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Introduction: Stroke is the second largest cause of death and third leading cause of disability worldwide. Some high-income countries have one in five lifetime cases and one in two in low-income countries. Due to the high stroke burden and aging population, better preventive and treatment approaches are needed. Recent research shows that stroke patients have a different gut microbiota than healthy people, suggesting a relationship between dysbiosis and stroke incidence and prognosis. Probiotics may improve stroke outcomes by strengthening the intestinal barrier and reducing inflammation. Hypothesis: Our study seeks to evaluate the potential benefits of probiotic supplementation in reducing the risk of ischemic stroke in healthy individuals as well as its impact on the prognosis of stroke patients, specifically in reducing gastrointestinal complications and improving gut microbiota balance (reduce dysbiosis). Methods: We conducted an umbrella meta-analysis of meta-analyses published in the last 10 years using PRISMA guidelines in PubMed. Using RevMan 5.4, we performed an inverse variance random effects model to calculate log (odds ratio) and converted it to pooled OR and 95% confidence interval to obtain a forest plot keeping alpha criteria 0.05. Heterogeneity and risk of bias assessment (by Newcastle-Ottawa Scale) were assessed. Results: While probiotic supplementation in healthy individuals did not significantly decrease the risk of ischemic stroke (OR 0.87 [95%CI 0.75-1.01]), it showed notable benefits in stroke patients. These positive effects included a substantial reduction in the odds of specific GI complications (constipation, diarrhea, gastric retention, esophageal reflux, vomiting, stress ulcers, and gastrointestinal bleeding) by 62% (0.38, 0.29-0.51), non-specific GI complications by 72% (0.28, 0.24-0.34), infection by 73% (0.27, 0.21-0.33) and a significant improvement in gut flora balance, reducing the odds of dysbiosis by 79% (0.21, 0.12-0.36). (p<0.00001) The inter-study heterogeneity was 91% with (p<0.00001, Chi 2 =128.76), a moderate risk of bias. Conclusion: Our umbrella meta-analysis highlights the potential benefits of probiotic supplementation in stroke patients, particularly in mitigating stroke-related GI complications and alleviating intestinal flora dysbiosis. These findings underscore the crucial role of gut-brain interactions in stroke and suggest that probiotics may serve as a promising component of stroke management.

ABSTRACT Iron deficiency (ID) is a top five leading cause of disability‐adjusted life‐years in women of reproductive age around the world. Despite its enormous health burden, no screening guidelines exist for the detection and treatment of ID in women of reproductive age. We sought to determine the cost‐effectiveness of screening versus no screening for ID in women of reproductive age in the United States. A lifetime simulation of women of reproductive age was conducted using a Markov cohort model under three strategies: (1) no screening, (2) screening at a ferritin threshold of 15 μg/L, and (3) screening at a ferritin threshold of 25 μg/L, from the US health system perspective, and at a willingness‐to‐pay threshold of $100 000/quality‐adjusted life year (QALY). Epidemiologically informed ID prevalence estimates sourced from the National Health and Nutrition Examination Survey were employed for model parameterization. The primary outcome was the incremental cost‐effectiveness ratio (ICER, in $/QALY). Base‐case results for the three strategies accrued $209 700, $210 200, and $210 200 discounted lifetime costs and 23.6, 24.0, and 24.4 discounted lifetime QALYs, respectively. Screening at a ferritin threshold of 25 μg/L was the cost‐effective intervention with an ICER of $680/QALY (95% credible interval $350–$750/QALY). In dual base‐case analyses examining intravenous rather than oral iron repletion for treatment, screening at a ferritin threshold of 25 μg/L remained the cost‐effective intervention with an ICER of $2300/QALY (95% CI $1800–$3800/QALY). In probabilistic sensitivity analyses, screening at a ferritin threshold of 25 μg/L was the cost‐effective intervention in 100% of 10 000 second order Monte Carlo iterations.

Purpose: To systematically review the literature on the effectiveness, safety, and long-term outcomes of genicular artery embolization (GAE) for knee joint osteoarthritis (OA) associated pain. Materials and Methods: After registering the protocol with the PROSPERO database, a search was conducted from inception until July 31, 2023, in MEDLINE, Cochrane Central Register of Controlled Trials, and ScienceDirect databases to gather studies evaluating GAE’s safety and efficacy in knee OA. A total of 4979 studies were identified and evaluated against the inclusion criteria. Data on study characteristics, success parameters, and adverse events were collected and synthesized. Results: Twenty-three studies, primarily single-center prospective studies with a total of 657 patients, were included. Most studies reported a 100% technical success rates, except one study reporting a rate of 84.2%. Clinical success rates, defined variably across studies, ranged from 30% to 100%, depending on the study’s follow-up period and outcome measures. The most frequent adverse events included skin discoloration without an ulcer (15.6%, n = 98) and transient post-procedural knee pain (10.2%, n = 64). Most studies were rated as fair in terms of quality, but the lack of robust randomized controlled trials highlighted the need for further comparative studies to standardize outcome reporting. Conclusion: GAE appears to be a promising option for knee OA pain, particularly for patients unresponsive to conservative treatments or ineligible for surgery. High-quality studies are needed to confirm long-term effectiveness and standardize outcome measures. Clinical Impact This study highlights the safety and efficacy of genicular artery embolization as a minimally invasive treatment for knee osteoarthritis, particularly in patients who are unresponsive to conservative treatments or unsuitable for surgery. By targeting neovascularization and reducing inflammation, genicular artery embolization provides pain relief and functional improvement. Clinicians can consider genicular artery embolization as an alternative to surgery for mild-to-moderate OA, offering a lower adverse event rate and faster recovery.

ABSTRACTBackgroundThe treatment landscape for multiple myeloma continues to evolve. Recently, the addition of anti‐CD38 monoclonal antibodies (mAbs) to the triplet regimen, comprising a proteasome inhibitor, an immunomodulatory agent, and a steroid, for transplant‐eligible newly diagnosed multiple myeloma (TENDMM) has shown promising results.AimsTo evaluate the overall efficacy and safety of quadruplet therapy with an anti‐CD38 mAb compared to a triplet regimen.MethodsA systematic search of Medline, Scopus, and EMBASE databases from inception to July 2024 identified relevant randomized controlled trials (RCTs). Efficacy and safety outcomes were derived using random‐effects meta‐analysis. Summarized outcomes include hazard ratios (HR) for progression‐free survival (PFS) and overall survival (OS), odds ratios (OR) for response rates, measurable residual disease (MRD) negativity rate, and grade 3 or higher adverse events (G ≥ 3 AEs).ResultsFive RCTs involving 2963 patients were included. A statistically significant PFS was observed for quadruplet therapy when compared to the triplet regimen (HR 0.44; 95% Confidence Interval [CI] 0.35–0.56). PFS benefit was consistent for the standard risk (SR) group (HR 0.38; 95% CI 0.27–0.52) and high risk (HiR) group (HR 0.62; 95% CI 0.41–0.92). No statistically significant benefit was observed for OS (HR 0.55; 95% CI 0.28–1.08). A statistically significant benefit was observed for the overall response rate (OR 1.77; 95% CI 1.02–3.06) and MRD negativity rate (OR 2.67; 95% CI 1.79–3.99). No significant differences were observed for G ≥ 3 AE (OR 1.21; 95% CI 0.92–1.58), lymphopenia (OR 1.09; 95% CI 0.62–1.89), and anemia (OR 1.06; 95% CI 0.83–1.37). However, a significantly increased risk was observed for all‐grade thrombocytopenia (OR 1.64; 95% CI 1.37–1.97), neutropenia (OR 2.24; 95% CI 1.67–3.02) and infections (OR 1.88; 95% CI 1.07–3.31).ConclusionQuadruplet therapy demonstrated a favorable efficacy and safety profile, with consistent benefit across subgroups. The findings support its potential as the new standard of care for TENDMM.