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Background This study aims to quantitatively summary the characteristics of synchronous multiple primary lung cancer (sMPLC), postoperative mortality, long‐term prognosis, and prognostic effects of potential clinical parameters in patients with sMPLC after surgery. Methods PubMed and Embase databases were systematically searched to identify studies that explored the prognosis of patients with sMPLC after surgery. Results Fifty‐two studies with 3486 participants were included, and clinical characteristics were quantitatively summarized. The pooled proportion of sMPLC in lung cancer was 2.0% (95%CI, 1.6%–2.5%) with an increasing trend over time, and postoperative mortality was 1.4% (95%CI, 0.5%–2.7%) with a decreasing trend over time. The 5‐year survival rate was 44.9% (95%CI, 37.4%–52.6%) and all long‐term survival rates showed increasing trends over time. Poor long‐term prognosis was observed in both limited resection (HR = 1.357, 95%CI, 1.047–1.759, p = 0.0210) and pneumonectomy (HR = 2.643, 95%CI, 1.539–4.541, p = 0.0004) by comparison of anatomical resection. Other clinical parameters of age, gender, smoking status, FEV1, and lymph node metastasis significantly impacted the long‐term prognosis (all p < 0.05). Conclusions The proportion of sMPLC in lung cancer and 5‐year survival rate are increasing, while postoperative mortality is decreasing trend over time. Lobectomy should be preferred, while pneumonectomy should be avoided for sMPLC. Age, gender, FEV1, smoking, tumor size, surgical methods, and lymph node status are prognostic factors for sMPLC. Considering the heterogeneity and publication bias, these findings should be treated with caution. The incidence of sMPLC increases over time, with an estimated incidence of 2.0%. The postoperative mortality decreases, while the long‐term survival rate increases over time.

Objective To examine the association between isolated maternal hypothyroxinaemia (IMH) and adverse obstetric outcomes and offspring outcomes and also investigate the effects of levothyroxine therapy on IMH for the above outcomes. Methods We systematically searched PubMed, EMBASE, and Cochrane Library, and the reference lists of key reviews were hand searched on June 9, 2021. Two authors independently screened titles/abstracts. Full articles were further assessed if the information suggested that the study met the inclusion/exclusion criteria, and two researchers performed data extraction and risk-of-bias assessment using standardized tables. Summary relative risks or the mean difference between maternal effects and offspring outcomes were calculated by a random-effects model. Results We identified 38 eligible articles (35 cohort studies and two randomized controlled trials [RCT]). Meta-analysis showed that maternal IMH was associated with increased gestational diabetes mellitus, preterm premature rupture of membranes, preterm birth, fetal distress, and macrosomia outcomes in IMH compared to euthyroid women, and the relative risks were 1.42 (1.03–1.96), 1.50 (1.05–2.14), 1.33 (1.15–1.55), 1.75 (1.16–2.65) and 1.62 (1.35–1.94), respectively. IMH was not associated with placenta previa, gestational hypertension, pre-eclampsia, intrauterine growth restriction, and offspring outcomes like birth weight, low birth weight infants, fetal macrosomia, neonatal intensive care, neonatal death, or fetal head circumference. In addition, we did not find an association between IMH and adverse offspring cognitive defects. Due to insufficient data for meta-analysis, it failed to pool the evidence of levothyroxine’s therapeutic effect on IMH and their offspring. Conclusions and relevance IMH in pregnancy may relate to a few maternal and offspring outcomes. Moreover, there is currently no sufficient evidence that levothyroxine treatment during pregnancy reduces adverse maternal outcomes and disability in offspring. Further investigation to explore the beneficial effects of levothyroxine therapy is warranted.

Background There is no evidence‐based guidance on the use of fractional CO2 laser in the excision of scars. Aim To explore the effectiveness and safety of fractional CO2 laser in the treatment of keloids. Methods In this meta‐analysis, we searched the PubMed, Embase, and Cochrane databases from inception to April 2023. We only included studies reporting fractional CO2 laser treatment of keloids. We excluded duplicate published studies, incomplete studies, those with incomplete data, animal experiments, literature reviews, and systematic studies. Results The pooled results showed that the Vancouver Scar Scale (VSS) parameters of height weighted mean difference (WMD) = −1.10, 95% confidence interval (CI): −1.46 to −0.74), pigmentation (WMD = −0.61, 95% CI: −1.00 to −0.21), and pliability (WMD = −0.90, 95% CI: −1.17 to −0.63) were significantly improved after fractional CO2 laser treatment of keloids. However, vascularity did not significantly change. Additionally, the total VSS was significantly improved after treatment (WMD = −4.01, 95% CI: −6.22 to −1.79). The Patient Scars Assessment Scale was significantly improved after treatment (WMD = −15.31, 95% CI: −18.31 to −12.31). Regarding safety, the incidences of hyperpigmentation, hypopigmentation, pain, telangiectasia, and atrophy were 5%, 0%, 11%, 2% (95% CI: 0%–6%), and 0% (95% CI: 0%–4%), respectively. Conclusions Fractional CO2 laser is effective in the treatment of keloids and can effectively improve the height, pigmentation, and pliability of scars, and patients are satisfied with this treatment. Further studies should explore the role of combination therapy.

Aim To determine the efficacy of Internet‐based interventions in decreasing the prevalence of postpartum depression in perinatal women. Design This review was conducted according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Methods We performed a systematic meta‐analysis of randomized controlled trials on the efficacy of Internet‐based interventions for postpartum depression. Studies (2008–2018) were identified through a search conducted on PubMed, EMBASE and the Cochrane Library. Risk ratios or weighted mean differences with 95% confidence intervals were calculated using a fixed‐effects model or a random‐effects model. Stata software 11.0 was used to perform the meta‐analysis. Results Most of the seven eligible studies were randomized controlled trials. The random‐effects model indicated that Internet‐based interventions significantly improved postpartum depression (d = 0.642, N = 7). Attrition rates ranged from 4.5%–86.9% and from 0%–87.1% for the intervention and control groups, respectively.

Background Vitreoretinal lymphoma (VRL) is regarded as a subtype of primary central nervous system lymphoma (PCNSL). Hence, extending progression‐free survival (PFS) is crucial for enhancing the prognosis of VRL patients. Nevertheless, a lack of standard treatment options currently exists for VRL. This systematic review aims to explore the most optimal treatment strategy. Methods The methods for this systematic review and meta‐analysis adhered to PRISMA guidelines and followed a protocol registered on the PROSPERO registry. A search was conducted on PubMed, Embase, and Scopus up to October 14, 2023, using predefined search terms. Primary endpoints included overall response rate (ORR) and complete response rate (CRR), while secondary endpoints comprised overall survival (OS) and progression‐free survival (PFS). Results Thirty‐seven studies comprising 801 patients were included in the meta‐analysis. The pooled CRR was 85%, and the ORR was 93%. The pooled 1‐year PFS was 83%, and the 2‐year PFS was 58%. The 1‐year OS was 92%, and the 2‐year OS was 80%. The combined median PFS was 22.87 months, and the median OS was 51.19 months. Survival analysis of the extracted data showed significant associations between PFS and OS with systemic therapy (p = 0.00098 and p = 0.0091) and multi‐strategy combination therapy (p = 0.0081 and p = 0.007); however, age, gender, and bilateral involvement exhibited no significant relationship (p > 0.05). Conclusions In conclusion, while existing treatment strategies have led to higher remission rates and longer OS for VRL patients, PFS remains suboptimal. The primary focus of future clinical and basic research will be to explore effective treatment strategies for controlling disease recurrence or progression. Trial Registration: This meta‐analysis was registered in the international prospective register of systematic reviews (PROSPERO) (CRD42023400305).

Objective Despite being well‐studied and widely utilized, the efficacy of cryotherapy after total knee arthroplasty (TKA) in enhancing early rehabilitation lacks consensus. The aim of this systematic review and meta‐analysis was to investigate (1) whether cryotherapy is able to promote the rehabilitation of patients undergoing TKA and (2) whether continuous cold flow device has superior results than cold pack in cryotherapy. Methods A comprehensive trial searching was performed in the PubMed, Embase, Cochrane Library, and Google Scholar electronic databases in May, 2024. Randomized controlled trials (RCTs) comparing cryotherapy with no cryotherapy or comparing continuous cold flow device with cold pack after TKA were included. The primary outcome was visual analogue scale (VAS) of pain, and secondary outcomes included opioid consumption, blood loss (hemoglobin decrease and drainage), range of motion (ROM), swelling, length of stay (LOS), and adverse event. Results A total of 31 RCTs were included in this meta‐analysis with 18 trials comparing cryotherapy with no cryotherapy and 13 trials comparing continuous cold flow device with cold pack. Pooled results showed cryotherapy group had significantly lower VAS scores than no cryotherapy group on postoperative day (POD) 1 (MD, −0.59 [95% CI, −1.14 to −0.04]; p = 0.04), POD 2 (MD, −0.84 [95% CI, −1.65 to −0.03]; p = 0.04), and POD 3 (MD, −0.86 [95% CI, −1.65 to −0.07]; p = 0.03). Cryotherapy group also showed reduced opioid consumption, reduced hemoglobin loss, decreased drainage, and improved ROM after TKA. Continuous cold flow device group had comparable VAS, opioid consumption, blood loss, ROM, knee swelling, and LOS with cold pack group. Conclusion Cryotherapy can effectively alleviate postoperative pain, reduce blood loss, improve ROM, and thus promote the postoperative rehabilitation for TKA patients, but the continuous cold flow device did not show better efficacy than cold packs. These findings support the routine use of cryotherapy for the rapid rehabilitation of TKA patients, and the traditional cold pack is still recommended. Meta‐analysis showed that cryotherapy group had significantly lower visual analogue scale scores than no cryotherapy group on postoperative day (POD) 1 (MD, −0.59 [95% CI, −1.14 to −0.04]; p = 0.04), POD 2 (MD, −0.84 [95% CI, −1.65 to −0.03]; p = 0.04), and POD 3 (MD, −0.86 [95% CI, −1.65 to −0.07]; p = 0.03).

Sleep disturbance has been described as a 'hallmark' symptom of posttraumatic stress disorder (PTSD). Although there are robust findings of self-reported sleep disturbance in PTSD, evidence of sleep disturbance measured using actigraphy is less certain. To conduct a systematic review and meta-analysis to determine whether there are any significant differences between individuals with and without PTSD in actigraph-derived sleep measures. Case-control studies comparing participants with current PTSD to those without PTSD were eligible for inclusion. Sleep parameters of interest were: (1) total sleep time; (2) sleep onset latency; (3) wake after sleep onset (WASO); and (4) sleep efficiency. Data were meta-analysed as standardised mean differences (SMDs) and potential sources of heterogeneity were explored through meta-regression. Six actigraphy studies with 405 participants were included. There was no evidence of a statistically significant difference between those with and without PTSD in total sleep time (SMD 0.09, 95%CI −0.23 to 0.42); WASO (SMD 0.18, 95%CI −0.06 to 0.43); sleep latency (SMD 0.32, 95%CI −0.04 to 0.69); or sleep efficiency (SMD −0.28, 95%CI −0.78 to 0.21). Further high-quality research is required to determine whether there is a true difference in sleep between those with and without PTSD.

Child malnutrition remains a significant concern in the Asia‐Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia‐Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia‐Pacific region between September 2000 and May 2023. Fixed‐effects or random‐effects meta‐analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta‐analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97–1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88–6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national‐level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia‐Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality. Key messages Short interval pregnancies pose a persistent public health threat in the South Asian region. While a potential link with child malnutrition exists, reported associations often conflict. Our findings suggest that short interval births slightly increase the risk of child malnutrition. Addressing short interval pregnancies is crucial to mitigate the ongoing nutritional burden in South Asian countries.

Objectives To evaluate the combination of the infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block and single adductor canal block (SACB) versus SACB for motor‐sparing knee analgesia effects after total knee arthroplasty (TKA). Methods PubMed, Ovid, Cochrane Library, and other databases were searched from the inception to January 2021. Randomized controlled trials (RCTs) comparing patients receiving iPACK plus SACB with patients receiving SACB after TKA were included. The included studies were assessed by two reviewers according to the Cochrane risk of bias criteria. Meta‐analysis was performed with STATA 13.0 software, the risk ratios (RR) and mean differences (MD) were used to compare dichotomous and continuous variables. The primary outcome was ambulation pain and secondary outcomes were rest pain, opioid consumption, function ability, clinical outcomes, and complications. Results Seven RCTs (304 knees in iPACK + SACB group; 305 knees in SACB group) were included. The follow‐up periods ranged from 2 days to 3 months. Pooled data indicated lower pain scores at ambulation (p < 0.0001) for iPACK + SACB. When comparing the pain scores of subgroups analyzed at specific periods, lower scores in subgroups within 12 h (at rest and ambulation) and after 48 h (at ambulation) were observed in the iPACK + SACB group. Analysis demonstrated greater reduction in morphine consumption (p = 0.007) in the iPACK + SACB group. The iPACK + SACB group is also superior to the SACB group regarding function ability, which included range of motion (ROM) (p = 0.001), time up to go (TUG) test (p = 0.030), and ambulation distance (p < 0.0001). No difference was found in clinical outcomes or complications. Conclusions With the iPACK added to SACB, pain scores, morphine consumption, functional ability were improved. Additional high‐quality studies are required to further address this topic. Our study confirmed that with the addition of IPACK, SACB could significantly reduce the pain scores, morphine consumption, as well as to improve functional ability.

Objective The study aims to assess whether the use of a peritoneal flap (PF) during robotic‐assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND) reduces the incidence of lymphoceles compared to the standard surgical approach without a flap. Methods The review was prospectively registered on PROSPERO (CRD420251052120). A systematic search of PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL and Google Scholar was performed up to May 2025. Eligible studies were randomised controlled trials (RCTs) or observational studies comparing PF use with the standard surgical technique without the flap during RARP with PLND. Primary outcomes were symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. Secondary outcomes included complications, operative time, blood loss, positive surgical margins and hospital stay. Results Fourteen studies (six RCTs, eight observational) including 7316 patients were analysed, with 2997 receiving the PF and 4319 receiving the standard technique. PF use was associated with a significantly lower incidence of symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. PF use reduces overall complications without significantly increasing operative time, hospital stay or positive margins. Intraoperative blood loss was slightly lower in the standard group. Conclusions PF use during RARP with PLND significantly reduces the incidence of lymphoceles and postoperative complications without compromising oncological or perioperative outcomes. These findings support PF use as a safe and effective technique for preventing lymphoceles.