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The International Journal of... Dec 2023To clarify prognosis of patients with non-obstructive coronary artery disease (NOCAD) and coronary microvascular disease (CMD) assessed as low coronary flow reserve... (Meta-Analysis)
Meta-Analysis
The prognostic value of coronary flow reserve in patients with non-obstructive coronary artery disease and microvascular dysfunction: a systematic review and meta-analysis with focus on imaging modality and sex difference.
To clarify prognosis of patients with non-obstructive coronary artery disease (NOCAD) and coronary microvascular disease (CMD) assessed as low coronary flow reserve (CFR) according to imaging modalities and sex difference. Comprehensive systematic literature review and meta-analyses were conducted. Risk of death and major adverse cardiac events (MACE) were pooled and compared in patients with abnormally low versus normal CFR using cut-off limits 2.0-2.5. Random effects model used for estimation of odds ratios (OR) and hazard ratios (HR) with 95% confidence interval (CI). Nineteen eligible observational studies provided data for death and MACE, publication bias was insignificant, p = 0.62. Risk of death and MACE were significantly higher in patients with low (n = 4.612, 29%) than normal CFR (n = 11.367, 71%): using transthoracal echocardiography (TTE) (OR 4.25 (95% CI 2.94, 6.15) p < 0.001) and (OR 6.98 (95% CI 2.56, 19.01) p < 0.001), positron emission tomography (PET) (OR 2.51 (CI 95%: 1.40, 4..49) p = 0.002) and (OR 2.87 (95% CI 2.16, 3.81) p < 0.001), and invasive intracoronary assessment (OR 2.23 (95% CI 1.15, 4.34) p < 0.018), and (OR 4.61 (95% CI 2.51, 8.48) p < 0.001), respectively. Pooled adjusted HR for death and MACE were (HR 2.45(95% CI 1.37, 3.53) p < 0.001) and (HR 2.08 (95% CI 1.54, 2.63) p < 0.001) respectively. Studies comparing men and women with abnormally low CFR demonstrated similar worse prognosis in both sexes. Low CFR is associated with poorer prognosis in patients with NOCAD regardless of sex. TTE may overestimate risk of death and MACE, while PET seems to be more appropriate. Future studies are needed to consolidate the current evidence.
Topics: Humans; Female; Male; Coronary Artery Disease; Prognosis; Sex Characteristics; Fractional Flow Reserve, Myocardial; Predictive Value of Tests; Tomography, X-Ray Computed
PubMed: 37716916
DOI: 10.1007/s10554-023-02948-1 -
Heart & Lung : the Journal of Critical... 2023Heart failure is a pathophysiological condition where decreased cardiac output is observed subsequent to any structural deformity or cessation of normal function.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Heart failure is a pathophysiological condition where decreased cardiac output is observed subsequent to any structural deformity or cessation of normal function. Thiamine deficiency is one of the risk factors responsible for causing HF; other risk factors include hypertension, smoking, and obesity.
OBJECTIVE
We conducted a systemic review and meta-analysis of RCTs to scrutinize whether the heart failure patients would benefit from thiamine supplementation or not when compared to placebo.
METHODS
We selected only those double-arm randomized controlled trials (RCTs) which included participants presenting with symptomatic heart failure. We excluded all the articles published in languages other than English Language. Furthermore, all the studies other than RCTs were also omitted. Articles yielded from the electronic search were exported to EndNote Reference Library software to remove any duplicates. Analyses were done using the Review manager 5.4 tool. Mean values and standard deviations were retrieved for the continuous outcomes given as raw data.
RESULTS
The 6 RCTs selected for the statistical analysis consisted of 298 participants (158 in the intervention group, 140 in the placebo group). The outcomes resulted to be non-significant with LVEF p-value= 0.08, NT-pro BNP p-value= 0.94, LVEDV p-value= 0.53, 6MWT p-value=0.59, mortality p-value= 0.61, hospitalization p-value= 0.53 and dyspnea p-value= 0.77. Heart rate is the only significant outcome with a p-value=0.04.
CONCLUSION
To conclude, except for heart rate, thiamine supplementation had no effect on the outcomes of heart failure patients.
Topics: Humans; Thiamine; Heart Failure; Research Design; Dietary Supplements
PubMed: 37126872
DOI: 10.1016/j.hrtlng.2023.04.011 -
PloS One 2023Liver metastasis is present in a wide range of malignancies, with colorectal cancer as the most common site. Several minimally invasive treatments have been suggested... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Liver metastasis is present in a wide range of malignancies, with colorectal cancer as the most common site. Several minimally invasive treatments have been suggested for managing hepatic metastases, and cryoablation is among them, yet not widely used. In this systematic review, we aimed to assess the effectiveness of percutaneous cryoablation in all types of liver metastases.
METHODS
A systematic search was performed in international databases, including PubMed, Scopus, Embase, and Web of Science, to find relevant studies reporting outcomes for percutaneous cryoablation in liver metastasis patients. In addition to baseline features such as mean age, gender, metastasis origin, and procedure details, procedure outcomes, including overall survival, local recurrence, quality of life (QoL), and complications, were extracted from the studies. Random-effect meta-analysis was performed to calculate the mean difference (MD) and 95% confidence interval for comparison of QoL.
RESULTS
We screened 2131 articles. Fifteen studies on 692 patients were included. Mean overall survival ranged from 14.5-29 months. The rate of local recurrence in the included studies ranged from 9.4% to 78%, and local control progression-free survival ranged from 1 to 31 months. The total QoL decreased one week after the cryoablation procedure (-3.08 [95% Confidence interval: -4.65, -1.50], p-value <0.01) but increased one month (5.69 [3.99, 7.39], p-value <0.01) and three months (3.75 [2.25, 5.24], p-value <0.01) after the procedure.
CONCLUSION
Cryoablation is an effective procedure for the treatment of liver metastases, especially in cases that are poor candidates for liver resection. It could significantly improve QoL with favorable local recurrence.
Topics: Humans; Quality of Life; Cryosurgery; Liver Neoplasms; Progression-Free Survival; Hepatectomy; Treatment Outcome
PubMed: 37585405
DOI: 10.1371/journal.pone.0289975 -
Frontiers in Immunology 2023The systemic immune-inflammation index (SII) is a cost-efficient indicator for carcinoma prognosis. However, its utility in urothelial carcinoma (UC) prognosis is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The systemic immune-inflammation index (SII) is a cost-efficient indicator for carcinoma prognosis. However, its utility in urothelial carcinoma (UC) prognosis is disputed. This meta-analysis aims to assess SII's prognostic value in UC.
METHODS
A thorough search of databases including PubMed, Web of Science, Embase, Cochrane Library, and Scopus, was conducted to find studies until January 11, 2023. Eligibility criteria were applied to select studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted from selected studies and compiled in a meta-analysis to gauge SII's association with survival outcomes such as overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and progression-free survival (PFS).
RESULTS
This analysis includes 19 studies with 12505 UC patients. It was found that high SII significantly correlated with worse OS in UC patients (HR 1.430, 95% CI 1.237-1.653, P<0.001). High SII values also linked with poorer CSS (HR 1.913, 95% CI 1.473-2.485, P<0.001), RFS (HR 1.240, 95% CI 1.097-1.403, P=0.001), and PFS (HR 1.844, 95% CI 1.488-2.284, P<0.001) compared to low SII values. Subgroup analysis revealed SII's consistent prognostic value in UC across races, carcinoma types, sample sizes, and SII cut-off values, suggesting its potential as a prognostic indicator in UC patients.
CONCLUSION
Current evidence suggests SII as a promising, cost-efficient predictor in UC patients. This meta-analysis indicates SII's potential as a valuable prognostic tool in UC patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=307643, identifier CRD42022307643.
Topics: Humans; Urinary Bladder Neoplasms; Prognosis; Carcinoma, Transitional Cell; Inflammation; Proportional Hazards Models
PubMed: 38053997
DOI: 10.3389/fimmu.2023.1275033 -
PeerJ 2023The receptor for activated C kinase 1 (RACK1) expression is associated with clinicopathological characteristics and the prognosis of various cancers; however, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The receptor for activated C kinase 1 (RACK1) expression is associated with clinicopathological characteristics and the prognosis of various cancers; however, the conclusions are controversial. As a result, this study aimed to explore the clinicopathological and prognostic values of RACK1 expression in patients with cancer.
METHODOLOGY
PubMed, Embase, Web of Science, Cochrane Library, and Scopus were comprehensively explored from their inception to April 20, 2023, for selecting studies on the clinicopathological and prognostic role of RACK1 in patients with cancer that met the criteria for inclusion in this review. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the prognosis-predictive value of RACK1 expression, while pooled odds ratios (ORs) and 95% CIs were used to evaluate the correlation between RACK1 expression and the clinicopathological characteristics of patients with cancer. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale.
RESULTS
Twenty-two studies (13 on prognosis and 20 on clinicopathological characteristics) were included in this systematic review and meta-analysis. The findings indicated that high RACK1 expression was significantly associated with poor overall survival (HR = 1.62; 95% CI, 1.13-2.33; = 0.009; I = 89%) and reversely correlated with disease-free survival/recurrence-free survival (HR = 1.87; 95% CI, 1.22-2.88; = 0.004; I = 0%). Furthermore, increased RACK1 expression was significantly associated with lymphatic invasion/N+ stage (OR = 1.74; 95% CI, 1.04-2.90; = 0.04; I = 79%) of tumors.
CONCLUSIONS
RACK1 may be a global predictive marker of poor prognosis in patients with cancer and unfavorable clinicopathological characteristics. However, further clinical studies are required to validate these findings.
Topics: Humans; Disease-Free Survival; Neoplasm Proteins; Neoplasms; Prognosis; Receptors for Activated C Kinase
PubMed: 37601269
DOI: 10.7717/peerj.15873 -
European Urology Oncology Jan 2024Although digital rectal examination (DRE) is recommended in combination with prostate-specific antigen (PSA) for detection of prostate cancer (PCa), there are limited... (Review)
Review
BACKGROUND AND OBJECTIVE
Although digital rectal examination (DRE) is recommended in combination with prostate-specific antigen (PSA) for detection of prostate cancer (PCa), there are limited data to support its use as a screening/early detection test. Our objective was to assess the diagnostic value of DRE in screening for early detection of PCa.
METHODS
In August 2023, we queried the PubMed, Scopus, and Web of Science databases to identify prospective studies simultaneously investigating the diagnostic performance of DRE and PSA for PCa screening. The primary endpoints were the positive predictive value (PPV) and cancer detection rate (CDR) of DRE. Secondary endpoints included the PPV and CDR of both PSA alone and in combination with DRE. We conducted meta-regression analysis to compare the CDR and PPV of different screening strategies. This meta-analysis is registered on PROSPERO (CRD42023446940).
KEY FINDINGS AND LIMITATIONS
We identified eight studies involving 85 738 participants, of which three were randomized controlled trials and five were prospective diagnostic studies, that reported the PPV and CDR of both DRE and PSA for the same cohort. Our analysis revealed a pooled PPV of 0.21 (95% confidence interval [CI] 0.13-0.33) for DRE, which is similar to the PPV of PSA (0.22, 95% CI 0.15-0.30; p = 0.9), with no benefit from combining DRE and PSA (PPV 0.19, 95% CI 0.13-0.26; p = 0.5). However, the CDR of DRE (0.01, 95% CI: 0.01-0.02) was significantly lower than that of PSA (0.03, 95% CI 0.02-0.03; p < 0.05) and the combination of DRE and PSA (0.03, 95% CI 0.02-0.04; p < 0.05). The screening strategy combining DRE and PSA was not different to that of PSA alone in terms of CDR (p = 0.5) and PPV (p = 0.5).
CONCLUSIONS AND CLINICAL IMPLICATIONS
Our comprehensive review and meta-analysis indicates that both as an independent test and as a supplementary measure to PSA for PCa detection, DRE exhibits a notably low diagnostic value. The collective findings from the included studies suggest that, in the absence of clinical symptoms and signs, DRE could be potentially omitted from PCa screening and early detection strategies.
PATIENT SUMMARY
Our review shows that the screening performance of digital rectal examination for detection of prostate cancer is not particularly impressive, suggesting that it might not be necessary to conduct this examination routinely.
PubMed: 38182488
DOI: 10.1016/j.euo.2023.12.005 -
Lasers in Medical Science Jul 2023Low back pain (LBP) is a widespread health issue affecting people globally and is the second leading cause of missed workdays. High-intensity laser therapy (HILT)... (Meta-Analysis)
Meta-Analysis Review
Low back pain (LBP) is a widespread health issue affecting people globally and is the second leading cause of missed workdays. High-intensity laser therapy (HILT) promises to decrease pain intensity in LBP patients. The aim of this work was to evaluate the effect of HILT in adult LBP patients. We searched for randomized controlled studies (RCTs) published before January of 2023. Our primary outcome was pain intensity, while our secondary outcomes included disability and flexibility scores. We synthesized the evidence using RevMan v.5.4 and assessed methodological quality with the Oxford/Jadad scale and the Cochrane collaboration's risk of bias tool 1. The model favors the HILT group over the control group in terms of pain intensity after treatment (MD with 95% CI is -1.65 [-2.22, -1.09], p-value < 0.00001, I=67%), Oswestry disability index (MD with 95% CI is -0.67 [-1.22, -0.12], p-value = 0.02, I=73%), and Roland disability index (MD with 95% CI is -1.36 [-1.76, -0.96], p-value <0.00001, I=0%). The patients in the high-intensity laser therapy had statistically significantly lower (low back) pain intensity compared to the patients in the control group. Based on three RCTs, our model also showed the positive effect of the HILT on LBP in terms of the Oswestry disability index and Roland disability index.
Topics: Adult; Humans; Low Back Pain; Laser Therapy; Low-Level Light Therapy; Exercise Therapy; Pain Measurement
PubMed: 37493840
DOI: 10.1007/s10103-023-03827-w -
Sports (Basel, Switzerland) Jul 2023Impact force and maximum velocity are important indicators of kick efficiency. Therefore, this systematic review compared the front kick (FK) and roundhouse kick (RK),... (Review)
Review
Impact force and maximum velocity are important indicators of kick efficiency. Therefore, this systematic review compared the front kick (FK) and roundhouse kick (RK), including their impact force, maximum velocity, angular velocity, and execution time, considering various target types and experience levels. Following PRISMA guidelines, the Web of Science, SportDiscus, and PubMed were systematically searched for articles published from January 1982 to May 2022. Normalized kicking values were compared using one-way ANOVA. Eighteen articles included FKs (sample: 113 elite men, 109 sub-elite men, and 46 novices), and twenty-five articles included RKs (sample: 238 elite men, 143 sub-elite men, and 27 novice men). The results indicate that the impact force of the FK were 47% ( < 0.01), 92% ( < 0.01), and 120% ( < 0.01) higher than those of the RK across novice, sub-elite, and elite groups, respectively. Moreover, the maximum foot velocity of the RK was 44% ( < 0.01) and 48% ( < 0.01) higher than that of the FK for the sub-elite and elite groups, respectively. Furthermore, the elite group had 65% ( < 0.01) higher knee extension angular velocity with the RK than with the FK and 138% ( < 0.01) higher hip extension angular velocity with the FK than with the RK. In summary, the findings suggest that the FK is more effective in generating forceful kicks, while the RK has the potential for rapid execution.
PubMed: 37624121
DOI: 10.3390/sports11080141 -
Heliyon Aug 2023The prognostic nutritional index (PNI), which is derived from the albumin concentration and absolute lymphocyte number, is an effective indicator of cancer patients'... (Review)
Review
Predictive value of the prognostic nutritional index in advanced non-small cell lung cancer patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis.
PURPOSE
The prognostic nutritional index (PNI), which is derived from the albumin concentration and absolute lymphocyte number, is an effective indicator of cancer patients' nutritional and immunological status. According to multiple studies, PNI was strongly linked to the prognosis of patients with non-small cell lung cancer (NSCLC). The predictive value of PNI for survival outcomes in NSCLC patients receiving immune checkpoint inhibitors (ICIs) is still in dispute at present. This meta-analysis is devoted to fill this information gap and investigate the predictive ability of PNI in NSCLC patients treated with ICIs.
METHODS
The PubMed, Embase, Cochrane Library databases, and conference proceedings were searched for eligible studies without language restriction. Overall survival (OS) and progression-free survival (PFS) were included. The predictive value of PNI was estimated using hazard ratios and their 95% confidence intervals.
RESULTS
Thirteen relevant retrospective cohort studies were included and these studies included 1119 patients with stage III-IV NSCLC. Lower PNI status was found to be an independent risk factor for worse survival outcomes in patients with NSCLC (OS HR = 2.68; 95%CI: 1.76-4.06; P < 0.0001; PFS HR = 1.84; 95%CI: 1.39-2.42; P < 0.0001). According to the subgroup analysis, PNI was similarly connected to OS in most subgroups of NSCLC patients receiving ICIs, except for those receiving chemoimmunotherapy or first-line treatment, and those with a cut-off value < 45.
CONCLUSION
Our findings indicated that lower PNI was associated with poorer prognosis in NSCLC patients undergoing ICI therapy. Further prospective research with bigger patient groups is required.
SYSTEMATIC REVIEW REGISTRATION
International Prospective Register of Systematic Reviews (PROSPERO), identifier CRD42022327528.
PubMed: 37520982
DOI: 10.1016/j.heliyon.2023.e17400 -
Journal of Ethnopharmacology Dec 2023Topical Chinese herbal medicine (CHM) is commonly used to relieve atopic dermatitis (AD); however, the up-to-date evidence concerning the effectiveness of topical CHM on... (Meta-Analysis)
Meta-Analysis
ETHNOPHARMACOLOGICAL RELEVANCE
Topical Chinese herbal medicine (CHM) is commonly used to relieve atopic dermatitis (AD); however, the up-to-date evidence concerning the effectiveness of topical CHM on treating AD is lacking. Moreover, the CHM prescriptions are often too complicated to realize the overall mechanisms of CHM, especially when compared to western medicines (WM).
AIM OF THE STUDY
To evaluate the effectiveness of topical CHM for treating AD by conducting a meta-analysis on randomized clinical trials (RCTs).
METHODS
Twenty RCTs comparing topical CHM to active control/placebo were included in the final analysis. The primary outcome was the symptom scores changed from baseline and the effectiveness rate was the secondary outcome. Subgroup analysis on different initial symptom severity and the different interventions in control groups was performed. System pharmacology analysis was performed to explore core CHM and possible pharmacological mechanisms of CHM for AD.
RESULTS
Compared with active/blank placebo, topical CHM seemed more effective (SMD: -0.35, 95 %CI: -0.59 to -0.10, p-value = 0.005, I = 60%). The effectiveness rate was higher (RR: 1.29, 95 %CI 1.15-1.44, p-value <0.00001, I = 71%). In subgroup analysis, mild and moderate AD patients with topical CHM were more effective than placebo (SMD: -0.28, 95 %CI -0.56 to -0.01, p-value = 0.04, I = 5%; -0.34, 95%CI -0.64 to -0.03, p-value = 0.03, I = 0%, separately). Topical CHM has 1.25 times more effective than the topical glucocorticoid (95 %CI 1.09-1.43, p-value = 0.001, I = 64%). Core CHMs, such as Phellodendron chinense C.K. Schneid., Sophora flavescens Ait., Cnidium monnieri (L.) Cusson, and Dictamnus dasycarpus Turcz., had effects on the pathways on immune and metabolism systems different from WM.
CONCLUSION
Our results exploit the potential role of CHM on treating AD, especially for mild and moderate AD.
Topics: Humans; Drugs, Chinese Herbal; Dermatitis, Atopic; Glucocorticoids; Eczema
PubMed: 37328084
DOI: 10.1016/j.jep.2023.116790