Background: Propofol is the most widely used intravenous anesthetic in endoscopic surgery, but is associated with several adverse reactions. Public research has shown that remimazolam, a safe general anesthetic, is increasingly being used as a substitute for propofol in clinical operations. Our meta-analysis aimed to analyze whether the adverse reaction rate of remimazolam in endoscopic surgery is acceptable and whether the surgical success rate is not lower than that of propofol. Aim: This meta-analysis examined the adverse events and efficacy of remimazolam vs. propofol during endoscopic surgery. Method: MEDLINE, Embase, ClinicalTrials.gov, and Google Scholar were comprehensively searched. Seven studies comparing remimazolam and propofol were included in our meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane manual were used to assess the quality of the results published in all included studies to ensure that our meta-analysis results are reliable and worthwhile. Results: Compared to propofol, the use of remimazolam reduced postoperative injection pain [relative risk (RR)=0.06, 95% confidence interval (CI): 0.03–0.12, P<0.00001], postoperative hypotension (RR=0.45, 95% CI: 0.28–0.73, P=0.001), and postoperative respiratory depression (RR=0.20, 95% CI: 0.08–0.47, P=0.0002); however, it also slightly reduced the success rate of the operation [risk difference (RD)=−0.02, 95% CI: −0.04 to −0.01, P=0.0007]. There were no significant differences in the occurrence of bradycardia symptoms after the operation (RD=−0.01, 95% CI: −0.03 to 0.01, P=0.35), recovery time after the operation [standardized mean difference (SMD)=0.68, 95% CI: −0.43 to 1.80, P=0.23] or discharge time (SMD=0.17, 95% CI: −0.58 to 0.23, P=0.41). We also performed a subgroup analysis of each corresponding outcome. Conclusion: Our analysis showed that remimazolam may be a safer shock option than propofol for endoscopic surgery. However, further research is required to determine their utility.

Objectives: Studies have shown that people with diabetes have a high risk of osteoporosis and fractures. The effect of diabetic medications on bone disease cannot be ignored. This meta-analysis aimed to compare the effects of two types of glucose-lowering drugs, metformin and thiazolidinediones (TZD), on bone mineral density and bone metabolism in patients with diabetes mellitus. Methods: This systematic review and meta-analysis were prospectively registered on PROSPERO, and the registration number is CRD42022320884. Embase, PubMed, and Cochrane Library databases were searched to identify clinical trials comparing the effects of metformin and thiazolidinediones on bone metabolism in patients with diabetes. The literature was screened by inclusion and exclusion criteria. Two assessors independently assessed the quality of the identified studies and extracted relevant data. Results: Seven studies involving 1656 patients were finally included. Our results showed that the metformin group had a 2.77% (SMD = 2.77, 95%CI [2.11, 3.43]; p < 0.00001) higher bone mineral density (BMD) than the thiazolidinedione group until 52 weeks; however, between 52 and 76 weeks, the metformin group had a 0.83% (SMD = −0.83, 95%CI: [−3.56, −0.45]; p = 0.01) lower BMD. The C-terminal telopeptide of type I collagen (CTX) and procollagen type I N-terminal propeptide (PINP) were decreased by 18.46% (MD = −18.46, 95%CI: [−27.98, −8.94], p = 0.0001) and 9.94% (MD = −9.94, 95%CI: [−16.92, −2.96], p = 0.005) in the metformin group compared with the TZD group.