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JAMA Network Open Jan 2022Oxygen supplementation is a cornerstone treatment in pediatric critical care. Accumulating evidence suggests that overzealous use of oxygen, leading to hyperoxia, is... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Oxygen supplementation is a cornerstone treatment in pediatric critical care. Accumulating evidence suggests that overzealous use of oxygen, leading to hyperoxia, is associated with worse outcomes compared with patients with normoxia.
OBJECTIVES
To evaluate the association of arterial hyperoxia with clinical outcome in critically ill children among studies using varied definitions of hyperoxia.
DATA SOURCES
A systematic search of EMBASE, MEDLINE, Cochrane Library, and ClinicalTrials.gov from inception to February 1, 2021, was conducted.
STUDY SELECTION
Clinical trials or observational studies of children admitted to the pediatric intensive care unit that examined hyperoxia, by any definition, and described at least 1 outcome of interest. No language restrictions were applied.
DATA EXTRACTION AND SYNTHESIS
The Meta-analysis of Observational Studies in Epidemiology guideline and Newcastle-Ottawa Scale for study quality assessment were used. The review process was performed independently by 2 reviewers. Data were pooled with a random-effects model.
MAIN OUTCOMES AND MEASURES
The primary outcome was 28-day mortality; this time was converted to mortality at the longest follow-up owing to insufficient studies reporting the initial primary outcome. Secondary outcomes included length of stay, ventilator-related outcomes, extracorporeal organ support, and functional performance.
RESULTS
In this systematic review, 16 studies (27 555 patients) were included. All, except 1 randomized clinical pilot trial, were observational cohort studies. Study populations included were post-cardiac arrest (n = 6), traumatic brain injury (n = 1), extracorporeal membrane oxygenation (n = 2), and general critical care (n = 7). Definitions and assessment of hyperoxia differed among included studies. Partial pressure of arterial oxygen was most frequently used to define hyperoxia and mainly by categorical cutoff. In total, 11 studies (23 204 patients) were pooled for meta-analysis. Hyperoxia, by any definition, showed an odds ratio of 1.59 (95% CI, 1.00-2.51; after Hartung-Knapp adjustment, 95% CI, 1.05-2.38) for mortality with substantial between-study heterogeneity (I2 = 92%). This association was also found in less heterogeneous subsets. A signal of harm was observed at higher thresholds of arterial oxygen levels when grouped by definition of hyperoxia. Secondary outcomes were inadequate for meta-analysis.
CONCLUSIONS AND RELEVANCE
These results suggest that, despite methodologic limitations of the studies, hyperoxia is associated with mortality in critically ill children. This finding identifies the further need for prospective observational studies and importance to address the clinical implications of hyperoxia in critically ill children.
Topics: Adolescent; Child; Child, Preschool; Critical Illness; Hospitalization; Humans; Hyperoxia; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Oxygen; Oxygen Inhalation Therapy
PubMed: 34985516
DOI: 10.1001/jamanetworkopen.2021.42105 -
Plastic and Reconstructive Surgery.... Mar 2022Functional recovery after peripheral nerve injury is often suboptimal despite the intrinsic permissive growth environment of the peripheral nervous system. The objective...
UNLABELLED
Functional recovery after peripheral nerve injury is often suboptimal despite the intrinsic permissive growth environment of the peripheral nervous system. The objective of this systematic review is to explore the use of electrical stimulation (ES) for peripheral nerve regeneration.
METHODS
A systematic literature search was conducted from inception to March 2, 2021 to retrieve articles on ES for peripheral nerve regeneration using the PubMed, Ovid MEDLINE, and Embase databases. Primary outcome measures included objective measures of motor and sensory nerve function.
RESULTS
Four randomized control trials, two case reports, and three case series that addressed the aims were identified. The stimulation parameters varied greatly between studies, without an apparent commonality for a given electrical conduit. Outcomes measured included motor (n = 8) and sensory (n = 7) modalities (cold detection, static two-point discrimination, tactile discrimination, and pressure detection), nerve-specific muscle function and bulk, and electromyography (EMG) motor and sensory terminal latency. Different parameters for measurement were utilized and improvement was observed across the studies compared with controls (n = 4) or pre-intervention measurements (n = 5). One randomized control trial reported no benefit of ES and attributed their findings to their stimulation protocol. Complications were documented in three patients only and included wire remnant removal, skin pigmentation, and bone formation.
CONCLUSIONS
ES in peripheral nerve regeneration is beneficial in improving and accelerating recovery. A meta-analysis was not performed due to the heterogeneity, but all studies showed positive findings and minor to no complications. These results provide a primer for further development of delivery methods.
PubMed: 35317464
DOI: 10.1097/GOX.0000000000004115 -
Reviews in Medical Virology Sep 2022The cornerstone of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection is reverse-transcription polymerase chain reaction (RT-PCR) of viral RNA. As a... (Meta-Analysis)
Meta-Analysis Review
The cornerstone of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection is reverse-transcription polymerase chain reaction (RT-PCR) of viral RNA. As a surrogate assay SARS-CoV-2 RNA detection does not necessarily imply infectivity. Only virus isolation in permissive cell culture systems can indicate infectivity. Here, we review the evidence on RT-PCR performance in detecting infectious SARS-CoV-2. We searched for any studies that used RT-PCR and cell culture to determine infectious SARS-CoV-2 in respiratory samples. We assessed (i) diagnostic accuracy of RT-PCR compared to cell culture as reference test, (ii) performed meta-analysis of positive predictive values (PPV) and (iii) determined the virus isolation probabilities depending on cycle threshold (Ct) or log genome copies/ml using logistic regression. We included 55 studies. There is substantial statistical and clinical heterogeneity. Seven studies were included for diagnostic accuracy. Sensitivity ranged from 90% to 99% and specificity from 29% to 92%. In meta-analysis, the PPVs varied across subgroups with different sampling times after symptom onset, with 1% (95% confidence interval [CI], 0%-7%) in sampling beyond 10 days and 27% (CI, 19%-36%) to 46% (CI, 33%-60%) in subgroups that also included earlier samples. Estimates of virus isolation probability varied between 6% (CI, 0%-100%) and 50% (CI, 0%-100%) at a Ct value of 30 and between 0% (CI, 0%-22%) and 63% (CI, 0%-100%) at 5 log genome copies/ml. Evidence on RT-PCR performance in detecting infectious SARS-CoV-2 in respiratory samples was limited. Major limitations were heterogeneity and poor reporting. RT-PCR and cell culture protocols need further standardisation.
Topics: COVID-19; COVID-19 Testing; Humans; RNA, Viral; SARS-CoV-2; Sensitivity and Specificity
PubMed: 35366033
DOI: 10.1002/rmv.2342 -
The Journal of Surgical Research Jun 2021Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a standard adjunct for the management of life-threatening truncal hemorrhage, but the...
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a standard adjunct for the management of life-threatening truncal hemorrhage, but the technique is limited by the sequalae of ischemia distal to occlusion. Partial REBOA addresses this limitation, and the recent Food and Drug Administration approval of a device designed to enable partial REBOA will broaden its application. We conducted a systematic review of the available animal and clinical literature on the methods, impacts, and outcomes associated with partial REBOA as a technique to enable targeted proximal perfusion and limit distal ischemic injury. We hypothesize that a systematic review of the published animal and human literature on partial REBOA will provide actionable insight for the use of partial REBOA in the context of future wider clinical implementation of this technique.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines, we conducted a search of the available literature which used partial inflation of a REBOA balloon catheter. Findings from 22 large animal studies and 14 clinical studies met inclusion criteria.
RESULTS
Animal and clinical results support the benefits of partial REBOA including extending the resuscitative window extended safe occlusion time, improved survival, reduced proximal hypertension, and reduced resuscitation requirements. Clinical studies provide practical physiologic targets for partial REBOA including a period of total occlusion followed by gradual balloon deflation to achieve a target proximal pressure and/or target distal pressure.
CONCLUSIONS
Partial REBOA has several benefits which have been observed in animal and clinical studies, most notably reduced ischemic insult to tissues distal to occlusion and improved outcomes compared with total occlusion. Practical clinical protocols are available for the implementation of partial REBOA in cases of life-threatening torso hemorrhage.
Topics: Animals; Aorta; Balloon Occlusion; Endovascular Procedures; Humans; Resuscitation; Shock, Hemorrhagic
PubMed: 33561721
DOI: 10.1016/j.jss.2020.12.054 -
Journal of Clinical Anesthesia Dec 2016This article reviews if a restrictive fluid management policy reduces the complication rate if compared to liberal fluid management policy during elective surgery. The... (Comparative Study)
Comparative Study Meta-Analysis Review
This article reviews if a restrictive fluid management policy reduces the complication rate if compared to liberal fluid management policy during elective surgery. The PubMed database was explored by 2 independent researchers. We used the following search terms: "Blood transfusion (MESH); transfusion need; fluid therapy (MESH); permissive hypotension; fluid management; resuscitation; restrictive fluid management; liberal fluid management; elective surgery; damage control resuscitation; surgical procedures, operative (MESH); wounds (MESH); injuries (MESH); surgery; trauma patients." A secondary search in the Medline, EMBASE, Web of Science, and Cochrane library revealed no additional results. We selected randomized controlled trials performed during elective surgeries. Patients were randomly assigned to a restrictive fluid management policy or to a liberal fluid management policy during elective surgery. The patient characteristics and the type of surgery varied. All but 3 studies reported American Society of Anaesthesiologists groups 1 to 3 as the inclusion criterion. The primary outcome of interest is total number of patients with a complication and the complication rate. Secondary outcome measures are infection rate, transfusion need, postoperative rebleeding, hospital stay, and renal function. In total, 1397 patients were analyzed (693 restrictive protocol, 704 liberal protocol). Meta-analysis showed that in the restrictive group as compared with the liberal group, fewer patients experienced a complication (relative risk [RR], 0.65; 95% confidence interval [CI], 0.55-0.78). The total complication rate (RR, 0.57; 95% CI, 0.52-0.64), risk of infection (RR, 0.62; 95% CI, 0.48-0.79), and transfusion rate (RR, 0.81; 95% CI, 0.66-0.99) were also lower. The postoperative rebleeding did not differ in both groups: RR, 0.76 (95% CI, 0.28-2.06). We conclude that compared with a liberal fluid policy, a restrictive fluid policy in elective surgery results in a 35% reduction in patients with a complication and should be advised as the preferred fluid management policy.
Topics: Blood Loss, Surgical; Blood Transfusion; Elective Surgical Procedures; Fluid Therapy; Humans; Intraoperative Care; Length of Stay; Odds Ratio; Postoperative Complications; Postoperative Hemorrhage; Randomized Controlled Trials as Topic
PubMed: 27871539
DOI: 10.1016/j.jclinane.2016.07.010 -
Progres En Urologie : Journal de... Dec 2020Clinical trials of cell therapy for erectile dysfunction (ED) and Peyronie's disease (PD) were recently conducted after preclinical studies.
INTRODUCTION
Clinical trials of cell therapy for erectile dysfunction (ED) and Peyronie's disease (PD) were recently conducted after preclinical studies.
AIMS
The aims of this study are to give an update on biotherapy for ED and PD and to describe the regulatory framework for these therapies.
MATERIALS AND METHODS
A literature review was performed through PubMed and Clinical.trials.gov addressing cell therapy for ED and PD and using following keywords "erectile dysfunction", "Peyronie's disease", "stem cell", and "platelet-rich plasma".
RESULTS
Preclinical studies in rodent models have shown the potential benefit of cell therapy for ED after radical prostatectomy or caused by metabolic diseases, and PD. The tissues used to obtain the therapeutic product were bone marrow, adipose tissue and blood (PRP, platelet-rich plasma). Mechanism of action was shown to be temporary and mainly paracrine. Four clinical trials were published concerning ED after radical prostatectomy and in diabetic patients and one for PD. Eleven clinical trials including three randomized trials are currently going on. Preclinical and preliminary clinical results suggested the possibility to improve spontaneous erectile function and response to pharmaceutical treatment in initially non-responder patients. This effect is mediated by an improvement of penile vascularization. A reduction of penile curvature without side effect was noted after injections into the plaque of PD patients. Most of these therapeutic strategies using autologous cells were considered as "Advanced Therapy Medicinal Products" with strict regulatory frameworks imposing heavy constraints, in particular in case of "substantial" modification of the cells. The regulatory framework remains unclear and more permissive for PRP and cell therapy processes with extemporaneous preparation/injection and no "substantial" modifications.
CONCLUSIONS
First results on cell therapy for ED and PD are promising. The regulatory framework can significantly change according to cell preparations and origins leading to various constraints. This regulatory framework is crucial to consider for the choice of the procedure.
Topics: Biological Therapy; Clinical Trials as Topic; Erectile Dysfunction; Humans; Male; Penile Induration; Stem Cell Transplantation
PubMed: 32826194
DOI: 10.1016/j.purol.2020.05.002 -
PeerJ 2023Parents influence their children's lifestyles through modeling and support, which modifies how children approach physical activity. As such, this systematic review aims...
BACKGROUND
Parents influence their children's lifestyles through modeling and support, which modifies how children approach physical activity. As such, this systematic review aims to know the influence of parental involvement in children's active lifestyles and the influence of parenting styles on children's practice and motivation towards physical activity.
METHODOLOGY
PubMed, Google Scholar, Scopus, ResearchGate, and Web of Science databases were searched from 15 July 2022 to 30 August 2022. The publication date of the included manuscripts was between November 2012 and January 2021. The methodological quality of the studies was analyzed using the Scale for Evaluating Scientific Articles in Social and Human Science. Furthermore, it was utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.
RESULTS
The sample of the 10 included studies (in which different self-report measures were administered) was 1,957 children and their parents. In one study, parental involvement across limits decreased sedentary behaviours. In another, parent-child co-participation in physical activity improved participation in it. In one study, democratic parents predicted moderate-vigorous physical activity. In another, authoritarian styles were associated with sports practice. In another, permissive styles were associated with the worst physical activity practice. In one study, permissive parents were not significantly related to physical activity. In another, negligent parents were negatively associated with sports practice. In two studies, parenting styles were not associated with physical activity. In a study, the autonomy support of permissive parents and the structure of democratic parents is related to autonomous motivations. The coercive control of authoritarian parents and the lack of structure of negligent parents are related to non-self-determined motivations or amotivation.
CONCLUSIONS
Parental involvement contributes to children's participation in physical activity. There is no unanimity in the results obtained in parenting styles and the practice of physical activity. Democratic and permissive styles are associated with self-determined motivations, as opposed to negligent and authoritarian ones. The results obtained have been extracted from studies where different self-report measures are administered, so it would be advisable to continue researching this subject.
Topics: Humans; Parenting; Exercise; Life Style; Sports; Surveys and Questionnaires
PubMed: 38144179
DOI: 10.7717/peerj.16668 -
Intensive Care Medicine May 2022Hypercapnia is frequent during mechanical ventilation for acute respiratory distress syndrome (ARDS), but its effects on morbidity and mortality are still controversial.... (Meta-Analysis)
Meta-Analysis
PURPOSE
Hypercapnia is frequent during mechanical ventilation for acute respiratory distress syndrome (ARDS), but its effects on morbidity and mortality are still controversial. We conducted a systematic review and meta-analysis to explore clinical consequences of acute hypercapnia in adult patients ventilated for ARDS.
METHODS
We searched Medline, Embase, and the Cochrane Library via the OVID platform for studies published from 1946 to 2021. "Permissive hypercapnia" defined hypercapnia in studies where the group with hypercapnia was ventilated with a protective ventilation (PV) strategy (lower V targeting 6 ml/kg predicted body weight) while the group without hypercapnia was managed with a non-protective ventilation (NPV); "imposed hypercapnia" defined hypercapnia in studies where hypercapnic and non-hypercapnic patients were managed with a similar ventilation strategy.
RESULTS
Twenty-nine studies (10,101 patients) were included. Permissive hypercapnia, imposed hypercapnia under PV, and imposed hypercapnia under NPV were reported in 8, 21 and 1 study, respectively. Studies testing permissive hypercapnia reported lower mortality in hypercapnic patients receiving PV as compared to non-hypercapnic patients receiving NPV: OR = 0.26, 95% CI [0.07-0.89]. By contrast, studies reporting imposed hypercapnia under PV reported increased mortality in hypercapnic patients receiving PV as compared to non-hypercapnic patients also receiving PV: OR = 1.54, 95% CI [1.15-2.07]. There was a significant interaction between the mechanism of hypercapnia and the effect on mortality.
CONCLUSIONS
Clinical effects of hypercapnia are conflicting depending on its mechanism. Permissive hypercapnia was associated with improved mortality contrary to imposed hypercapnia under PV, suggesting a major role of PV strategy on the outcome.
Topics: Adult; Humans; Hypercapnia; Respiration; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 35294565
DOI: 10.1007/s00134-022-06640-1 -
JMIR Public Health and Surveillance May 2017Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles...
BACKGROUND
Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles and practices are important influences on children's eating behaviors and weight status, especially during early childhood. Therefore, understanding parental factors that may influence nonresponsive parental feeding styles and practices is significant for the development of interventions to prevent childhood obesity.
OBJECTIVE
The objectives of this systematic review were to (1) identify and review existing research examining the associations between maternal depressive symptoms and use of nonresponsive feeding styles and practices among mothers of young children (2-8 years of age), (2) highlight the limitations of reviewed studies, and (3) generate suggestions for future research.
METHODS
Using the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines, six electronic academic databases were searched for peer-reviewed, full-text papers published in English between January 2000 and June 2016. Only studies with mothers 18+ years old of normally developing children between 2 and 8 years of age were included. Of the 297 citations identified, 35 full-text papers were retrieved and 8 were reviewed.
RESULTS
The reviewed studies provided mixed evidence for associations between maternal depressive symptoms and nonresponsive feeding styles and practices. Two out of three studies reported positive associations with nonresponsive feeding styles, in that mothers with elevated depressive symptoms were more likely than mothers without those symptoms to exhibit uninvolved and permissive or indulgent feeding styles. Furthermore, results of reviewed studies provide good evidence for association between maternal depressive symptoms and instrumental feeding (3 of 3 reviewed studies) and nonresponsive family mealtime practices (3/3), but mixed evidence for pressuring children to eat (3/6) and emotional feeding (1/3). In addition, evidence for the association between maternal depressive symptoms and restricting child food intake was mixed: one study (1/6) found a positive association; two studies (2/6) found a negative association; whereas one study (1/6) found no association.
CONCLUSIONS
This review indicates that the results of studies examining the associations between maternal depressive symptoms and parental feeding styles and practices are mixed. Limitations of studies included in this review should be noted: (1) the use of a diverse set of self-report questionnaires to assess parental feeding practices is problematic due to potential misclassification and makes it difficult to compare these outcomes across studies, thus caution must be taken in drawing conclusions; and (2) the majority of included studies (6/8) were cross-sectional. There is a need for additional longitudinal studies to disentangle the influence of depression on parental feeding styles and practices. Nevertheless, given that depressive symptoms and feeding styles and practices are potentially modifiable, it is important to understand their relationship to inform obesity prevention interventions and programs.
PubMed: 28550007
DOI: 10.2196/publichealth.6492 -
Sleep Medicine Reviews Aug 2020Behavioral sleep problems in early childhood are common, affecting about 25% of children, and include symptoms such as problems going to sleep and staying asleep. This...
Behavioral sleep problems in early childhood are common, affecting about 25% of children, and include symptoms such as problems going to sleep and staying asleep. This review employed the developmental psychopathology framework and 4P model (Predisposing, Precipitating, Perpetuating, Protective) to organize the diverse risk/protective factors (distal variables experienced indirectly by the child) and processes (proximal variables experienced directly by the child) for child sleep problems among preschool (1-5 y) and school-age (6-10 y) children. Variables were categorized into biological, psychological, and environmental factors/processes at the individual, family/parent, and community levels. The quality of evidence was assessed using GRADE. A literature search identified 98 articles meeting inclusion criteria. Older child age, difficult temperament, previous sleep problems, externalizing psychopathology, internalizing psychopathology, and electronics use (e.g., bedtime TV viewing) were identified as child risk variables predicting sleep problems. Parental presence at bedtime (risk), negative parenting style (e.g., lax or permissive parenting; risk), consistent bedtime routines (protective), and lower composite socioeconomic status (risk) were identified as family/parent variables predicting child sleep problems. No well-established predictors were found at the community level. Future research should employ advanced research designs more frequently and investigate: 1) risk pathways across development; and 2) nightly fluctuations in sleep problems.
Topics: Child; Child, Preschool; Humans; Infant; Parenting; Protective Factors; Risk Factors; Schools; Sleep Initiation and Maintenance Disorders
PubMed: 32320935
DOI: 10.1016/j.smrv.2020.101303