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Journal of the American Medical... Aug 2023This systematic review aims to reevaluate the role of minerals on muscle mass, muscle strength, physical performance, and the prevalence of sarcopenia in... (Review)
Review
OBJECTIVE
This systematic review aims to reevaluate the role of minerals on muscle mass, muscle strength, physical performance, and the prevalence of sarcopenia in community-dwelling and institutionalized older adults.
DESIGN
Systematic review.
SETTING AND PARTICIPANTS
In March 2022, a systematic search was performed in PubMed, Scopus, and Web of Sciences using predefined search terms. Original studies on dietary mineral intake or mineral serum blood concentrations on muscle mass, muscle strength, and physical performance or the prevalence of sarcopenia in older adults (average age ≥65 years) were included.
METHODS
Eligibility screening and data extraction was performed by 2 independent reviewers. Quality assessment was performed with the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Risk of bias was evaluated using the Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) tool.
RESULTS
From the 15,622 identified articles, a total of 45 studies were included in the review, mainly being cross-sectional and observational studies. Moderate quality of evidence showed that selenium (n = 8) and magnesium (n = 7) were significantly associated with muscle mass, strength, and physical performance as well as the prevalence of sarcopenia. For calcium and zinc, no association could be found. For potassium, iron, sodium, and phosphorus, the association with sarcopenic outcomes remains unclear as not enough studies could be included or were nonconclusive (low quality of evidence).
CONCLUSIONS AND IMPLICATIONS
This systematic review shows a potential role for selenium and magnesium on the prevention and treatment of sarcopenia in older adults. More randomized controlled trials are warranted to determine the impact of minerals on sarcopenia in older adults.
Topics: Humans; Aged; Sarcopenia; Magnesium; Selenium; Cross-Sectional Studies; Muscle Strength
PubMed: 37355247
DOI: 10.1016/j.jamda.2023.05.017 -
European Urology Jul 2023Whether prostate-specific membrane antigen positron emission tomography (PSMA-PET) should replace conventional imaging modalities (CIM) for initial staging of... (Meta-Analysis)
Meta-Analysis Review
Head-to-head Comparison of the Diagnostic Accuracy of Prostate-specific Membrane Antigen Positron Emission Tomography and Conventional Imaging Modalities for Initial Staging of Intermediate- to High-risk Prostate Cancer: A Systematic Review and Meta-analysis.
CONTEXT
Whether prostate-specific membrane antigen positron emission tomography (PSMA-PET) should replace conventional imaging modalities (CIM) for initial staging of intermediate-high risk prostate cancer (PCa) requires definitive evidence on their relative diagnostic abilities.
OBJECTIVE
To perform head-to-head comparisons of PSMA-PET and CIM including multiparametric magnetic resonance imaging (mpMRI), computed tomography (CT) and bone scan (BS) for upfront staging of tumour, nodal, and bone metastasis.
EVIDENCE ACQUISITION
A search of the PubMed, EMBASE, CENTRAL, and Scopus databases was conducted from inception to December 2021. Only studies in which patients underwent both PSMA-PET and CIM and imaging was referenced against histopathology or composite reference standards were included. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist and its extension for comparative reviews (QUADAS-C). Pairwise comparisons of the sensitivity and specificity of PSMA-PET versus CIM were performed by adding imaging modality as a covariate to bivariate mixed-effects meta-regression models. The likelihood ratio test was applied to determine whether statistically significant differences existed.
EVIDENCE SYNTHESIS
A total of 31 studies (2431 patients) were included. PSMA-PET/MRI was more sensitive than mpMRI for detection of extra-prostatic extension (78.7% versus 52.9%) and seminal vesicle invasion (66.7% versus 51.0%). For nodal staging, PSMA-PET was more sensitive and specific than mpMRI (73.7% versus 38.9%, 97.5% versus 82.6%) and CT (73.2% versus 38.5%, 97.8% versus 83.6%). For bone metastasis staging, PSMA-PET was more sensitive and specific than BS with or without single-photon emission computerised tomography (98.0% versus 73.0%, 96.2% versus 79.1%). A time interval between imaging modalities >1 month was identified as a source of heterogeneity across all nodal staging analyses.
CONCLUSIONS
Direct comparisons revealed that PSMA-PET significantly outperforms CIM, which suggests that PSMA-PET should be used as a first-line approach for the initial staging of PCa.
PATIENT SUMMARY
We reviewed direct comparisons of the ability of a scan method called PSMA-PET (prostate-specific membrane antigen positron emission tomography) and current imaging methods to detect the spread of prostate cancer outside the prostate gland. We found that PSMA-PET is more accurate for detection of the spread of prostate cancer to adjacent tissue, nearby lymph nodes, and bones.
Topics: Male; Humans; Prostate; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatic Neoplasms; Magnetic Resonance Imaging; Gallium Radioisotopes; Neoplasm Staging
PubMed: 37032189
DOI: 10.1016/j.eururo.2023.03.001 -
Survey of Ophthalmology 2023Wolfram-like syndrome (WFLS) is a recently described autosomal dominant disorder with phenotypic similarities to autosomal recessive Wolfram syndrome (WS), including... (Review)
Review
Wolfram-like syndrome (WFLS) is a recently described autosomal dominant disorder with phenotypic similarities to autosomal recessive Wolfram syndrome (WS), including optic atrophy, hearing impairment, and diabetes mellitus. We summarize current literature, define the clinical characteristics, and investigate potential genotype phenotype correlations. A systematic literature search was conducted in electronic databases Pubmed/MEDLINE, EMBACE, and Cochrane Library. We included studies reporting patients with a clinical picture consisting at least 2 typical clinical manifestations of WSF1 disorders and heterozygous mutations in WFS1. In total, 86 patients from 35 studies were included. The most common phenotype consisted of the combination of optic atrophy (87%) and hearing impairment (94%). Diabetes mellitus was seen in 44% of the patients. Nineteen percent developed cataract. Patients with missense mutations in WFS1 had a lower number of clinical manifestations, less chance of developing diabetes insipidus, but a younger age at onset of hearing impairment compared to patients with nonsense mutations or deletions causing frameshift. There were no studies reporting decreased life expectancy. This review shows that, within the spectrum of WFS1-associated disorders or "wolframinopathies," autosomal dominantly inherited WFLS has a relatively mild phenotype compared to autosomal recessive WS. The clinical manifestations and their age at onset are associated with the specific underlying mutations in the WFS1 gene.
Topics: Humans; Hearing Loss; Mutation; Optic Atrophy; Tungsten; Wolfram Syndrome
PubMed: 36764396
DOI: 10.1016/j.survophthal.2023.01.012 -
The Journal of Prosthetic Dentistry Apr 2024When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the literature is inconclusive on the long-term clinical performance of available post systems.
PURPOSE
The purpose of this systematic review and meta-analysis was to analyze the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts.
MATERIAL AND METHODS
The research question was formulated by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the Population, Intervention, Comparison, Outcome, Study Type (PICOS) tool. Medline (PubMed), Embase, and Scopus searches complemented by manual search were performed for randomized controlled clinical trials with a follow-up of at least 2 years. Two independent authors performed screening and data extraction of the articles. Meta-analyses were performed with the RevMan software program. Homogeneity was checked by using chi and I tests, and random-effects meta-analyses were applied. Odds ratio and 95% confidence interval were calculated (α=.05). The publication bias was evaluated by using funnel plots and the Begg and Egger tests.
RESULTS
A total of 184 studies were retrieved through the electronic searches, and an additional 4 through the hand search. After title- and abstract-level exclusion, 23 studies remained for full-text analyses, of which 7 were selected for data extraction. Meta-analyses revealed an overall survival rate of 92.8% for endodontically treated teeth restored with glass-fiber-reinforced posts compared with 78.1% of those restored with metal posts. No statistically significant difference (P>.05) was found in the survival, success, or failure rates.
CONCLUSIONS
No statistically significant differences were found between the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts. The overall survival rate was 92.8% for glass fiber posts and 78.1% for metal posts. Both are reliable materials when a significant amount of coronal tooth structure is missing and treatment with a post is indicated.
Topics: Humans; Post and Core Technique; Tooth, Nonvital; Survival Rate; Glass; Metals; Tooth Fractures; Composite Resins
PubMed: 35430048
DOI: 10.1016/j.prosdent.2022.01.003 -
International Journal of Dermatology Feb 2024Radiesse is a filler composed of calcium hydroxylapatite microspheres suspended in a carboxymethylcellulose gel (CaHA/CMC). It has robust rheological properties that... (Review)
Review
Radiesse is a filler composed of calcium hydroxylapatite microspheres suspended in a carboxymethylcellulose gel (CaHA/CMC). It has robust rheological properties that have been associated with its versatility. CaHA/CMC is employed for both on-label indications of filling wrinkles or lines, volumizing, and contouring of areas as well as off-label indications aiming at biostimulation and skin tightening. However, despite the expanding use of CaHA/CMC, overall evidence and recommendations for treatment are currently lacking. This paper aims to provide an up-to-date overview of CaHA/CMC clinical applications, together with a level of evidence of supporting literature, focusing on the face. Based on the data, CaHA/CMC may be considered a safe and effective treatment option for cheeks, jawline, HIV-related facial lipoatrophy, and nasolabial folds. Treatment of marionette lines, chin, pre-jowl, and corner of the mouth also tends to respond with a high degree of efficacy. Despite the recent trend, guidelines, and safety profile of diluted and hyperdiluted Radiesse , no randomized controlled trials have been published.
Topics: Humans; Biocompatible Materials; Calcium; Carboxymethylcellulose Sodium; Cheek; Cosmetic Techniques; Durapatite; Face; Lipodystrophy; Skin Aging
PubMed: 37897174
DOI: 10.1111/ijd.16888 -
International Endodontic Journal Sep 2023The results of vital pulp treatments in permanent teeth have been encouraging. Currently, pulpotomy treatment for permanent teeth primarily utilizes mineral trioxide... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The results of vital pulp treatments in permanent teeth have been encouraging. Currently, pulpotomy treatment for permanent teeth primarily utilizes mineral trioxide aggregate (MTA) as the dressing material, followed by calcium hydroxide. While other calcium-silicate-based cements have been suggested for pulpotomy, there is a limited number of studies evaluating their long-term effectiveness.
OBJECTIVES
The objective of this systematic review and meta-analysis was to evaluate the success rate of pulpotomies performed on permanent teeth, comparing the use of ProRoot MTA with that of calcium hydroxide and other bioceramic materials.
METHODS
A comprehensive search was conducted in several electronic databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase and Science Direct until December 2022. The search was guided by PICOS criteria, including only randomized clinical trials (RCTs) that evaluated the success rate of pulpotomy treatments in permanent teeth using ProRoot MTA in comparison to calcium hydroxide and other bioceramic materials. The quality of the included studies was assessed using the RoB-2 tool to evaluate the risk of bias, and relevant data were extracted and analysed in RevMan software 5.3 using fixed-effect models. The GRADE tool was used to determine the overall quality of evidence.
RESULTS
The initial search retrieved 1072 studies and, after eliminating duplicates, 677 studies were screened and 28 studies were considered for eligibility. In the final selection process, 16 studies were included in the systematic review, with 10 being determined as having a high risk of bias. Pulpotomy showed an overall mean success rate of 92% after 1 year. The meta-analysis indicated a significantly higher success rate for pulpotomies utilizing MTA in comparison with calcium hydroxide, while no significant difference was seen between MTA and calcium-enriched mixture (CEM) or Biodentine. The GRADE assessment revealed an overall low level of evidence for the included studies.
DISCUSSION
Most randomized controlled trials exhibited a significant absence of control over confounding factors.
CONCLUSIONS
This systematic review and meta-analysis demonstrate that pulpotomy is a highly effective treatment for managing permanent teeth. The results indicate that the success rate of pulpotomy using ProRoot MTA is significantly higher than when using calcium hydroxide. However, the certainty of evidence supporting these findings is low, and there is a need for well-designed RCTs to assess the long-term outcomes of pulpotomy using newer bioceramic materials.
REGISTRATION
This systematic review was registered in the PROSPERO database (registration number CRD42023393970).
Topics: Humans; Calcium Hydroxide; Pulpotomy; Calcium; Aluminum Compounds; Drug Combinations; Oxides; Randomized Controlled Trials as Topic; Calcium Compounds; Treatment Outcome; Silicates
PubMed: 37254176
DOI: 10.1111/iej.13939 -
Renal Failure Dec 2023The safety of sodium-glucose co-transporter 2 (SGLT2) inhibitors in elderly patients with diabetic kidney disease (DKD) is still controversial. This study aimed to... (Meta-Analysis)
Meta-Analysis Review
Comparative safety of sodium-glucose co-transporter 2 inhibitors in elderly patients with type 2 diabetes mellitus and diabetic kidney disease: a systematic review and meta-analysis.
The safety of sodium-glucose co-transporter 2 (SGLT2) inhibitors in elderly patients with diabetic kidney disease (DKD) is still controversial. This study aimed to analyze the safety of SGLT2 inhibitors in elderly patients with type 2 diabetes mellitus (T2DM) and DKD. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to March 2023. Randomized controlled trials (RCTs) were included. Data including patient characteristics and interesting outcomes were extracted, and the dichotomous data and continuous variables were evaluated using risk ratio (RR) with 95% confidence intervals (CIs) and mean difference (MD) with 95% CIs, respectively. A total of 14 RCTs with 59874 participants were finally included. There were 38,252 males (63.9%) and 21,622 females (36.1%). The patients' mean age was > 64.6 years. SGLT2 inhibitors could delay the further decline of estimated glomerular filtration rate (eGFR) when eGFR ≥ 60 ml/min/1.73m (MD: 2.36; 95%CI [1.15-3.57]). SGLT2 inhibitors in elderly patients with eGFR < 60 ml/min/1.73m (RR: 0.86; 95%CI [0.67-1.11]) may have a relatively increased risk of acute kidney injury compared to eGFR ≥ 60 ml/min/1.73m. SGLT2 inhibitors increased the incidence of genital mycotic infections (RR: 3.47; 95%CI [2.97-4.04]) and diabetic ketoacidosis (RR: 2.25; 95%CI [1.57-3.24]). Except for genital mycotic infections and diabetic ketoacidosis, other adverse reactions were few, indicating that SGLT2 inhibitors are relatively safe for elderly patients with T2DM and DKD. Safety and renoprotection may be diminished when SGLT2 inhibitors are used in elderly patients with eGFR < 60 ml/min/1.73m.
Topics: Male; Female; Humans; Aged; Middle Aged; Sodium-Glucose Transporter 2 Inhibitors; Diabetic Nephropathies; Diabetic Ketoacidosis; Diabetes Mellitus, Type 2; Symporters; Glucose; Sodium; Hypoglycemic Agents
PubMed: 37246403
DOI: 10.1080/0886022X.2023.2217287 -
Ageing Research Reviews Feb 2024The comparative clinical utility of the disease-modifying treatments for mild cognitive impairment and Alzheimer's disease that are approved or under review by the Food... (Meta-Analysis)
Meta-Analysis Review
Comparative efficacy, tolerability and acceptability of donanemab, lecanemab, aducanumab and lithium on cognitive function in mild cognitive impairment and Alzheimer's disease: A systematic review and network meta-analysis.
BACKGROUND
The comparative clinical utility of the disease-modifying treatments for mild cognitive impairment and Alzheimer's disease that are approved or under review by the Food and Drug Administration (i.e., donanemab, lecanemab and aducanumab), and lithium, which is a potential disease-modifying agent for this condition, remains elusive.
OBJECTIVE
We aimed to compare the efficacy on cognitive decline, tolerability and acceptability of these drugs in this condition.
METHODS
We systematically searched in MEDLINE, CENTRAL, CINHAL and ClinicalTrials,gov for randomized controlled trials from their inception to 7 November 2023, and then performed a random-effect network meta-analysis.
RESULTS
The analysis included 8 randomized placebo-controlled trials with 6547 participants. On the Mini-Mental State Examination, lithium significantly outperformed donanemab, aducanumab and placebo. On the Alzheimer's Disease Assessment Scale-cognitive subscale, the efficacy of all active drugs was significantly higher than placebo. In addition, in the Clinical Dementia Rating sum of boxes, the efficacy of donanemab and lecanemab was significantly higher than placebo. Compared to placebo, donanemab and lecanemab were significantly less acceptable and tolerable. Aducanumab was also less well tolerated compared to placebo. There were no significant differences in the other comparisons.
CONCLUSION
Although it is yet to be determined which is more effective between lithium or lecanemab or donanemab, lithium may be more effective than aducanumab. Aducanumab, lecanemab and donanemab do not appear to differ in their effectiveness on cognitive function. Low-dose lithium may be safer than aducanumab, lecanemab and donanemab.
Topics: Humans; Alzheimer Disease; Lithium; Network Meta-Analysis; Cognitive Dysfunction; Cognition; Antibodies, Monoclonal, Humanized
PubMed: 38253184
DOI: 10.1016/j.arr.2024.102203 -
Pediatric Nephrology (Berlin, Germany) Jan 2024Iatrogenic hyponatremia is a common complication following intravenous maintenance fluid therapy (IV-MFT) in hospitalized children. Despite the American Academy of... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety of isotonic versus hypotonic intravenous maintenance fluids in hospitalized children: an updated systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
Iatrogenic hyponatremia is a common complication following intravenous maintenance fluid therapy (IV-MFT) in hospitalized children. Despite the American Academy of Pediatrics' 2018 recommendations, IV-MFT prescribing practices still vary considerably.
OBJECTIVES
This meta-analysis aimed to compare the safety and efficacy of isotonic versus hypotonic IV-MFT in hospitalized children.
DATA SOURCES
We searched PubMed, Scopus, Web of Science, and Cochrane Central from inception to October 1, 2022.
STUDY ELIGIBILITY CRITERIA
We included randomized controlled trials (RCTs) comparing isotonic versus hypotonic IV-MFT in hospitalized children, either with medical or surgical conditions. Our primary outcome was hyponatremia following IV-MFT. Secondary outcomes included hypernatremia, serum sodium, serum potassium, serum osmolarity, blood pH, blood sugar, serum creatinine, serum chloride, urinary sodium, length of hospital stay, and adverse outcomes.
STUDY APPRAISAL AND SYNTHESIS METHODS
Random-effects models were used to pool the extracted data. We performed our analysis based on the duration of fluid administration (i.e., ≤ 24 and > 24 h). The Grades of Recommendations Assessment Development and Evaluation (GRADE) scale was used to evaluate the strength and level of evidence for recommendations.
RESULTS
A total of 33 RCTs, comprising 5049 patients were included. Isotonic IV-MFT significantly reduced the risk of mild hyponatremia at both ≤ 24 h (RR = 0.38, 95% CI [0.30, 0.48], P < 0.00001; high quality of evidence) and > 24 h (RR = 0.47, 95% CI [0.37, 0.62], P < 0.00001; high quality of evidence). This protective effect of isotonic fluid was maintained in most examined subgroups. Isotonic IV-MFT significantly increased the risk of hypernatremia in neonates (RR = 3.74, 95% CI [1.42, 9.85], P = 0.008). In addition, it significantly increased serum creatinine at ≤ 24 h (MD = 0.89, 95% CI [0.84, 0.94], P < 0.00001) and decreased blood pH (MD = -0.05, 95% CI [-0.08 to -0.02], P = 0.0006). Mean serum sodium, serum osmolarity, and serum chloride were lower in the hypotonic group at ≤ 24 h. The two fluids were comparable in terms of serum potassium, length of hospital stay, blood sugar, and the risk of adverse outcomes.
LIMITATIONS
The main limitation of our study was the heterogeneity of the included studies.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
Isotonic IV-MFT was superior to the hypotonic one in reducing the risk of iatrogenic hyponatremia in hospitalized children. However, it increases the risk of hypernatremia in neonates and may lead to renal dysfunction. Given that the risk of hypernatremia is not important even in the neonates, we propose to use balanced isotonic IV-MFT in hospitalized children as it is better tolerated by the kidneys than 0.9% saline.
SYSTEMATIC REVIEW REGISTRATION NUMBER
CRD42022372359. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Infant, Newborn; Child; Humans; Hyponatremia; Child, Hospitalized; Hypernatremia; Blood Glucose; Chlorides; Creatinine; Infusions, Intravenous; Isotonic Solutions; Hypotonic Solutions; Randomized Controlled Trials as Topic; Fluid Therapy; Saline Solution; Sodium; Iatrogenic Disease; Potassium
PubMed: 37365423
DOI: 10.1007/s00467-023-06032-7 -
JAMA Network Open Aug 2023Emerging evidence has consistently demonstrated that sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart failure (HF) hospitalization and...
IMPORTANCE
Emerging evidence has consistently demonstrated that sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart failure (HF) hospitalization and cardiovascular (CV) death among patients with HF. However, it remains unclear how long a patient needs to live to potentially benefit from SGLT2 inhibitors in this population.
OBJECTIVES
To estimate the time to benefit from SGLT2 inhibitors among patients with HF.
DESIGN, SETTING, AND PARTICIPANTS
This comparative effectiveness study systematically searched PubMed for completed randomized clinical trials about SGLT2 inhibitors and patients with HF published until September 5, 2022; 5 trials with the year of publication ranging from 2019 to 2022 were eventually included. Statistical analysis was performed from April to October 2022.
INTERVENTION
Addition of SGLT2 inhibitors or placebo to guideline-recommended therapy.
MAIN OUTCOMES AND MEASURES
The primary outcome was the time to first event of CV death or worsening HF, which was broadly comparable across the included trials.
RESULTS
Five trials consisting of 21 947 patients with HF (7837 [35.7%] were female; mean or median age older than 65 years within each trial) were included. SGLT2 inhibitors significantly reduced the risk of worsening HF or CV death (hazard ratio [HR], 0.77 [95% CI, 0.73-0.82]). Time to first nominal statistical significance (P < .05) was 26 days (0.86 months), and statistical significance was sustained from day 118 (3.93 months) onwards. A mean of 0.19 (95% CI, 0.12-0.35) months were needed to prevent 1 worsening HF or CV death per 500 patients with SGLT2 inhibitors (absolute risk reduction [ARR], 0.002). Likewise, 0.66 (95% CI, 0.43-1.13) months was estimated to avoid 1 event per 200 patients with SGLT2 inhibitors (ARR, 0.005), 1.74 (95% CI, 1.07-2.61) months to avoid 1 event per 100 patients (ARR, 0.010), and 4.96 (95% CI, 3.18-7.26) months to avoid 1 event per 50 patients (ARR, 0.020). Further analyses indicated a shorter time to benefit for HF hospitalization and among patients with diabetes or HF with reduced ejection fraction.
CONCLUSIONS AND RELEVANCE
In this comparative effectiveness research study of estimating the time to benefit from SGLT2 inhibitors among patients with HF, a rapid clinical benefit in reducing CV death or worsening HF was found, suggesting that their use may be beneficial for most individuals with HF.
Topics: Humans; Female; Aged; Male; Diabetes Mellitus, Type 2; Sodium-Glucose Transporter 2 Inhibitors; Heart Failure; Glucose; Sodium; Randomized Controlled Trials as Topic
PubMed: 37615988
DOI: 10.1001/jamanetworkopen.2023.30754