did not reach statistical significancep = 0.1113
While a visual examination of the funnel plot (see Materials Supplementary File S1, Figure S7 ) showed no pronounced asymmetry, Egger’s test approached but did not reach statistical significance (t = 1.71, df = 13, p = 0.1113; bias estimate = 1.0076, SE = 0.5897), suggesting no definitive evidence of publication bias or small-study effects for the MER subgroup.