Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 3 appraisals
European journal of pediatrics
Oral dextrose gel vs standard care for the treatment of hypoglycemia in high-risk neonates: an open-label randomized controlled trial
UNLABELLED: To determine whether 40% dextrose gel with oral feeds reduces NICU admission for asymptomatic hypoglycemia compared with standard care with oral feeds in at-risk neonates within 48 h of life. Secondary objectives were to assess rebound and recurrent hypoglycemia, hyperglycemia, and exclusive breastfeeding at discharge and at 6 weeks. Open-label randomized controlled trial conducted at a tertiary hospital in South India between April 2023 and May 2024. Neonates born at ≥ 35 weeks of gestation with asymptomatic hypoglycemia within the first 48 h of life were randomly assigned to receive either 200 mg/kg of oral 40% dextrose gel with oral feeds or standard care with oral feeds alone. The primary outcome was NICU admission for hypoglycemia. A total of 193 neonates were enrolled, with 98 in the standard care group and 95 in the gel group. Baseline characteristics were comparable. NICU admission for hypoglycemia occurred in 4.2% in gel group and 12.2% in standard care group (RR 0.34, 95% CI 0.11-1.03; p = 0.06), with a number needed to treat of 13. Exclusive breastfeeding was higher in gel group at discharge (97% vs 76%; p < 0.001) and at 6 weeks (90% vs 69%; p < 0.001). Rebound hypoglycemia, recurrent hypoglycemia, and hyperglycemia were similar between groups. CONCLUSION: Oral dextrose gel was associated with fewer NICU admissions, but the primary outcome did not reach statistical significance. Improved breastfeeding rates were observed as secondary outcomes. These findings should be interpreted cautiously and confirmed in adequately powered studies. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2023/02/050027). WHAT'S KNOWN: • Oral 40% dextrose gel is an eff ective fi rst-line treatment for neonatal hypoglycemia and has been shown to reduce treatment failure and intravenous glucose use in previous trials. • Existing evidence is predominantly from high-income settings, with limited randomized data from low- and middle-income countries assessing pragmatic outcomes such as NICU admission. WHAT IS NEW: • In this open-label randomized controlled trial, oral dextrose gel was associated with fewer NICU admissions for hypoglycemia (4.2% vs 12.2%) and higher exclusive breastfeeding rates at discharge and 6 weeks compared with standard care. • These fi ndings support the potential utility of dextrose gel as a simple, low-cost intervention for managing neonatal hypoglycemia in resource-limited settings.
11 May 2026
Read appraisal →Journal of clinical ultrasound : JCU
Deep Learning Radiomics Model Based on Ultrasound Images Predicts Myometrial Infiltration of Endometrial Cancer
OBJECTIVE: This study aims to develop and validate a deep learning radiomics (DLR) model based on ultrasound images for non-invasively distinguishing the myometrial infiltration (MI) of patients with endometrial cancer (EC). METHODS: We retrospectively collected 310 patients with EC who underwent surgical resection from center 1 from September 2017 to January 2025, forming a training group and a validation group. An external testing group was comprised of 80 patients from center 2. We extracted deep learning (DL) features and radiomics features from ultrasound images, establishing a DLR model after dimensionality reduction. The receiver operating characteristic analysis was used to evaluate the practicality of the proposed model. The utility of the proposed model was evaluated using receiver operating characteristic, calibration, and decision curve analysis. RESULTS: A total of 390 EC patients were included in the study. In the validation set, the AUC of the radiomics model was 0.874 (0.774-0.949), and in the testing group, the AUC of the DL model was 0.844 (0.699-0.957). The DLR model was superior to radiomics models and DL models in interpreting images, and also outperformed the diagnostic performance of advanced ultrasound physicians. CONCLUSION: The DLR model based on ultrasound images can accurately and non-invasively distinguish the MI depth of EC patients, assisting doctors in formulating more favorable treatment plans for patients.
5 May 2026
Read appraisal →Regional anesthesia and pain medicine
Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials
BACKGROUND: Cesarean section (CS) rates have increased globally, necessitating effective anesthesia management. Single-shot spinal anesthesia has limitations due to its duration and the dose-limiting adverse effects of local anesthetics. OBJECTIVES: To evaluate the effectiveness and safety of intrathecal adjuvants combined with local anesthetics in the perioperative management of CS pain. DESIGN: Systematic review with network meta-analysis. DATA SOURCES: PubMed, Cochrane Library for Clinical Trials, and Embase. ELIGIBILITY CRITERIA: We included women undergoing CS under single-shot spinal anesthesia with any intrathecal drug or placebo added to a long-acting local anesthetic. We selected single- or double-blind, parallel-group, randomized controlled trials (RCTs) reported in English. We excluded crossover, non-randomized, up-and-down dose-finding studies and clinical trials comparing the same drugs in all study arms. RESULTS: We included 166 RCTs with 14 925 patients assigned to 32 interventions. Buprenorphine and diamorphine were the highest-ranked treatments for reducing pain intensity at 24 hours, though not statistically significant. Morphine alone or in combination with meperidine, neostigmine, epinephrine, or nalbuphine significantly increased the duration of effective analgesia and reduced opioid consumption. Dexmedetomidine and morphine significantly prolonged the motor block duration. The safety profile of intrathecal adjuvants was generally adequate. CONCLUSIONS: While the strength of evidence, overall, was very low to low, our study suggests that while none of the interventions significantly reduced pain intensity at 24 hours, several significantly prolonged effective analgesia and reduced postoperative opioid consumption. Dexmedetomidine and morphine prolonged the duration of motor block. None of the intrathecal adjuvants evaluated significantly increased the occurrence of severe adverse events. Future large-scale RCTs are essential to provide more robust evidence. PROSPERO REGISTRATION NUMBER: CRD42024479424.
4 Apr 2026
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