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Frontiers in Medicine 2023The progression of early stage non-small cell lung cancer (NSCLC) is closely related to epidermal growth factor receptor (EGFR) mutation status. The purpose of this...
Distinguishing EGFR mutant subtypes in stage IA non-small cell lung cancer using the presence status of ground glass opacity and final histologic classification: a systematic review and meta-analysis.
BACKGROUND
The progression of early stage non-small cell lung cancer (NSCLC) is closely related to epidermal growth factor receptor (EGFR) mutation status. The purpose of this study was to systematically investigate the relationship between EGFR mutation status and demographic, imaging, and ultimately pathologic features in patients with NSCLC.
METHODS
A complete literature search was conducted using the PubMed, Web of Science, EMBASE, and Cochrane Library databases to discover articles published by May 15, 2023 that were eligible. The relationship between EGFR mutation status and specific demographic, imaging, and ultimately pathologic features in patients with NSCLC was evaluated using pooled odds ratios (ORs) and their 95% confidence intervals (CIs). The standardized mean difference (SMD) with 95% CIs was the appropriate statistic to summarize standard deviations (SDs) means for continuous variables.
RESULTS
A total of 9 studies with 1789 patients were included in this analysis. The final findings suggested that patients with a greater age, female gender, and non-smoking status would have a relatively higher incidence of EGFR mutations. Additionally, the risk of EGFR mutations increased with larger tumor diameter, tumor imaging presentation of mixed ground glass opacity (mGGO), and tumor pathological findings of minimally invasive adenocarcinoma (MIA) or invasive adenocarcinoma (IAC). Significantly, malignancies presenting as MIA are more likely to contain L858R point mutations (OR = 1.80; 95% CI: 1.04-3.13; = 0.04) rather than exon 19 deletions (OR = 1.81; 95% CI: 0.95-3.44; = 0.07).
CONCLUSION
This meta-analysis showed that imaging parameters and histological classifications of pulmonary nodules may be able to predict stage IA NSCLC genetic changes.
PubMed: 38126071
DOI: 10.3389/fmed.2023.1268846 -
Frontiers in Pharmacology 2024Although Shen Gui capsules (SGCP) are widely used as an adjuvant treatment for chronic heart failure (CHF), their clinical efficacy and safety remain controversial.
BACKGROUND
Although Shen Gui capsules (SGCP) are widely used as an adjuvant treatment for chronic heart failure (CHF), their clinical efficacy and safety remain controversial.
PURPOSE
To assess the efficacy and safety of SGCP in the treatment of CHF through a systematic review and meta-analysis, to provide high-quality evidence for evidence-based medicine.
METHODS
Seven databases were searched for randomized controlled trials (RCTs) assessing SGCP for CHF, from inception to 9 January 2023. RCT quality of evidence was evaluated using the Cochrane Handbook for the Evaluation of Intervention Systems to assess risk of bias and Grading of Recommendations Assessment, Development, and Evaluation. A meta-analysis with subgroup and sensitivity analyses was performed using Review Manager 5.4 and Stata 12.
RESULTS
Nine RCTs representing 888 patients with CHF were included in the review. Meta-analysis revealed that SGCP combined with conventional heart failure therapy is more advantageous for improving left ventricular ejection fraction [LVEF; mean difference (MD) = 5.26, 95% confidence interval (CI) (3.78, 6.74), < 0.0000] and increasing effective rate [relative risk (RR) = 1.21, 95%CI (1.14, 1.29), < 0.001] compared with conventional therapy alone. The experimental treatment also reduced brain natriuretic peptide [MD = -100.15, 95%CI (-157.83, -42.47), = 0.0007], left ventricular end-diastolic diameter [MD = -1.93, 95%CI (-3.22, -0.64), = 0.003], and hypersensitive C-reactive protein [MD = -2.70, 95%CI (-3.12,-2.28), < 0.001] compared with the control group. However, there was not a statistically significant difference in tumor necrosis factor-α [MD = -14.16, 95%CI (-34.04, 5.73), = 0.16] or left ventricular end-systolic diameter [MD = -1.56, 95%CI (-3.13, 0.01), = 0.05]. Nor was there a statistically significant between-groups difference in incidence of adverse events ( > 0.05).
CONCLUSION
SGCP combined with conventional heart failure therapy can improve LVEF and increase the effective rate to safely treat patients with CHF. However, further high-quality studies are needed to confirm these findings, due to the overall low quality of evidence in this literature.
UNLABELLED
https://www.crd.york.ac.uk/PROSPERO/logout.php, PROSPERO [CRD42023390409].
PubMed: 38659585
DOI: 10.3389/fphar.2024.1347828 -
Translational Stroke Research Feb 2024Robust preclinical models are inevitable for researchers to unravel pathomechanisms of subarachnoidal hemorrhage (SAH). For the mouse perforation model of SAH, the goal... (Meta-Analysis)
Meta-Analysis Review
Robust preclinical models are inevitable for researchers to unravel pathomechanisms of subarachnoidal hemorrhage (SAH). For the mouse perforation model of SAH, the goal of this meta-review was the determination of variances in mortality, SAH severity grade, and vasospasm, and their experimental moderators, as many researchers are facing with incomparable results. We searched on the databases PubMed, Embase, and Web of Science for articles describing in vivo experiments using the SAH perforation mouse model and measuring mortality, SAH grade, and/or vasospasm. After screening, 42 articles (total of 1964 mice) were included into systematic review and meta-analysis. Certain model characteristics were insufficiently reported, e.g., perforation location (not reported in six articles), filament (material (n = 15) and tip texture (n = 25)), mouse age (n = 14), and weight (n = 10). Used injective anesthetics and location of perforation showed large variation. In a random-effects meta-analysis, the overall animal mortality following SAH was 21.3% [95% CI: 17.5%, 25.7%] and increased with longer observational periods. Filament material significantly correlated with animal mortality (p = 0.024) after exclusion of hyperacute studies (time after SAH induction < 24 h). Reported mean SAH grade was 10.7 [9.6, 11.7] on the scale of Sugawara (J Neurosci Methods 167:327-34, 2008). Furthermore, mean diameter of large cerebral arteries after SAH was reduced by 27.6% compared to sham-operated non-SAH mice. Uniforming standards of experimental procedures and their reporting are indispensable to increase overall comparability.
Topics: Mice; Animals; Subarachnoid Hemorrhage; Disease Models, Animal; Autonomic Nervous System Diseases; Vasospasm, Intracranial
PubMed: 36422813
DOI: 10.1007/s12975-022-01106-4 -
Heart Rhythm O2 Nov 2023Left bundle branch area pacing (LBBAP) may offer greater physiological benefits than traditional biventricular pacing (BiVP). However, there are limited data comparing...
BACKGROUND
Left bundle branch area pacing (LBBAP) may offer greater physiological benefits than traditional biventricular pacing (BiVP). However, there are limited data comparing the efficacy of LBBAP vs BiVP in patients with systolic heart failure (HF).
OBJECTIVE
The purpose of this meta-analysis was to compare the feasibility and electromechanical and clinical outcomes of both LBBAP and BiVP.
METHODS
We conducted a systematic review of studies retrieved from various databases including PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Control Trials (CENTRAL) published up to May 22, 2023. The risk ratio (RR) and standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively.
RESULTS
We included 12 studies with a total of 3004 patients (LBBAP = 1242, BiVP = 1762). Pooled results showed that LBBAP resulted in a significant increase in left ventricular ejection fraction (SMD 0.40, 95% CI 0.25, 0.54, .00001), echocardiographic response (RR 1.19, 95% CI 1.10 to 1.29, .0001), improvement in New York Heart Association functional class (SMD -0.44, 95% CI -0.65 to -0.23, .0001), QRS duration reduction (SMD -0.90, 95% CI -1.14 to -0.66, .00001), left ventricular end-diastolic diameter reduction (SMD -0.31, 95% CI -0.57 to -0.05, .02), fewer HF hospitalizations (RR 0.72, 95% CI 0.62, 0.85, .0001), and improved survival (RR 0.73, 95% CI 0.58, 0.92, .007). In addition, LBBAP was associated with shorter fluoroscopy time (SMD -0.94, 95% CI -1.42 to -0.47, .0001) and lower pacing threshold at implantation (SMD -1.03, 95% CI -1.32 to -0.74, .00001) and at 6 months (SMD -1.44, 95% CI -2.11 to -0.77, .0001) as compared with BiVP.
CONCLUSION
Compared with BiVP, LBBAP was associated with better electromechanical and clinical outcomes, including left ventricular ejection fraction, QRS duration, echocardiographic response, New York Heart Association functional class, HF hospitalization, and all-cause mortality in patients with systolic HF.
PubMed: 38034886
DOI: 10.1016/j.hroo.2023.06.011 -
Journal of Clinical Medicine Apr 2024: this systematic review aims to explore the efficacy and safety of the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing... (Review)
Review
Laparoscopic Ligation of the Inferior Mesenteric Artery: A Systematic Review of an Emerging Trend for Addressing Type II Endoleak Following Endovascular Aortic Aneurysm Repair.
: this systematic review aims to explore the efficacy and safety of the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing a type II endoleak following endovascular aortic aneurysm repair (EVAR). : A comprehensive literature search was conducted across several databases including Medline, Scopus, and the Cochrane Central Register of Controlled Trials, adhering to the PRISMA guidelines. The search focused on articles reporting on the laparoscopic ligation of the IMA for the treatment of a type II endoleak post-EVAR. Data were extracted regarding study characteristics, patient demographics, technical success rates, postoperative outcomes, and follow-up results. : Our analysis included ten case studies and two retrospective cohort studies, comprising a total of 26 patients who underwent a laparoscopic ligation of the IMA between 2000 and 2023. The mean age of the cohort was 72.3 years, with a male predominance (92.3%). The mean AAA diameter at the time of intervention was 69.7 mm. The technique demonstrated a high technical success rate of 92.3%, with a mean procedure time of 118.4 min and minimal blood loss. The average follow-up duration was 19.9 months, with 73% of patients experiencing regression of the aneurysmal sac, and no reports of an IMA-related type II endoleak during the follow-up period. : The laparoscopic ligation of the IMA for a type II endoleak following EVAR presents a promising, minimally invasive alternative with high technical success rates and favorable postoperative outcomes. Despite its potential advantages, including reduced contrast agent use and radiation exposure, its application remains limited to specialized centers. The findings suggest the need for further research in larger prospective studies to validate the effectiveness of this procedure and potentially broaden its clinical adoption.
PubMed: 38731113
DOI: 10.3390/jcm13092584 -
Archives of Gynecology and Obstetrics Jul 2023Ovarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to... (Review)
Review
STUDY OBJECTIVE
Ovarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to assess some possible associated factors that can help surgeons in decision-making.
DESIGN
We conducted a retrospective multicentric study of pediatric OT surgically treated between 2010 and 2020 in six Italian and German institutions, comparing our findings with a literature review of the last 10 years (2010-2020).
PARTICIPANTS
Patients aged 0-18 years with a diagnosis of OT intraoperatively confirmed and surgically treated at the involved institutions.
RESULTS
Ninety-seven patients with a mean age at diagnosis of 8.37 years were enrolled in the study. Severe abdominal pain was present in 82 patients (84.5%). Eighty children (82.5%) presented an enlarged ovary with an US diameter > 5 cm and only 32 (40%) of them underwent conservative surgery. A laparoscopic approach was performed in 60 cases (61.9%) although in 15 (15.5%) conversion to open surgery was deemed necessary. A functional cyst was present in 49 patients (50.5%) while 11 children (11.3%) suffered from OT on a normal ovary.
CONCLUSIONS
Our results showed that a post-menarchal age (p = .001), a pre-operative US ovarian size < 5 cm, (p = .001), the presence of severe abdominal pain (p = .002), a laparoscopic approach (p < .001), and the presence of a functional cyst (p = .002) were significantly associated with conservative surgery.
Topics: Female; Child; Humans; Retrospective Studies; Ovarian Torsion; Torsion Abnormality; Ovarian Diseases; Abdominal Pain; Cysts; Multicenter Studies as Topic
PubMed: 35751675
DOI: 10.1007/s00404-022-06522-3 -
World Journal of Clinical Cases May 2024The specific benefits of Yangxinshi tablet (YXST) in the treating chronic heart failure (CHF) remain uncertain.
BACKGROUND
The specific benefits of Yangxinshi tablet (YXST) in the treating chronic heart failure (CHF) remain uncertain.
AIM
To systematically evaluate the efficacy and safety of YXST in the treatment of CHF.
METHODS
Randomized controlled trials (RCTs) investigating YXST for CHF treatment were retrieved from eight public databases up to November 2023. Meta-analyses of the included clinical studies were conducted using Review Manager 5.3.
RESULTS
Twenty RCTs and 1845 patients were included. The meta-analysis results showed that the YXST combination group, compared to the conventional drug group, significantly increased the clinical efficacy rate by 23% [relative risk (RR) = 1.23, 95%CI: 1.17-1.29], < 0.00001), left ventricular ejection fraction by 6.69% [mean difference (MD) = 6.69, 95%CI: 4.42-8.95, < 0.00001] and 6-min walk test by 49.82 m (MD = 49.82, 95%C: 38.84-60.80, < 0.00001), and reduced N-terminal pro-B-type natriuretic peptide by 1.03 ng/L [standardized MD (SMD) = -1.03, 95%CI: -1.32 to -0.74, < 0.00001], brain natriuretic peptide by 80.95 ng/L (MD = -80.95, 95%CI: -143.31 to -18.59, = 0.01), left ventricular end-diastolic diameter by 3.92 mm (MD = -3.92, 95%CI: -5.06 to -2.78, < 0.00001), and left ventricular end-systolic diameter by 4.34 mm (MD = -4.34, 95%CI: -6.22 to -2.47, < 0.00001). Regarding safety, neither group reported any serious adverse events during treatment (RR = 0.54, 95%CI: 0.15-1.90, = 0.33). In addition, Egger's test results indicated no significant publication bias ( = 0.557).
CONCLUSION
YXST effectively improves clinical symptoms and cardiac function in patients with CHF while maintaining a favorable safety profile, suggesting its potential as a therapeutic strategy for CHF.
PubMed: 38808352
DOI: 10.12998/wjcc.v12.i13.2218 -
Cardiology Journal Jul 2023Coronary slow flow (CSF) is an angiographic finding defined as delayed distal vessel perfusion without severe stenosis of the epicardial coronary arteries. However,...
BACKGROUND
Coronary slow flow (CSF) is an angiographic finding defined as delayed distal vessel perfusion without severe stenosis of the epicardial coronary arteries. However, definite alterations in left ventricular (LV) function in patients with CSF remains inconsistent. This study aimed to clarify the changes in LV function in patients with CSF and explore the factors that may influence LV function.
METHODS
PubMed, Embase, and Cochrane Library databases were systematically searched. Standardized mean differences and 95% confidence intervals (CI) for the LV function parameters were calculated. Subgroup analysis, meta-regression analysis, and correlation analysis were performed to explore the factors influencing LV function.
RESULTS
Twenty-two studies (1101 patients with CSF) were included after searching three databases. In patients with CSF, LV ejection function in patients with CSF was marginally lower (61.8%; 95% CI: 61.0%, 62.7%), global longitudinal strain was decreased (-18.2%; 95% CI: -16.7%, -19.7%). Furthermore, left atrial diameter, left atrial volume index, and E/e' were significantly increased, while E/A and e' were significantly decreased. The mean thrombolysis in myocardial infarction frame count (TFC) was linearly associated with LV function; the larger the mean TFC, the greater the impairment of LV function.
CONCLUSIONS
Left ventricular systolic and diastolic functions were impaired in patients with CSF, and this impairment was aggravated with increasing mean TFC.
PubMed: 37519056
DOI: 10.5603/CJ.a2023.0046 -
Annals of Intensive Care Feb 2024The prevalence of hyperdynamic left ventricular (LV) systolic function in septic patients and its impact on mortality remain controversial. In this systematic review and...
PURPOSE
The prevalence of hyperdynamic left ventricular (LV) systolic function in septic patients and its impact on mortality remain controversial. In this systematic review and meta-analysis, we investigated the prevalence and association of hyperdynamic LV systolic function with mortality in patients with sepsis.
METHODS
We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. Primary outcomes were the prevalence of hyperdynamic LV systolic function in adult septic patients and the associated short-term mortality as compared to normal LV systolic function. Hyperdynamic LV systolic function was defined using LV ejection fraction (LVEF) of 70% as cutoff. Secondary outcomes were heart rate, LV end-diastolic diameter (LVEDD), and E/e' ratio.
RESULTS
Four studies were included, and the pooled prevalence of hyperdynamic LV systolic function was 18.2% ([95% confidence interval (CI) 12.5, 25.8]; I = 7.0%, P < 0.0001). Hyperdynamic LV systolic function was associated with higher mortality: odds ratio of 2.37 [95%CI 1.47, 3.80]; I = 79%, P < 0.01. No difference was found in E/e' (P = 0.43) between normal and hyperdynamic LV systolic function, while higher values of heart rate (mean difference: 6.14 beats/min [95%CI 3.59, 8.69]; I = 51%, P < 0.0001) and LVEDD (mean difference: - 0.21 cm [95%CI - 0.33, - 0.09]; I = 73%, P < 0.001) were detected in patients with hyperdynamic LV systolic function.
CONCLUSION
The prevalence of hyperdynamic LV systolic function is not negligible in septic patients. Such a finding is associated with significantly higher short-term mortality as compared to normal LV systolic function.
PubMed: 38308701
DOI: 10.1186/s13613-024-01255-9 -
Imaging Science in Dentistry Sep 2023This systematic review examined the detection of the posterior superior alveolar artery, along with various anatomic characteristics, on cone-beam computed tomography...
PURPOSE
This systematic review examined the detection of the posterior superior alveolar artery, along with various anatomic characteristics, on cone-beam computed tomography images.
MATERIALS AND METHODS
Studies were identified electronically through the Web of Science, MEDLINE, Scopus, and Embase databases. The quality of the included studies was evaluated using a 5-item binary scale. The detection rate, location, and classified diameter of the posterior superior alveolar artery were estimated as prevalence values. The diameter of this artery, as well as the distances from the artery to the alveolar crest and sinus floor, were estimated as means with associated 95% confidence intervals.
RESULTS
Thirty-seven studies were enrolled, with 34 of these included in the meta-analysis. The mean detection rate was 79% (range: 72%-84%), and the mean diameter was 1.06±0.05 mm (range: 0.96-1.16 mm). The posterior superior alveolar artery was located intraosseously in 64% of cases. The mean distance of the artery from the alveolar crest was 16.71±0.49 mm (range: 15.75-17.68 mm), while the mean distance from the artery to the sinus floor was 8.85±0.4 mm (range: 8.05-9.64 mm).
CONCLUSION
According to the findings of this meta-analysis regarding various anatomic characteristics of the posterior superior alveolar artery, severe hemorrhage after damage to this artery during sinus augmentation procedures is not a substantial clinical problem.
PubMed: 37799745
DOI: 10.5624/isd.20230009