Objectives: We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes. Materials and methods: We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the “meta” package of RStudio software. Results: We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes. Conclusions: Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.

Introduction: Esophagectomy for esophageal cancer traditionally involves delayed postoperative oral feeding due to concerns about complications like anastomotic leakage. Enhanced Recovery After Surgery (ERAS) protocols favor early oral feeding (EOF), but its safety and benefits remain debated. This systematic review and meta-analysis compared EOF versus late oral feeding (LOF) after esophagectomy. Methods: We systematically searched PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library through March 2025 for primary studies comparing EOF (≤7 days post-op) with LOF (>7 days or delayed) in adult patients after esophagectomy. Outcomes included anastomotic leakage, pneumonia, other complications, gastrointestinal recovery, length of hospital stay (LOS), quality of life (QoL), and mortality. Results: Twenty-nine studies involving 3962 patients were included. There was no significant difference in the risk of anastomotic leakage between the two groups (RR: 1.03, 95% CI: 0.80–1.33, p = 0.82, I² = 0%). EOF was associated with a significantly shorter time to first flatus (Cohen’s d: −1.26, 95% CI: −1.93 to −0.58, p < 0.001) and first defecation (Cohen’s d: −0.87, 95% CI: −1.51 to −0.22, p = 0.01) and a shorter LOS (p = 0.01). No significant differences were found for other complications (acute respiratory distress syndrome [ARDS], chyle leak, conduit issues, ileus, sepsis, wound infection) or mortality rates (in-hospital, 30-day, 90-day, overall). QoL assessment suggested potential improvement in emotional function with EOF. Conclusions: EOF after esophagectomy appears safe, as it does not increase the risk of anastomotic leakage or other major complications compared to LOF. It is associated with faster gastrointestinal recovery and shorter hospital stays, supporting its use within ERAS protocols.

Objective: Adolescent depression is a significant public health concern, with prevalence rates increasing globally over recent years. Mobile-based cognitive behavioural therapy applications are increasingly used to address adolescent depression, but their effectiveness remains unclear. This study evaluated the impact of mobile-based cognitive behavioural therapy apps on depressive symptoms in this population, with secondary analyses examining anxiety, quality of life, usability and adverse events. Method: A systematic review identified 10 randomized controlled trials containing 1896 participants. These studies were published since 2014 and assessed the effects of mobile-based cognitive behavioural therapy for depression in adolescents (aged 13–25 years). Databases searched included MEDLINE, PsycINFO, Embase, PubMed and the Cochrane Library. Subsequent meta-analysis was conducted on nine studies ( n = 1127). Studies reporting depressive symptom outcomes were included in meta-analyses using a random-effects model. Results: Meta-analysis showed a significant reduction in depressive symptoms compared with the control groups (Cohen’s d = −0.24; 95% confidence interval = [−0.36, −0.13], p < 0.001), with negligible heterogeneity ( I ² = 0%). Meta-regression showed no significant association between follow-up duration and effect size. No significant effects were found for anxiety ( d = −0.16), but improvements were observed in quality of life ( d = 0.37) and usability ( d = 0.37). Adverse event rates were lower in the intervention groups (risk ratio = 0.68). Conclusion: Mobile-based cognitive behavioural therapy is a moderately effective short-term intervention for adolescent and young adult depression. These findings support its integration into mental health service delivery, although strategies to sustain long-term benefits are needed.

Background: Postnatal systemic steroids can reduce inflammation that contributes to bronchopulmonary dysplasia (BPD) in extremely preterm infants; however, prior experience with dexamethasone raised concerns regarding long-term neurodevelopmental harm. As a result, hydrocortisone has been proposed as a potentially safer alternative. Methods: We conducted a meta-analysis of randomized controlled trials comparing hydrocortisone with placebo/routine care in preterm infants, stratified by early prophylaxis (<7 days) or late treatment (≥7 days). We searched major databases through February 2026. The primary outcome was the composite of death or neurodevelopmental impairment (NDI) at 2 years of corrected age. Results: We included 17 studies representing seven distinct trials and their follow-up publications, comprising a total of 2,213 infants (1,096 receiving hydrocortisone and 1,117 receiving placebo). At 2 years, death/NDI occurred in 53.5% (531/993) of infants in the hydrocortisone group and 56.8% (581/1,023) of infants in the placebo group, with no significant effect observed with either early administration [risk ratio (RR) 0.89, 95% CI 0.70–1.13; I ²=0%] or late administration (RR 0.97, 95% CI 0.80–1.17; I ²=0%). Hydrocortisone was not associated with significant differences in death at 2 years (17.1% vs. 20.8%) or NDI at 2 years (42.5% vs. 43.9%) nor in cerebral palsy, hearing impairment, or visual impairment. Exploratory analyses showed no significant reduction in death or BPD at 36 week of postmenstrual age overall, and available school-age outcomes did not demonstrate differences in neurocognitive measures. Conclusion: Across randomized trials with long-term follow-up, postnatal hydrocortisone was not associated with improved survival free of NDI at 2 years nor was it associated with an increased risk of major neurodevelopmental or sensory impairments. These findings do not demonstrate an increased neurodevelopmental risk with hydrocortisone as used in current regimens, but its use should still be individualized based on respiratory phenotype, timing, and short-term monitoring for steroid-related adverse effects. Systematic Review Registration: PROSPERO CRD420261280132