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Journal of Pediatric Urology Feb 2022This systematic review and meta-analysis aimed to define the current evidence and systematically summarize the relevant data regarding the utility and safety of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to define the current evidence and systematically summarize the relevant data regarding the utility and safety of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment in complicated re-operative cases of hypospadias.
METHOD
The authors systematically searched the PubMed, EMBASE, Web of Science, and Scopus databases on August 5, 2021. Patients were divided into two groups, i.e. HBOT and non-HBOT. The main outcomes were graft failure rate and the incidence of complications following urethroplasty. The proportion of patients developing adverse events due to HBOT was the secondary outcome. The pooled risk ratio and heterogeneity were calculated using the Mantel-Haenszel method and the I statistics respectively. The quality assessment of the included studies was performed using the Downs and Black scale.
RESULT
Four studies constituting 176 patients (101 in the HBOT group) were included (Figure). Variations were observed among these studies in terms of the age of participants, the number and types of previous operations performed, and the protocol of administration of HBOT. The graft failure rate (RR 0.19; 95% CI 0.05-0.73, p = 0.02) and the incidence of complications (RR 0.40, 95% CI 0.20-0.77, p = 0.007) were significantly low in the HBOT versus the non-HBOT group. Apart from myringotomy insertion (n = 10; 9.9%) and claustrophobia (n = 1), no other adverse events were associated with HBOT. All studies had a moderate risk of bias. An almost perfect agreement (kappa = 0.956, p < 0.0001) was observed between the two investigators assessing the risk of bias.
CONCLUSION
The present systematic review and meta-analysis significantly favor the administration of HBOT versus no HBOT in terms of graft failure rate and incidence of complications following urethroplasty. The available data also highlights the safety of HBOT in complicated cases of hypospadias. However, well-designed randomized controlled trials need to be conducted for an optimal comparison between the two treatment groups.
Topics: Humans; Hyperbaric Oxygenation; Hypospadias; Male; Urethra
PubMed: 34696963
DOI: 10.1016/j.jpurol.2021.10.004 -
American Journal of Nephrology 2023Clinical guidelines recommend exercise training for patients undergoing maintenance hemodialysis (MHD). However, the effectiveness of different types of exercise remains... (Meta-Analysis)
Meta-Analysis
Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis.
BACKGROUND
Clinical guidelines recommend exercise training for patients undergoing maintenance hemodialysis (MHD). However, the effectiveness of different types of exercise remains uncertain.
OBJECTIVES
The aims of the study were to compare and rank the effect of different types of exercise on walking capacity, cardiorespiratory fitness, dialysis adequacy, and health-related quality of life (HRQOL) in patients undergoing MHD.
METHODS
Eight databases (four English and four Chinese) were searched from inception to January 1, 2022. Randomized controlled trials evaluating the efficacy of different exercises for patients undergoing MHD were included. Two independent reviewers screened the literature, extracted data, assessed the risk of bias, and evaluated the certainty of evidence. A frequentist random-effect network meta-analysis was conducted.
RESULTS
Ninety trials with 4,084 participants comparing 15 types of exercise were included, reporting on the six-minute walking test (45 trials), peak oxygen uptake (22 trials), dialysis adequacy (30 trials), and HRQOL (23 trials). Network meta-analysis showed that the most effective intervention for walking capacity was intradialytic aerobic exercise combined with blood flow restriction with a mean difference and 95% confidence interval of 97.35 (11.89-182.81), for peak oxygen uptake it was non-intradialytic combined aerobic and resistance exercise with a value of 4.35 (2.25-6.44), for dialysis adequacy it was intradialytic combined aerobic and resistance exercise with a value of 0.17 (0.06-0.28), for the physical component summary of HRQOL it was intradialytic aerobic exercise with a value of 4.93 (2.31-7.54), and for the mental component summary of HRQOL it was non-intradialytic combined aerobic and resistance exercise with a value of 6.36 (0.45-12.27). Ultimately, intradialytic combined aerobic and resistance exercise could improve all the above outcomes compared to usual care.
CONCLUSIONS
This study concluded that intradialytic combined aerobic and resistance exercise is optimal for MHD patients due to its significant positive effects on multiple outcomes. Walking capacity can be further enhanced by combining blood flow restriction with exercise. For improving dialysis adequacy, intradialytic exercise proves to be more effective than non-intradialytic exercise. Further well-designed clinical trials are needed to investigate the effects of exercise with varying durations, intensities, and frequencies.
Topics: Humans; Quality of Life; Renal Dialysis; Network Meta-Analysis; Exercise Therapy; Exercise; Oxygen
PubMed: 37536298
DOI: 10.1159/000532109 -
The Journal of Evidence-based Dental... Dec 2020This systematic review and meta-analysis aimed to investigate the effectiveness and safety of ozone therapy for treating dental caries. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to investigate the effectiveness and safety of ozone therapy for treating dental caries.
METHODS
We searched for randomized controlled trials (RCTs) in 8 databases, from inception to April 4, 2020 (MEDLINE, EMBASE, CENTRAL, LILACS, Bibliografia Brasileira de Odontologia, ClinicalTrials.gov, WHO, and OpenGrey). Primary outcome measures were antimicrobial effect and adverse events. We used the Cochrane risk of bias tool to evaluate methodological quality of included RCTs and GRADE approach to evaluate the certainty of the evidence. We used the Review Manager software to conduct meta-analyses.
RESULTS
We included 12 RCTs comparing ozone therapy with no ozone, chlorhexidine digluconate, fissure sealants (alone and added to ozone), and fluoride. Considering primary outcomes, ozone therapy showed (a) lower reduction in the bacterial number than chlorhexidine digluconate in children (mean difference [MD]: -5.65 [-9.79 to -1.51]), but no difference was observed in adults (MD: -0.10 [-1.07 to 0.88]); (b) higher reduction in the bacterial number than sealant (MD: 12.60 [3.86-21.34]), but no difference was observed after final excavation (MD: -0.00 [-0.01 to 0.01]). Regarding safety of ozone therapy, results from individual studies presented no adverse events during or after treatment. Most of these results are imprecise and should be interpreted with caution because of clinical and methodological concerns, small sample size, and wide confidence interval, precluding to determine the real effect direction.
CONCLUSION
Based on a very low certainty of evidence, there is not enough support from published RCTs to recommend the use of ozone for the treatment of dental caries. Well-conducted studies should be encouraged, measuring mainly the antimicrobial effects of ozone therapy at long term and following the recommendations of the CONSORT statement for the reporting of RCTs.
Topics: Adult; Child; Dental Caries; Fluorides; Humans; Ozone; Pit and Fissure Sealants
PubMed: 33303100
DOI: 10.1016/j.jebdp.2020.101472 -
Environmental Pollution (Barking, Essex... Nov 2019Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However,... (Meta-Analysis)
Meta-Analysis
Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However, results from epidemiologic research on the association between exposure to AAP and altered lipid profile have been inconsistent. This study aims to systematically review and meta-analyse epidemiologic evidence on the association between exposure to ambient air pollutants (particulate matter, nitrogen oxides, sulphur dioxide, ozone, carbon monoxide, back carbon) and lipid profile parameters (Total cholesterol; High-Density Lipoprotein Cholesterol; Low-Density Lipoprotein Cholesterol; TG-Triglycerides) or dyslipidaemia. Systematic electronic literature search was performed in PubMed, Web of Science and Scopus databases (last search on 24th May 2019) using keywords related to the exposure (ambient air pollutants) and to the outcomes (lipid profile parameters/dyslipidaemia). Qualitative and quantitative information of the studies were extracted and fixed or random-effects models were used to obtain a pooled effect estimate per each pollutant/outcome combination. 22 studies were qualitatively analysed and, from those, 3 studies were quantitatively analysed. Particulate matters were the most studied pollutants and a considerable heterogeneity in air pollution assessment methods and outcomes definitions was detected. Age, obesity related measures, tobacco consumption, sex and socioeconomic factors were the most frequent considered variables for confounding adjustment in the models. In a long-term exposure scenario, we found a 3.14% (1.36%-4.95%) increase in TG levels per 10 μg/m PM increment and a 4.24% (1.37%-7.19%) increase in TG levels per 10 μg/m NO increment. No significant associations were detected for the remaining pollutant/outcome combinations. Despite the few studies included in the meta-analysis, our study suggests some epidemiologic evidence supporting the association between PM and NO exposures and increased TG levels. Due to the very low level of evidence, more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects.
Topics: Air Pollutants; Air Pollution; Carbon Monoxide; Environmental Exposure; Environmental Pollutants; Female; Humans; Lipids; Male; Nitrogen Oxides; Ozone; Particulate Matter; Socioeconomic Factors; Sulfur Dioxide
PubMed: 31465899
DOI: 10.1016/j.envpol.2019.113036 -
Training Periodization, Intensity Distribution, and Volume in Trained Cyclists: A Systematic Review.International Journal of Sports... Feb 2023A well-planned periodized approach endeavors to allow road cyclists to achieve peak performance when their most important competitions are held.
UNLABELLED
A well-planned periodized approach endeavors to allow road cyclists to achieve peak performance when their most important competitions are held.
PURPOSE
To identify the main characteristics of periodization models and physiological parameters of trained road cyclists as described by discernable training intensity distribution (TID), volume, and periodization models.
METHODS
The electronic databases Scopus, PubMed, and Web of Science were searched using a comprehensive list of relevant terms. Studies that investigated the effect of the periodization of training in cyclists and described training load (volume, TID) and periodization details were included in the systematic review.
RESULTS
Seven studies met the inclusion criteria. Block periodization (characterized by employment of highly concentrated training workload phases) ranged between 1- and 8-week blocks of high-, medium-, or low-intensity training. Training volume ranged from 8.75 to 11.68 h·wk-1 and both pyramidal and polarized TID were used. Traditional periodization (characterized by a first period of high-volume/low-intensity training, before reducing volume and increasing the proportion of high-intensity training) was characterized by a cyclic progressive increase in training load, the training volume ranged from 7.5 to 10.76 h·wk-1, and pyramidal TID was used. Block periodization improved maximum oxygen uptake (VO2max), peak aerobic power, lactate, and ventilatory thresholds, while traditional periodization improved VO2max, peak aerobic power, and lactate thresholds. In addition, a day-by-day programming approach improved VO2max and ventilatory thresholds.
CONCLUSIONS
No evidence is currently available favoring a specific periodization model during 8 to 12 weeks in trained road cyclists. However, few studies have examined seasonal impact of different periodization models in a systematic way.
Topics: Humans; Athletic Performance; Oxygen Consumption; Oxygen; Lactic Acid; Bibliometrics
PubMed: 36640771
DOI: 10.1123/ijspp.2022-0302 -
Environmental Pollution (Barking, Essex... Jan 2022Studies have linked gaseous air pollutants to multiple health effects via inflammatory pathways. Several major inflammatory biomarkers, including C-reactive protein... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies have linked gaseous air pollutants to multiple health effects via inflammatory pathways. Several major inflammatory biomarkers, including C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) have also been considered as predictors of cardiovascular disease. However, there has been no meta-analysis to evaluate the associations between gaseous air pollutants and these typical biomarkers of inflammation to date.
OBJECTIVES
To evaluate the overall associations between short-term and long-term exposures to ambient ozone (O), nitrogen dioxide (NO), sulfur dioxide (SO), carbon dioxide (CO) and major inflammatory biomarkers including CRP, fibrinogen, IL-6 and TNF-α.
METHODS
A meta-analysis was conducted for publications from PubMed, Web of Science, Scopus and EMBASE databases up to Feb 1st, 2021.
RESULTS
The meta-analysis included 38 studies conducted among 210,438 participants. Generally, we only observed significant positive associations between short-term exposures to gaseous air pollutants and inflammatory biomarkers. For a 10 μg/m increase in short-term exposure to O, NO, and SO, there were significant increases of 1.05% (95%CI: 0.09%, 2.02%), 1.60% (95%CI: 0.49%, 2.72%), and 10.44% (95%CI: 4.20%, 17.05%) in CRP, respectively. Meanwhile, a 10 μg/m increase in NO was also associated with a 4.85% (95%CI: 1.10%, 8.73%) increase in TNF-α. Long-term exposures to gaseous air pollutants were not statistically associated with these biomarkers, but the study numbers were relatively small. Subgroup analyses found more apparent associations in studies with better study design, higher quality, and smaller sample size. Meanwhile, the associations also varied across studies conducted in different geographical regions.
CONCLUSION
Short-term exposure to gaseous air pollutants is associated with increased levels of circulating inflammatory biomarkers, suggesting that a systemic inflammatory state is activated upon exposure. More studies on long-term exposure to gaseous air pollutants and inflammatory biomarkers are warranted to verify the associations.
Topics: Air Pollutants; Air Pollution; Biomarkers; Environmental Exposure; Humans; Inflammation; Nitrogen Dioxide; Ozone; Particulate Matter
PubMed: 34634403
DOI: 10.1016/j.envpol.2021.118336 -
Anaesthesia Nov 2022We performed a systematic review and meta-analysis to identify, classify and evaluate the body of evidence on novel wearable and contactless devices that measure heart... (Meta-Analysis)
Meta-Analysis Review
We performed a systematic review and meta-analysis to identify, classify and evaluate the body of evidence on novel wearable and contactless devices that measure heart rate, respiratory rate and oxygen saturations in the clinical setting. We included any studies of hospital inpatients, including sleep study clinics. Eighty-four studies were included in the final review. There were 56 studies of wearable devices and 29 of contactless devices. One study assessed both types of device. A high risk of patient selection and rater bias was present in proportionally more studies assessing contactless devices compared with studies assessing wearable devices (p = 0.023 and p < 0.0001, respectively). There was high but equivalent likelihood of blinding bias between the two types of studies (p = 0.076). Wearable device studies were commercially available devices validated in acute clinical settings by clinical staff and had more real-time data analysis (p = 0.04). Contactless devices were more experimental, and data were analysed post-hoc. Pooled estimates of mean (95%CI) heart rate and respiratory rate bias in wearable devices were 1.25 (-0.31-2.82) beats.min (pooled 95% limits of agreement -9.36-10.08) and 0.68 (0.05-1.32) breaths.min (pooled 95% limits of agreement -5.65-6.85). The pooled estimate for mean (95%CI) heart rate and respiratory rate bias in contactless devices was 2.18 (3.31-7.66) beats.min (pooled limits of agreement -6.71-10.88) and 0.30 (-0.26-0.87) breaths.min (pooled 95% limits of agreement -3.94-4.29). Only two studies of wearable devices measured S O ; these reported mean measurement biases of 3.54% (limits of agreement -5.65-11.45%) and 2.9% (-7.4-1.7%). Heterogeneity was observed across studies, but absent when devices were grouped by measurement modality and reference standard. We conclude that, while studies of wearable devices were of slightly better quality than contactless devices, in general all studies of novel devices were of low quality, with small (< 100) patient datasets, typically not blinded and often using inappropriate statistical techniques. Both types of devices were statistically equivalent in accuracy and precision, but wearable devices demonstrated less measurement bias and more precision at extreme vital signs. The statistical variability in precision and accuracy between studies is partially explained by differences in reference standards.
Topics: Heart Rate; Humans; Monitoring, Physiologic; Oxygen; Oxygen Saturation; Respiratory Rate; Wearable Electronic Devices
PubMed: 35947876
DOI: 10.1111/anae.15834 -
Critical Care Medicine Feb 2020RBC transfusions can increase oxygen availability to the tissues, but studies have provided conflicting results. The objectives of this study were, therefore, to... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
RBC transfusions can increase oxygen availability to the tissues, but studies have provided conflicting results. The objectives of this study were, therefore, to evaluate, using systematic review and meta-analysis, the effects of transfusion on hemodynamic/oxygenation variables in patients without acute bleeding.
DATA SOURCES
PubMed, Scopus, Cochrane Database of Systematic Reviews, and Embase from inception until June 30, 2019.
STUDY SELECTION
All articles that reported values of prespecified hemodynamic or oxygenation variables before and after RBC transfusion.
DATA EXTRACTION
Publication year, number of patients, number of transfusions and the type of population studied, hemodynamic and oxygenation data (heart rate, cardiac index, mixed venous oxygen saturation or central venous oxygen saturation, oxygen delivery index, oxygen consumption index, oxygen extraction ratio, arteriovenous oxygen difference and arterial blood lactate) before and after transfusion. We performed a meta-analysis for each variable for which there were sufficient data to estimate mean differences. We also performed subgroup analyses comparing septic with nonseptic patients.
DATA SYNTHESIS
We retrieved 6,420 studies; 33 met the inclusion criteria, 14 of which were in patients with sepsis. In the meta-analysis, the estimated mean differences and 95% CIs comparing the periods before and after transfusion were -0.0 L/min/m (-0.1 to 0.1 L/min/m) (p = 0.86) for cardiac index; -1.8 beats/min (-3.7 to 0.1 beats/min) (p = 0.06) for heart rate; 96.8 mL/min/m (71.1-122.5 mL/min/m) (p < 0.01) for oxygen delivery index; 2.9% (2.2-3.5%) (p < 0.01) for mixed venous oxygen saturation or central venous oxygen saturation; -3.7% (-4.4% to -3.0%) (p < 0.01) for oxygen extraction ratio; and 4.9 mL/min/m (0.9-9.0 mL/min/m) (p = 0.02) for oxygen consumption index. The estimated mean difference for oxygen consumption index in the patients with sepsis was 8.4 mL/min/m (2.3-14.5 mL/min/m; p = 0.01).
CONCLUSIONS
Transfusion was not associated with a decrease in mean cardiac output or mean heart rate. The increase in mean oxygen delivery following transfusion was associated with an increase in mean oxygen consumption after transfusion, especially in patients with sepsis.
Topics: Erythrocyte Transfusion; Hemodynamics; Humans; Oxygen
PubMed: 31939794
DOI: 10.1097/CCM.0000000000004115 -
International Journal of Environmental... Mar 2020Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and ozone exposure is a main cause of its disease burden. However, studies on... (Meta-Analysis)
Meta-Analysis
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and ozone exposure is a main cause of its disease burden. However, studies on COPD hospitalizations from short-term ambient level ozone exposure have not generated consensus results. To address the knowledge gap, comprehensive and systematic searches in several databases were conducted using specific keywords for publications up to February 14, 2020. Random-effect models were used to derive overall excess risk estimates between short-term ambient-level ozone exposure and COPD hospitalizations. The influence analyses were used to test the robustness of the results. Both meta-regression and subgroup analyses were used to explore the sources of heterogeneity and potential modifying factors. Based on the results from 26 eligible studies, the random-effect model analyses show that a 10 µg/m increase in maximum 8-h ozone concentration was associated with 0.84% (95% CI: 0.09%, 1.59%) higher COPD hospitalizations. The estimates were higher for warm season and multiple-day lag but lower for old populations. Results from subgroup analyses also indicate a multiple-day lag trend and bigger significant health effects during longer day intervals. Although characteristics of individual studies added modest heterogeneity to the overall estimates, the results remained robust during further analyses and exhibited no evidence of publication bias. Our systematic review and meta-analysis indicate that short-term ambient level ozone exposure was associated with increased risk of COPD hospitalizations. The significant association with multiple-day lag trend indicates that a multiple-day exposure metric should be considered for establishing ambient ozone quality and exposure standards for improvement of population health. Future investigations and meta-analysis studies should include clinical studies as well as more careful lag selection protocol.
Topics: Air Pollutants; Environmental Exposure; Hospitalization; Humans; Ozone; Pulmonary Disease, Chronic Obstructive; Seasons
PubMed: 32210080
DOI: 10.3390/ijerph17062130 -
Frontiers in Pediatrics 2022This review assesses the effect of apnoeic oxygenation during paediatric intubation on rates of hypoxaemia, successful intubation on the first attempt and other adverse... (Review)
Review
OBJECTIVE
This review assesses the effect of apnoeic oxygenation during paediatric intubation on rates of hypoxaemia, successful intubation on the first attempt and other adverse events.
DATA SOURCES
The databases searched included PubMed, Medline, CINAHL, EMBASE and The Cochrane Library. An electronic search for unpublished studies was also performed.
STUDY SELECTION
We screened studies that include children undergoing intubation, studies that evaluate the use of apnoeic oxygenation by any method or device with outcomes of hypoxaemia, intubation outcome and adverse events were eligible for inclusion.
DATA EXTRACTION
Screening, risk of bias, quality of evidence and data extraction was performed by two independent reviewers, with conflicts resolved by a third reviewer where consensus could not be reached.
DATA SYNTHESIS
From 362 screened studies, fourteen studies ( = 2442) met the eligibility criteria. Randomised controlled trials ( = 482) and studies performed in the operating theatre ( = 835) favoured the use of apnoeic oxygenation with a reduced incidence of hypoxaemia (RR: 0.34, 95% CI: 0.24 to 0.47, < 0.001, = 0% and RR: 0.27, 95% CI: 0.11 to 0.68, = 0.005, = 68% respectively). Studies in the ED and PICU were of lower methodological quality, displaying heterogeneity in their results and were unsuitable for meta-analysis. Among the studies reporting first attempt intubation success, there were inconsistent effects reported and data were not suitable for meta-analysis.
CONCLUSION
There is a growing body of evidence to support the use of apnoeic oxygenation during the intubation of children. Further research is required to determine optimal flow rates and delivery technique. The use of humidified high-flow oxygen shows promise as an effective technique based on data in the operating theatre, however its efficacy has not been shown to be superior to low flow oxygen in either the elective anesthetic or emergency intubation situations This review was prospectively registered in the PROSPERO international register of systematic reviews (Reference: CRD42020170884, registered April 28, 2020).
PubMed: 36479287
DOI: 10.3389/fped.2022.918148