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Micheluzzi V, Burrai F, Casula M, Serra G, Al Omary S, Merella P, Casu G. Effectiveness of virtual reality on pain and anxiety in patients undergoing cardiac procedures: A systematic review and meta-analysis of randomized controlled trials. Curr Probl Cardiol 2024; 49:102532. [PMID: 38503359 DOI: 10.1016/j.cpcardiol.2024.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Cardiac procedures often induce pain and anxiety in patients, adversely impacting recovery. Pharmachological approaches have limitations, prompting exploration of innovative digital solutions like virtual reality (VR). Although early evidence suggests a potential favourable benefit with VR, it remains unclear whether the implementation of this technology can improve pain and anxiety. We aimed to assess by a systematic review and meta-analysis the effectiveness of VR in alleviating anxiety and pain on patients undergoing cardiac procedures. METHODS Our study adhered to the PRISMA method and was registered in PROSPERO under the code CRD42024504563. The search was carried out in the PubMed, Web of Science, Scopus, and the Cochrane Library databases in January 2024. Four randomized controlled trials were included (a total of 382 patients). Risk of bias was employed to assess the quality of individual studies, and a random-effects model was utilized to examine the overall effect. RESULTS The results showed that VR, when compared to the standard of care, had a statistically significant impact on anxiety (SMD = -0.51, 95 % CI: -0.86 to -0.16, p = 0.004), with a heterogeneity I2 = 57 %. VR did not show a significant difference in terms of pain when compared to standard care (SMD= -0.34, 95 % CI: -0.75 to -0.07, p = 0.10). The included trials exhibited small sample sizes, substantial heterogeneity, and variations in VR technology types, lengths, and frequencies. CONCLUSIONS VR effectively lowers anxiety levels in patients undergoing cardiac procedures, however, did not show a statistically significant difference on pain.
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Affiliation(s)
| | - Francesco Burrai
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Marta Casula
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giuseppe Serra
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Shadi Al Omary
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Pierluigi Merella
- Clinical and interventional cardiology, University Hospital, Sassari, Italy
| | - Gavino Casu
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
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Mahler JV, Solti M, Apóstolos-Pereira SL, Adoni T, Silva GD, Callegaro D. Vitamin D 3 as an add-on treatment for multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials. Mult Scler Relat Disord 2024; 82:105433. [PMID: 38211504 DOI: 10.1016/j.msard.2024.105433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Vitamin D deficiency has been linked to a higher risk of multiple sclerosis (MS) and disease progression. However, the efficacy of vitamin D3 as an adjuvant therapy for MS remains a controversial topic. OBJECTIVE To perform a systematic review and meta-analysis of randomized controlled trials to assess the impact of adjunct high-dose vitamin D3 on clinical and radiological outcomes. METHODS PubMed, Embase, and Cochrane Library were searched for trials published until December 18th, 2022. Authors independently selected randomized controlled trials involving patients with MS, with an intervention group receiving high dose (≥ 1000 IU/day) cholecalciferol and reporting clinical or radiological outcomes. Authors independently extracted data and assessed the risk of bias using a standardized, pilot-tested form. The meta-analysis was conducted using RStudio for EDSS at the last follow-up, ARR, and new T2 lesion count. RESULTS We included 9 studies with 867 participants. No significant reduction of EDSS (MD = 0.02, CI 95 % [-0.37; 0.41], p = 0.91), ARR (MD -0.03, CI 95 % [-0.08; 0.02], p = 0.26), or new T2 lesions (MD -0.59, CI 95 % [-1.24;0.07], p = 0.08) was observed at 6-24 months. We found no evidence of publication bias. CONCLUSION The findings of this meta-analysis strengthen current evidence that vitamin D3 supplementation has no significant impact on clinical outcomes in patients with MS. However, the non-significant reduction of new T2 lesions could precede long-term clinical benefits and should be validated in additional studies.
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Affiliation(s)
| | - Marina Solti
- School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Tarso Adoni
- Neuroimmunology Group, Department of Neurology, Hospital of Clinics of the University of São Paulo, São Paulo, Brazil
| | - Guilherme Diogo Silva
- Neuroimmunology Group, Department of Neurology, Hospital of Clinics of the University of São Paulo, São Paulo, Brazil
| | - Dagoberto Callegaro
- Neuroimmunology Group, Department of Neurology, Hospital of Clinics of the University of São Paulo, São Paulo, Brazil
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Spiezia L, Campello E, Simioni P, Lumbreras-Marquez MI. Whole blood viscoelastic testing profile and mortality in patients hospitalized with acute COVID-19 pneumonia: A systematic review and meta-analysis. Thromb Res 2024; 234:21-31. [PMID: 38142487 DOI: 10.1016/j.thromres.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Several studies have evaluated the possible association between whole blood viscoelastic testing (VET) parameters in patients hospitalized for acute Coronavirus disease 2019 (COVID-19) pneumonia and mortality. A few studies found no significant differences between survivors and non-survivors, though other studies identified potential predictors of COVID-19-related mortality. We conducted a systematic review and meta-analysis of the literature to evaluate the possible association between standard thromboelastometry/graphy parameters and mortality in patients hospitalized for acute COVID-19 pneumonia. METHODS Relevant studies were searched through MEDLINE, EMBASE, and Google Scholar from their inception until 15th June 2023. We aimed to identify any study including: i) adults admitted to intensive care units (ICU) or medicine wards (MW) for acute COVID-19 pneumonia; ii) viscoelastic testing; iii) mortality. RESULTS We included 13 studies: nine prospective and four retrospective, 231 (30.4 %) non-survivors and 528 (69.6 %) survivors. Mortality rates ranged from 12.8 % to 67.5 %. The studies using the TEG apparatus found a significant difference in K time in the Kaolin test among survivors vs. non-survivors (mean difference [MD] 0.20, 95 % confidence interval [CI] 0.12, 0.28, I2 0%). The studies using the rotational thromboelastometry apparatus found a significant difference in CT-INTEM (MD -17.14, 95 % CI -29.23, -5.06, I2 0%) and LI60-EXTEM (MD -1.00, 95 % CI -1.00, -1.00, I2 0%) assays among survivors vs. non-survivors. CONCLUSION We identified no specific hypercoagulable or hypocoagulable profile associated with mortality in patients with COVID-19-related pneumonia. Large prospective studies are needed to explore the possible prognostic role of VET in this subset of patients.
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Affiliation(s)
- Luca Spiezia
- General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padova University School of Medicine, Padova, Italy.
| | - Elena Campello
- General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padova University School of Medicine, Padova, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padova University School of Medicine, Padova, Italy
| | - Mario I Lumbreras-Marquez
- Universidad Panamericana School of Medicine, Mexico City, Mexico; Maternal-Fetal Medicine Division, Instituto Nacional de Perinatologia, Mexico City, Mexico
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El-Nakeep S, Madala S, Chidharla A, Surapaneni BK, Saha S, Martin B, Kasi A. Radical versus Local Surgical Excision for Early Rectal Cancer: A Systematic Review and Meta-Analysis. Arch Intern Med Res 2024; 7:1-11. [PMID: 38605826 PMCID: PMC11008054 DOI: 10.26502/aimr.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Background Radical excision (RE) for rectal cancer carries a higher risk of mortality and morbidity, while local excision (LE) could decrease these postoperative risks. However, the long-term benefit of LE is still debatable. Aim To study the effectiveness of LE versus RE in T1 and T2 rectal cancer. Methods A systematic review and meta-analysis was conducted using key databases like PubMed and ClinicalTrials.gov. Only cohort studies and randomized controlled trials were included. RevMan 5.4 tool was used for data analysis. Both clinical and statistical heterogeneity of the studies were assessed, and I2 >75% was considered as highly heterogeneous. The primary outcomes being measured were 5-year overall survival (OS) and 5-year disease free survival (DFS). A subgroup analysis of patients with T1-only was also conducted, without adjuvant chemo/radiotherapy. Results A total of 18 studies were included for final meta-analysis. Four were RCTs, while the other 15 were retrospective cohort studies. One included study had data from both RCT and non-RCT study groups. Nine studies were multicentered or national studies while nine were unicentral.There was no difference in risk ratio (RR) between OS: RR 0.95, 95% Confidence Interval (CI) [0.91, 0.99] and DFS: RR 0.93, 95% CI [0.87, 1.01]. There were lower hazards ratios in OS: RR 1.41, 95% CI [1.14, 1.74] and DFS: RR 1.95, 95% CI [1.36, 2.78] with radical, as compared to LE. Lower recurrence rate was associated with RE. Random effect model was used due to clinical heterogeneity between studies (different surgical procedures, tumor staging, adjuvant chemo or radiotherapy). Conclusions LE for early-stage rectal cancer has lower 5-year OS and DFS than RE, with higher local recurrence rate. However, LE is associated with lower early postoperative mortality, morbidity and length of stay as compared to RE.
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Affiliation(s)
| | - Samragnyi Madala
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, United States; 52242
| | - Anusha Chidharla
- Division of Medical Oncology, University of Kansas Cancer Center, 2650 Shawnee Mission Pkwy, Westwood, KS, United States 66205
| | | | - Subhrajit Saha
- Division of Radiation Oncology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, United States: 66160
| | - Benjamin Martin
- Division of Colorectal Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, United States: 66160
| | - Anup Kasi
- Division of Medical Oncology, University of Kansas Cancer Center, 2650 Shawnee Mission Pkwy, Westwood, KS, United States 66205
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Miller ML, McGuire JF. Targeting intolerance of uncertainty in treatment: A meta-analysis of therapeutic effects, treatment moderators, and underlying mechanisms. J Affect Disord 2023; 341:283-295. [PMID: 37657623 DOI: 10.1016/j.jad.2023.08.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Anxiety-related disorders are among the most prevalent psychiatric conditions and cause significant impairment. Intolerance of uncertainty (IU) contributes to the emergence, maintenance, and symptom severity of anxiety-related disorders, yet information regarding treatment-related changes in IU is limited. This systematic review and meta-analysis examined the efficacy of evidence-based treatments for anxiety-related disorders on IU, explored factors moderating treatment effects of IU, and examined whether therapeutic improvement in IU corresponded with improvements in anxiety symptom severity. METHODS PubMED and PsycINFO were searched for randomized controlled trials (RCTs) using the terms "intolerance of uncertainty" AND "treatment" OR "therapy." Data for pre and post-treatment measures and patient, intervention, and trial-level characteristics were extracted from 28 RCTs. Separate random effects models examined the treatment efficacy of interventions on IU and symptom severity. Moderators of therapeutic effects were analyzed via method-of-moments meta-regression or an analog to the analysis of variance. RESULTS Across RCTs, interventions exhibited a large therapeutic effect on IU compared to control conditions (g = 0.89). Treatment effects on IU positively corresponded with improved symptom severity and accounted for 36 % of the variance. Interestingly, comorbid depression and certain treatment approaches were associated with larger improvements in IU. CONCLUSION Evidence-based treatments are effective in improving IU, highlighting the importance of IU in the treatment of anxiety-related disorders. Moderator analyses identified patient and intervention-level factors to inform approaches to improve therapeutic effects on IU. Future research is needed to optimize interventions targeting IU and evaluate long-term efficacy of interventions on IU for anxiety-related disorders.
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Affiliation(s)
- Michelle L Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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ZHANG M, HAO X, TANG Y, CHEN Y, HE P, ZHAO L, PANG B, NI Q. Efficacy and safety of Buyang Huanwu decoction for diabetic peripheral neuropathy: a systematic review and Metaanalysis. J TRADIT CHIN MED 2023; 43:841-850. [PMID: 37679971 PMCID: PMC10465838 DOI: 10.19852/j.cnki.jtcm.20230802.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/11/2022] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of Buyang Huanwu decoction (BYHWD) in treating diabetic peripheral neuropathy (DPN). METHODS Eight electronic databases, including China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, Chinese Biomedical Literature Database, Cochrane Library, Embase, Web of Science, and PubMed, were searched for randomized controlled trials (RCTs) of BYHWD to treat DPN. We identified all RCTs related to BYHWD and those on the treatment of DPN with the combination of mecobalamin. RevMan software was used for the statistical analysis. RESULTS Twentyone RCTs with a total of 1945 patients were included. The methodological quality of the literature included was low. Metaanalysis showed that the efficacy of the treatment group was significantly better than that of the control group in the treatment of DPN with BYHWD [risk ratio () = 0.33, 95% (0.27, 0.40), 11.25, 0.000 01]. The median nerve of median motor nerve conduction velocity (MNCV) [mean difference () = 4.16, 95% (1.35, 6.98)] and median sensory NCV (SNCV) [(= 3.28, 95% (2.35, 4.22)] were improved in the treatment group. The MNCV in the common peroneal nerve [(= 1.63, 95% (0.39, 2.87)] and SNCV [(= 4.56, 95% (3.16, 5.97)] were significantly higher than those in the control group ( 0.01). Plasma viscosity [(= -0.15, 95% (-0.20, -0.09), 5.17, 0.01)], whole blood high shear [(= 0.83, 95% (1.56, -0.11), 2.26, 0.02)]and whole blood low shear [(= 1.61, 95% (2.28, 0.94), 4.68, 0.01)] decreased significantly after treatment. There was no significant difference in fasting blood glucose [(= 0.42, 95% ( 0.89, 0.05), 1.76, 0.08)] between the treatment and control groups; postprandial blood glucose [(= 0.62, 95% ( 1.19, 0.05), 2.12, 0.03)] decreased significantly. No significant difference was found in the blood lipid levels between the treatment and control groups, including triglycerides [(= 0.21, 95% (0.52, 0.10), 1.34, 0.18)] and cholesterol [(= 0.13, 95% ( 0.27, 0.00), 1.92, 0.06)]. Of the 21 RCTs, only five reported adverse reactions, and four studies reported the length of followup. No serious adverse events were reported. None of the studies reported the quality of life and economic conditions. CONCLUSIONS Our study suggests that BYHWD has a significant therapeutic effect on DPN. Highquality, largescale RCTs are needed to provide more reliable evidence.
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Affiliation(s)
- Meizhen ZHANG
- 1 Department of Endocrinology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xiaohui HAO
- 2 Graduate School of Beijing University of Chinese Medicine, Beijing 100029, China
- 3 Department of Endocrinology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yiting TANG
- 1 Department of Endocrinology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yupeng CHEN
- 1 Department of Endocrinology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Puyu HE
- 1 Department of Endocrinology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Liming ZHAO
- 1 Department of Endocrinology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Bing PANG
- 1 Department of Endocrinology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Qing NI
- 1 Department of Endocrinology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China
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Abdelnaby R, Moawad MHED, Shabib AS, Mohamed KA, Ebrahim MA, Aboutaleb AM, Gaber DE, Serour AS, Shamim MA, Elberry MH, Bedewi MA, Elsayed M, Walter U. Sonographic vagus nerve atrophy in Parkinson's disease: Myth or fact? A systematic review and meta-analysis of recent evidence answers. Parkinsonism Relat Disord 2023; 112:105451. [PMID: 37236044 DOI: 10.1016/j.parkreldis.2023.105451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a major cause of disability. We aimed to assess the benefit of ultrasonography of the vagus nerve (VN) to compare between PD and healthy controls as well as to deliver reference values of nerve cross sectional area (CSA). MATERIALS AND METHODS We performed a systematic search on Medline (PubMed), Scopus, Embase, and Web of Science, up till July 25, 2022. After article selection and screening, we performed a quality assessment using the Newcastle-Ottawa Scale. Furthermore, a statistical analysis and subgroup analysis was performed. RESULTS Eleven studies were included with a total of 809 participants (409 PD patients and 400 controls). A statistically significant difference in the CSA of the right and left VN between PD patients and healthy controls was observed, indicating the atrophy of VN in PD patients (p < 0.00001). The subgroup meta-analysis for average measurements of VN CSA showed insignificant heterogeneity for age (I2 = 48.67%, p = 0.058), level of measurements (I2 = 57.91%, p = 0.05), and disease duration (I2 = 27.1%, p = 0.241). CONCLUSION Our meta-analysis showed a sonographically detectable degree of neuronal damage in PD, which correlates with VN atrophy with high confidence. Therefore, we believe this is a potential marker for vagus neuronal lesions. Future studies are required to assess the potential clinical correlation.
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Affiliation(s)
- Ramy Abdelnaby
- Department of Neurology, RWTH Aachen University, Aachen, Germany.
| | - Mostafa Hossam El Din Moawad
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | | | | | | | | | | | | | - Muhammad A Shamim
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India.
| | - Mostafa H Elberry
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Mohamed Abdelmohsen Bedewi
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia.
| | - Mohamed Elsayed
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany; Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, and the German Center of Neurodegenerative Diseases, Research Site Rostock, Rostock, Germany.
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Naghedi A, Varastehravan H, Haghaninejad H, Naghedi A, Farshadi N. Importance of so called "novel cardiovascular risk factors" in severity of coronary artery calcification; how serious they should be taken: a systematic review and metaanalysis. Arch Cardiol Mex 2023; 93:212-222. [PMID: 36634706 PMCID: PMC10161817 DOI: 10.24875/acm.210004061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/21/2022] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular diseases are among important causes of death. Atherosclerosis is an important etiology for coronary artery diseases in which coronary artery calcification plays a principal role. Recently novel cardiovascular risk factors in coronary calcification are under attention. In this study, we investigated possible association between novel cardiovascular risk factors and coronary calcification. This is a prospectively registered systematic review and meta-analysis in PROSPERO and was performed in accordance with PRISMA guidelines. Medical databases were searched. Primary papers were screened and studies reporting our outcomes of interest were selected for data extraction. Quantitative data syntheses were performed using Comprehensive Meta-analysis Ver.3. In this study, 5252 papers were screened and finally 28 papers including 31241 patients underwent data extraction. Based on our findings, neutrophil/lymphocyte ratio (8 out of 10), red cell distribution width (r = 0.250, p < 0.0001), and interleukin 6 (odds ratio [OR]: 1.101 [95% confidence interval (CI): 1.001-1.210], p = 0.047) were associated with severity of coronary calcification while C-reactive protein (one out of eight) was not associated with coronary calcification. Results of lymphocyte/monocyte ratio (r = -0.120, p < 0.001), platelet/lymphocyte ratio (OR: 1.47 [95% CI: 0.89-2.41, p = 0.124]), and MPV (r = 0.017, p = 0.814 vs. OR: 1.91 [95% CI: 1.28-2.85, p = 0.002]) remained controversial due to few number of included studies or contrary results. We can conclude that neutrophil/lymphocyte ratio, red cell distribution width, and interleukin-6 are significantly associated with coronary calcification and C-reactive protein is not significantly associated with severity of coronary calcification. Our results about mean platelet volume, platelet/lymphocyte ratio, and lymphocyte/monocyte ratio are not reliable and require further investigations.
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Affiliation(s)
- Aryan Naghedi
- Faculty of Medicine, Shahid Sadoughi University of Medical Sciences
| | - Hamidreza Varastehravan
- Department of Cardiology, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences
| | - Hasan Haghaninejad
- Department of Cardiology, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences
| | - Arvin Naghedi
- Department of Mathematics, Yazd University. Yazd, Iran
| | - Nima Farshadi
- Faculty of Medicine, Shahid Sadoughi University of Medical Sciences
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Mirshahi A, Khalilipour E, Faghihi H, Riazi-Esfahani H, Mirshahi R, Mehrjardi HZ, Najibzadeh E, Amini A, Nabavi A. Pars plana vitrectomy combined with phacoemulsification versus pars plana vitrectomy only for treatment of phakic rhegmatogenous retinal detachment: a systematic review and meta-analysis. Int Ophthalmol 2023; 43:697-706. [PMID: 35986229 DOI: 10.1007/s10792-022-02465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the visual, refractive, and anatomical outcomes and incidence of complications between combined pars plana vitrectomy and phacoemulsification (phacovitrectomy) versus pars plana vitrectomy (PPV-only) in phakic eyes with rhegmatogenous retinal detachment (RRD). METHODS Two independent reviewers searched MEDLINE, Cochrane Central, and Web of Science to identify relevant articles. Prospective or retrospective studies comparing PPV-only and phacovitrectomy for RRD were included. Recruited studies provided information about at least anatomical success or refractive outcomes. Meta-analysis was performed for single surgery success rate, final best-corrected visual acuity (BCVA), postoperative complications, mean predicted refractive error, and mean absolute predicted refractive error. RESULTS Seven studies (788 eyes) were selected, including two clinical trials and five retrospective comparative case series. The single surgery success rate was similar in PPV-only and phacovitrectomy groups (risk ratio [RR] = 1.02; 95% confidence interval [CI] 0.95-1.10; P = 0.57). Mean final BCVA was significantly better in the PPV-only group than the phacovitrectomy group (MD = 0.06; 95% CI 0.00-0.12; P = 0.04). The risk of epiretinal membrane formation was significantly higher in eyes that underwent phacovitrectomy than PPV-only (RR = 2.85; 0.95% CI 1.5-5.41; P = 0.001). Phacovitrectomy group showed a more myopic final mean predicted refractive error than PPV-only group (MD = -0.31; 95% CI -0.55--0.07; P = 0.01). CONCLUSION There was no significant difference between the two groups regarding the anatomical outcome. Slightly better visual and refractive results were observed in the PPV-only group. However, the results should be interpreted with caution as the majority of included studies were low-quality retrospective studies.
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Affiliation(s)
- Ahmad Mirshahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalilipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Romina Mirshahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Z Mehrjardi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Najibzadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdulrahim Amini
- Department of Ophthalmology, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Nabavi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. .,Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, Guilan University of Medical Sciences, 17th Shahrivar St, Rasht, Iran.
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Yao Y, Zhenni Z, Fengqin C, Yufei L, Xiangtian P, Xiao XU, Zhiling S. Effectiveness of moxibustion alone on lumbar disc herniation: a Metaanalysis of randomized controlled trials. J TRADIT CHIN MED 2023; 43:14-26. [PMID: 36639991 PMCID: PMC9924778 DOI: 10.19852/j.cnki.jtcm.20221108.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the available evidence from randomized controlled trials (RCTs) of moxibustion alone for lumbar disc herniation (LDH) treatment. METHODS A systematic search of 10 databases (until August 30, 2021) was used to identify studies that reported the response rate, visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score, and Oswestry Disability Index (ODI) score. Study selection and data extraction were independently performed by two reviewers. Cochrane criteria for risk of bias were used to assess the methodological quality of the trials. The Grading of Recommendations Assessment, Development, and Evaluation Methodology (GRADE) were also used to test the quality of the result evidence. RESULTS Nineteen RCTs, including 1888 patients, met the inclusion criteria. Five studies showed no difference between moxibustion and acupuncture on response rate [risk ratio () = 1.07, 95%(0.98, 1.16), = 0.11]. Meanwhile, six studies suggested that there is no significant difference between moxibustion and acupuncture on VAS score [mean difference () = -0.43, 95% (-0.91, 0.05), = 0.08]. Eight studies implied that there is no significant difference between moxibustion and acupuncture on JOA score [ = 0.84, 95% (-1.27, 2.96), = 0.44]. Two studies indicated that moxibustion may have equivalent effects for treating LDH in the VAS score in comparison with drug therapy [ = -1.16, 95% (-2.63, 0.31), = 0.12]. The evidence level of results was determined to be very low to low. CONCLUSIONS Based on the existing evidence, moxibustion may not be suitable for treating LDH alone, but it may be applied as an adjuvant treatment. Furthermore, welldesigned RCTs with high quality and larger samples are still needed to evaluate the efficacy and safety of moxibustion alone for LDH treatment.
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Affiliation(s)
- Yao Yao
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Zhao Zhenni
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Chen Fengqin
- Office of Academic Affairs, Nanjing Normal University of Special Education, Nanjing 210038, China
| | - Leng Yufei
- Auxiliary Teaching Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Pang Xiangtian
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - X U Xiao
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Sun Zhiling
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, China
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11
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Chandrasekharam VVS, Babu R. A systematic review and metaanalysis of open, conventional laparoscopic and robot-assisted laparoscopic techniques for re-do pyeloplasty for recurrent uretero pelvic junction obstruction in children. J Pediatr Urol 2022; 18:642-649. [PMID: 36117037 DOI: 10.1016/j.jpurol.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 08/14/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE About 3% of primary pyeloplasties may require a re-do pyeloplasty for recurrent uretero pelvic junction obstruction (UPJO) making it an uncommon operation even in large volume centers. In this MA we have compared the outcomes of open (OP), laparoscopic (LP) and robot assisted LP (RALP) approaches in managing recurrent UPJO. METHODS Pubmed/Index medicus etc. were searched for re-do pyeloplasty (Open OR Laparoscopic OR Robot-assisted) AND (Redo OR Reoperative OR failed) AND (child OR pediatric OR paediatric), for articles published between 2001 and 2021. Duplicate publications were identified and removed. Articles with grossly incomplete data and errors in reporting were excluded, as were articles reporting <5 cases. The systematic review was carried out according to PRISMA guidelines and meta-analysis of proportions was carried out using MetaXL 5.3. RESULTS A total of 18 articles on re-do pyeloplasty were included in the analysis. In total, there were 87, 77 and 123 redo pyeloplasties in OP, LP and RALP groups respectively. The I2 statistics for OP, LP and RALP showed low heterogeneity with I2 of 24%, 0% and 20% respectively. LFK index was 0.88, 0.30 and 1.62 for OP, LP and RALP respectively, suggesting no or minor publication bias. The overall success rates of OP, LP and RALP re-do pyeloplasty were 93.1% (95% CI 86-98), 92.1% (95% CI 83-96) and 89.4% (95% CI 83-96) respectively (summary table). The success rate between the techniques was not significantly different, with p values (x2) of 1 (OP vs LP), 0.5 (OP vs RALP) and 0.6 (LP vs RALP). Overall, redo RALP took significantly longer time than redo LP (p < 0.001, Fisher's). Overall, RALP had significantly shorter hospital stay than LP (p < 0.001) and LP had significantly shorter hospital stay than OP (p < 0.001). The complication rate was 9% in OP and LP and 16% in RALP, the difference being not statistically significant (p value 1, 0.26 and 0.27 for OP vs LP, OP vs RALP and LP vs RALP respectively, x2). CONCLUSIONS In conclusion MIS techniques (LP and RALP) seem to be good alternatives to OP for redo pyeloplasty in children, with comparable success and complications. Redo RALP had longer duration of surgery but shorter hospital stay than redo LP. With comparable success & complication rate between RALP and LP, this MA could not favor one over the other for redo pyeloplasty.
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Affiliation(s)
- V V S Chandrasekharam
- Pediatric Surgery, Pediatric Urology & MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India.
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12
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Neradi D, Sodavarapu P, Jindal K, Kumar D, Kumar V, Goni V. Locked Plating Versus Retrograde Intramedullary Nailing for Distal Femur Fractures: a Systematic Review and Meta-Analysis. Arch Bone Jt Surg 2022; 10:141-152. [PMID: 35655740 PMCID: PMC9117898 DOI: 10.22038/abjs.2021.53515.2656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/24/2021] [Indexed: 05/13/2023]
Abstract
Modern advances in techniques and implants have allowed for a better operative fixation for distal femoral fractures. Both locked plating and retromedullary nail have allowed surgeons to stabilize these fractures with minimal soft tissue dissection and preserve blood supply. Although both the implants have been used extensively for such types of fractures, the superiority of one implant over the other is still doubtful. Therefore, we conducted this meta-analysis to compare locked plating and retrograde intramedullary nailing in distal femoral fractures. Based on prisma guidelines, electronic databases, including PubMed, Embase, Scopus, and Ovid Medline were searched using a well-defined search strategy. Outcome measures which were studied included blood loss, implant failure, infection, knee range of motion, malunion, non-union, pain, surgical duration and union time Surgical duration (95% CI 2.90 to 17.13, p <0.01) and blood loss (95% CI 69.60 to123.18, p <0.01) favoured plating group and the difference is significant. But while analysing parameters like implant failure, knee range of motion, non-union and union time, our analysis favoured nailing group, but the difference is not significant. Overall, both locked plating and retrograde intramedullary nailing are comparable with respect to union and complications in distal femur fractures, but we need further larger and high quality randomized studies to evaluate the difference.
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Affiliation(s)
- Deepak Neradi
- Senior Resident, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Praveen Sodavarapu
- Senior Resident, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Karan Jindal
- Senior Resident, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Deepak Kumar
- Assistant Professor, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Vishal Kumar
- Assistant Professor, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Vijay Goni
- Professor, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Kaegi-Braun N, Faessli M, Kilchoer F, Dragusha S, Tribolet P, Gomes F, Bretscher C, Germann S, Deutz NE, Stanga Z, Mueller B, Schuetz P. Nutritional trials using high protein strategies and long duration of support show strongest clinical effects on mortality.: Results of an updated systematic review and meta-analysis. Clin Nutr ESPEN 2021; 45:45-54. [PMID: 34620354 DOI: 10.1016/j.clnesp.2021.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is increasing evidence from randomized-controlled trials demonstrating that nutritional support improves clinical outcomes in the population of malnourished medical inpatients. We investigated associations of trial characteristics including clinical setting, duration of intervention, individualization of nutritional support and amount of energy and protein, and effects on clinical outcomes in an updated meta-analysis. METHODS We searched Cochrane Library, MEDLINE and EMBASE, from inception to December 15, 2020. Randomized-controlled trials investigating the effect of oral and enteral nutritional support interventions, when compared to usual care, on clinical outcomes of malnourished non-critically ill medical inpatients were included. Two reviewers independently extracted data and assessed risk of bias. The primary endpoint was all cause-mortality within 12-months. RESULTS We included 29 randomized-controlled trials with a total of 7,166 patients. Heterogeneity across RCTs was high, with overall moderate study quality and mostly moderate or unclear risk of bias. Overall, there was an almost 30%-reduction in mortality in patients receiving nutritional support compared to patients not receiving nutritional support (253/2960 [8.5%] vs. 336/2976 [11.3%]) with an odds ratio of 0.72 (95% CI 0.57 to 0.91, p = 0.006). The most important predictors for the effect of nutritional trials on mortality were high protein strategies (odds ratio 0.57 vs. 0.93, I2 = 86.3%, p for heterogenity = 0.007) and long-term nutritional interventions (odds ratio 0.53 vs. 0.85, I2 = 76.2%, p for heterogenity = 0.040). Nutritional support also reduced unplanned hospital readmissions and length of hospital stay. CONCLUSIONS There is increasing evidence from randomized trials showing that nutritional support significantly reduces mortality, unplanned hospital readmissions and length of stay in medical inpatients at nutritional risk, despite heterogeneity and varying methodological quality among trials. Trials with high-protein strategies and long-lasting nutritional support interventions were most effective.
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Affiliation(s)
- Nina Kaegi-Braun
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Montserrat Faessli
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Fiona Kilchoer
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Saranda Dragusha
- Medical Faculty of the Università della Svizzera italiana, Switzerland
| | - Pascal Tribolet
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Filomena Gomes
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland; Nutrition Science Program, The New York Academy of Sciences, New York, USA; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Céline Bretscher
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Sara Germann
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Nicolaas E Deutz
- Center for Translational Research in Aging and Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, USA
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine, & Metabolism, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
| | - Beat Mueller
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland
| | - Philipp Schuetz
- University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, Switzerland and Medical Faculty of the University of Basel, Aarau, Basel, Switzerland.
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Zhou Q, Yuan M, Qiu W, Cao W, Xu R. Preclinical studies of mesenchymal stem cells transplantation in amyotrophic lateral sclerosis: a systemic review and metaanalysis. Neurol Sci 2021; 42:3637-3646. [PMID: 33433755 DOI: 10.1007/s10072-020-05036-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the quality of preclinical evidence for mesenchymal stromal cell (MSCs) therapy of amyotrophic lateral sclerosis (ALS), decide the effect size of MSCs treatment, and identify clinical parameters that associate with differences in MSCs effects. METHODS A literature search identified studies of MSCs in animal models of ALS. Four main indicators (age of onset, disease progression deceleration, survival time, hazard ratio reduction) obtained through specific neurobehavioral assessment, and 14 relative clinical parameters were extracted for metaanalysis and systematic review. Subgroup analysis and metaregression were performed to explore sources of heterogeneity. RESULTS A total of 25 studies and 41 independent treated arms were used for systematic review and metaanalysis. After adjusted by sensitivity analysis, the mean effect sizes were significantly improved by 0.28 for the age of onset, 0.25 for the disease progression deceleration, 0.54 for the survival time, and 0.48 for hazard ratio reduction. With further analysis, we demonstrated that both the clinical parameter of animal gender and immunosuppressive drug of cyclosporin A (CSA) had a close correlation with disease progression deceleration effect size. CONCLUSIONS These results showed that MSCs transplantation was beneficial for neurobehavioral improvement in the treatment of ALS animal model and recommended that all potential reparative roles of MSCs postdelivery, should be carefully considered and fused to maximize the effectiveness of MSCs therapy in ALS.
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Affiliation(s)
- Qi Zhou
- Department of Neurology, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China
| | - Min Yuan
- Department of Neurology, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China
| | - Weiwen Qiu
- Department of Neurology, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China
| | - Wenfeng Cao
- Department of Neurology, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China.
| | - Renshi Xu
- Department of Neurology, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, No. 152, Aiguo Road, Nanchang, 330006, Jiangxi, China.
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Restivo V, Candiloro S, Daidone M, Norrito R, Cataldi M, Minutolo G, Caracci F, Fasano S, Ciccia F, Casuccio A, Tuttolomondo A. Systematic review and meta-analysis of cardiovascular risk in rheumatological disease: Symptomatic and non-symptomatic events in rheumatoid arthritis and systemic lupus erythematosus. Autoimmun Rev 2021; 21:102925. [PMID: 34454117 DOI: 10.1016/j.autrev.2021.102925] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 12/14/2022]
Abstract
Although each autoimmune disease is associated with specific tissue or organ damage, rheumatic diseases share a pro-inflammatory pattern that might increase cardiovascular risk. Retrospective and prospective studies on patients affected by systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) highlighted the concept of "accelerated atherosclerosis". Therefore, the purpose of this systematic review and meta-analysis is the assessment of symptomatic or asymptomatic cardiovascular events among patients with rheumatic diseases as RA and SLE. The literature research obtained all manuscripts published in the English language between 2015 and 2019 for a total of 2355 manuscripts. After selection through inclusion and exclusion criteria, four articles examined cardiovascular risk in RA patients, 8 in SLE patients, and 2 in RA and SLE patients. Patients with SLE had a RR of 1.98 (95% CI: 1.18-3.31) of symptomatic cardiovascular events compared to the unexposed cohort. The meta-regression analysis showed that younger patient (age per year increase β = -0.12 95%CI: -0.20, -0.4), belonging to studies conducted in continent different from America (β = -0.89; -95% CI: 1.67, -0.10), after 2000 (β = 0.87; 95% CI: 0.09, 1.65) and with a higher quality score 0.80 (95% CI: 0.31, 1.29) had a higher risk of cardiovascular events. In patients with RA, the RR of cardiovascular events was 1.55 (95% CI: 1.18-2.02). These data are helpful to implement cardiovascular preventive strategies among people suffering from rheumatologic diseases to decrease the incidence of cardiovascular events. However, these implementation needs to build a higher network between rheumatologists and primary care healthcare workers to furnish the same information to patients and monitor their preventive practice compliance.
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Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy.
| | - Stefania Candiloro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Mario Daidone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Rosario Norrito
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Marco Cataldi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Giuseppa Minutolo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Francesca Caracci
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Serena Fasano
- Division of Rheumatology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Ciccia
- Division of Rheumatology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Antonino Tuttolomondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
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Sofi AA, Khan MA, Ahmad S, Khan Z, Peerzada MM, Sunguk J, Vargo J. Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis- a systematic review and meta-analysis. Pancreatology 2021; 21:854-861. [PMID: 33941467 DOI: 10.1016/j.pan.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/24/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Symptomatic pancreatic duct (PD) strictures in chronic pancreatitis refractory to single plastic stenting are usually managed by placement of multiple plastic stents (MPS). Fully covered self-expanding metallic stents (FCSEMS) have also been used in the management of these patients. However, the overall efficacy and safety of different types of stents is unclear from the currently available studies. We performed this meta-analysis to assess the efficacy and complications from MPS and FCSEMS in patients with PD strictures refractory to treatment with single plastic stents. METHODS Several electronic databases were searched for all the studies evaluating the outcome of placement of multiple plastic stents and fully covered metal stents in patients with PD strictures refractory to single plastic stenting. We calculated the Weighted Pooled Ratio (WPR) with Confidence Interval (CI) between the MPS and FCSEMS. RESULTS A total of 13 studies (including 2 abstracts) were included in the analysis. MPS were placed in 106 patients and FCSEMS in 192 patients. Improvement in pain after stenting (P = 0.794), risk of recurrence of pain after removal of stent (P = 0.48) and stricture recurrence after stent removal (P = 0.52) were comparable between MPS and FCSEMS. Risk of endoscopic re-intervention was also comparable between metal stents and MPS. However, FCSEMS was associated with overall higher risk of adverse events (P < 0.0001). CONCLUSION FCSEMS are comparable to multiple plastic stents in the treatment of symptomatic refractory PD strictures. However, use of FCSEMS is associated with increased risk of adverse events.
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Affiliation(s)
- Aijaz Ahmed Sofi
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Muhammad Ali Khan
- Division of Gastroenterology, University of Alabama, Birmingham, AL, USA
| | | | - Zubair Khan
- Division of Gastroenterology, University of Texas-Houston, Houston, TX, USA
| | | | - Jang Sunguk
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Vargo
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Barrett MC, Wilkinson FO, Blom AW, Whitehouse MR, Kunutsor SK. Incidence, temporal trends and potential risk factors for aseptic loosening following primary unicompartmental knee arthroplasty: A meta-analysis of 96,294 knees. Knee 2021; 31:28-38. [PMID: 34111799 DOI: 10.1016/j.knee.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aseptic loosening (AL) is among the major reasons for revision of failed primary unicompartmental knee arthroplasty (UKA). There is an ongoing temporal increase in the use of UKA with a resultant increase in the revision burden. We aimed to evaluate the incidence of, temporal trends and risk factors for AL. METHODS Longitudinal studies reporting the incidence of AL following primary UKA were sought from MEDLINE, Embase, Web of Science and Cochrane Library up to 6th April 2020. Incidence and relative risks (RR) (with 95% confidence intervals) were calculated. RESULTS We identified 62 studies for inclusion. Overall, 96,294 primary UKA procedures accounting for 1752 AL cases were included. AL incidence ranged from 0.00% to 22.70% over a 7.7 year weighted mean follow-up. The pooled random effects incidence (95% CI) was 1.77% (1.34-2.25) in the same follow-up period. The annual rate of AL was 0.10% (0.02-0.22). AL incidence increased with length of follow-up, but there was a temporal decrease from the 1970s onwards. Tibial loosening was more common than femoral component loosening: incidence (95% CI) of 1.63% (0.96-2.44) and 0.58% (0.20-1.09) respectively over a weighted follow-up of 6.6 years. Fixed bearing implant design and cemented fixation were both associated with increased AL risk, whereas robotic-assisted surgery was associated with decreased risk. CONCLUSION The overall incidence of AL following primary UKA is primarily driven by tibial component loosening and there is a temporal decline in rates. The use of mobile bearing, uncemented implants inserted with robotic assisted surgery may reduce the risk of AL.
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Affiliation(s)
- Matthew C Barrett
- Barts and The London School of Medicine and Dentistry, 4 Newark St, Whitechapel, London E1 2AT, UK.
| | - Florence O Wilkinson
- Barts and The London School of Medicine and Dentistry, 4 Newark St, Whitechapel, London E1 2AT, UK
| | - Ashley W Blom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
| | - Michael R Whitehouse
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
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18
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Bhurwal A, Tawadros A, Mutneja H, Gjeorgjievski M, Shah I, Bansal V, Patel A, Sarkar A, Bartel M, Brahmbhatt B. EUS guided pancreatic duct decompression in surgically altered anatomy or failed ERCP - A systematic review, meta-analysis and meta-regression. Pancreatology 2021; 21:990-1000. [PMID: 33865725 DOI: 10.1016/j.pan.2021.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION EUS-PD (EUS guided pancreatic duct drainage) is classified into two types: EUS-guided rendezvous techniques and EUS-guided PD stenting. Prior studies showed significant variation in terms of technical success, clinical success and adverse events. METHODS Three independent reviewers performed a comprehensive review of all original articles published from inception to June 2020, describing pancreatic duct drainage utilizing EUS. Primary outcomes were technical success, clinical success of EUS-PDD and safety of EUS-PD in terms of adverse events. All meta-analysis and meta-regression tests were 2-tailed. Finally, probability of publication bias was assessed using funnel plots and with Egger's test. RESULTS A total of sixteen studies (503 patients) described the use of EUS-PD for pancreatic duct decompression yielded a pooled technical success rate was 81.4% (95% CI 72-88.1, I 2 = 74). Meta-regression revealed that proportion of altered anatomy and method of dilation of tract explain the variance. Overall pooled clinical success rate was 84.6% (95% CI 75.4-90.8, I 2 = 50.18). Meta-regression analysis revealed that the type of pancreatic duct decompression, proportion of altered anatomy and follow up time explained the variance. Overall pooled adverse event rate was 21.3% (95% CI 16.8-26.7, I 2 = 36.6). The most common post procedure adverse event was post procedure pain. Overall pooled adverse event rate of post EUS-PD pancreatitis was 5% (95% CI 3.2-7.8, I 2 = 0). CONCLUSION The systematic review, meta-analysis and meta-regression provides answer to the questions of the overall technical success, clinical success and the adverse event rate of EUS-PD by summarizing the available literature.
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Affiliation(s)
- Abhishek Bhurwal
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States.
| | - Augustine Tawadros
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Hemant Mutneja
- Division of Gastroenterology and Hepatology, John H. Stroger Cook County Hospital, Chicago, IL, United States
| | - Mihajlo Gjeorgjievski
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Ishani Shah
- Department of Gastroenterology, BIDMC, Boston, United States
| | - Vikas Bansal
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, United States
| | - Anish Patel
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Avik Sarkar
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Michal Bartel
- Division of Gastroenterology and Hepatology, Fox Chase Cancer Center, Philadelphia, United States
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, United States
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19
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Mongkhon P, Fanning L, Wong KHTW, Man KKC, Wong ICK, Lau WCY. Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis. Europace 2021; 23:39-48. [PMID: 33085751 DOI: 10.1093/europace/euaa242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Comparative fracture risk for non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) among patients with atrial fibrillation (AF) remains unclear. This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs and fracture risk. METHODS AND RESULTS PubMed, EMBASE, and Cochrane Library were searched from 2010 to 26 May 2020. Observational studies investigating the association between NOACs vs. VKAs and fracture risk in patients with AF were included. The adjusted effect estimates were pooled using the DerSimonian-Laird random effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiological (MOOSE) guidelines were followed. Five observational studies comprising 269 922 patients and 4289 fractures were included. Non-vitamin K antagonist oral anticoagulants use was associated with a lower risk of any fractures compared to VKAs use, with moderate heterogeneity [pooled RR = 0.83, 95% confidence interval (CI): 0.75-0.92, P < 0.001, I2 = 73.0%]. When comparing individual NOAC to VKAs, a statistically significant lower risk of any fractures was found for rivaroxaban (pooled RR = 0.79, 95% CI: 0.71-0.88, P < 0.001, I2 = 55.2%) and apixaban (pooled RR = 0.75, 95% CI: 0.60-0.92, P = 0.007, I2 = 54.5%), but not dabigatran (pooled RR = 0.87, 95% CI: 0.74-1.01, P = 0.061, I2 = 74.6%). No differences were observed in all head-to-head comparisons between NOACs. CONCLUSION This large meta-analysis suggests that NOACs use was associated with a lower risk of fractures compared with VKAs. Fracture risks were similar between NOACs. These findings may help inform the optimal anticoagulant choice for patients with AF at high risk of fracture.
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Affiliation(s)
- Pajaree Mongkhon
- Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Faculty of Pharmacy, Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
| | - Laura Fanning
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.,Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK
| | - Kirstie H T W Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
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20
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Piotrowicz K, Gryglewska B, Grodzicki T, Gąsowski J. Arterial stiffness and frailty - A systematic review and metaanalysis. Exp Gerontol 2021; 153:111480. [PMID: 34265411 DOI: 10.1016/j.exger.2021.111480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/24/2022]
Abstract
Frailty and cardiovascular disease share some of the pathophysiologic features. Our objective was to review and metaanalyse the available published evidence on the topic. We performed a comprehensive literature search for studies where pulse wave velocity (PWV) or carotid-ankle vascular index (CAVI) has been linked with frailty in older persons. Of the initial 362 abstracts, after the application of the PRISMA approach, 5 were analysed in detail. We calculated within-study and pooled standardised mean differences of aortic stiffness measures between frail and non-frail (0.62 [0.31-0.92], p < 0.0001, I2 = 88%), and pre-frail and non-frail (0.32 [0.14-0.51], p = 0.0006, I2 = 72%) groups. In two studies it was possible to extract directly or calculate based on published data the odds ratios for the concomitant frailty, associated in one case with CAVI greater by 1 m/s and in another with cfPWV >13 m/s, indicating greater probability of concomitant frailty given greater aortic stiffness. Across the studies, the prevalence of hypertension, diabetes mellitus, hyperlipidaemia, and smoking tended to increase from non-frail, to pre-frail, and frail groups, presenting a possibility of important confounding, but also a common pathophysiology. In conclusion, the pooled analysis of the published cross-sectional study results indicates a relation between aortic stiffness and frailty in older subjects. However, well designed prospective studies are needed to answer the questions of causality.
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Affiliation(s)
- Karolina Piotrowicz
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kraków, Poland
| | - Barbara Gryglewska
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kraków, Poland
| | - Tomasz Grodzicki
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kraków, Poland
| | - Jerzy Gąsowski
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kraków, Poland.
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21
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Huang Y, Guo T. A commentary on "Efficacy of pulmonary rehabilitation in improving the quality of life for patients with chronic obstructive pulmonary disease: Evidence based on nineteen randomized controlled trials" (Int J Surg 2020; 73:78-86). Int J Surg 2021; 90:105986. [PMID: 34098076 DOI: 10.1016/j.ijsu.2021.105986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Yun Huang
- Department of Respiratory, The Fourth Affiliated Hospital of Anhui Medical University, Anhui, 230000, China
| | - Tao Guo
- Department of General Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Anhui, 230000, China.
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22
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Chan MF, Al Balushi R, Al Falahi M, Mahadevan S, Al Saadoon M, Al-Adawi S. Child and adolescent mental health disorders in the GCC: A systematic review and meta-analysis. Int J Pediatr Adolesc Med 2021; 8:134-145. [PMID: 34350324 PMCID: PMC8319685 DOI: 10.1016/j.ijpam.2021.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/25/2021] [Indexed: 12/01/2022]
Abstract
Background The Gulf Cooperation Council (GCC), with a predominant ‘youth bulge’ among its 54 million people, has witnessed an exponential increase in research pertinent to child and adolescent mental health (CAMH). Aside from a few narrative reviews, to date, no critical appraisal examining the magnitude of CAMH has emerged from this region. Aims This study aimed to report the prevalence rates of CAMH disorders in the GCC through a systematic review of the existing literature followed by a meta-analysis. Methods A systematic review of the literature from the six GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) was conducted. The databases used included Scopus, ProQuest, Pubmed, and a final check was performed on Google Scholar to account for any remaining studies that may have still been under review. Meta analytic techniques were then used to estimate prevalence rates of each specific mental disorder, i.e. ADHD, depression, anxiety, stress, eating disorders, and tobacco use disorder. Results A total of 33 studies from the six countries were included. The pooled prevalence of ADHD as per the Vanderbilt ADHD Diagnostic Rating Scale (VADHDDRS), clinical judgments, Attention Deficit Disorders Evaluation Scale (ADDES), and the Strengths and Difficulties Questionnaire (SDQ) was found to be 13.125%, 13.38%, 26.135%, and 12.83%, respectively. The pooled prevalence of depressive symptoms solicited by the Patient Health Questionnaire (PHQ-9), Depression, Anxiety, and Stress Scale (DASS), and Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) was 44.684%, 45.09%, and 26.12%, respectively. The pooled prevalence of anxiety according to the DASS and the MINI Kid was 57.04% and 17.27%, respectively, while the pooled prevalence of stress as per the DASS was found to be 43.15%. The pooled prevalence of disordered eating solicited by the Eating Attitudes Test (EAT-26) was 31.55%. Lastly, the pooled prevalence of tobacco use disorder per the Global Youth Tobacco Survey was 19.39%. Discussion To date, this is the first systematic review and meta-analysis of its kind from the GCC. The prevalence rate of CAMH disorders appears to be in the upper range of international trends. The higher rates could be attributed to the existing studies using suboptimal methodological approaches and instruments to solicit the presence of CAMH.
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Affiliation(s)
- Moon Fai Chan
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Rola Al Balushi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Maryam Al Falahi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sangeetha Mahadevan
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Muna Al Saadoon
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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23
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Ghimire S, Sharma S, Patel A, Budhathoki R, Chakinala R, Khan H, Lincoln M, Georgeston M. Diarrhea Is Associated with Increased Severity of Disease in COVID-19: Systemic Review and Metaanalysis. SN Compr Clin Med 2021;:1-8. [PMID: 33432303 DOI: 10.1007/s42399-020-00662-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
COVID-19 has become a pandemic since its emergence in Wuhan, China. The disease process was initially defined by presence of respiratory symptoms; however, it is now well studied and shown in evidence that this is a multisystem process. Involvement of gastrointestinal (GI) system has been identified, and GI symptoms can be the only presenting symptoms in some patients. Hence, it is important to identify and understand the GI symptoms associated with COVID-19 for appropriate care of patient. We conducted a systematic review and metaanalysis to identify the GI symptoms of COVID-19 and identify association of diarrhea with severity of COVID-19. We performed extensive search of Medline and Embase from December 2019 to May 2020 to identify articles reporting GI symptoms in COVID-19 patients. The primary outcome was prevalence of GI symptoms in COVID-19 patients, and secondary outcome was the association of diarrhea with disease severity. A total of 38 studies with 8407 patients were included. Of the total patients, 15.47% patients had at least one GI symptom. The pooled prevalence of nausea/vomiting was 7.53% and diarrhea was 11.52%. On metaanalysis, patients with diarrhea as one of the presenting symptoms were more likely to have severe disease (OR 1.63, 95% CI: 1.11–3.38, p = 0.01). Our systematic review and metaanalysis demonstrated that GI symptoms are common in COVID-19. Presence of diarrhea as a presenting symptom is associated with increased disease severity and likely worse prognosis. Early recognition of patients is needed for prompt management of this at-risk population.
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Monteiro LPB, Guerreiro MYR, de Castro Valino R, Magno MB, Maia LC, da Silva Brandão JM. Effect of intracanal cryotherapy application on postoperative endodontic pain: a systematic review and metaanalysis. Clin Oral Investig 2021; 25:23-35. [PMID: 33222053 DOI: 10.1007/s00784-020-03693-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the influence of intracanal cryotherapy application on postoperative pain after endodontic treatment. MATERIALS AND METHODS A systematic review (SR) was conducted in seven databases. Articles that were published up to 04 February 2020 were included and randomized clinical trials that used a cold saline solution for final irrigation to manage postoperative endodontic pain were compared with those that used a saline solution at room temperature. Metaanalysis was performed to assess postoperative pain after 6, 24, 48, and 72 h using a random effects model, a confidence interval of 95%, and heterogeneity tested by the I2 index. The certainty of evidence was rated using GRADE. RESULTS Qualitative and quantitative analysis included eight and six studies, respectively. Individuals treated with cryotherapy presented lower means of postendodontic pain than the controls, 6 and 24 h after endodontic treatment (MD - 1.30 [- 2.32, - 0.28] p = 0.01 and SMD - 0.68 [ - 1.21, - 0.16] p = 0.01, respectively, with very low certainty of evidence). After 48 and 72 h, both groups demonstrated similar means of postendodontic pain (MD - 0.06 [- 0.18, 0.07] p = 0.38 and SMD - 0.54 [- 1.18, - 0.11] p = 0.10, with high and low certainty of evidence, respectively). CONCLUSIONS Based on the limited quality evidence, intracanal cryotherapy application reduced postoperative endodontic pain after 6 and 24 h. New clinical trials are needed to support the result of this review. CLINICAL SIGNIFICANCE This SR provides information about the use of intracanal cryotherapy in clinical practice, guides clinicians to make evidence-based decisions and suggests recommendations for further high-quality studies.
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25
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Faulkner H, Chakankar S, Mammi M, Lo JYT, Doucette J, Al-Otaibi N, Abboud J, Le A, Mekary RA, Bunevicius A. Safety and efficacy of prothrombin complex concentrate (PCC) for anticoagulation reversal in patients undergoing urgent neurosurgical procedures: a systematic review and metaanalysis. Neurosurg Rev 2020; 44:1921-1931. [PMID: 33009989 DOI: 10.1007/s10143-020-01406-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/28/2020] [Accepted: 09/28/2020] [Indexed: 12/31/2022]
Abstract
Anticoagulant therapy poses a significant risk for patients undergoing emergency neurosurgery procedures, necessitating reversal with prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). Data on PCC efficacy lack consistency in this setting. This systematic review and metaanalysis aimed to evaluate efficacy and safety of PCC for anticoagulation reversal in the context of urgent neurosurgery. Articles from PubMed, Embase, and Cochrane databases were screened according to the PRISMA checklist. Adult patients receiving anticoagulation reversal with PCC for emergency neurosurgical procedures were included. When available, patients who received FFP were included as a comparison group. Pooled estimates of observational studies were calculated for efficacy and safety outcomes via random-effects modeling. Initial search returned 4505 articles, of which 15 studies met the inclusion criteria. Anticoagulants used included warfarin (83%), rivaroxaban (6.8%), phenprocoumon (6.1%), apixaban (2.2%), and dabigatran (1.5%). The mean International Normalized Ratio (INR) prePCC administration ranged from 2.3 to 11.7, while postPCC administration from 1.1 to 1.4. All-cause mortality at 30 days was 27% (95%CI 21, 34%; I2 = 44.6%; p-heterogeneity = 0.03) and incidence of thromboembolic events was 6.00% among patients treated with PCC (95%CI 4.00, 10.0%; I2 = 0%; p-heterogeneity = 0.83). Results comparing PCC and FFP demonstrated no statistically significant differences in INR reversal, mortality, or incidence of thromboembolic events. This metaanalysis demonstrated adequate safety and efficacy for PCC in the reversal of anticoagulation for urgent neurosurgical procedures. There was no significant difference between PCC and FFP, though further trials would be useful in demonstrating the safety and efficacy of PCC in this setting.
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Affiliation(s)
| | | | - Marco Mammi
- Neurosurgery Unit, Department of Neurosciences, University of Turin, via Cherasco 15, 10126, Turin, Italy
| | - Jack Yu Tung Lo
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Neurosurgery, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Joanne Doucette
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Nawaf Al-Otaibi
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Judi Abboud
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Andrew Le
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Rania A Mekary
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA. .,Neurosurgery Unit, Department of Neurosciences, University of Turin, via Cherasco 15, 10126, Turin, Italy.
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da Costa RMB, Poluha RL, De la Torre Canales G, Junior JFS, Conti PCR, Neppelenbroek KH, Porto VC. The effectiveness of microwave disinfection in treating Candida-associated denture stomatitis: a systematic review and metaanalysis. Clin Oral Investig 2020; 24:3821-3832. [PMID: 32974776 DOI: 10.1007/s00784-020-03599-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of microwave disinfection in treating Candida-associated denture stomatitis (CADS). MATERIALS AND METHODS The PubMed/MEDLINE, Embase, and Scopus databases were searched for reports on randomized clinical trials (RCTs) published in English until May 2020 (PROSPERO CRD42020192062) that evaluated the treatment of CADS by using microwave disinfection. The main outcomes were the improvement of clinical signs and/or the decrease in the residual yeast present on the dentures and palatal mucosa. The mean differences, standard deviations, risk ratio, and 95% confidence interval were calculated by using the random-effects model. Heterogeneity was assessed by using Cochran's Q test and I2 values. The level of significance was set at α = 0.05. RESULTS Five RCTs with 245 participants were included. The descriptive investigations demonstrated that microwave disinfection was as effective (p > 0.05) as 0.2% chlorhexidine, 0.02% sodium hypochlorite, and topical nystatin (100.000 IU/mL), and was superior to topical miconazole in treating CADS. The metaanalysis did not show a statistical difference between microwave disinfection and nystatin (100.000 IU/mL) treatment in terms of mycological counts, cure, and recurrence rates (p > 0.05). CONCLUSION Microwave disinfection showed comparable results with those of conventional therapies for treating CADS. In addition, treatment with 650 W for 3 min once a week for 14 days had better cost-effect results, indicating both the prevention and treatment of CADS. CLINICAL RELEVANCE Our findings provide evidence regarding the treatment of CADS using microwave disinfection, and also indicating the best cost-effective option for this treatment modality.
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Affiliation(s)
- Rodrigo Moreira Bringel da Costa
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil.
| | - Rodrigo Lorenzi Poluha
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Giancarlo De la Torre Canales
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Joel Ferreira Santiago Junior
- Department of Health Sciences, School of Dentistry, Centro Universitário Sagrado Coração - UNISAGRADO, Irmã Arminda St., 10-50, Bauru, SP, 17011-160, Brazil
| | - Paulo Cesar Rodrigues Conti
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Karin Hermana Neppelenbroek
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Vinicius Carvalho Porto
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
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Liu Q, Wu J. A commentary on "Arthroscopic Partial Meniscectomy Combined With Medical Exercise Therapy Versus Isolated Medical Exercise Therapy for Degenerative Meniscal Tear: A Meta-Analysis of Randomized Controlled Trials" (Int J Surg 2020 Jul; 79: 222-232). Int J Surg 2020; 82:229-230. [PMID: 32898665 DOI: 10.1016/j.ijsu.2020.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Qixi Liu
- Department of Nursing, Mindong Hospital of Fujian Medical University, Fujian Province, 355000, China
| | - Jingqing Wu
- Department of Bone and Joint Surgery, Mindong Hospital of Fujian Medical University, Fujian Province, 355000, China.
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Dzierlenga MW, Crawford L, Longnecker MP. Birth weight and perfluorooctane sulfonic acid: a random-effects meta-regression analysis. Environ Epidemiol 2020; 4:e095. [PMID: 33778349 DOI: 10.1097/EE9.0000000000000095] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Perfluorooctane sulfonic acid (PFOS) is a ubiquitous environmental contaminant. Most people in developed countries have detectable serum concentrations. Lower birth weight has been associated with serum PFOS in studies world-wide, many of which have been published only recently.
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Malik AH, Yandrapalli S, Shetty S, Aronow WS, Jain D, Frishman WH, Cooper HA, Panza JA. Impact of weight on the efficacy and safety of direct-acting oral anticoagulants in patients with non-valvular atrial fibrillation: a meta-analysis. Europace 2020; 22:361-367. [PMID: 31985781 DOI: 10.1093/europace/euz361] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 09/20/2023] Open
Abstract
AIMS This study sought to determine the impact of weight and body mass index (BMI) on the safety and efficacy of direct-acting oral anticoagulants (DOACs) compared with warfarin in patients with non-valvular atrial fibrillation. METHODS AND RESULTS A systematic literature search was employed in PubMed, Embase, and Cochrane clinical trials with no language or date restrictions. Randomized trials or their substudies were assessed for relevant outcome data for efficacy that included stroke or systemic embolization (SSE), and safety including major bleeding and all-cause mortality. Binary outcome data and odds ratios from the relevant articles were used to calculate the pooled relative risk. For SSE, the data from the four Phase III trials showed that DOACs are better or similarly effective with low BMI 0.73 (0.56-0.97), normal BMI 0.72 (0.58-0.91), overweight 0.87 (0.76-0.99), and obese 0.87 (0.76-1.00). The risk of major bleeding was also better or similar with DOACs in all BMI subgroups with low BMI 0.62 (0.37-1.05), normal BMI 0.72 (0.58-0.90), overweight 0.83 (0.71-0.96), and obese 0.91 (0.81-1.03). There was no impact on mortality in all the subgroups. In a meta-regression analysis, the effect size advantage of DOACs compared with warfarin in terms of safety and efficacy gradually attenuated with increasing weight. CONCLUSION Our findings suggest that a weight-based dosage adjustment may be necessary to achieve optimal benefits of DOACs for thromboembolic prevention in these patients with non-valvular atrial fibrillation. Further dedicated trials are needed to confirm these findings. PROSPERO 2019 CRD42019140693. Available from: https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42019140693.
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Affiliation(s)
- Aaqib H Malik
- Department of Medicine, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Suchith Shetty
- Department of Medicine, University of Iowa Healthcare, Carver College of Medicine, Iowa City, IA, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Diwakar Jain
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - William H Frishman
- Department of Medicine, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Howard A Cooper
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Li X, Chen Q, Zheng X, Li Y, Han M, Liu T, Xiao J, Guo L, Zeng W, Zhang J, Ma W. Effects of ambient ozone concentrations with different averaging times on asthma exacerbations: A meta-analysis. Sci Total Environ 2019; 691:549-561. [PMID: 31325855 DOI: 10.1016/j.scitotenv.2019.06.382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mounting evidence suggests that short-term exposure to ozone increases the risk of asthma exacerbations. However, ozone exposures have been assessed using ambient ozone concentrations averaged over different time periods in different studies. OBJECTIVE To evaluate the risks for asthma exacerbations related to ambient ozone measured as 1-hour or 8-hour daily maximum and 24-hour average concentrations. METHODS Based on a literature search in PubMed, EMBASE and Web of Science, we identified all time-series studies as of December 4th, 2018 and included 47 eligible studies in our analyses. Asthma exacerbation is defined as the risk for emergency room visits or hospital admissions. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) for a 10 μg/m3 increase in daily ozone concentration were estimated using random effect models. Subgroup analyses and sensitivity analyses were also performed to examine the risks for different seasons, regions and age groups and for the robustness of our main findings. RESULTS Significant and similar associations were found for O3-1 h max (RR,1.012; 95%CI, 1.005-1.019) and O3-8 h max (RR, 1.011; 95%CI, 1.007-1.014), while marginal effect was identified for O3-24 h average (RR, 1.005; 95%CI, 0.996-1.014). No significant publication bias but high heterogeneities were observed. During the warm season, ozone was significantly associated with asthma exacerbation. O3-1 h max had the highest RR of 1.014 (95%CI, 1.005-1.024), followed by O3-8 h max (RR, 1.012; 95%CI, 1.009-1.016), while marginal association was identified for O3-24 h avg (RR, 1.008; 95%CI, 0.998-1.017). During the cold season, null associations were identified for all the three averaging times. Variations were also observed in region and age. CONCLUSION Ozone exposure measured as 1-hour or 8-hour daily max were more consistently associated with asthma exacerbations than 24-hour average exposure during the warm season.
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Affiliation(s)
- Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Xueyan Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Yongzhi Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Min Han
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Junfeng Zhang
- Nicholas School of the Environment, Duke Global Health Institute, Duke University, Durham, NC 27705, USA; Duke Kunshan University, Kunshan, Jiangsu Province 215316, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China.
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Peer V, Schwartz N, Green MS. Consistent, Excess Viral Meningitis Incidence Rates in Young Males: A Multi-country, Multi-year, Meta-analysis of National Data. The Importance of Sex as a Biological Variable. EClinicalMedicine 2019; 15:62-71. [PMID: 31709415 PMCID: PMC6833362 DOI: 10.1016/j.eclinm.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sex can be an important biological variable in the immune response to infections and the response to vaccines. The magnitude and consistency in age-specific sex differences in the incidence of viral infections remain unclear. METHODS We obtained data from national official agencies on cases of viral meningitis by sex and age group over a period of 6-16 years from five countries: Canada, Czech Republic, Germany, Israel, and Poland. Male to female incidence rate ratios (RR) were computed for each year, by country, and age group. For each age group, we used meta-analysis methodology to combine the incidence RRs. Meta-regression was conducted to the estimate the effects of age, country, and time period on the RR. FINDINGS In the age groups < 1, 1-4, 5-9, 10-14, there were consistently higher incidence rates in males, over countries and time. The pooled incidence RRs (with 95% CI) were 1.38 (1.30-1.47), 1.94 (1.85-2.03), 1.98 (1.88-2.07), and 1.58 (1.47-1.71) respectively. In young and middle-age adults there were no differences with pooled incidence RRs of 1.00 (0.97-1.03), and 0.97 (0.94-1.00), respectively. Sensitivity analysis confirms that the results are stable and robust. Meta-regression showed that almost all the variations in the incidence RRs were contributed by age group. INTERPRETATION The higher incidence rates from viral meningitis in males under the age of 15 are remarkably consistent across countries and time-periods. These findings emphasize the importance of sex as a biological variable in infectious diseases. This could provide keys to the mechanisms of infection and lead to more personalized treatment and vaccine doses and schedules. FUNDING There was no funding source for this article.
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Affiliation(s)
| | | | - Manfred S. Green
- Corresponding author at: School of Public Health, University of Haifa, Abba Khoushy 199, Mount Carmel, Haifa 3498838, Israel.
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Rosca EC, Albarqouni L, Simu M. Montreal Cognitive Assessment (MoCA) for HIV-Associated Neurocognitive Disorders. Neuropsychol Rev 2019; 29:313-327. [PMID: 31440882 DOI: 10.1007/s11065-019-09412-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 07/15/2019] [Indexed: 01/01/2023]
Abstract
This study aims to systematically review the evidence on the accuracy of the Montreal Cognitive Assessment (MoCA) test for diagnosing HIV-associated neurocognitive disorders (HAND) and to outline the quality and quantity of research evidence available about the accuracy of MoCA in populations infected with HIV. We conducted a systematic literature review, searching five databases from inception until January 2019. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of MoCA. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Eight cross-sectional studies met the inclusion criteria for meta-analysis. Overall, 1014 patients were included but most studies recruited small samples. Recruitment period ranged from 2009 to 2015. We assessed most studies as being applicable to the review question though we had concerns about the selection of participants in three studies. The accuracy of MoCA for diagnosing HAND was reported at six cut-off points (scores 22-27). The MoCA test provides information about general cognitive functioning disturbances that contribute to a diagnosis of HAND. A lower threshold than the original cut-off of 26 is probably more useful for optimal screening of HAND, as it lowers false positive rates and improves diagnostic accuracy. Nonetheless, the choice of cut-off always comes with a sensitivity-specificity trade-off, the preferred cut point depending on whether sensitivity or specificity is more valuable in a given context.
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Affiliation(s)
- Elena Cecilia Rosca
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania. .,Department of Neurology, Clinical Emergency County Hospital, Bd. Iosif Bulbuca nr. 10, 300736, Timisoara, Romania.
| | - Loai Albarqouni
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Mihaela Simu
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.,Department of Neurology, Clinical Emergency County Hospital, Bd. Iosif Bulbuca nr. 10, 300736, Timisoara, Romania
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Froján-Parga MX, Núñez de Prado-Gordillo M, Álvarez-Iglesias A, Alonso-Vega J. Functional Behavioral Assessment-based interventions on adults' delusions, hallucinations and disorganized speech: A single case meta-analysis. Behav Res Ther 2019; 120:103444. [PMID: 31398535 DOI: 10.1016/j.brat.2019.103444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/29/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
The Functional Behavioral Assessment (FBA) approach involves the use of single-case designs (SCD) to study the problem behavior-environment contingencies and conduct interventions that consider this functional relationship. Although this approach has been considered an evidence-based practice (EBP) for the treatment of several psychological problems, no meta-analytic studies of FBA-based interventions on delusions, hallucinations and disorganized speech -commonly operationalized as "atypical vocalizations"- have been carried out. Therefore, the purpose of this study was to review and synthesize the results of FBA-based interventions on adults' atypical vocalizations. We conducted a systematic review and a multi-level meta-analysis of these interventions, using a recently developed effect size estimator for SCD studies (i.e., log response ratio). All the studies that met our eligibility criteria provided evidence supporting the effectiveness of FBA-based interventions on atypical vocalizations, with an overall average effect size of a 72% reduction. Both the publication year and the methodological quality were found to be significant moderators. Despite some methodological limitations, we can conclude that FBA-based interventions are effective to reduce atypical vocalizations. The implications of these results could be of interest for the mental health community.
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Spencer JC, Calo WA, Brewer NT. Disparities and reverse disparities in HPV vaccination: A systematic review and meta-analysis. Prev Med 2019; 123:197-203. [PMID: 30930259 PMCID: PMC6724708 DOI: 10.1016/j.ypmed.2019.03.037] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 01/20/2023]
Abstract
Studies disagree about whether racial and ethnic groups have lower or higher human papillomavirus (HPV) vaccination uptake, an important issue given large disparities in some HPV cancers. We sought to characterize and explain racial and ethnic differences in HPV vaccination. We systematically searched PubMed, CINAHL, Embase, and Web of Science to identify US studies through mid-2017 reporting associations of race and ethnicity with HPV vaccination. We identified 118 studies (n = 3,095,486) published in English that reported HPV vaccine initiation or follow-through in the US from which we could calculate effect sizes. We used random effects meta-analysis to synthesize effect sizes for comparisons of Whites or non-Hispanics to Blacks, Hispanics, Asians, or all minority groups combined. Studies showed no racial or ethnic differences in HPV vaccine initiation overall. However, when restricting to studies using provider-verified vaccination data, minorities were 6.1% [3.3%-8.8%] more likely than Whites to initiate HPV vaccination. Advantages were larger for Hispanics, males, and younger samples (age < 18). In contrast, minorities were 8.6% [5.6%, 11.7%], less likely than Whites to follow-through with the full HPV vaccine series, a disparity present across all participant and study characteristics. More recent studies found larger advantages for racial and ethnic minorities in HPV vaccine initiation and smaller disparities in follow-through. In summary, high-quality studies found racial and ethnic minorities are more likely to initiate but less likely to follow-through with HPV vaccination, a clear finding that self-report studies obscure. Higher HPV vaccine initiation among minorities suggests potential reductions in HPV cancer disparities.
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Affiliation(s)
- Jennifer C Spencer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America.
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America
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Li Y, Cai S, Ling Y, Mi S, Fan C, Zhong Y, Shen Q. Association between total sleep time and all cancer mortality: non-linear dose-response meta-analysis of cohort studies. Sleep Med 2019; 60:211-218. [PMID: 31182327 DOI: 10.1016/j.sleep.2019.03.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Appropriate total sleep time is reported to be associated with several important health outcomes. However, the relationship between total sleep time and all cancer mortality is not well defined because of inconsistent results from published studies, and no dose-response meta-analysis was performed to evaluate the exact dose-response relationship. METHODS We conducted a literature search of PubMed and Web of Science to identify all relevant epidemiological studies published before August 9, 2018. We performed categorical and non-linear dose-response meta-analyses to quantify the association between total sleep time and all cancer mortality. RESULTS Finally, we included 14 cohort studies in the present meta-analyses enrolling 866,877 participants with 43,021 cancer deaths. We found that total sleep time less than seven hours was not significantly associated with increased risk of all cancer mortality [relative risk (RR) = 1.02; 95% confidence interval (CI) = 0.99-1.05]. However, four to five hours total sleep time was related to an 8% increased risk of all cancer mortality (RR = 1.08; 95% CI = 1.02-1.13) in dose-response meta-analysis. Furthermore, long total sleep time (≥8 hours) was weakly associated with all cancer mortality (RR = 1.05; 95% CI = 1.02-1.08). However, the increment in total sleep time longer than nine hours was notably associated with an increased risk of cancer mortality. CONCLUSION The current meta-analysis provides evidence of a positive association between total sleep time of four to five hours and total sleep time longer than eight hours with the risk of all cancer mortality among the general population. Additional studies are needed to establish causality.
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Affiliation(s)
- Yingjun Li
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Shaofang Cai
- Department of Science and Education, Xiamen Second Hospital, Xiamen, China
| | - Yuxiao Ling
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Shuai Mi
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Chunhong Fan
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Yaohong Zhong
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Qing Shen
- School of Public Health, Hangzhou Medical College, Hangzhou, China.
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Krause M, Huhn M, Schneider-Thoma J, Bighelli I, Gutsmiedl K, Leucht S. Efficacy, acceptability and tolerability of antipsychotics in patients with schizophrenia and comorbid substance use. A systematic review and meta-analysis. Eur Neuropsychopharmacol 2019; 29:32-45. [PMID: 30472164 DOI: 10.1016/j.euroneuro.2018.11.1105] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/09/2018] [Indexed: 01/16/2023]
Abstract
Patients with schizophrenia and substance related comorbidity or substance induced psychotic disorder are difficult to treat. Although the prevalence of a comorbid substance use is approximately 40% in schizophrenia, such patients are usually excluded from clinical trials. We therefore performed a random-effects meta-analysis of all randomized controlled antipsychotic drug trials in this patient subgroup. We searched multiple databases up to May, 2018. The primary outcome was the reduction of substance user; secondary outcomes were craving, mean reduction of substance use, overall change in schizophrenia symptoms, positive and negative symptoms, response, dropouts, quality of life, social functioning, weight gain, sedation, prolactin, extrapyramidal side effects and use of antiparkinsonian medication. We identified 27 references from 19 RCTs published from 1999 to March 2017 including 1742 participants. The most frequent types of substance abuse were cannabis (8 studies) and cocaine (6 studies) use/dependence. Clozapine was superior to other antipsychotics for reduction of substance use and risperidone to olanzapine for craving. Olanzapine, clozapine and risperidone showed superiority for symptom reduction compared to some other drugs. When reported, results of side-effects followed known patterns. The evidence-base is considerable (19 RCTs), however, firm conclusions cannot be drawn due to small sample sizes of individual studies and insufficient reporting.
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Kalaian SA, Kasim RM. Effectiveness of various innovative learning methods in health science classrooms: a meta-analysis. Adv Health Sci Educ Theory Pract 2017; 22:1151-1167. [PMID: 28091976 DOI: 10.1007/s10459-017-9753-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 01/06/2017] [Indexed: 05/13/2023]
Abstract
This study reports the results of a meta-analysis of the available literature on the effectiveness of various forms of innovative small-group learning methods on student achievement in undergraduate college health science classrooms. The results of the analysis revealed that most of the primary studies supported the effectiveness of the small-group learning methods in improving students' academic achievement with an overall weighted average effect-size of 0.59 in standard deviation units favoring small-group learning methods. The subgroup analysis showed that the various forms of innovative and reform-based small-group learning interventions appeared to be significantly more effective for students in higher levels of college classes (sophomore, junior, and senior levels), students in other countries (non-U.S.) worldwide, students in groups of four or less, and students who choose their own group. The random-effects meta-regression results revealed that the effect sizes were influenced significantly by the instructional duration of the primary studies. This means that studies with longer hours of instruction yielded higher effect sizes and on average every 1 h increase in instruction, the predicted increase in effect size was 0.009 standard deviation units, which is considered as a small effect. These results may help health science and nursing educators by providing guidance in identifying the conditions under which various forms of innovative small-group learning pedagogies are collectively more effective than the traditional lecture-based teaching instruction.
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Yang B, Liu Y, Kan S, Zhang D, Xu H, Liu F, Ning G, Feng S. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis. Int J Surg 2017; 40:178-186. [PMID: 28288878 DOI: 10.1016/j.ijsu.2017.03.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Acute Achilles tendon rupture (AATR) is a frequent injury occurring dominantly in young to middle-aged males. Outcomes and complications between percutaneous and open repair are still controversial. Thus, the purpose of this meta-analysis is to evaluate the outcomes and complications of these two operative methods. MATERIALS AND METHODS We searched multiple databases: PubMed, Web of Science, EMBASE and the Cochrane Library up to October 2016. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by Rev Man 5.3 software. RESULTS Five randomized controlled trials (RCTs) and seven retrospective cohort studies involving 815 patients met the inclusion criteria. The sural nerve injury rate in the percutaneous group was significantly higher (RR = 3.52, 95%CI 1.45 to 8.57, P = 0.006). However, deep infection rate in the open group was higher (RR = 0.33, 95%CI 0.11 to 0.96, P = 0.04) and subgroup analysis of five RCTs showed no significant difference (RR = 0.42, 95%CI 0.09 to 2.10, P = 0.29). No significant difference was seen regarding the rate of re-rupture. The time of operation in the percutaneous group was shorter (RR = -1.99, 95%CI -3.81 to -0.80, P = 0.001). American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score showed statistically different in the two groups. Other functional outcomes were similar in the two groups. CONCLUSIONS Percutaneous repair has the advantages of operation time, deep infection and AOFAS score. The functional outcomes were similar in two treatment groups except AOFAS score. Despite the higher incidence of sural nerve injury, we still believe that percutaneous repair is superior to open repair for treating AATR.
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Affiliation(s)
- Bo Yang
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Yang Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Shunli Kan
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Di Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Hong Xu
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Feifei Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Guangzhi Ning
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
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Trivedi C, Upadhyay A, Solanki K. Efficacy of ranolazine in preventing atrial fibrillation following cardiac surgery: Results from a meta-analysis. J Arrhythm 2016; 33:161-166. [PMID: 28607609 PMCID: PMC5459427 DOI: 10.1016/j.joa.2016.10.563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/08/2016] [Accepted: 11/04/2016] [Indexed: 12/19/2022] Open
Abstract
Background Atrial fibrillation (AF) is a common complication after cardiac surgery. Ranolazine is a Food and Drug Administration approved anti-ischemic drug, which also has anti-arrhythmic properties. Recent studies have demonstrated the benefit of ranolazine in preventing post-operative AF (POAF) in patients undergoing cardiac surgery. Hence, we performed a meta-analysis of published studies comparing ranolazine plus standard therapy versus standard therapy for POAF prevention in patients undergoing cardiac surgery. Methods We performed a comprehensive search of Medline, Google Scholar, PubMed, abstracts from annual scientific sessions, and Cochrane library database for studies that assessed the effectiveness of ranolazine plus standard therapy by comparing it with standard therapy alone in preventing POAF in patients undergoing cardiac surgery. From all the studies, data on POAF events among groups were collected, and the random-effects (DerSimonian and Laird) method was used for meta-analysis. Results Four studies with 663 patients were included in the final analysis, with 300 and 363 patients in the ranolazine plus standard therapy and standard therapy groups, respectively. The types of cardiac surgeries were coronary artery bypass grafting (CABG), valve surgery or combination of CABG, and valve surgeries. After pooled analysis, ranolazine plus standard therapy was associated with a significant reduction in POAF events compared to standard therapy alone (risk ratio=0.44 [0.25, 0.78], p-value=0.005). There was no difference in adverse events between the two therapies. However, in one study, more patients in the ranolazine group had transient symptomatic hypotension after the surgery. Conclusions Ranolazine may prove beneficial in POAF prevention following cardiac surgeries. Although the pooled treatment effect is quite impressive with a reduction of more than 50% of risk of developing POAF, small number of studies and variation in ranolazine dose regimen in each study make our results inconclusive, but worthy of further investigation. That is why this result has to be interpreted as only hypothesis generating, rather than conclusion drawing.
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Affiliation(s)
- Chintan Trivedi
- St David׳s Healthcare, 1015 East 32nd Street, Austin, TX 78705, USA
| | - Ankit Upadhyay
- Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Kinjal Solanki
- Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY, USA
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Faraoni D, Schaefer ST. Randomized controlled trials vs. observational studies: why not just live together? BMC Anesthesiol 2016; 16:102. [PMID: 27769172 PMCID: PMC5073487 DOI: 10.1186/s12871-016-0265-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/07/2016] [Indexed: 12/21/2022] Open
Abstract
Randomized controlled trials (RCTs) are considered the gold standard for clinical research, thus having a high impact on clinical guidelines and our daily patients’ care. However, various treatment strategies which we consider “evidence based” have never been subject to a prospective RCT, as we would rate it unethical to withheld an established treatment to individuals in an placebo controlled trial. In a recent BMC Anesthesiology publication, Trentino et al. analyzed the usefulness of observational studies in assessing benefit and risk of different transfusion strategies. The authors nicely reviewed and summarized similarities and differences, advantages and limitations, between different study types frequently used in transfusion medicine. In this interesting article, the authors conclude, that ‘when comparing the results of observational studies with RCTs assessing transfusion outcomes, it is important that one consider not only the study method, but also the key elements of the study design’. Thus, in this commentary we now discuss the pro’s and con’s of different study types, even irrespective of transfusion medicine.
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Affiliation(s)
- David Faraoni
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Simon Thomas Schaefer
- Department of Anesthesiology, Ludwig-Maximilians University of Munich, Marchioninistraße 15, 81377, München, Germany.
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Zavala-González MA, Cabrera-Pivaral CE, Orozco-Valerio MDJ, Ramos-Herrera IM. [Effectiveness of interventions for improving drug prescribing in Primary Health Care]. Aten Primaria 2016; 49:13-20. [PMID: 27296077 PMCID: PMC6875915 DOI: 10.1016/j.aprim.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 02/14/2016] [Accepted: 02/23/2016] [Indexed: 12/03/2022] Open
Abstract
Objetivo Determinar la efectividad de las intervenciones para mejorar la calidad de la prescripción de medicamentos en unidades de atención primaria. Diseño Revisión sistemática y meta-análisis. Fuentes de datos Se buscó en MedLine, ScienceDirect, Springer, SciELO, Dialnet, RedALyC e Imbiomed en español, inglés y portugués, usando los descriptores: «calidad de la prescripción», «estudios de intervención» y «atención primaria», desde la indexación de cada base de datos hasta agosto de 2014. Selección de estudios Se incluyeron estudios experimentales y cuasi-experimentales con puntuación CASPe > 5, en los que se evaluó el efecto de una intervención de cualquier tipo sobre la calidad de la prescripción de tratamientos farmacológicos en atención primaria. Resultados Se encontraron 522 artículos de los que se analizaron 12 que reportaron 17 intervenciones: 64,7% educativas, 23,5% incorporación de farmacéuticos y 11,8% informáticas. Las fuerzas de asociación «intervención/mejora» fueron: intervenciones educativas OR = 2,47 (IC 95%: 2,28 a 2,69), incorporación de farmacéuticos OR = 3,28 (IC 95%: 2,58 a 4,18) e intervenciones informáticas OR = 10,16 (IC 95%: 8,81 a 11,71). Conclusiones Las intervenciones informáticas son más efectivas que las educativas y la incorporación del farmacéutico. Se requiere incorporar a los estudios de intervención variables alusivas al coste de implementación, gasto en medicamentos y otros gastos relacionados con la atención a la salud y el tratamiento de las enfermedades.
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Affiliation(s)
- Marco Antonio Zavala-González
- Programa de Doctorado en Ciencias de la Salud Pública, Departamento de Salud Pública, División de Disciplinas para el Desarrollo, Promoción y Preservación de la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.
| | - Carlos Enrique Cabrera-Pivaral
- Programa de Doctorado en Ciencias de la Salud Pública, Departamento de Salud Pública, División de Disciplinas para el Desarrollo, Promoción y Preservación de la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - María de Jesús Orozco-Valerio
- Programa de Doctorado en Ciencias de la Salud Pública, Departamento de Salud Pública, División de Disciplinas para el Desarrollo, Promoción y Preservación de la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Igor Martín Ramos-Herrera
- Programa de Doctorado en Ciencias de la Salud Pública, Departamento de Salud Pública, División de Disciplinas para el Desarrollo, Promoción y Preservación de la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
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Pyo JS, Sohn JH, Kang G. Core Needle Biopsy Is a More Conclusive Follow-up Method Than Repeat Fine Needle Aspiration for Thyroid Nodules with Initially Inconclusive Results: A Systematic Review and Meta-Analysis. J Pathol Transl Med 2016; 50:217-24. [PMID: 27077724 PMCID: PMC4876081 DOI: 10.4132/jptm.2016.02.15] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 01/21/2023] Open
Abstract
Background: This study investigated the appropriate management of thyroid nodules with prior non-diagnostic or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) through a systematic review and meta-analysis. Methods: This study included 4,235 thyroid nodules from 26 eligible studies. We investigated the conclusive rate of follow-up core needle biopsy (CNB) or repeat fine needle aspiration (rFNA) after initial fine needle aspiration (FNA) with non-diagnostic or AUS/FLUS results. A diagnostic test accuracy (DTA) review was performed to determine the diagnostic role of the follow-up CNB and to calculate the area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve. Results: The conclusive rates of follow-up CNB and rFNA after initial FNA were 0.879 (95% confidence interval [CI], 0.801 to 0.929) and 0.684 (95% CI, 0.627 to 0.736), respectively. In comparison of the odds ratios of CNB and rFNA, CNB had more frequent conclusive results than rFNA (odds ratio, 5.707; 95% CI, 2.530 to 12.875). Upon subgroup analysis, follow-up CNB showed a higher conclusive rate than rFNA in both initial non-diagnostic and AUS/FLUS subgroups. In DTA review of followup CNB, the pooled sensitivity and specificity were 0.94 (95% CI, 0.88 to 0.97) and 0.88 (95% CI, 0.84 to 0.91), respectively. The AUC for the SROC curve was 0.981, nearing 1. Conclusions: Our results show that CNB has a higher conclusive rate than rFNA when the initial FNA produced inconclusive results. Further prospective studies with more detailed criteria are necessary before follow-up CNB can be applied in daily practice.
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Affiliation(s)
- Jung-Soo Pyo
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Guhyun Kang
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
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Shazly SAM, Murad MH, Dowdy SC, Gostout BS, Famuyide AO. Robotic radical hysterectomy in early stage cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2015; 138:457-71. [PMID: 26056752 DOI: 10.1016/j.ygyno.2015.06.009] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/01/2015] [Accepted: 06/05/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare intraoperative and short-term postoperative outcomes of robotic radical hysterectomy (RRH) to laparoscopic and open approaches in the treatment of early stage cervical cancer. METHODS A search of MEDLINE, EMBASE (using Ovid interface) and SCOPUS databases was conducted from database inception through February 15, 2014. We included studies comparing surgical approaches to radical hysterectomy (robotic vs. laparoscopic or abdominal, or both) in women with stages IA1-IIA cervical cancer. Intraoperative outcomes included estimated blood loss (EBL), operative time, number of pelvic lymph nodes harvested and intraoperative complications. Postoperative outcomes were hospital stay and surgical morbidity. The random effects model was used to pool weighted mean differences (WMDs) and odds ratios (OR). RESULTS Twenty six nonrandomized studies were included (10 RRH vs abdominal radical hysterectomy [ARH], 9 RRH vs laparoscopic radical hysterectomy [LRH] and 7 compared all 3 approaches) enrolling 4013 women (1013 RRH, 710 LRH and 2290 ARH). RRH was associated with less EBL (WMD=384.3, 95% CI=233.7, 534.8) and shorter hospital stay (WMD=3.55, 95% CI=2.10, 5.00) than ARH. RRH was also associated with lower odds of febrile morbidity (OR=0.43, 95% CI=0.20-0.89), blood transfusion (OR=0.12, 95% CI 0.06, 0.25) and wound-related complications (OR=0.31, 95% CI=0.13, 0.73) vs. ARH. RRH was comparable to LRH in all intra- and postoperative outcomes. CONCLUSION Current evidence suggests that RRH may be superior to ARH with lower EBL, shorter hospital stay, less febrile morbidity and wound-related complications. RRH and LRH appear equivalent in intraoperative and short-term postoperative outcomes and thus the choice of approach can be tailored to the choice of patient and surgeon.
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Affiliation(s)
- Sherif A M Shazly
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Department of Obstetrics and Gynecology, Women Health Hospital, Assiut University, Egypt
| | - Mohammad H Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sean C Dowdy
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Bobbie S Gostout
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Abimbola O Famuyide
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
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SAYEHMIRI F, BABAKNEJAD N, BAHRAMI S, SAYEHMIRI K, DARABI M, REZAEI-TAVIRANI M. Zn/Cu Levels in the Field of Autism Disorders: A Systematic Review and Meta-analysis. Iran J Child Neurol 2015; 9:1-9. [PMID: 26664435 PMCID: PMC4670971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There is probably a relationship between zinc/cupper concentration in individuals with autism. The present review was written to estimate this probability by using meta-analysis method. MARTIALS & METHODS In this meta-analysis of Fixed Effect Model, by searching PubMed, Scopus and Google scholar databases, 11 articles were selected and verified published in 1978 to 2012. I² statistics were calculated to examine heterogeneity. The information was analyzed by R and STATA Ver. 11.2. RESULTS Due to non-uniform measurement methods of Zn/Cu concentrations, the concentration of these elements was measured in various subgroups (plasma, hair and general) in both study cases and controls. There was a significant statistical difference between plasma OR=0.252 (95% CI: -0.001-0.504) and hair OR=0.27(95% CI: 0.059-0.481, P=0.01) concentrations of Zn/Cu statuses between controls and autistic patients. Using a Fixed Effects Model, the overall integration of data from the two groups was significant as risk factor OR=0.31(95% CI:0.16-0.46, P=0.001). CONCLUSION Significant correlation existed between Zn/Cu levels and the development of autistic disorders in general analysis. Therefore, Zn/Cu levels could be mentioned as a pathogenesis reason of autism spectrum disorders.
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Affiliation(s)
- Fatemeh SAYEHMIRI
- Biochemistrist, Ilam University of Medical Sciences Research Committee, Ilam, Iran
| | - Nasim BABAKNEJAD
- Biochemistrist, Ilam University of Medical Sciences Research Committee, Ilam, Iran
| | - Somayeh BAHRAMI
- Biochemistrist, Ilam University of Medical Sciences Research Committee, Ilam, Iran
| | - Kourosh SAYEHMIRI
- Department of Biostatistics, Department of Social Medicine, School of Medicine, University of Ilam, Ilam, Iran
| | - Mojtaba DARABI
- Biochemistrist, Ilam University of Medical Sciences Research Committee, Ilam, Iran
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Walters WA, Xu Z, Knight R. Meta-analyses of human gut microbes associated with obesity and IBD. FEBS Lett 2014; 588:4223-33. [PMID: 25307765 DOI: 10.1016/j.febslet.2014.09.039] [Citation(s) in RCA: 579] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 12/14/2022]
Abstract
Recent studies have linked human gut microbes to obesity and inflammatory bowel disease, but consistent signals have been difficult to identify. Here we test for indicator taxa and general features of the microbiota that are generally consistent across studies of obesity and of IBD, focusing on studies involving high-throughput sequencing of the 16S rRNA gene (which we could process using a common computational pipeline). We find that IBD has a consistent signature across studies and allows high classification accuracy of IBD from non-IBD subjects, but that although subjects can be classified as lean or obese within each individual study with statistically significant accuracy, consistent with the ability of the microbiota to experimentally transfer this phenotype, signatures of obesity are not consistent between studies even when the data are analyzed with consistent methods. The results suggest that correlations between microbes and clinical conditions with different effect sizes (e.g. the large effect size of IBD versus the small effect size of obesity) may require different cohort selection and analysis strategies.
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Affiliation(s)
- William A Walters
- Department of Molecular, Cellular and Developmental Biology, University of Colorado, Boulder, CO 80309, USA
| | - Zech Xu
- BioFrontiers Institute, University of Colorado, Boulder, CO 80309, USA
| | - Rob Knight
- BioFrontiers Institute, University of Colorado, Boulder, CO 80309, USA; Department of Chemistry & Biochemistry, University of Colorado, Boulder, CO 80309, USA; Howard Hughes Medical Institute, Boulder, CO 80309, USA.
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Deodati A, Ferroli BB, Cianfarani S. Association between growth hormone therapy and mortality, cancer and cardiovascular risk: systematic review and meta-analysis. Growth Horm IGF Res 2014; 24:105-111. [PMID: 24818783 DOI: 10.1016/j.ghir.2014.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/23/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The potential involvement of growth hormone therapy in tumor promotion and progression has been of concern for several decades. Our aim was to assess systematically the association between growth hormone therapy and all-cause, cancer and cardiovascular mortality, cancer morbidity and risk of second neoplasm mainly in patients treated during childhood and adolescence. DESIGN A systematic review of all articles published until September 2013 was carried out. The primary efficacy outcome measures were the all-cause, cancer and cardiovascular standardized mortality ratios (SMR). The secondary efficacy outcome measures were the standardized incidence ratio (SIR) for cancer and the relative risk (RR) for second neoplasms. The global effect size was calculated by pooling the data. When the effect size was significant in a fixed model we repeated the analyses using a random model. RESULTS The overall all-cause SMR was 1.19 (95% CI 1.08-1.32, p<0.001). Malignancy and cardiovascular SMRs were not significantly increased. Both the overall cancer SIR 2.74 (95% CI 1.18-5.41), and RR for second neoplasms 1.99 (95% CI 1.28-3.08, p=0.002), were significantly increased. CONCLUSION The results of this meta-analysis may raise concern on the long-term safety of GH treatment. However, several confounders and biases may affect the analysis. Independent, long-term, well-designed studies are needed to properly address the issue of GH therapy safety.
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Affiliation(s)
- Annalisa Deodati
- D.P.U.O. "Bambino Gesù" Children's Hospital - "Tor Vergata" University, Rome, Italy
| | | | - Stefano Cianfarani
- D.P.U.O. "Bambino Gesù" Children's Hospital - "Tor Vergata" University, Rome, Italy; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Baandrup L, Thomsen LT, Olesen TB, Andersen KK, Norrild B, Kjaer SK. The prevalence of human papillomavirus in colorectal adenomas and adenocarcinomas: a systematic review and meta-analysis. Eur J Cancer 2014; 50:1446-61. [PMID: 24560489 DOI: 10.1016/j.ejca.2014.01.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/20/2014] [Accepted: 01/25/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of human papillomavirus (HPV) in colorectal cancer has been widely studied with conflicting results. We performed a systematic review and a meta-analysis to estimate the prevalence of HPV in colorectal adenocarcinomas and adenomas, and test the potential association. METHODS The pooled HPV prevalence was estimated using a random effects model and the I(2) statistic was used to describe the amount of heterogeneity. Potential sources of heterogeneity were evaluated by meta-regression and stratified analyses. For the studies on adenocarcinomas including control tissue, random effects estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS Thirty-seven studies were included. Among the 2630 adenocarcinomas, the pooled HPV prevalence was 11.2% (95% CI, 4.9-19.6%) with substantial between-study heterogeneity (I(2)=97.2%). The HPV prevalence varied by geographical region with highest prevalence in South America (45.1%, 95% CI, 21.9-69.4%), Asia (39.2%, 95% CI, 20.3-60.0%) and the Middle East (32.2%, 95% CI, 1.1-79.3%), and by detection method with the highest HPV prevalence in PCR-based studies. In the eight case-control studies, the pooled HPV prevalence was 36.8% (95% CI, 21.3-53.8%) in adenocarcinomas and 1.6% (95% CI, 0.0-9.6%) in controls giving an OR of 6.0 (95% CI, 2.0-17.9%) for the association between HPV and colorectal cancer. Among the 415 adenomas, the pooled HPV prevalence was 5.1% (95% CI, 0.0-17.8%; I(2)=93.7%). CONCLUSIONS HPV may be associated with a subset of colorectal cancers. Future large-scale multicenter case-control studies with data on risk factors such as lifestyle and sexual behaviour are needed.
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Affiliation(s)
- Louise Baandrup
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Tina Bech Olesen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Klaus Kaae Andersen
- Unit of Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Bodil Norrild
- Department of Cellular and Molecular Medicine, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark; Gynaecologic Clinic, Juliane Marie Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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