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Ultrasound in Obstetrics & Gynecology :... Dec 2017To establish reference values for flow-mediated dilatation (FMD) and brachial artery diameter (BAD) in pregnancy and to provide insight into the physiological and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To establish reference values for flow-mediated dilatation (FMD) and brachial artery diameter (BAD) in pregnancy and to provide insight into the physiological and pathological course of endothelial adaptation throughout human singleton pregnancy.
METHODS
A meta-analysis was performed following a systematic review of current literature on FMD, as a derivative for endothelial function, and BAD, throughout uncomplicated and complicated pregnancy. PubMed (NCBI) and EMBASE (Ovid) electronic databases were used for the literature search, which was performed from inception to 9 June 2016. To allow judgment of changes in comparison with the non-pregnant state, studies were required to report both non-pregnant mean reference of FMD (matched control group, prepregnancy or postpartum measurement) and mean FMD at a predetermined and reported gestational age. Pooled mean differences between the reference and pregnant FMD values were calculated for predefined intervals of gestational age.
RESULTS
Fourteen studies that enrolled 1231 participants met the inclusion criteria. Publication dates ranged from 1999 to 2014. In uncomplicated pregnancy, FMD was increased in the second and third trimesters. Between 15 and 21 weeks of gestation, absolute FMD increased the most, by a mean (95% CI) of 1.89% (0.25-3.53%). This was a relative increase of 22.5% (3.0-42.0%) compared with the non-pregnant reference. BAD increased progressively, in a steady manner, by the second trimester but not significantly in the first half of the second trimester. We could not discern differences in FMD and BAD between complicated and uncomplicated pregnancies at 29-35 weeks' gestation, reported in the three studies that met our inclusion criteria. Despite the increase in FMD and BAD throughout gestation, both reference curves were characterized by wide 95% CIs.
CONCLUSION
During healthy pregnancy, endothelium-dependent vasodilatation and BAD increase. Women with a complicated pregnancy had FMD values within the lower range when compared with those with uncomplicated pregnancy but, as a group, did not differ from each other. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adaptation, Physiological; Brachial Artery; Endothelium, Vascular; Female; Humans; Hypertension, Pregnancy-Induced; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Regional Blood Flow; Vasodilation
PubMed: 28170124
DOI: 10.1002/uog.17431 -
Burns & Trauma 2019Burn-related injury to the face involving the structures of the eyes, eyelids, eyelashes, and/or eyebrows could result in multiple reconstructive procedures to improve... (Review)
Review
BACKGROUND
Burn-related injury to the face involving the structures of the eyes, eyelids, eyelashes, and/or eyebrows could result in multiple reconstructive procedures to improve functional and cosmetic outcomes, and correct complications following poor acute phase management. The objective of this article was to evaluate if non-surgical or surgical interventions are best for acute management of ocular and/or peri-ocular burns.
METHODS
This systematic review and meta-analysis compared 272 surgical to 535 non-surgical interventions within 1 month of patients suffering burn-related injuries to 465 eyes, 253 eyelids, 90 eyelashes, and 0 eyebrows and evaluated associated outcomes and complications. The PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical and medical interventions, outcomes, and complications were recorded.
RESULTS
Eight of the 14,927 studies queried for this study were eligible for the systematic review and meta-analysis, with results from 33 of the possible 58 outcomes and complications using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines. Surgery was associated with standard mean differences (SMD) 0.44 greater visual acuity on follow-up, SMD 1.63 mm shorter epithelial defect diameters on follow-up, SMD 1.55 mm greater changes in epithelial diameters from baseline, SMD 1.17 mm smaller epithelial defect areas on follow-up, SMD 1.37 mm greater changes in epithelial defect areas from baseline, risk ratios (RR) 1.22 greater numbers of healed epithelial defects, RR 11.17 more keratitis infections, and a 2.2 greater reduction in limbal ischemia compared to no surgical intervention.
CONCLUSIONS
This systematic review and meta-analysis found that compared to non-surgical interventions, acute surgical interventions for ocular, eyelid, and/or eyelash burns were found to have greater visual acuity on follow-up, shorter epithelial defect diameters on follow-up, greater changes in epithelial diameters from baseline, smaller epithelial defect areas on follow-up, greater changes in epithelial defect areas from baseline, greater numbers of healed epithelial defects, more keratitis infections, and a greater reduction in limbal ischemia, possibility preventing the need of a future limbal stem cell transplantation.
PubMed: 31497611
DOI: 10.1186/s41038-019-0161-4 -
Frontiers in Cardiovascular Medicine 2022To investigate the safety and efficacy of total endovascular repair for thoracoabdominal aortic aneurysms (TAAAs) with fenestrated and branched stent-grafts. (Review)
Review
PURPOSE
To investigate the safety and efficacy of total endovascular repair for thoracoabdominal aortic aneurysms (TAAAs) with fenestrated and branched stent-grafts.
METHODS
The MEDLINE, EMBASE, and Cochrane databases were searched between January 2001 and December 2021 to identify literature relevant to the use of fenestrated and branched endografts for the treatment of TAAAs. Studies with <4 cases and those on juxtarenal or pararenal aortic aneurysms were excluded. Meta-analyses were conducted to evaluate spinal cord ischemia (SCI), irreversible SCI, renal insufficiency, dialysis, endoleak, reintervention, target vessel patency, 30-day mortality and overall mortality. Fourteen studies comprising 1,114 patients (mean age 72.42 years, 847 men) were selected. The mean TAAA diameter was 67 mm. The Crawford TAAA classification was type I-III in 759 cases, type IV in 344 cases, and type V in 10 cases. Outcomes of the meta-analysis are reported as proportions and 95% confidence intervals (CIs).
RESULTS
The pooled rates for 30-day mortality and overall mortality were 6% and 18%, respectively. The pooled rate for technical success was 94% (95% CI, 93-96%), for SCI was 8% (95% CI, 7-10%), for irreversible SCI was 6% (95% CI, 4-7%), for reversible SCI was 5% (95% CI, 4-6%), for reversible SCI was 2% (95% CI, 2-3%), for renal insufficiency was 7% (95% CI, 5-10%), for dialysis was 3% (95% CI, 2-4%), for target vessel patency was 98% (95% CI, 97-99%), and for reintervention was 15% (95% CI, 9-24%).
CONCLUSION
Fenestrated and branched endografts for the treatment of TAAAs are safe and effective with acceptable early results. Lifelong regular follow-up and additional prospective studies are necessary to substantiate whether this technique is valid.
PubMed: 35711352
DOI: 10.3389/fcvm.2022.901193 -
European Journal of Vascular and... Jul 2022To analyse the characteristics of normal infrarenal aortic diameter (AD) in the general worldwide population, to examine changes over time, and to investigate... (Review)
Review
OBJECTIVE
To analyse the characteristics of normal infrarenal aortic diameter (AD) in the general worldwide population, to examine changes over time, and to investigate geographical differences.
DATA SOURCES
PubMed, Cochrane Library, and Web of Science.
REVIEW METHODS
This was a systematic review and meta-analysis of studies published up to October 2020 describing infrarenal AD measured by ultrasound in the general adult population. The study was conducted in accordance with the PRISMA statement and placed no restrictions on geographical location or year of publication. Studies of individuals pre-selected for certain diseases or risk factors and opportunistic screening were excluded. A random effects model was used to estimate pooled mean AD, and meta-regression analysis was used to study the effects of determinants of AD.
RESULTS
Thirty-two studies were included, reporting data for 941 144 individuals (98% were men). The pooled mean AD was 19.4 mm (95% confidence interval [CI] 18.8 - 20.1), being 20.1 mm (95% CI 19.4 - 20.8) in men and 17.8 mm (95% CI 16.5 - 19.1) in women (p < .001). Outer edge to outer edge (OTO) caliper placement method (p = .015) and body surface area (BSA; p = .010) were significantly associated with larger AD. In men, the largest mean AD was observed in Oceania (p < .001) and the smallest in Asia (p < .020). As none of the studies collected data between 2002 and 2007, the studies were divided into two periods: 2001 and before, and 2008 and after. All recent studies were European, with the diameters being significantly smaller (p = .003) in the latter period (18.3 mm [95% CI 17.5 - 19.1] vs. 20.7 mm [95% CI 19.1 - 22.3]). In the meta-regression models, the reduction in AD over time remained significant after adjustment for potential effect modifiers such as sex, age, geographical area, body size, cardiovascular risk factors, and ultrasound method.
CONCLUSION
Mean infrarenal AD in older European adults has decreased significantly in recent decades. Male sex, BSA, and OTO ultrasound measurement method are associated with larger AD, and geographical differences were observed in men.
PubMed: 35483578
DOI: 10.1016/j.ejvs.2022.04.014 -
The Cochrane Database of Systematic... Feb 2015An abdominal aortic aneurysm (AAA) is an abnormal ballooning of the major abdominal artery. Some AAAs present as emergencies and require surgery; others remain... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
An abdominal aortic aneurysm (AAA) is an abnormal ballooning of the major abdominal artery. Some AAAs present as emergencies and require surgery; others remain asymptomatic. Treatment of asymptomatic AAAs depends on many factors, but an important one is the size of the aneurysm, as risk of rupture increases with aneurysm size. Large asymptomatic AAAs (greater than 5.5 cm in diameter) are usually repaired surgically; very small AAAs (less than 4.0 cm diameter) are monitored with ultrasonography. Debate continues over the appropriate roles of immediate repair and surveillance with repair on subsequent enlargement in people presenting with asymptomatic AAAs of 4.0 cm to 5.5 cm diameter. This is the third update of the review first published in 1999.
OBJECTIVES
To compare mortality, quality of life, and cost effectiveness of immediate surgical repair versus routine ultrasound surveillance in people with asymptomatic AAAs between 4.0 cm and 5.5 cm in diameter.
SEARCH METHODS
For this update, the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (February 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1). We checked reference lists of relevant articles for additional studies.
SELECTION CRITERIA
Randomised controlled trials in which men and women with asymptomatic AAAs of diameter 4.0 cm to 5.5 cm were randomly allocated to immediate repair or imaging-based surveillance at least every six months. Outcomes had to include mortality or survival.
DATA COLLECTION AND ANALYSIS
Three members of the review team independently extracted the data, which were cross-checked by other team members. Risk ratios (RR) (endovascular aneurysm repair only), hazard ratios (HR) (open repair only), and 95% confidence intervals based on Mantel-Haenszel Chi(2) statistic were estimated at one and six years (open repair only) following randomisation. We included all relevant published studies in this review.
MAIN RESULTS
For this update, four trials with a combined total of 3314 participants fulfilled the inclusion criteria. Two trials compared surveillance with immediate open repair; two trials compared surveillance with immediate endovascular repair. Overall, the risk of bias within the included studies was low and the quality of the evidence high. The four trials showed an early survival benefit in the surveillance group (due to 30-day operative mortality with surgery) but no significant differences in long-term survival (adjusted HR 0.88, 95% confidence interval (CI) 0.75 to 1.02, mean follow-up 10 years; HR 1.21, 95% CI 0.95 to 1.54, mean follow-up 4.9 years; HR 0.76, 95% CI 0.30 to 1.93, median follow-up 32.4 months; HR 1.01, 95% CI 0.49 to 2.07, mean follow-up 20 months). A pooled analysis of participant-level data from two trials (with a maximum follow-up of seven to eight years) showed no statistically significant difference in survival between immediate open repair and surveillance (propensity score-adjusted HR 0.99; 95% CI 0.83 to 1.18), and that this lack of treatment effect did not vary by AAA diameter (P = 0.39) or participant age (P = 0.61). The meta-analysis of mortality at one year for the endovascular trials likewise showed no significant association (RR at one year 1.15, 95% CI 0.60 to 2.17). Quality-of-life results among trials were conflicting.
AUTHORS' CONCLUSIONS
The results from the four trials to date demonstrate no advantage to immediate repair for small AAA (4.0 cm to 5.5 cm), regardless of whether open or endovascular repair is used and, at least for open repair, regardless of patient age and AAA diameter. Thus, neither immediate open nor immediate endovascular repair of small AAAs is supported by currently available evidence.
Topics: Aortic Aneurysm, Abdominal; Asymptomatic Diseases; Cost-Benefit Analysis; Endovascular Procedures; Female; Humans; Male; Organ Size; Quality of Life; Randomized Controlled Trials as Topic; Time Factors; Ultrasonography; Watchful Waiting
PubMed: 25927098
DOI: 10.1002/14651858.CD001835.pub4 -
European Journal of Vascular and... May 2016The growth rates of thoracic aortic aneurysms (TAAs) and factors influencing their expansion are poorly understood. This study aimed to review systematically published... (Review)
Review
OBJECTIVE/BACKGROUND
The growth rates of thoracic aortic aneurysms (TAAs) and factors influencing their expansion are poorly understood. This study aimed to review systematically published literature describing TAA expansion and examine factors that may be associated with this.
METHODS
A comprehensive search of MEDLINE and Embase databases was performed until 30 April 2015. Studies describing rates of TAA growth were identified and systematically reviewed. Outcomes of interest were TAA growth rates and associated factors. Study quality was assessed using Scottish Intercollegiate Guidelines Network quality checklists for cohort studies.
RESULTS
Eleven publications, involving 1383 patients, met the eligibility criteria and were included in the review. Included studies were generally low in quality. Aneurysm measurement and growth-rate estimation techniques were inconsistently reported. Mean growth rates for all TAAs ranged from 0.2 to 4.2 mm/year. Mean growth rates for ascending and aortic arch aneurysms ranged from 0.2 to 2.8 mm/year, while those for descending and thoracoabdominal aneurysms ranged from 1.9 to 3.4 mm/year in studies reporting according to anatomical location. Large aneurysm size, distal aneurysm locations, presence of Marfan's syndrome, and bicuspid aortic valve were consistently associated with accelerated TAA growth. Presence of chronic dissection and chronic obstructive pulmonary disorder were also implicated as risk factors for faster TAA growth. Associations between medical comorbidity and aneurysm expansion were conflicting. Previous aortic surgery and anticoagulants were reported to have a protective effect on aneurysm growth in two studies.
CONCLUSION
There is a shortfall in the understanding of TAA expansion rates. Existing studies are heterogeneous in methodology and reported outcomes. Identified unifying themes suggest that TAAs grow at a slow rate with large presenting diameter, distal aneurysm, and history of bicuspid aortic valve or Marfan's syndrome serving as main risk factors for accelerated aneurysm growth. High-quality studies with a standardised approach to TAA growth assessment are required.
Topics: Aortic Aneurysm, Thoracic; Disease Progression; Humans; Risk Factors
PubMed: 26947541
DOI: 10.1016/j.ejvs.2016.01.017 -
Medicine May 2016Calcifying fibrous tumor (CFT) is a benign lesion characterized by its specific histological findings and is found as solitary or multiple lesions in several locations... (Review)
Review
Calcifying fibrous tumor (CFT) is a benign lesion characterized by its specific histological findings and is found as solitary or multiple lesions in several locations of the human body. The aim of the present systematic review is to give a detailed account of all reported cases of CFT in the literature and to analyze the available data, to completely characterize the entity from epidemiological, medical, and surgical aspects.A bibliographic research was performed from 1988 until 2015. A database with the patients' characteristics was made, including sex, age, location of the tumor, symptoms, symptoms duration, size of the tumor, diagnostic methods, treatment, metastasis, and follow-up.A total of 104 articles were identified, reporting 157 cases of CFT. Mean age of patients was 33.58 years and the ratio between men and women was 1:1.27. The most common locations of CFT were stomach (18%), small intestine (8.7%), pleura (9.9%), mesentery (5%), and peritoneum (6.8%). Mean diameter of the tumor was estimated 4.6 cm. The correlations proceeded showed that as age increases, size decreases (P = 0.001) and that the tumor is larger in females (P = 0.027). Kruskal-Wallis test showed that the larger tumors appear in the neck and adrenal gland (P = 0.001). The percentage of asymptomatic patients was 30.57%. Computed tomography and biopsy were the most common tests for the diagnosis of CFT. Open surgical procedure was performed in the majority of cases. The median hospitalization was 6.06 days and the mean follow-up period was 29.97 months. Recurrences were mentioned in 10 of 96 patients with available data. No deaths owing to CFT were mentioned in the literature.CFT should be included in the differential diagnosis of enlarging mass revealed by clinical or imaging examination either incidentally or after specific acute or chronic symptomatology.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Calcinosis; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Neoplasms, Fibrous Tissue; Sex Factors; Tumor Burden; Young Adult
PubMed: 27196478
DOI: 10.1097/MD.0000000000003690 -
Annals of Palliative Medicine Aug 2021The most common metastatic site of hepatocellular carcinoma (HCC) is lung metastasis. When the patient has lung metastasis, the development of the disease will become... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The most common metastatic site of hepatocellular carcinoma (HCC) is lung metastasis. When the patient has lung metastasis, the development of the disease will become very rapid. In severe cases, it will cause rapid death of the patient. Therefore, the treatment of HCC after lung metastasis has become a hot research topic. This study was designed to investigate the curative effect and prognostic factors of hepatectomy in patients with HCC with lung metastasis (LM) (HCC + LM patients) using meta-analysis.
METHODS
RevMan 5.3 software was used to screen literature based on randomized controlled studies on the curative effect and prognostic factors of hepatectomy for HCC + LM published between January 2000 to January 2020 in the PubMed, Web of Science, Spring, and Science Direct databases.
RESULTS
A total of 13 articles were included, comprising 754 patients in the H group and 1,201 patients in the NH group. Meta-analysis results showed that the maximum diameter of liver tumors in the H group was much larger than that in the NH group (MD =-0.62; 95% CI: -1.20 to -0.04; Z=2.09; P=0.04). The survival rate 1, 3, and 5 years after treatment in group H was higher than that in the NH group [Mantel-Haenszel (MH) =2.91, 2.80, and 4.96; 95% CI: 2.25-3.76, 2.22-3.52, and 3.74-6.59; Z=8.20, 8.73, and 11.09, respectively; P<0.00001], and the mean survival time in group H was much longer than that in the NH group (MD =17.30; 95% CI: 11.78-22.83; Z=6.14; and P<0.00001).
DISCUSSION
The MDLT is a prognostic indicator for hepatectomy, and hepatectomy can effectively prolong the survival time of HCC + LM patients.
Topics: Carcinoma, Hepatocellular; Hepatectomy; Humans; Liver Neoplasms; Lung Neoplasms; Prognosis; Survival Rate; Treatment Outcome
PubMed: 34488390
DOI: 10.21037/apm-21-1784 -
Adherence to guidelines strongly improves reproducibility of brachial artery flow-mediated dilation.Atherosclerosis May 2016Brachial artery FMD is widely used as a non-invasive measure of endothelial function. Adherence to expert guidelines is believed to be of vital importance to obtain... (Review)
Review
BACKGROUND
Brachial artery FMD is widely used as a non-invasive measure of endothelial function. Adherence to expert guidelines is believed to be of vital importance to obtain reproducible measurements. We conducted a systematic review of studies reporting on the reproducibility of the FMD in order to determine the relation between adherence to current expert guidelines for FMD measurement and its reproducibility.
METHODS
Medline-database was searched through July 2015 and 458 records were screened for FMD reproducibility studies reporting the mean difference and variance of repeated FMD measurements. An adherence score was assigned to each of the included studies based on reported adherence to published guidelines on the assessment of brachial artery FMD. A Typical Error Estimate (TEE) of the FMD was calculated for each included study. The relation between the FMD TEE and the adherence score was investigated by means of Pearson correlation coefficients and multiple linear regression analysis.
RESULTS
Twenty-seven studies involving 48 study groups and 1537 subjects were included in the analyses. The adherence score ranged from 2.4 to 9.2 (out of a maximum of 10) and was strongly and inversely correlated with FMD TEE (adjusted R(2) = 0.36, P < 0.01). Use of automated edge-detection software, continuous diameter measurement, true peak diameter for %FMD calculation, a stereostatic probe holder, and higher age emerged as factors associated with a lower FMD TEE.
CONCLUSIONS
These data demonstrate that adherence to current expert consensus guidelines and applying contemporary techniques for measuring brachial artery FMD decreases its measurement error.
Topics: Adult; Aged; Blood Flow Velocity; Brachial Artery; Cardiovascular Diseases; Dilatation; Endothelium, Vascular; Guideline Adherence; Humans; Middle Aged; Regional Blood Flow; Regression Analysis; Reproducibility of Results; Risk Factors; Vasodilation; Young Adult
PubMed: 27023841
DOI: 10.1016/j.atherosclerosis.2016.03.011 -
Acta Medica Academica Dec 2022The current study records the prevalence of the accessory foramen, located posterior to the transverse foramen (TF), the so-called the retrotransverse foramen (RTF), its... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The current study records the prevalence of the accessory foramen, located posterior to the transverse foramen (TF), the so-called the retrotransverse foramen (RTF), its morphometry, exact location, and coexistence with ossified posterior bridges. Additionally, factors associated with the length of the RTF are investigated.
MATERIALS
One-hundred and forty-one dried atlas vertebrae were examined.
RESULTS
Thirty-seven out of the 141 vertebrae (26.2%) had at least one RTF. The RTF was unilateral in 67.6% and bilateral in 32.4%. The mean RTF anteroposterior diameter (length) was 4.2±1.4 mm on the right and 3.8±1.0 mm on the left side. The mean RTF laterolateral diameter (width) was 2.6±1.2 mm on the right and 2.5±0.8 mm on the left side. Both dimensions were symmetrical. The RTF was symmetrically located from the TF, at a mean distance of 4.6±1.1 mm on the right and of 4.5±0.9 mm on the left side. For the given TF-RTF distance, laterality, and presence of posterior bridges, each mm increase in the RTF width was associated with a 0.74 mm increase in the relevant length.
CONCLUSION
The estimated prevalence was higher than most of those reported in other studies. However, the between-studies prevalence varies to a significant degree. Hence, a systematic review and meta-analysis should be performed to identify a more precise estimate due to the clinical importance of the RTF.
Topics: Humans; Cervical Atlas; Prevalence; Spine
PubMed: 36799311
DOI: 10.5644/ama2006-124.388