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Scientific Reports Nov 2022Treatment planning is key to clinical success. Permanent teeth diagnosed with "irreversible pulpitis" have long been implied to have an irreversibly damaged dental pulp... (Meta-Analysis)
Meta-Analysis
Treatment planning is key to clinical success. Permanent teeth diagnosed with "irreversible pulpitis" have long been implied to have an irreversibly damaged dental pulp that is beyond repair and warranting root canal treatment. However, newer clinical approaches such as pulpotomy, a minimally invasive and biologically based procedure have re-emerged to manage teeth with pulpitis. The primary aim of the study was to conduct a meta-analysis to comprehensively estimate the overall success rate of pulpotomy in permanent teeth with irreversible pulpitis as a result of carious pulp exposure. The secondary aim of the study was to investigate the effect of predictors such as symptoms, root apex development (closed versus open), and type of pulp capping material on the success rate of pulpotomy. Articles were searched using PubMed, Scopus, CENTRAL, and Web of Science databases, until January 2021. Outcomes were calculated by pooling the success rates with a random effect model. Comparison between the different subgroups was conducted using the z statistic test for proportion with significance set at alpha = 0.05. A total of 1,116 records were retrieved and 11 studies were included in the quantitative analysis. The pooled success rate for pulpotomy in teeth with irreversible pulpitis was 86% [95% CI: 0.76-0.92; I = 81.9%]. Additionally, prognostic indicators of success were evaluated. Stratification of teeth based on (1) symptoms demonstrated that teeth with symptomatic and asymptomatic irreversible pulpitis demonstrated success rate of 84% and 91% respectively, with no significant difference (p = 0.18) using z-score analysis; (2) open apex teeth demonstrated a significantly greater success rate (96%) compared to teeth with closed apex (83%) (p = 0.02), and (3) pulp capping materials demonstrated that Biodentine yielded significantly better success rates compared to Mineral Trioxide Aggregate (MTA), calcium hydroxide, and Calcium Enriched Mixture (CEM.) Collectively, this is the first meta-analytical study to determine the clinical outcome of pulpotomy for carious teeth with irreversible pulpitis and it's predictors for success. Moreover, we identify the stage of root development and type of biomaterial as predictors for success of pulpotomy.
Topics: Humans; Pulpotomy; Pulpitis; Dentition, Permanent; Calcium Hydroxide; Root Canal Therapy
PubMed: 36385132
DOI: 10.1038/s41598-022-20918-w -
The Cochrane Database of Systematic... Apr 2015There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised.
OBJECTIVES
To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated).
SEARCH METHODS
Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies.
SELECTION CRITERIA
Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables.
DATA COLLECTION AND ANALYSIS
Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuous test may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to create receiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three. These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability.
MAIN RESULTS
There were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests to be used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. We assessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary target condition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95% CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration.
AUTHORS' CONCLUSIONS
There is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicate water-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a high proportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy.
Topics: Aged; Dehydration; Drinking Water; Electric Impedance; Female; Humans; Male; Mouth Diseases; Osmolar Concentration; Sensitivity and Specificity; Skin Physiological Phenomena; Symptom Assessment; Urine
PubMed: 25924806
DOI: 10.1002/14651858.CD009647.pub2 -
International Journal of Sports... Sep 2022Sleep, nutrition, active recovery, cold-water immersion, and massage were recently reported as the most used postmatch recovery methods in professional football....
BACKGROUND
Sleep, nutrition, active recovery, cold-water immersion, and massage were recently reported as the most used postmatch recovery methods in professional football. However, the recommendations concerning the effect of these methods remain unclear.
PURPOSE
To systematically review the literature regarding the effectiveness of the most common recovery methods applied to male and female football players (or other team sports) 72 hours postmatches and to provide graded recommendations for their use.
METHODS
A systematic search of the literature was performed, and the level of evidence of randomized and nonrandomized studies was classified as 1 or 2, respectively, with additional ++, +, and - classification according to the quality of the study and risk of bias. Graded recommendations were provided regarding the effectiveness of recovery methods for physical, physiological, and perceptive variables.
RESULTS
From the 3472 articles identified, 39 met the inclusion criteria for analysis. The studies' levels of evidence varied among methods (sleep: 2+ to 1++; nutrition: 2- to 1+; cold-water immersion: 2- to 1++; active recovery: 2- to 1+; and massage: 1- to 1+). Different graded recommendations were attributed, and none of them favored the effective use of recovery methods for physiological and physical parameters, whereas massage and cold-water immersion were recommended as beneficial for perceptive variables.
CONCLUSIONS
Cold-water immersion and massage can be recommended to recover up to 72 hours postmatch at a perceptive level. However, there is a current need for high-quality research that identifies effective recovery strategies that enhance recovery at the physical and physiological levels.
Topics: Female; Humans; Male; Athletic Performance; Massage; Soccer; Water
PubMed: 35961644
DOI: 10.1123/ijspp.2022-0038 -
Small (Weinheim An Der Bergstrasse,... Nov 2022Power generation by converting energy from the ambient environment has been considered a promising strategy for developing decentralized electrification systems to... (Review)
Review
Power generation by converting energy from the ambient environment has been considered a promising strategy for developing decentralized electrification systems to complement the electricity supply for daily use. Wet gases, such as water evaporation or moisture in the atmosphere, can be utilized as a tremendous source of electricity by emerging power generation devices, that is, moisture-enabled-electric nanogenerators (MEENGs). As a promising technology, MEENGs provided a novel manner to generate electricity by harvesting energy from moisture, originating from the interactions between water molecules and hydrophilic functional groups. Though the remarkable progress of MEENGs has been achieved, a systematic review in this specific area is urgently needed to summarize previous works and provide sharp points to further develop low-cost and high-performing MEENGs through overcoming current limitations. Herein, the working mechanisms of MEENGs reported so far are comprehensively compared. Subsequently, a systematic summary of the materials selection and fabrication methods for currently reported MEENG construction is presented. Then, the improvement strategies and development directions of MEENG are provided. At last, the demonstrations of the applications assembled with MEENGs are extracted. This work aims to pave the way for the further MEENGs to break through the performance limitations and promote the popularization of future micron electronic self-powered equipment.
Topics: Electric Power Supplies; Electricity; Electronics; Water
PubMed: 36135971
DOI: 10.1002/smll.202204603 -
Sports Medicine (Auckland, N.Z.) Jan 2021Cold-water immersion (CWI) is one of the main recovery methods used in sports, and is commonly utilized as a means to expedite the recovery of performance during periods... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cold-water immersion (CWI) is one of the main recovery methods used in sports, and is commonly utilized as a means to expedite the recovery of performance during periods of exercise training. In recent decades, there have been indications that regular CWI use is potentially harmful to resistance training adaptations, and, conversely, potentially beneficial to endurance training adaptations. The current meta-analysis was conducted to assess the effects of the regular CWI use during exercise training on resistance (i.e., strength) and endurance (i.e., aerobic exercise) performance alterations.
METHODS
A computerized literature search was conducted, ending on November 25, 2019. The databases searched were MEDLINE, Cochrane Central Register of Controlled Trials, and SPORTDiscus. The selected studies investigated the effects of chronic CWI interventions associated with resistance and endurance training sessions on exercise performance improvements. The criteria for inclusion of studies were: (1) being a controlled investigation; (2) conducted with humans; (3) CWI performed at ≤ 15 °C; (4) being associated with a regular training program; and (5) having performed baseline and post-training assessments.
RESULTS
Eight articles were included before the review process. A harmful effect of CWI associated with resistance training was verified for one-repetition maximum, maximum isometric strength, and strength endurance performance (overall standardized mean difference [SMD] = - 0.60; Confidence interval of 95% [CI95%] = - 0.87, - 0.33; p < 0.0001), as well as for Ballistic efforts performance (overall SMD = - 0.61; CI95% = - 1.11, - 0.11; p = 0.02). On the other hand, selected studies verified no effect of CWI associated with endurance training on time-trial (mean power), maximal aerobic power in graded exercise test performance (overall SMD = - 0.07; CI95% = - 0.54, 0.53; p = 0.71), or time-trial performance (duration) (overall SMD = 0.00; CI95% = - 0.58, 0.58; p = 1.00).
CONCLUSIONS
The regular use of CWI associated with exercise programs has a deleterious effect on resistance training adaptations but does not appear to affect aerobic exercise performance.
TRIAL REGISTRATION
PROSPERO CRD42018098898.
Topics: Adaptation, Physiological; Cold Temperature; Exercise; Humans; Immersion; Resistance Training; Water
PubMed: 33146851
DOI: 10.1007/s40279-020-01362-0 -
Journal of Physiotherapy Apr 2019What are the effects of aquatic exercise on disease severity, (non-)motor impairments, activity performance, fear of falling, and quality of life in people with...
QUESTIONS
What are the effects of aquatic exercise on disease severity, (non-)motor impairments, activity performance, fear of falling, and quality of life in people with Parkinson's disease (PD)? Does aquatic exercise have greater effects on these outcomes than other forms of exercise in people with PD?
DESIGN
Systematic review and meta-analysis of randomised controlled trials.
PARTICIPANTS
People with idiopathic PD.
INTERVENTION
Supervised aquatic exercise programs ≥ 2 weeks.
OUTCOMES MEASURES
The primary outcomes were disease severity, motor impairments, activity performance, and fear of falling. The secondary outcomes were non-motor impairments and quality of life.
RESULTS
Of the 129 identified records, seven trials met the inclusion criteria and six were meta-analysed (159 participants). One trial assessed the effect of aquatic exercise compared with control and found a significant improvement in the Unified Parkinson's Disease Rating Scale Part III (MD -4.6, 95% CI -7.5 to -1.7) in favour of aquatic exercise. Six studies compared aquatic exercise with land-based exercise after intervention (mean 7.2 weeks of training (SD 2.2); 159 participants). The effect of aquatic exercise was superior to land-based exercise on the Berg Balance Scale (MD 2.7, 95% CI 1.6 to 3.9), the Falls Efficacy Scale (MD -4.0, 95% CI -6.1 to -1.8) and the 39-item Parkinson's Disease Questionnaire (MD -6.0, 95% CI -11.3 to -0.6), with no other significant effects identified. The significant benefit on the Berg Balance Scale was maintained at the follow-up assessment (MD 6.3, 95% CI 2.1 to 10.5, 54 participants).
CONCLUSION
Aquatic exercise improves motor impairments in people with PD significantly more than no intervention. It also has slightly to moderately greater benefits than land-based exercise on balance capacity, fear of falling, and health-related quality of life. On other outcomes, the benefits of aquatic exercise are similar to those of land-based exercise.
TRIAL REGISTRATION
PROSPERO CRD42017077370.
Topics: Accidental Falls; Exercise Therapy; Humans; Motor Disorders; Parkinson Disease; Postural Balance; Quality of Life; Randomized Controlled Trials as Topic; Swimming Pools; Water
PubMed: 30904467
DOI: 10.1016/j.jphys.2019.02.003 -
Current Environmental Health Reports Dec 2023We performed a systematic review and meta-analysis on the relation between fluoride exposure and skeletal fluorosis (SF) using a novel statistical methodology for... (Meta-Analysis)
Meta-Analysis Review
PURPOSE OF REVIEW
We performed a systematic review and meta-analysis on the relation between fluoride exposure and skeletal fluorosis (SF) using a novel statistical methodology for dose-response modeling.
RECENT FINDINGS
Skeletal fluorosis, a major health issue that is endemic in some regions, affects millions of people worldwide. However, data regarding the dose-response relation between fluoride exposure and SF are limited and outdated. We included twenty-three studies in the meta-analysis. When comparing the highest versus the lowest fluoride category, the summary risk ratio (RR) for SF prevalence was 2.05 (95% CI 1.60; 2.64), with a value of 2.73 (95% CI 1.92; 3.90) for drinking water and 1.40 (95% CI 0.90; 2.17) for urinary fluoride. The RR by the risk of bias (RoB) was 2.37 (95% CI 1.56; 3.58) and 1.78 (95% CI 1.34; 2.36) for moderate and high RoB studies, respectively. The dose-response curve based on a one-stage cubic spline regression model showed an almost linear positive relation between exposure and SF occurrence starting from relatively low concentrations up to 5 mg/L and 2.5 mg/L, respectively, for water and urinary fluoride, with no substantial increase above this threshold. The RR for developing moderate-severe forms increases at 5.00 mg/L and 2.5 mg/L of water and urinary fluoride, respectively. Better-quality studies are needed to confirm these results, but greater attention should be given to water fluoride levels to prevent SF, in addition to the other potential adverse effects of fluoride exposure.
Topics: Humans; Fluorides; Fluorosis, Dental; Drinking Water; Prevalence
PubMed: 37861949
DOI: 10.1007/s40572-023-00412-9 -
Alimentary Pharmacology & Therapeutics Jan 2024Dietary approaches are recommended for the management of chronic constipation. Until now, there has been no systematic review and meta-analysis on foods, drinks and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dietary approaches are recommended for the management of chronic constipation. Until now, there has been no systematic review and meta-analysis on foods, drinks and diets in constipation.
AIMS
To investigate the effect of foods, drinks and diets on response to treatment, stool output, gut transit time, symptoms, quality of life, adverse events and compliance in adults with chronic constipation via a systematic review and meta-analysis.
METHODS
Studies were identified using electronic databases (12th July 2023). Intervention trials (randomised controlled trials [RCTs], non-randomised, uncontrolled) were included. Risk of bias was assessed using Cochrane 2.0 (RCTs) or JBI Critical Appraisal (uncontrolled trials). Data from RCTs only were synthesised using risk ratios (RRs), mean differences (MDs), standardised mean differences (95% CI) using random-effects.
RESULTS
We included 23 studies (17 RCTs, 6 uncontrolled; 1714 participants): kiwifruit (n = 7), high-mineral water (n = 4), prunes (n = 2), rye bread (n = 2), mango, fig, cereal, oat bran, yoghurt, water supplementation, prune juice, high-fibre diet, no-fibre diet (n = 1). Fruits resulted in higher stool frequency than psyllium (MD: +0.36 bowel movements [BM]/week, [0.25-0.48], n = 232), kiwifruits in particular (MD: +0.36 BM/week, [0.24-0.48], n = 192); there was no difference for prunes compared with psyllium. Rye bread resulted in higher stool frequency than white bread (MD: +0.43 BM/week, [0.03-0.83], n = 48). High-mineral water resulted in higher response to treatment than low-mineral water (RR: 1.47, [1.20-1.81], n = 539).
CONCLUSIONS
Fruits and rye bread may improve certain constipation-related outcomes. There is a scarcity of evidence on foods, drinks and diets in constipation and further RCTs are needed.
Topics: Adult; Humans; Psyllium; Constipation; Dietary Fiber; Diet; Mineral Waters
PubMed: 37905980
DOI: 10.1111/apt.17782 -
Rheumatology International Sep 2023This systematic review is aimed to evaluate the effects of balneotherapy with thermal mineral water for managing the symptoms and signs of osteoarthritis located at any...
This systematic review is aimed to evaluate the effects of balneotherapy with thermal mineral water for managing the symptoms and signs of osteoarthritis located at any anatomical site. The systematic review was conducted according to the PRISMA Statement. The following databases were consulted: PubMed, Scopus, Web of Science, Cochrane Library, DOAJ and PEDro. We included clinical trials evaluating the effects of balneotherapy as a treatment for patients with osteoarthritis, published in English and Italian language, led on human subjects. The protocol was registered in PROSPERO. Overall, 17 studies have been included in the review. All of these studies were performed on adults or elderly patients suffering from osteoarthritis localized to knees, hips, hands or lumbar spine. The treatment assessed was always the balneotherapy with thermal mineral water. The outcomes evaluated were pain, palpation/pressure sensibility, articular tenderness, functional ability, quality of life, mobility, deambulation, ability to climb stairs, medical objective and patients' subjective evaluation, superoxide dismutase enzyme activity, serum levels of interleukin-2 receptors. The results of all the included studies agree and demonstrated an improvement of all the symptoms and signs investigated. In particular, pain and quality of life were the main symptoms evaluated and both improved after the treatment with thermal water in all the studies included in the review. These effects can be attributed to physical and chemical-physical properties of thermal mineral water used. However, the quality of many studies resulted not so high due and, consequently, it is necessary to perform new clinical trial in this field using more correct methods for conducting the study and for processing statistical data.
Topics: Humans; Aged; Quality of Life; Balneology; Osteoarthritis; Mineral Waters; Pain
PubMed: 37301799
DOI: 10.1007/s00296-023-05358-7 -
The Science of the Total Environment Feb 2024Hydropower is commonly considered a renewable energy source. Nevertheless, this does not imply an absence of impacts on the riverine ecosystem, the extent of which is... (Review)
Review
Hydropower is commonly considered a renewable energy source. Nevertheless, this does not imply an absence of impacts on the riverine ecosystem, the extent of which is expected to increase in the coming years due to the energy transition from fossil fuels to renewable sources and for the climate change. A common consequence of hydroelectric power generation is hydropeaking, which causes rapid and frequent fluctuations in the water flow downstream of hydropower plants. The review incorporates 155 relevant studies published up until November 2023 and follows a systematic review method, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), which is a multi-stage systematic procedure for the identification and selection of research documents. The selected studies highlighted several prominent impacts of hydropeaking on aquatic environments. The primary effects include alterations in flow patterns, modification of water temperature, changes in sediment dynamics and fluctuations in dissolved gas levels. These alterations have been found to affect various aspects of aquatic ecosystems, including fish growth, behavior, reproductive success, habitat, and migration patterns, and benthic macroinvertebrate communities. Furthermore, hydropeaking can also lead to habitat fragmentation, erosion, and loss of riparian vegetation, thereby impacting terrestrial ecosystems that depend on the aquatic environment. Despite the body of literature reviewed, several knowledge gaps were identified, underscoring the need for further research. There is limited understanding of the long-term ecological consequences of hydropeaking and its cumulative effects on aquatic ecosystems. Additionally, there is lack of consensus regarding the quantification of ecosystem services, economic impact, soil moisture content, and weighted usable area due to flow fluctuation and global evolution of energy production from renewable energy sources. Addressing the identified research gaps is crucial for achieving a balance between energy production and the conservation of freshwater ecosystems in the context of a rapidly changing global climate.
Topics: Animals; Ecosystem; Power Plants; Renewable Energy; Fishes; Water
PubMed: 38101637
DOI: 10.1016/j.scitotenv.2023.169251