The best perioperative management of renin–angiotensin system inhibitors (RASi) in patients undergoing noncardiac surgery has been an ongoing debate as a result of inconclusive previous studies and insufficient data for robust guidelines. Although continuation of RASi may lead to intraoperative hypotension, withholding might also cause postoperative complications. Our meta-analysis aims to explore the postoperative outcomes of strategies of RASi management before surgery by evaluating randomised clinical trials, to provide more definitive conclusions for clinical practice. We systematically searched PubMed, Scopus, Cochrane, and Web of Science until September 2024. Inclusion criteria included patients (≥18 yr) who underwent noncardiac surgery and received long-term RASi, which were either withheld or continued before surgery. Statistical analysis was conducted using R Studio version 4.4.2. A total of seven RCTs with 8741 patients receiving long-term RASi before noncardiac surgery revealed no significant difference between continuation and withholding groups regarding cardiovascular complications (risk ratio [RR] 0.94, 95% confidence interval [CI] 0.80–1.09, P=0.41), mortality (RR 1.16, 95% CI 0.55–2.43, P=0.71), and acute kidney injury (RR 0.95, 95% CI 0.84–1.06, P=0.33). However, continuation of RASi was associated with a higher incidence of intraoperative hypotension (RR 1.33, 95% CI 1.23–1.44, P180 mm Hg) was significantly lower in the continuation group (RR 0.63, 95% CI 0.40–0.98, P<0.002). Continuing RASi before noncardiac surgery does not significantly impact mortality, cardiovascular complications or the risk of acute kidney injury. However, continuation is associated with an increased risk of intraoperative hypotension, and withholding with a higher risk of postoperative severe hypertension. CRD42024605208 (PROSPERO).

Acute ischemic stroke (AIS) is a leading cause of mortality and disability worldwide. Recombinant human prourokinase (rhPro-UK) has emerged as a promising thrombolytic agent amid the global shortage of thrombolytics. We assessed the safety and efficacy of rhPro-UK in AIS patients within 4.5 h of stroke onset through a systematic review and meta-analysis of RCTs from PubMed, Web of Science, Scopus, and Cochrane until January 2024. Data were pooled using risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) in R version 4.3. PROSPERO ID: CRD42025638980. Three RCTs (2289 patients) were included. rhPro-UK showed comparable efficacy to recombinant tissue plasminogen activator (r-tPA) in excellent neurological recovery (mRS 0–1: RR 1.04, 95% CI [0.98, 1.10], P = 0.19) and functional independence (mRS 0–2: RR 1.00, 95% CI [0.96, 1.05], P = 0.87). However, rhPro-UK significantly reduced NIHSS scores at 24 h (MD −0.43, 95% CI [−0.85, −0.02], P = 0.04) and seven days (MD −0.85, 95% CI [−1.39, −0.30], P < 0.01), and decreased systemic bleeding (RR 0.60, 95% CI [0.49, 0.75], P < 0.01). No significant differences were observed in 90-day mortality (RR 1.13, 95% CI [0.62, 2.05], P = 0.69) or intracerebral hemorrhage (RR 0.83, 95% CI [0.61, 1.13], P = 0.23). rhPro-UK demonstrates comparable efficacy to r-tPA with reduced NIHSS scores and systemic bleeding, supporting its role as a cost-effective and safer alternative for AIS treatment within 4.5 h. Further investigation in stroke management protocols is warranted.

Background: Healive is an inactivated vaccine for hepatitis A virus developed in China and was found to be well-tolerated and highly immunogenic in adults and children. It is our aim this study to compare the safety and immunogenicity of Healive® with Havrix® and live attenuated vaccines in pediatric populations. Methods: A systematic search of PubMed, Scopus, Web of Science, and Embase databases was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing Healive with other vaccines were included. Results: Seven RCTs involving 3664 patients were included. Healive showed comparable efficacy to Havrix regarding seroconversion rates and GMT at one month (SMD = 0.24, 95% CI [-0.11 to 0.59]), but achieved better results at six (SMD = 0.85, 95% CI [0.57 to 1.07]) and seven months (SMD = 0.55, 95% CI [0.41 to 0.70]). When compared to live attenuated vaccines, Healive demonstrated superior GMT at one month (SMD = 0.31, 95% CI [0.07 to 0.56]) and two years (SMD = 0.36, 95% CI [0.06 to 0.67]). Conclusion: Healive appears to be effective and safe for preventing hepatitis A, providing at least five years of protection. This review underscores the importance of ongoing research to optimize hepatitis A vaccination strategies, including standardized assays for antigen content, clarification of protective antibody levels, and large-scale trials in regions of intermediate endemicity.