Background: Selective laser trabeculoplasty (SLT) is a first-line treatment for open-angle glaucoma (OAG) or ocular hypertension (OHT). However, the optimal SLT protocol remains unsettled. Randomized controlled trials (RCTs) comparing 180 degrees and 360 degrees SLT have yielded conflicting outcomes. This systematic review and meta-analysis aimed to determine which approach provides superior efficacy and safety. Methods: We searched PubMed, Embase, Cochrane, and Web of Science through November 8, 2025 for RCTs comparing 180 degrees with 360 degrees SLT in OAG or OHT. We excluded conference abstracts. The primary outcome was intraocular pressure (IOP). Secondary outcomes included treatment success, visual acuity, and adverse events. We assessed the risk of bias with the Cochrane risk-of-bias tool for randomized trials, and estimated mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. Trial sequential analysis (TSA) evaluated the robustness of evidence. Results: We included six studies comprising 892 eyes. 180 degrees SLT was associated with higher IOP at 1 month (MD 1.17 mmHg; 95% CI: 0.52-1.81; P<0.01; I-2=36%), 3 months (MD 0.96 mmHg; 95% CI: 0.45-1.47; P<0.01; I-2=0%), 6 months (MD 1.03 mmHg; 95% CI: 0.14-1.92; P=0.02; I-2=58%), and 12 months (MD 1.63 mmHg; 95% CI: 0.66-2.60; P<0.01; I-2=0%). Treatment success (RR 0.72; 95% CI: 0.58-0.90; P<0.01; I-2=50%) and pain or discomfort rates (RR 0.63; 95% CI: 0.50-0.81; P<0.01; I-2=0%) were lower with 180 degrees SLT. There was no difference between groups in visual acuity (MD -0.002 logMAR; 95% CI: -0.029 to 0.026 logMAR; P=0.90; I-2=41%) and adverse events risk (RR 1.08; 95% CI: 0.69-1.68; P=0.75; I-2=0%). TSA showed robust evidence for the superiority of 360 degrees vs. 180 degrees SLT on IOP. Conclusions: 180 degrees SLT was inferior to 360 degrees SLT for IOP control and treatment success in OAG or OHT, yet it was associated with a lower risk of pain or discomfort. These findings support 360 degrees SLT as the preferred protocol, though evidence is limited by the number of trials, heterogeneity, and follow-up. High-quality, long-term RCTs are required to validate these findings.

Anastomotic leakage (AL) increases morbidity and mortality in colonic and rectal surgery. Omentoplasty (OMP), the use of a pedicled flap from the omentum to shield the anastomotic site, has been proposed as a potential method to prevent this complication. This study aims to evaluate the effectiveness of OMP in reducing the incidence of AL and its clinical repercussions. We searched PubMed, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies comparing OMP and non-omentoplasty (n-OMP) in colonic and rectal surgeries. Mean differences (MDs) were computed for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analysis was performed using R software, version 4.3.3 (R Foundation for Statistical Computing, Vienna, Austria). Eight studies (four RCTs and four observational studies) involving a total of 5,330 patients were included, with 806 patients (15%) in the OMP group and 4,524 patients (85%) in the n-OMP group. Clinical AL, reported in three studies that distinguished leak type, was significantly reduced in the OMP group (OR 0.35; 95% CI 0.15-0.81; p=0.01; I²=0). There were no significant differences in overall AL (OR 0.61; 95% CI 0.33-1.12; p=0.11; I²=56%), radiological AL (OR 0.77; 95% CI 0.40-1.47; p=0.42; I²=0%), reoperation rates (OR 0.63; 95% CI 0.37-1.08; p=0.09; I²=0%), mortality (OR 0.78; 95% CI 0.33-1.86; p=0.58; I²=25%), or postoperative infection rates. OMP was not associated with a significant reduction in overall or radiological AL. Clinical AL, however, was significantly lower in the OMP group, a finding drawn from a small subset of studies that may point to a role for OMP in containing the consequences of a leak rather than preventing it outright. No significant differences were observed in reoperation rates, mortality, or postoperative infection rates. Given the heterogeneity and inclusion of observational data, further RCTs are needed to confirm these findings.

Macronutrient sequence has been proposed as a practical strategy to improve postprandial glycemia in individuals with type 2 diabetes (T2D). However, current evidence remains inconclusive. This meta-analysis aims to provide an updated evaluation of the impact of a carbohydrate-last (CL) strategy, compared to carbohydrate-first or unordered (CF) intake, on metabolic parameters in adults with T2D. A systematic search was conducted in PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) evaluating nutrient intake order in T2D. Outcomes were analyzed using mean difference (MD) with 95

Importance:Tranexamic acid (TXA) is increasingly used to minimize perioperative bleeding. However, its efficacy and safety profile across general surgical procedures remains unclear. Objective:To evaluate the efficacy and safety of prophylactic TXA in reducing intraoperative blood loss, need for transfusion, and major bleeding in general surgery, while assessing its association with thromboembolic events and mortality. Data Sources:PubMed, Embase, and Cochrane Library were systematically searched from inception to April 3, 2025. Study Selection:Randomized clinical trials (RCTs) comparing TXA to placebo in adult patients undergoing general surgery and reporting at least 1 predefined outcome of interest were included. Data Extraction and Synthesis:Two reviewers independently extracted data and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% CIs were pooled using random-effects models. Heterogeneity was assessed using the I2 statistic. Results:Twenty-six RCTs with a total of 6976 patients were included. TXA use was associated with lower intraoperative blood loss (MD, -35.85 mL; 95% CI, -57.20 to -14.51 mL; I2 = 91%; P = .001), reduced need for transfusion (RR, 0.75; 95% CI, 0.60-0.94; I2 = 54%; P = .01), and fewer major bleeding events (RR, 0.72; 95% CI, 0.59-0.89; I2 = 0%; P = .002). No significant differences were found in venous thromboembolism (RR, 1.09; 95% CI, 0.62-1.92; I2 = 15%; P = .75), mortality (RR, 1.08; 95% CI, 0.72-1.61; I2 = 0%; P = .71), and length of stay (MD, -0.54 days; 95% CI, -1.15 to 0.06 days; I2 = 73%; P = .08). In the subgroup analysis restricted to abdominal procedures, the benefits observed in the overall population on intraoperative blood loss and need for transfusion were no longer present. In the hepatobiliary subgroup, TXA was associated with a significant reduction in major bleeding (RR, 0.59; 95% CI, 0.39-0.90; I2 = 0%; P = .01), while no significant differences were observed for the other outcomes. Conclusions and Relevance:This systematic review and meta-analysis found that prophylactic TXA use was associated with lower intraoperative blood loss, transfusion requirements, and major bleeding without an observed increase in thromboembolic or mortality risk. Although these findings support the use of TXA in general surgery procedures, the decision to use TXA should be individualized considering individual patient characteristics and the specific procedure being performed.

Objective:To evaluate the efficacy and safety of high molecular weight hyaluronic acid (HMWHA) versus other therapies for hip osteoarthritis (OA) management. Methods:The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) comparing HMWHA versus other therapies (corticosteroids, platelet-rich plasma, saline, or low molecular weight hyaluronic acid) for hip OA treatment were included. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes with 95% confidence intervals (CIs). Results:Four RCTs were included, involving 823 patients with hip OA, of whom 408 (49.5%) were treated with HMWHA. The mean age of the patients was 60.1 (±10.21) years. No significant differences were observed between groups for pain (SMD -0.30 points; 95% CI -1.60 to 0.99), Lequesne index (MD 1.30 points; 95% CI -8.83 to 11.44), WOMAC total (MD -9.26 points; 95% CI -51.33 to 32.56), WOMAC stiffness (MD -0.93 points; 95% CI -12.30 to 10.45), WOMAC physical function (MD -0.15 points; 95% CI -7.24 to 7.60), and patient global self-assessment (MD -1.95 points; 95% CI -27.49 to 23.59). Conclusion:No significant differences were observed between HMWHA and other treatments regarding pain relief and functional recovery in patients with hip OA. However, further high-quality RCTs are needed to evaluate the HMWHA in the treatment of hip OA.

BACKGROUND:Totally laparoscopic distal gastrectomy (TLDG) is a minimally invasive alternative to laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. While both are widely used, it remains unclear which yields better outcomes. Therefore, this meta-analysis aimed to compare surgical outcomes and postoperative quality of life (QoL) between TLDG and LADG. METHODS:We searched PubMed, Embase, and Cochrane Library databases in May 2025. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using the R software. RESULTS:Three studies involving a total of 954 patients were included, of whom 484 underwent TLDG. Compared with LADG, TLDG significantly reduced Clavien-Dindo (CD) grades I-II complications (RR = 0.54; 95% CI: 0.33-0.89) and intraoperative blood loss (MD = -13.97 mL; 95% CI: -23.71, -4.23). Additionally, TLDG was associated with improved postoperative QoL assessed with the Stomach Module questionnaire (QLQ-STO22) (MD = -5.96 points; 95% CI: -11.51, -0.40). No significant differences were found between the groups in CD grades III-IV complications, early complications, operative time, or QoL measured by Quality-of-Life questionnaire. Postoperative mortality was rare, with only one reported death across all studies. CONCLUSIONS:TLDG was associated with fewer low-grade complications and less intraoperative blood loss, compared with LADG. However, no significant differences were observed in major complications and operative time. Furthermore, there was an improvement in QoL assessed using the QLQ-STO22 in favor of TLDG. These findings support TLDG as a safe and effective alternative to LADG for early gastric cancer.

Introduction and Objective: Non-pharmacological therapies for type 2 diabetes (T2D) require simpler, adaptable recommendations that align with diverse contexts, preferences, and long-term goals. This study aims to evaluate the impact of a carbohydrate-last (CL) strategy compared to carbohydrate-first or unordered (CF) nutrient intake on metabolic parameters in T2D. Methods: PubMed, EMBASE, and Cochrane Central were systematically searched for randomized controlled trials (RCTs) evaluating nutrient intake order in T2D. Mean difference (MD) with 95% confidence intervals (CI) was used for all outcomes. Heterogeneity was assessed with I² statistics. Statistical analyses were performed using R version 4.2.3. Results: Seventeen studies involving 389 participants were included, with 114 (29%) in a parallel design and 192 (49%) in a crossover design receiving CL. In the pooled analysis, the CL group had significantly lower postprandial glucose at 120 minutes (MD: -13.00 mg/dL; 95% CI: -21.07, -4.93; p<0.01). Insulin levels at 120 minutes postprandial (MD: -3.90 uIU/mL; 95% CI: -16.85, 9.04; p=0.55) showed no significant differences. The CL group had significantly higher postprandial GLP-1 levels at 120 minutes (MD: 8.21 pmol/L; 95% CI: 2.33, 14.09; p<0.01), while GIP levels at the same time point (MD: 5.79 pmol/L; 95% CI: -6.33, 17.90; p=0.35) showed no significant differences. Gastric emptying half-time in the CL group (MD: 28.14 min; 95% CI: 16.06, 40.23; p<0.01) was significantly delayed. Glycated hemoglobin (HbA1C) levels at the end of the follow-up (MD: -0.16%; 95% CI: -0.31, -0.01; p=0.04) were significantly lower in the CL group. Conclusion: Carbohydrate-last nutrient intake is associated with improved postprandial glucose profile and HbA1C levels in individuals with T2D. Further research is needed to confirm its sustainability and applicability across diverse populations. L. Saldarriaga: None. A.D. Andrade: None. P. Ratan: None. S. Kodalak: None. E. Pasqualotto: None. T.G. Bovi: None. T. Trevisan: None.

Background: Abdominal perineal resection (APR) remains the gold standard for lower rectal cancer involving the anal sphincter. However, the optimal patient position remains unclear. While lithotomy or Lloyd-Davies are commonly used, APR and extra-levator abdominal perineal excision (ELAPE) in a prone jackknife position have been linked to better oncological outcomes. Methods: We searched PubMed, Embase, the Central Register of Clinical Trials, and Web of Science for randomized controlled trials (RCTs) and observational studies published up to February 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using I2 statistics. Statistical analysis was performed with R Software version 4.4.1. Results: Two RCTs and 26 observational studies, including 4529 patients, were analyzed. Among them, 2249 (49.7%) underwent APR or ELAPE in the prone position and 2280 (50.3%) in the supine position. The prone position was associated with reduced surgical specimen perforation (5.3% versus 9.4%; OR: 0.44; 95% CI: 0.39-0.78; P < .001), lower positive circumferential resection margins (CRMs) rates (9.8% versus 14.3%; OR: 0.69; 95% CI: 0.53-0.89; P < .001), and decreased intraoperative bleeding (mean difference: -63.7 mL; 95% CI: -104.5, -22.8; P < .01). No significant differences were observed in operative time, urinary retention, urinary injury, wound infections, perineal dehiscence, Clavien-Dindo ≥3, reoperation, local recurrence, distal recurrence, or overall survival. Conclusion: The prone position during APR is associated with reduced specimen perforation, lower positive CRM rates, and less intraoperative bleeding without significant differences in other clinical outcomes.

INTRODUCTION:Inguinal hernia (IH) repair is one of the most common surgical procedures worldwide. Among the various techniques available, the Shouldice (SHD) technique is mainly used for nonmesh open repair whereas, the transabdominal preperitoneal (TAPP) approach is a commonly performed minimally invasive method. Despite its widespread use, a direct comparison between the two techniques is lacking. Therefore, this study aims to evaluate the short and long-term outcomes of SHD and TAPP for elective IH repair. METHODS:We searched the PubMed, Embase, and Cochrane Library on April 16. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary endpoints, respectively. Heterogeneity was assessed with I2 statistics. RESULTS:Thirteen RCTs comprising 2214 patients were included. Of these, 1089 patients (49%) underwent SHD repair and 1125 (51%) patients underwent TAPP repair. The mean BMI was reported in four studies ranging from 23 to 25.7 kg/m2. Data regarding hernia sizes were not available. Compared with TAPP, SHD significantly reduced seroma (RR 0.20; 95% CI 0.04-0.90; p = 0.04; and I2 = 0%) and increased chronic pain (RR 2.13; 95% CI 1.31-3.46; p < 0.01; and I2 = 0%) and 1-day postoperative pain (MD 2.01; 95% CI 0.72-3.29; p < 0.01; and I2 = 97%). However, there were no significant differences between the groups in recurrence (RR 0.94; 95% CI 0.66-1.35; p = 0.75; and I2 = 12%), hematoma (RR 1.08; 95% CI 0.80-1.46; p = 0.63; and I2 = 0%), urinary retention (RR 0.82; 95% CI 0.49-1.36; p = 0.43; and I2 = 0%), and testicular atrophy (RR 3.28; 95% CI 0.79-13.54; p = 0.10; and I2 = 0%). CONCLUSION:SHD repair demonstrated a lower occurrence of seromas; however, it was associated with a higher occurrence of both acute and chronic postoperative pain compared to TAPP in patients with a normal BMI. No significant differences were observed between the two techniques in terms of hernia recurrence, hematoma formation, urinary retention, or testicular atrophy rates.

Disclosure: L. Saldarriaga Callejas: None. P. Ratan: None. E. Pasqualotto: None. A. Andrade: None. S. Kodalak: None. T. Trevisan: None. Introduction and Objective: Continuous glucose monitoring (CGM) has emerged as a valuable tool in optimizing glycemic control for individuals with type 2 diabetes (T2D). However, integrating CGM data with evidence-based nutrition strategies remains a challenge, as many individuals struggle to interpret their glucoses profiles to make informed dietary choices. This study aims to evaluate the impact of a carbohydrate-last (CL) strategy compared to carbohydrate-first or unordered (CF) nutrient intake on CGM parameters in people with T2D. Methods: PubMed, EMBASE, and Cochrane Central were systematically searched for randomized controlled trials (RCTs) evaluating the impact of nutrient intake order on CGM data in T2D. Mean difference (MD) with 95% confidence interval (CI) was used for all outcomes. Heterogeneity was assessed with I² statistics. Statistical analyses were performed using RevMan Web. Results: Four studies involving 68 individuals were included, all of whom received both CL and CF in a crossover design. The mean age of participants ranged from 50 to 65.5 years, while the mean duration of diabetes varied between 4 and 16.4 years. The average body mass index ranged from 22.5 to 34.5 kg/m², and mean glycated hemoglobin levels were between 6.8% and 7.4%. In the pooled analysis, the CL group had significantly lower postprandial glucose at 120 minutes (MD: -18.59 mg/dL; 95% CI: -28.72, -8.47; p=0.0003). Mean glucose (MD: -6.49 mg/dL; 95% CI: -17.23, 4.25; p=0.24) and glycemic variability assessed using the coefficient of variation (MD: -1.11%; 95% CI: -4.31, 2.09; p=0.50) showed no significant differences. Conclusion: Carbohydrate-last nutrient intake is associated with improved postprandial glucose levels as measured by CGM in individuals with T2D. Larger, well-designed studies are needed to better assess this simple nutrient sequencing strategy on various glucose metrics. Presentation: Monday, July 14, 2025

PRÉCIS:Micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation demonstrated comparable intraocular pressure across all follow-ups. MP-TLT was associated with significantly lower risks of ocular complications, such as hypotony, prolonged inflammation, and phthisis bulbi. PURPOSE:To compare the efficacy and safety of micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) for the treatment of glaucoma or ocular hypertension. METHODS:A systematic search was conducted in PubMed, Cochrane Library, Embase, and ClinicalTrials.gov. Randomized controlled trials (RCTs) or cohort studies comparing MP-TLT and CW-TSCPC were included. Weighted mean differences (MDs) were computed for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% CIs. Heterogeneity was assessed with I2 statistics. Software R, version 4.4.0, was used for statistical analyses. Subgroup analyses were conducted on glaucoma types. RESULTS:Eleven studies encompassing 1054 eyes from 986 patients were included, with 47.4% receiving MP-TLT. There were no significant differences in IOP between CW-TSCPC and MP-TLT at 1 week, 1 month, 3 months, 6 months, 12 months, and 18 months of follow-up. The MP-TLT group required a significantly higher number of hypotensive medications but displayed significantly reduced risks of overall complications, ocular hypotony, prolonged inflammation, and phthisis bulbi compared with CW-TSCPC. CONCLUSION:MP-TLT and CW-TSCPC showed similar efficacy in IOP control. However, MP-TLT demonstrated a greater safety profile, suggesting its potential suitability for patients requiring repeat interventions or those with lower tolerance for ocular complications.

PURPOSE:To compare home-based remote rehabilitation with usual rehabilitation care for knee osteoarthritis (OA). METHODS:PubMed, Cochrane, and Embase databases were searched for randomized controlled trials (RCTs) comparing home-based remote rehabilitation (telephone calls, video calls, apps, or websites) with usual in-person rehabilitation in patients with knee OA. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes and risk ratios (RRs) for binary outcomes, with 95 % confidence intervals (CIs). Statistical analyses were performed using R Software, version 4.4.1. RESULTS:A total of 9 RCTs were included, comprising 974 patients with knee OA, of whom 483 (49.6 %) were randomized to home-based remote rehabilitation. Compared with usual rehabilitation, home-based remote rehabilitation significantly reduced pain severity (SMD -0.34; 95 % CI -0.67 to -0.02) and significantly improved physical activity levels (SMD -0.45; 95 % CI -0.85 to -0.05). Furthermore, the home-based remote rehabilitation group showed a significant reduction in pain assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MD -0.95 points; 95 % CI -1.84 to -0.06), an improvement in functionality assessed with the Timed Up and Go test (MD -0.83 s; 95 % CI -1.64 to -0.02), and a greater patient satisfaction (RR 2.01; 95 % CI 1.46 to 2.76). CONCLUSION:The results demonstrated that home-based remote rehabilitation reduced pain and increased patient satisfaction, however, there is insufficient evidence to state that remote rehabilitation significantly improved physical activity and functionality. Home-based remote rehabilitation appears to be a viable and effective alternative for patients with knee OA.

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a critical procedure for managing choledocholithiasis, with primary closure (PC) and T-tube drainage (TTD) as common methods for common bile duct closure. However, the substantial number of new studies comparing PC and TTD underscores the need for an updated meta-analysis. Therefore, this study aims to compare surgery-related outcomes in PC and TTD for biliary duct closure following LCBDE. Methods: We searched PubMed, Embase, and Cochrane Library databases on June 20, 2024. Mean differences (MDs) and risk ratios with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: A total of 31 studies comprising 4432 patients were included. A total of 2301 (51.9%) were submitted to PC and 2131 (48.1%) were submitted to TTD. The mean age of patients ranged from 39 to 69.8 years and 44.3% were male. Compared with TTD, PC significantly reduced retained stones (odds ratio [OR] 0.57; 95% CI 0.35-0.93; P = .02; I2 = 0%), biliary peritonitis (OR 0.22; 95% CI 0.08-0.60; P < .01; I2 = 0%), operative time (MD -21.07 minutes; 95% CI -27.68-14.46; P <. 01; I2 = 97%) and postoperative hospital stay (MD -2.20 days; 95% CI -2.80-1.60; P <. 01; I2 = 96%). However, there were no significant differences between the groups in recurrent stones (OR 0.57; 95% CI 0.32-1.02; P = .06; I2 = 0%), bile leakage (OR 0.89; 95% CI 0.65-1.23; P = .49; I2 = 0%), bile duct stricture (OR 2.08; 95% CI 0.36-12.11; P = .42; I2 = 0%), pneumonia (OR 1.38; 95% CI 0.66-2.88; P = .39; I2 = 0%), and pancreatitis (OR 0.64; 95% CI 0.29-1.38; P = .25; I2 = 0%). Conclusion: In this meta-analysis, PC was associated with decreased retained stones, biliary peritonitis, operative time, and postoperative hospital stay. However, no significant differences were observed for the other outcomes. These findings underscore PC as a safe and reliable method for bile duct closure following LCBDE.

CONTEXT AND OBJECTIVES:The efficacy of erector spinae plane block (ESPB) analgesia among children undergoing surgery remains unsettled. We aimed to perform an updated systematic review, meta-analysis, and trial sequential analysis to determine whether ESPB is effective for pediatric patients undergoing major surgeries. METHODS:PubMed, Embase, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing systemic analgesia with vs. without ESPB in pediatric patients undergoing surgery. We computed mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95 % confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Statistical analyses were performed using R Software, version 4.2.3. RESULTS:We included 10 RCTs, comprising 570 participants, of whom 287 (50,4 %) underwent ESPB. Compared with systemic analgesia alone, ESPB was associated with a lower intraoperative (MD -1.03 μg/kg; 95 % CI -1.73 to -0.33; p < 0.01) and postoperative (MD -0.08 mg/kg; 95 % CI -0.12 to -0.03; p < 0.01) opioid consumption; a longer time to first analgesic requirement (MD 138.76 min; 95 % CI 84.20 to 193.32; p < 0.01); and lower incidence of postoperative nausea and vomiting (PONV) (RR 0.42; 95 % CI 0.23 to 0.77; p < 0.01). There were no differences between groups for postoperative pain at 6 h (SMD -0.61; 95 % CI -1.16 to -0.07; p = 0.03), and 12 h (SMD -0.13; 95 % CI -0.36 to 0.11; p = 0.28); however, postoperative pain at 24 h was lower with ESPB (SMD -0.59; 95 % CI -0.97 to -0.21; p < 0.01). CONCLUSIONS:In children undergoing surgery, ESPB was associated with lower intra and postoperative opioid consumption, higher time to first analgesic requirement, and lower PONV, but these differences may be of modest clinical significance.

Aim To evaluate the effect of liraglutide on body composition in people living with obesity or overweight. Methods A systematic search was conducted in PubMed, Embase, and Cochrane Library databases up to June 10, 2024. Randomized controlled trials (RCTs) comparing liraglutide to placebo and reporting body composition outcomes were included. Results Data from 15 studies involving 960 participants were analyzed. Liraglutide consistently demonstrated significant reductions in total weight, fat mass, and visceral adipose tissue (VAT) compared to placebo across the included studies. VAT reductions ranged from 12.49 % to 23 %, highlighting liraglutide's effectiveness in targeting visceral fat, a key factor in cardiometabolic risk. Fat mass reductions were also substantial and consistent, reinforcing the efficacy of liraglutide in improving overall body composition. In contrast, lean mass outcomes were more variable, with some studies reporting preservation or even gains in lean mass, while others indicated losses. Conclusions Liraglutide effectively reduces fat mass and VAT, supporting its use in managing obesity and related cardiometabolic risks. However, the inability to accurately calculate lean and fat mass proportions underscores the need for standardized reporting and availability of individual-level data. Future research should prioritize these elements and include muscle function assessments to better evaluate the clinical impacts of GLP-1 receptor agonists on body composition.

BACKGROUND:Radiofrequency ablation guided by ultrasound (RFA-USG) is an alternative treatment for primary hyperparathyroidism (PHPT) patients. Despite showing accurate precision and minimal invasion, its efficacy remains questionable. METHODS:We searched PubMed, Embase, Scopus, Cochrane Library, Portal Regional da Biblioteca Virtual em Saúde (BVS), Web of Science databases for randomized controlled trials (RCTs) and observational studies evaluating RFA-USG in PHPT patients. Statistical analysis was performed with R software, version 4.4.3. RESULTS:Eight studies were included with 208 patients with PHPT undergoing RFA-USG treatment. After 3 months of treatment, parathyroid volume was 0.31 mL (0.16-0.61), Parathyroid hormone (PTH) level was 60.71 pg/mL (53.87-68.42), and calcium level was 5.43 mEq/L (2.63-11.23). The occurrence of hoarseness among the patients was 4.4% (1.64-11.02). CONCLUSION:RFA-USG is safe for PHPT patients, with associated parathyroid volume reduction and decrease in PTH. However, further study is needed to compare RFA-USG to the gold standard of surgery for PHPT.

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a well-established and effective minimally invasive surgical approach for managing choledocholithiasis. However, its safety in the elderly population is not well established. Therefore, this study compares surgery-related outcomes in elderly patients undergoing LCBDE. Methods: We systematically searched PubMed, Embase, and Cochrane Library for studies comparing elderly and young patients undergoing LCBDE. Binary outcomes were compared using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: Twelve studies comprising 3791 patients were included, of whom 1411 patients (37%) were from the elderly group. Elderly patients were associated with an increase in mortality (OR: 3.42; 95% CI: 1.08-10.85; P = .04; I2 = 0%), overall postoperative complications (OR: 1.60; 95% CI: 1.11-2.22; P = .01; I2 = 52%), and pneumonia (OR: 4.37; 95% CI: 2.00-9.55; P < .01; I2 = 0%) rates. However, there were no significant differences between groups in remnant stones (OR: 1.37; 95% CI: 0.70-2.68; P = .36; I2 = 0%) and recurrent stones (OR: 1.37; 95% CI: 0.64-2.95; P = .42; I2 = 0%) pancreatitis (OR: 0.98; 95% CI: 0.16-5.95; P = .98; I2 = 0%) and bile leakage (OR: 1.24; 95% CI: 0.75-2.07; P = .40; I2 = 0%). Conclusion: In this meta-analysis, elderly patients who underwent LCBDE experienced increased mortality, overall complications, and pneumonia rates compared with young patients. Furthermore, there were no significant differences between the groups in remnant and retained stones, pancreatitis, and bile leakage.

BACKGROUND:The supraglottic airway device (SGD) was introduced as a breakthrough in airway management. The Fastrach emerged as the first commercially available intubating SGD, drawing extensive investigation. I-gel is a more recent device that has gained popularity, can be used as an intubating SGD, and replaced Fastrach in many institutions. However, there is uncertainty regarding the comparison between these devices in terms of efficacy for intubation and ventilation, and safety in an airway rescue situation. METHODS:PubMed, EMBASE, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing I-gel and Fastrach SGD in adult patients undergoing intubation. The primary outcome was the first-pass success rate for tracheal intubation. Secondary outcomes were tracheal intubation time, SGD insertion time and success, and complications. We computed risk ratios (RRs) to assess binary end points and weighted mean differences (WMDs) for continuous outcomes, with corresponding 95% confidence intervals (CIs) for the primary outcome and its subgroup analysis ( P < .05 was considered statistically significant) and 99% CI after Bonferroni correction for the secondary outcomes ( P < .01 was considered statistically significant). RESULTS:This study included a total of 14 RCTs encompassing 1340 patients. The results indicated a significant difference in the first-pass success rate favoring Fastrach (RR, 0.81; 95% CI, 0.67-0.98; P = .03; I² = 91%). In the subgroup analysis, when a flexible scope was utilized through I-gel, providers achieved a better tracheal intubation first-pass success rate (RR, 1.05; 95% CI, 1.01-1.11; P = .03; I² = 0%), compared with the Fastrach. Overall intubation success rates (RR, 0.92; 99% CI, 0.82-1.04; P = .08, I² = 92%) and time (WMD - 1.03 seconds; 99% CI, -4.75 to 2.69; P = .48; I² = 84%) showed no significant difference irrespective of the device used. There was no significant difference regarding device insertion time by the providers (WMD -6.48 seconds; 99% CI, -13.23 to 0.27; P = .01; I 2 = 98%). Success rates of the providers' initial SGD insertion and complications such as sore throat (RR, 1.01; 99% CI, 0.65-1.57; P = .95, I² = 33%) and blood presence post-SGD removal (RR, 0.89; 99% CI, 0.42-1.86; P = .68, I² = 0%) showed no significant difference. CONCLUSIONS:Based on our findings, a higher first-pass success rate was observed with the use of Fastrach when compared to I-gel. However, the use of I-gel might result in a better intubation success rate with the flexible scope-guided intubation. There are no significant differences in performance in terms of the success rate for intubation overall, time for device insertion, or time to intubation or complications regardless of the device used.