surveyed up to November 10, 2023, for studies reporting data on Galectin-3 levels and the severity and mortality of patients with COVID-19. We performed frequentist random-effects network meta-analysis and presented the standard mean difference (SMD) and 95% confidence interval (CI). Results: Galectin-3 levels among patients with and without COVID-19 varied with the following values: 15.73±13.03 vs. 8.72±5.82 pg/mL, respectively (SMD = 2.59; 95%CI: 1.52 to 3.67; p

Aim:The aim of this systematic review and meta-analysis was to assess the influence of the Coronavirus disease-2019 (COVID-19) pandemic on the incidence, characteristics, and clinical consequences of out-of-hospital cardiac arrest (OHCA).Materials and Methods:We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library databases up to May 30, 2023 for studies containing comparative data of OHCA patients in COVID-19 and pre-pandemic periods.Results:A total of 35 articles concerning to 34 studies screening based on the inclusion criteria. COVID-19 was associated with higher incidence of OHCA at home compared with the pre-pandemic period (p

Introduction: As the major mechanism for coronavirus disease 2019, cytokine storm-mediated organ harm continues to dominate current understanding. Despite the first hyper-inflammatory phase, emerging data show that virus-induced poor host immunity may be the true cause of mortality in many individuals. Interleukin 7 (IL-7) is an interleukin that participates in the COVID-19 cytokine storm and regulates the immune system. Its role in COVID-19 cytokine storms is thought to be related to its ability to stimulate the formation and activation of immune cells such as T cells and B cells. This meta-analysis aims to determine the relationship, if any, between interleukin-7 and COVID-19 severity. Methods: This study was planned as a systematic review and meta-analysis and followed the PRISMA guidelines. Four main electronic databases (Web of Science, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials) were searched from January 1st, 2020 to September 2nd, 2022, to find papers investigating the prognostic significance of interleukin-7 in COVID-19-hospitalized adults. Google Scholar was used in addition to the online database search. A random effects model was used to calculate mean differences and 95% confidence interval (CIs) as well as the I2 statistics for heterogeneity analysis. Results: Seven papers were chosen for meta-analysis findings synthesis. All six trials reported interleukin-7 levels among severe and non-severe COVID-19 patients. Pooled analysis showed that IL-7 levels in the severe group were 62.79Б}81.03 pg/mL, compared to 33.39Б}56.54 pg/mL for the nonsevere group (SMD = -0.17; 95%CI: -0.93 to 0.60; p=0.67). Discussion: Available evidence suggests that elevated levels of IL-7 were not associated with the disease severity of COVID-19. While IL-7 levels alone may not have a substantial impact on COVID-19 severity, the interaction between IL-7 and other cytokines, immune cells, and variables such as viral load and genetics should be investigated further.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) caused a new coronavirus disease (COVID-19), which is highly contagious and its pathogenesis has not been fully elucidated. In COVID-19, the inflammation and blood coagulation systems are excessively activated. SARS-CoV-2 damages endothelial cells and pneumocytes, which leads to disruption of hemostasis in SARS. Thromboembolism is the main cause of mortality in patients with COVID-19. Clots, including pulmonary embolism (PE) and deep vein thrombosis (DVT), ranging from minor to fatal complications of the SARS-CoV-2 infection are known. Individuals with pre-existing diseases are more susceptible to the development of blood clots and poor outcomes. High levels of circulating cytokines and D-dimer (DD) are influential biomarkers of poor outcomes in COVID-19. The latter occurs as a result of hyperfibrinolysis and hypercoagulation. Plasmin is a key player in fibrinolysis and is involved in the cleavage of many viral envelope proteins, including SARS-CoV. Due to this function penetration of viruses into the host cell occurs. In addition, plasmin is involved in the pathophysiology of acute respiratory distress syndrome (ARDS) in SARS and promotes the secretion of cytokines, such as IL-6 and TNF, from activated macrophages. The focus of existing treatment to alleviate fibrinolysis in patients with COVID-19 is the use of systemic fibrinolytic therapy given thrombotic pathology in severe forms of COVID-19 which may lead to death. However, fibrinolytic therapy may be harmful in the advanced stages of COVID-19, when the status of disseminated intravascular coagulation (DIC) changes from suppressed fibrinolysis to its enhancement during the progression of the disease. This narrative review aims to elucidate the pathogenesis of COVID-19, which will further help in precise diagnosis and treatment.

Background The present meta-analysis of clinical and simulation trials aimed to compare video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (V-DACPR) with conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (C-DACPR). Methods We searched PubMed, Embase, Web of Science, Cochrane Collaboration databases and Scopus from inception until June 10, 2021. The primary outcomes were the prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with a good neurological outcome for clinical trials, and chest compression quality for simulation trials. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) indicated the pooled effect. The analyses were performed with the RevMan 5.4 and STATA 14 software. Results Overall, 2 clinical and 8 simulation trials were included in this meta-analysis. In clinical trials, C-DACPR and V-DACPR were characterised by, respectively, 11.8% vs. 24.3% of prehospital ROSC (OR = 0.46; 95% CI: 0.30, 0.69; I2 = 66%; p

Melittin, as an agent to lyse biological membranes, may be a promising therapeutic agent in the treatment of cancer. However, because of its nonspecific actions, there is a need to use a delivery method. The conducted research determined whether carbon nanoparticles, such as graphene and graphene oxide, could be carriers for melittin to breast cancer cells. The studies included the analysis of intracellular pH, the potential of cell membranes, the type of cellular transport, and the expression of receptor proteins. By measuring the particle size, zeta potential, and FT-IT analysis, we found that the investigated nanoparticles are connected by electrostatic interactions. The level of melittin encapsulation with graphene was 86%, while with graphene oxide it was 78%. A decrease in pHi was observed for all cell lines after administration of melittin and its complex with graphene. The decrease in membrane polarization was demonstrated for all lines treated with melittin and its complex with graphene and after exposure to the complex of melittin with graphene oxide for the MDA-MB-231 and HFFF2 lines. The results showed that the investigated melittin complexes and the melittin itself act differently on different cell lines (MDA-MB-231 and MCF-7). It has been shown that in MDA-MD-231 cells, melittin in a complex with graphene is transported to cells via caveolin-dependent endocytosis. On the other hand, the melittin–graphene oxide complex can reach breast cancer cells through various types of transport. Other differences in protein expression changes were also observed for tumor lines after exposure to melittin and complexes.

This study aimed to compare the intubation effectiveness of the bébé Vie Scope™ (VieScope) and direct laryngoscopy for emergency intubation in a pediatric manikin model performed by paramedics with and without personal protective equipment for aerosol generating procedures (PPE-AGP). Participants performed endotracheal intubation using VieScope and standard Macintosh laryngoscope (MAC) in two research scenarios: (1) without PPE-AGP, and (2) with PPE-AGP. Fifty-one paramedics without any previous experience with the VieScope participated in this study. In the PPE-AGP scenario, in the VieScope group, the percentage of successful tracheal intubation on the first attempt was higher compared to the MAC group (94.1 vs. 78.4%, p = 0.031), intubation time was shorter (29.8 vs. 33.9 s, p < 0.001), and percentage of glottic opening (POGO) score was higher 91.0 vs 77.8 (p < 0.001). On the Cormack–Lehane scale, intubation with VieScope intubation was associated with higher scores rated at 1 (64.7 vs. 29.4%) than in the MAC group (p = 0.001). For intubation in the non-PPE scenario, there were no statistically significant differences between VieScope and MAC in relation to above parameters. Summarize, the bébé VieScope™ under PPE-AGP wearing conditions has proven to be a useful device for airway management in children providing better visualization of the larynx, better intubation conditions, and a higher success rate of tracheal intubation on the first attempt and reduced intubation time compared to the standard Macintosh laryngoscope.

Coronary artery disease (CAD) is the leading cause of death worldwide. Patients with pre-existing CAD were shown to have a more severe course of COVID-19, but this association has not been clarified. We performed a meta-analysis to determine the association between CAD and COVID-19 outcomes. We searched Scopus, Medline (PubMed), Web of Science, Embase, and Cochrane databases up to 2 November 2021. There were 62 studies with a total population of 49,286 patients included in the meta-analysis. CAD occurrence in survivor vs. non-survivor groups varied and amounted to 9.2% vs. 22.9%, respectively (OR = 0.33; 95%CI: 0.29 to 0.39; I2 = 70%; p < 0.001). CAD was also associated with increased severity of COVID-19 disease and was (10.8% vs. 5.6%, respectively, for severe vs. non-severe groups (OR = 2.28; 95%CI: 1.59 to 3.27; I2 = 72%; p < 0.001). The role of history of CAD in mortality and severe condition in COVID-19 presents itself as prominent—although a risk of bias in retrospective trials needs to be assessed, in case of our meta-analysis the statistically significant results when it comes to higher mortality among patients with CAD compared to non-CAD patients, a more severe condition observed in patients with CAD, and a visibly more frequent admission to intensive care unit in patients with CAD, it seems that an incidence of cardiovascular events plays a role in COVID-19 prognosis.

Diagnosis of acute coronary syndrome (ACS) based on copeptin level may enable one to confirm or rule-out acute myocardial infarction (AMI) with higher sensitivity and specificity, which may in turn further reduce mortality rate and decrease the economic costs of ACS treatment. We conducted a systematic review and meta-analysis to investigate the relationship between copeptin levels and type of ACS. We searched Scopus, PubMed, Web of Science, Embase, and Cochrane to locate all articles published up to 10 October 2021. We evaluated a meta-analysis with random-effects models to evaluate differences in copeptin levels. A total of 14,139 patients (4565 with ACS) were included from twenty-seven studies. Copeptin levels in AMI and non-AMI groups varied and amounted to 68.7 ± 74.7 versus 14.8 ± 19.9 pmol/L (SMD = 2.63; 95% CI: 2.02 to 3.24; p < 0.001). Copeptin levels in the AMI group was higher than in the unstable angina (UAP) group, at 51.9 ± 52.5 versus 12.8 ± 19.7 pmol/L (SMD = 1.53; 95% CI: 0.86 to 2.20; p < 0.001). Copeptin levels in ST-elevation myocardial infarction (STEMI) versus non-ST elevation myocardial infarction (NSTEMI) patient groups were 54.8 ± 53.0 versus 28.7 ± 46.8 pmol/L, respectively (SMD = 1.69; 95% CI: = 0.70 to 4.09; p = 0.17). In summary, elevated copeptin levels were observed in patients with ACS compared with patients without ACS. Given its clinical value, copeptin levels may be included in the assessment of patients with ACS as well as for the initial differentiation of ACS.