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Prostate Cancer and Prostatic Diseases Sep 2014There is conflicting evidence regarding the role of folate on the risk of developing prostate cancer. We performed a systematic review and quantitative meta-analysis of... (Meta-Analysis)
Meta-Analysis Review
There is conflicting evidence regarding the role of folate on the risk of developing prostate cancer. We performed a systematic review and quantitative meta-analysis of folate blood levels and folate intake, and the risk of prostate cancer. Four electronic databases (Medline, PubMed, Embase and Current Contents Connect) were searched to 11 October 2013, with no language restrictions for observational studies that measured folate intake or blood levels and the risk of prostate cancer. Pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using a random effects model. The dietary folate meta-analysis comprising 11 studies with 15 336 cases and a total sample size of 146 782 found no statistically significant association with prostate cancer, with an OR of 0.97 (95% CI 0.89-1.06). The total folate meta-analysis comprising of 5 studies with 7114 cases and a total sample size of 93 781 also found no statistically significant association with prostate cancer, with an OR of 0.99 (95% CI 0.82-1.19). The blood folate meta-analysis comprising of seven studies with 6122 cases and a total sample size of 10 232 found an increased risk of prostate cancer with high blood folate levels, with an OR of 1.43 (95% CI 1.06-1.93). There was significant heterogeneity (I(2)=79.5%, P<0.01). Removal of an outlier study removed the heterogeneity (I(2)=0.0%, P=0.54) and the association remained significant with an OR of 1.14 (95% CI 1.02-1.28). Dietary and total folate intake do not appear to be significantly associated with the risk of prostate cancer. High blood folate levels are associated with an increased risk of prostate cancer. These conclusions are limited by the predominance of included studies originating from developed countries with mostly Caucasian populations. Further research in populations with a high prevalence of non-Caucasian backgrounds is needed.
Topics: Diet; Dietary Supplements; Folic Acid; Humans; Male; Odds Ratio; Prostatic Neoplasms; Risk
PubMed: 24819234
DOI: 10.1038/pcan.2014.16 -
Acta Orthopaedica Feb 2023Robotic-assisted total knee arthroplasty (RATKA) is an alternative surgical treatment method to conventional total knee arthroplasty (COTKA) that may deliver better... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Robotic-assisted total knee arthroplasty (RATKA) is an alternative surgical treatment method to conventional total knee arthroplasty (COTKA) that may deliver better surgical accuracy. However, its impact on patient outcomes is uncertain. The aim of this systematic review of randomized controlled trials (RCTs) is to evaluate whether RATKA could improve functional and radiological outcomes compared with COTKA in adult patients with primary osteoarthritis of the knee.
METHODS
We searched Ovid MEDLINE, EMBASE, Scopus, and the Cochrane Library to identify published RCTs comparing RATKA with COTKA. 2 reviewers independently screened eligible studies, reviewed the full texts, assessed risk of bias using the Risk of Bias 2.0 tool, and extracted data. Outcomes were patient-reported outcomes, range of motion, and mechanical alignment (MA) deviation and outliers, and complications.
RESULTS
We included 12 RCTs involving 2,200 patients. RATKA probably results in little to no effect on patient-reported outcomes (mean difference (MD) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of -0.35 (95% confidence interval [CI] -0.78 to 0.07) and range of motion (MD -0.73°; CI -7.5° to 6.0°) compared with COTKA. However, RATKA likely results in a lower degree of MA outliers (risk ratio 0.43; CI 0.27 to 0.67) and less deviation from neutral MA (MD -0.94°; CI -1.1° to -0.73°). There were no differences in revision rate or major adverse effects associated with RATKA.
CONCLUSION
Although RATKA likely results in higher radiologic accuracy than COTKA, this may not be clinically meaningful. Also, there is probably no clinically important difference in clinical outcomes between RATKA and COTKA, while it is as yet inconclusive regarding the revision and complication rates due to insufficient evidence.
Topics: Adult; Humans; Arthroplasty, Replacement, Knee; Robotic Surgical Procedures; Randomized Controlled Trials as Topic; Radiography; Knee Joint
PubMed: 36805771
DOI: 10.2340/17453674.2023.9411 -
Genetic Testing and Molecular Biomarkers Jan 2017Evidence supporting an association of intervertebral disc degeneration (DD) with polymorphisms of the vitamin D receptor (VDR) gene has been controversial. We performed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Evidence supporting an association of intervertebral disc degeneration (DD) with polymorphisms of the vitamin D receptor (VDR) gene has been controversial. We performed a meta-analysis of these studies to determine if there was substantial evidence to support such an association between the VDR polymorphisms and DD.
METHODS
PubMed, Embase, and Science Direct databases were searched for studies that investigated associations of the FokI (rs2228570, rs10735810), and ApaI (rs7975253) polymorphisms of the VDR gene with DD. From the extracted genotype data from 14 publications, we estimated risk (odds ratio [OR] with 95% confidence intervals).
RESULTS
Overall associations of FokI with DD were absent (OR 0.96-1.04, p = 0.73-0.95) with heterogeneity in the dominant and codominant models (p <0.10, I = 47-57%). Post-outlier pooled effects yielded dominant significance indicating reduced risk (OR 0.77, p = 0.01) with concomitant zero heterogeneity (I = 0%). ApaI effects pointed to reduced risks, with overall dominant significance (OR 0.69, p = 0.04) and Asian subgroup nonsignificance (OR 0.75-0.93, p = 0.17-0.74). In FokI, Non-Hispanic Caucasians (OR 0.77, p = 0.01) and males (OR 0.36-0.66, p = 0.001-0.04) were protected but not Hispanic Caucasians (OR 1.39-1.85, p = 0.006-0.05) and females (OR 1.72, p = 0.05). Tests of interaction between the genders highlighted female susceptibility and male protection (p = 0.001-0.005). Zero heterogeneity (I = 0%) is a key strength of these significant effects.
CONCLUSION
This meta-analysis confirmed the protective role of the ApaI polymorphism, however, susceptibility and protective effects of the FokI polymorphism may be ethnic and gender specific.
Topics: Case-Control Studies; Deoxyribonucleases, Type II Site-Specific; Female; Genetic Predisposition to Disease; Humans; Intervertebral Disc Degeneration; Male; Polymorphism, Single Nucleotide; Receptors, Calcitriol
PubMed: 27797588
DOI: 10.1089/gtmb.2016.0054 -
JAMA Network Open Feb 2024Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use.
OBJECTIVE
To summarize trials comparing alternative SBTs.
DATA SOURCES
Several databases (MEDLINE [from inception to February 2023], the Cochrane Central Register of Controlled Trials [in February 2023], and Embase [from inception to February 2023] and 5 conference proceedings (from January 1990 to April 2023) were searched in this systematic review and meta-analysis.
STUDY SELECTION
Randomized trials directly comparing SBT techniques in critically ill adults or children and reporting at least 1 clinical outcome were selected.
DATA EXTRACTION AND SYNTHESIS
Paired reviewers independently screened citations, abstracted data, and assessed quality for the systematic review and meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA guidelines). Data were pooled using random-effects models.
MAIN OUTCOMES AND MEASURES
Primary outcomes included SBT success, extubation success, and reintubation.
RESULTS
The systematic review and meta-analysis identified 40 trials that included 6716 patients. Low-quality evidence (14 trials [n = 4459]) suggested that patients were not more likely to pass a pressure support (PS) compared with a T-piece SBT (risk ratio [RR], 1.04; 95% CI, 0.97-1.11; P = .31; I2 = 73%), unless 1 outlier trial accounting for all heterogeneity was excluded (RR, 1.09; 95% CI, 1.06-1.12; P < .001; I2 = 0% [13 trials; n = 3939]; moderate-quality evidence), but were significantly more likely to be successfully extubated (RR, 1.07; 95% CI, 1.04-1.10; P < .001; I2 = 0%; 16 trials [n = 4462]; moderate-quality evidence). Limited data (5 trials [n = 502]) revealed that patients who underwent automatic tube compensation/continuous positive airway pressure compared with PS SBTs had a significantly higher successful extubation rate (RR, 1.10; 95% CI, 1.00-1.21; P = .04; I2 = 0% [low-quality evidence]). Compared with T-piece SBTs, high-flow oxygen SBTs (3 trials [n = 386]) had significantly higher successful extubation (RR, 1.06; 95% CI, 1.00-1.11; P = .04; I2 = 0%) and lower reintubation (RR, 0.37; 95% CI, 0.21-0.65; P = <.001; I2 = 0% [both low-quality evidence]) rates. Credible subgroup effects were not found.
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, the findings suggest that patients undergoing PS compared with T-piece SBTs were more likely to be extubated successfully and more likely to pass an SBT, after exclusion of an outlier trial. Pressure support SBTs were not associated with increased risk of reintubation. Future trials should compare SBT techniques that maximize differences in inspiratory support.
Topics: Adult; Child; Humans; Critical Illness; Ventilator Weaning; Oxygen; Continuous Positive Airway Pressure; Intubation, Intratracheal
PubMed: 38393729
DOI: 10.1001/jamanetworkopen.2023.56794 -
Journal of the American Heart... Oct 2017The recent finding that aortic pulse wave velocity (aPWV) is increased in patients with inflammatory bowel disease may explain why the cardiovascular risk is increased... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The recent finding that aortic pulse wave velocity (aPWV) is increased in patients with inflammatory bowel disease may explain why the cardiovascular risk is increased despite the low prevalence of traditional cardiovascular risk factors. We aimed to test whether inflammation is associated with aortic stiffening in this setting after adjustment for major confounders and to perform subgroup analyses.
METHODS AND RESULTS
A systematic literature search for aPWV in inflammatory bowel disease was performed using PubMed, Scopus, Web of Science, and Google Scholar databases (last accessed May 7, 2017). Inclusion criterion was peer-reviewed publications on clinical studies reporting original data. This study followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data 2015 guidelines. Data were provided for 4 cohorts in 3 countries (151 participants with ulcerative colitis, 159 with Crohn's disease, and 227 control patients). Using aPWV, cohort-specific scores were calculated after log-transform and combined in meta-analysis to form pooled effects using a random-effects model. Compared with controls, aPWV was increased in patients with Crohn's disease (mean difference 0.78 score; 95% confidence interval, 0.56-1.00 score [<0.001]) and ulcerative colitis (mean difference 0.75 score; 95% confidence interval, 0.52-0.97 score [<0.001]). In an outlier-robust multivariate linear regression model adjusted for prespecified confounders, aPWV was associated with disease duration (years, β=0.05 score; 95% confidence interval, 0.02-0.08 score [<0.001]) and white blood cell count (billion cells/L, β=0.07 score; 95% confidence interval, 0.02-0.11 score [=0.002]) but not with markers of acute inflammation (C-reactive protein and erythrocyte sedimentation rate), cardiovascular risk factors, and therapy.
CONCLUSIONS
The increased aPWV reported in patients with inflammatory bowel disease is associated with inflammation.
CLINICAL TRIAL REGISTRATION
URL: http://www.crd.york.ac.uk. Unique identifier: PROSPERO 2016: CRD42016053070.
Topics: Biomarkers; Blood Sedimentation; C-Reactive Protein; Cardiovascular Diseases; Colitis, Ulcerative; Crohn Disease; Humans; Inflammation; Inflammation Mediators; Leukocyte Count; Linear Models; Multivariate Analysis; Prognosis; Pulse Wave Analysis; Risk Factors; Vascular Stiffness
PubMed: 29018026
DOI: 10.1161/JAHA.117.007003 -
Heliyon Jan 2024This review aimed to harmoniously summarize and compare outlier rates for various cardiac troponin (cTn) assays, including high-sensitivity-cTn (hs-cTn) assays and... (Review)
Review
OBJECTIVES
This review aimed to harmoniously summarize and compare outlier rates for various cardiac troponin (cTn) assays, including high-sensitivity-cTn (hs-cTn) assays and contemporary cTn (generation of assays prior to hs-cTn ones) assays, from the published studies.
METHODS
The PRISMA guidelines were utilized to perform this systematic review. Five databases, including PubMed, Scopus, Embase, Cochrane Library, and Web of Science, were searched using specific keywords up to June 30th, 2023. Studies reporting specifically calculated outlier rates for cTn assays when conducting in-vitro diagnosis in human samples were included. Selected studies were then further assessed using the GRADE tool.
RESULTS
Thirteen studies were included. The data from the studies were summarized statistically in this review. The results showed substantial evidence of improved analytical robustness or reduced respective mean rates of outliers, critical outliers, and analytical outliers for hs-cTn assays (0.14 %, 0.18 %, and 0.18 %) compared to contemporary cTn assays (0.63 %, 0.71 %, and 0.50 %).
CONCLUSION
The findings offer promisingly provide a comprehensive reference for laboratory scientists and clinical staff in choosing the most suitable cTn assay for patient care regrading outlier rates. Besides, this review reveals the advancements of hs-cTn assays with lower outlier rates than contemporary cTn assays. The emerging challenges for continuously improving analytical robustness of cTn assays are also elaborated.
PubMed: 38205298
DOI: 10.1016/j.heliyon.2023.e23788 -
Comprehensive Psychiatry Apr 2023The aim of this systematic review and meta-analysis (PROSPERO 2020 CRD42020169323) was to evaluate the efficacy of psychological therapy for people with intellectual... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review and meta-analysis (PROSPERO 2020 CRD42020169323) was to evaluate the efficacy of psychological therapy for people with intellectual disabilities.
METHOD
A comprehensive literature search yielded 22,444 studies which were screened for eligibility. Studies were eligible for inclusion if a psychological therapy was delivered to people with intellectual disabilities compared to a group who did not receive the therapy. Thirty-three controlled trials were eligible for inclusion in the review, with 19 included within a DerSimonian-Laird random effects meta-analysis. Subgroup analysis was completed by clinical presentation, and by comparing randomised trials to non-randomised trials, and group-based to individually delivered psychotherapy.
RESULTS
Following the removal of outliers, psychological therapy for a range of mental health problems was associated with a small and significant effect size, g = 0.43, 95% CI [0.20, 0.67], N = 698. There was evidence of heterogeneity and bias due to studies with small sample sizes and a lack of randomisation. Non-randomised studies were associated with a large effect size, g = 0.90, 95% CI [0.47, 1.32], N = 174, while randomised studies were associated with a small effect size, g = 0.36, 95% CI [0.17, 0.55], N = 438, excluding outliers. Individually delivered psychological therapy was associated with a small and non-significant effect size, g = 0.32, 95% CI [-0.01, 0.65], N = 146, while group-based interventions were associated with a small and significant effect size, g = 0.37, 95% CI [0.05, 0.68], N = 361, again, excluding outliers. Psychological therapy for anger was associated with a moderate effect size, g = 0.60, 95% CI [0.26, 0.93], N = 324, while treatment for depression and anxiety was associated with a small and non-significant effect size, g = 0.38, 95% CI [-0.10, 0.85], N = 216, after outliers were removed.
CONCLUSIONS
Studies are fraught with methodological weaknesses limiting the ability to make firm conclusions about the effectiveness of psychological therapy for people with intellectual disabilities. Improved reporting standards, appropriately powered and well-designed trials, and greater consideration of the nature and degree of adaptations to therapy are needed to minimise bias and increase the certainty of conclusions.
Topics: Humans; Intellectual Disability; Psychotherapy; Anger; Anxiety; Anxiety Disorders
PubMed: 36724728
DOI: 10.1016/j.comppsych.2023.152372 -
The Clinical Neuropsychologist Jan 2017Computerized neuropsychological assessment of concussion has rapidly expanded and Immediate Post-Concussion and Cognitive Testing (ImPACT) is among the most commonly... (Review)
Review
OBJECTIVE
Computerized neuropsychological assessment of concussion has rapidly expanded and Immediate Post-Concussion and Cognitive Testing (ImPACT) is among the most commonly used measures in this domain. ImPACT was primarily developed for use with athletic populations but continues to expand beyond athletics to settings such as the workplace and schools where motivational dispositions may vary. The purpose of the present study was to conduct a systematic review of existing research investigating the prevalence of invalid baseline results and the effectiveness of ImPACT's embedded invalidity indicators in detecting suspect effort.
METHOD
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in order to systematically structure a search across four databases and analysis of studies that presented data related to the prevalence of invalid performance and/or the effectiveness of ImPACT's embedded invalidity indicators.
RESULTS
A total of 17 studies included prevalence rates of invalid performances or examined the effectiveness of ImPACT's invalidity indicators. Of the 17 studies, 12 included prevalence rates of invalid baseline results; and across this group of studies (after removing an outlier), the weighted prevalence rate of invalid baseline results was 6%. Four of the 17 studies examined the effectiveness of ImPACT's embedded invalidity indicators. ImPACT's embedded invalidity indicators correctly identified suboptimal effort in approximately 80% of individuals instructed to perform poorly and avoid detection ('coached') or instructed to perform poorly ('naïve').
CONCLUSIONS
These findings raise a number of issues pertaining to the use of ImPACT. Invalid performance incidence may increase with large group versus individual administration, use in nonclinical settings, and among those with Attention Deficit-Hyperactivity Disorder or learning disability. Additionally, the older desktop version of ImPACT appears to be associated with a higher rate of invalid performances than the online version. Although ImPACT's embedded invalidity indicators detect invalid performance at a rate of 6% on average, known group validity studies suggest that these measures miss invalid performance approximately 20% of the time when individuals purposefully underperform.
Topics: Brain Concussion; Cognition; Humans; Malingering; Neuropsychological Tests; Reproducibility of Results
PubMed: 27687890
DOI: 10.1080/13854046.2016.1220622 -
Brazilian Journal of Microbiology :... Mar 2024Aminoglycosides are vital antibiotics for treating Brucella infections, because they interfere with bacterial protein production and are often combined with other... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Aminoglycosides are vital antibiotics for treating Brucella infections, because they interfere with bacterial protein production and are often combined with other antibiotics. They are cost-effective, have fewer side effects, and can penetrate biofilms. The prevalence of brucellosis has increased in recent years, increasing the need for effective treatments. In addition, the emergence of multidrug-resistant Brucella strains has highlighted the need for an updated and comprehensive understanding of aminoglycoside resistance. This systematic review aimed to provide a comprehensive overview of the global prevalence of aminoglycoside resistance in B. melitensis and B. abortus.
METHODS
A systematic search of online databases was conducted and eligible studies met certain criteria and were published in English. Quality assessment was performed using the JBI Checklist. A random-effects model was fitted to the data, and meta-regression, subgroup, and outlier/influential analyses were performed. The analysis was performed using R and the metafor package.
RESULTS
The results of this systematic review and meta-analysis suggested that the average prevalence rates of streptomycin, gentamicin, and amikacin resistance were 0.027 (95% confidence interval [CI], 0.015-0.049), 0.023 (95% CI, 0.017-0.032), and 0.008 (95% CI, 0.002-0.039), respectively. The prevalence of streptomycin resistance was higher in the unidentified Brucella group than in the B. abortus and B. melitensis groups (0.234, 0.046, and 0.017, respectively; p < 0.02). The prevalence of gentamicin resistance increased over time (r = 0.064; 95% CI, 0.018 to 0.111; p = 0.007). The prevalence of resistance did not correlate with the quality score for any antibiotic. Funnel plots showed a potential asymmetry for streptomycin and gentamicin. These results suggest a low prevalence of antibiotic resistance in the studied populations.
CONCLUSION
The prevalence of aminoglycoside resistance in B. melitensis and B. abortus was low. However, gentamicin resistance has increased in recent years. This review provides a comprehensive and updated understanding of aminoglycoside resistance in B. melitensis and B. abortus.
Topics: Humans; Brucella melitensis; Brucella abortus; Aminoglycosides; Prevalence; Brucellosis; Anti-Bacterial Agents; Streptomycin; Gentamicins
PubMed: 38228936
DOI: 10.1007/s42770-023-01233-6 -
Journal of Shoulder and Elbow Surgery Jul 2016The last decade has shown a shift toward operative treatment of a subset of midshaft clavicle fractures. However, it is unclear whether there are differences between... (Meta-Analysis)
Meta-Analysis Review
Plate fixation or intramedullary fixation for midshaft clavicle fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies.
BACKGROUND
The last decade has shown a shift toward operative treatment of a subset of midshaft clavicle fractures. However, it is unclear whether there are differences between plate fixation and intramedullary fixation regarding complications and functional outcome. The aim of this systematic review and meta-analysis was to compare plate fixation and intramedullary fixation for midshaft clavicle fractures.
METHODS
The Medline, Embase, and Cochrane databases were searched for both randomized controlled trials and observational studies. The methodologic quality of all included studies was assessed using the Methodological Index for Non-Randomized Studies.
RESULTS
Twenty studies were included. Ten of the 20 included studies used a fracture classification. Seven of these studies reported exclusion of patients with comminuted fractures. No difference in the total re-intervention rate was found (odds ratio [OR], 1.21; 95% confidence interval [CI], 0.71 to 2.04). Major re-interventions occurred more often after plate fixation (OR, 1.88; 95% CI, 1.02 to 3.46). The mean implant removal rates were 38% after plate fixation and 73% after intramedullary fixation. Re-fracture after implant removal occurred more often after plate fixation (OR, 3.42; 95% CI, 1.12 to 10.42). The Constant-Murley scores showed no differences at both short term (mean difference, -1.18; 95% CI, -13.41 to 11.05) and long term (mean difference, 0.15; 95% CI, -1.57 to 1.87). No differences were observed regarding nonunion (OR, 1.50; 95% CI, 0.82 to 2.75). The rate of infections showed no differences when outlier studies were excluded (OR, 1.54; 95% CI, 0.88 to 2.69).
CONCLUSION
Major re-intervention and re-fracture after implant removal occurred more frequently after plate fixation of non-comminuted, displaced midshaft clavicle fractures. No differences in terms of function and nonunion between plate fixation and intramedullary fixation were observed.
Topics: Bone Plates; Clavicle; Device Removal; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Fractures, Bone; Humans; Observational Studies as Topic; Randomized Controlled Trials as Topic; Recurrence; Reoperation
PubMed: 27068381
DOI: 10.1016/j.jse.2016.01.018