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Reproductive Sciences (Thousand Oaks,... Apr 2023Uterine fibroids are the most common tumor of reproductive-age women worldwide and cause significant morbidity in affected women. Vitamin D has emerged as a potential... (Review)
Review
Uterine fibroids are the most common tumor of reproductive-age women worldwide and cause significant morbidity in affected women. Vitamin D has emerged as a potential therapy for uterine fibroids based on experimental and epidemiologic evidence. The objective of this systematic review was to evaluate the role of vitamin D in the pathophysiology of uterine fibroids and its efficacy for prevention and treatment of fibroids. A comprehensive search was conducted of Cochrane Library, Embase, PubMed, Scopus, and Web of Science from inception to March 2022. English-language publications that evaluated vitamin D and uterine fibroids in humans, whether experimental or clinical, were considered. The search yielded 960 publications, and 89 publications met inclusion criteria: 23 preclinical studies, 25 clinical studies, and 41 review articles. Preclinical studies indicated that the vitamin D receptor was decreased in fibroid cells. Vitamin D treatment of fibroid cells decreased proliferation, extracellular matrix protein expression, and Wnt/β-catenin signaling. Fourteen clinical studies (n = 3535 participants) assessed serum vitamin D level in women with ultrasound-proven fibroids, and all found an inverse correlation between serum vitamin D level and presence of fibroids. Five clinical studies (n = 472 patients) evaluated treatment of fibroids with vitamin D. Four of five studies showed vitamin D significantly inhibited fibroid growth. One pilot study (n = 109 patients) of vitamin D for secondary prevention of fibroids demonstrated smaller recurrent fibroids in the treated group. These studies provide evidence for vitamin D as a therapy for uterine fibroids and underscore the need for well-designed, randomized, placebo-controlled clinical trials.
Topics: Humans; Female; Vitamin D; Uterine Neoplasms; Pilot Projects; Leiomyoma
PubMed: 35960442
DOI: 10.1007/s43032-022-01011-z -
The American Journal of Cardiology May 2023Neuroendocrine tumors (NETs) are a rare group of malignancies which are aggressive and widely metastatic. Cardiac metastases (CMs) are rarely reported because of NET. We... (Meta-Analysis)
Meta-Analysis
Neuroendocrine tumors (NETs) are a rare group of malignancies which are aggressive and widely metastatic. Cardiac metastases (CMs) are rarely reported because of NET. We aim to analyze the available literature to study the proportional prevalence of CM because of NET and its location and effect on the ejection fraction (EF) and survival rate. Our search strategy and meta-analysis are in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) AMSTAR-2 (Assessing the methodological quality of systematic Reviews-2) Guidelines. A literature search was conducted on MEDLINE (EMBASE and PubMed) for randomized clinical trials, pilot trials, and retrospective and prospective studies. Statistical analysis was performed using the CRAN-R software (https://CRAN.R-project.org/doc/FAQ/R-FAQ.html). The quality assessment of the included articles was performed using the Cochrane Risk of Bias and Newcastle-Ottawa Scale. A total of 16,685 patients were included in the study. The mean age of patients included in the study was 61.28 ± SD 9.89 years. Of these, 257 patients had a total of 283 CM. Metastasis was mainly located in the left ventricle with a pooled proportion of 0.48, 95% confidence interval (CI) 0.4 to 0.56, pericardium: 0.34, 95% CI 0.19 to 0.53, right ventricle 0.28, 95% CI 0.16 to 0.44, interventricular septum 0.25, 95% CI 0.16 to 0.37, left atrium 0.1, 95% CI 0.03 to 0.26 and right atrium 0.05, 95% CI 0.01 to 0.20. Decrease in EF at the time of CM diagnosis was the effect most consistently reported in patients with CM. Pooled mean survival was 35.89, 95% CI 8.27 to 155.68 months after the diagnosis of CM. CM due to NET was <2% and the left ventricle is the most common metastatic location, followed by the pericardium. Decreased EF was the most common clinical picture observed. Further studies are needed to analyze the clinical impact of NET CM.
Topics: Humans; Middle Aged; Prospective Studies; Prevalence; Retrospective Studies; Melanoma; Melanoma, Cutaneous Malignant
PubMed: 36996525
DOI: 10.1016/j.amjcard.2023.02.011 -
Advances in Experimental Medicine and... 2023Higher education's expectations place demands on students' attainment, leading them to experience stress and anxiety, which negatively affect their academic improvement...
Higher education's expectations place demands on students' attainment, leading them to experience stress and anxiety, which negatively affect their academic improvement and life satisfaction. The aim of this systematic review was to investigate (a) if mindfulness as an inner ability is related to academic attainment, through dependent variables, including compassion, engagement, stress or anxiety state, depression, self-efficacy, mindfulness's facets (non-reactivity, acting with awareness) and (b) if mindfulness-based interventions positively affect the academic performance of college and university students. The systematic review was conducted in accordance with the PRISMA statement. PubMed, Web of Science, and Cochrane Library Wiley were screened to identify studies published relevant to the topic. In total, 568 papers were retrieved in the initial search. Five papers met the eligibility criteria and were included in the systematic review: a randomized controlled trial, a non-randomized controlled trial, a quasi-experimental study, a quantitative exploratory pilot study, and a longitudinal randomized controlled study. Most interventional studies revealed a non-significant direct effect of practicing mindfulness technique on academic attainment. Further research, especially randomized controlled trials are necessary to clarify the effect of mindfulness on academic performance of college and university students.
Topics: Humans; Academic Performance; Depression; Mindfulness; Pilot Projects; Randomized Controlled Trials as Topic; Stress, Psychological; Students; Universities
PubMed: 37581795
DOI: 10.1007/978-3-031-31986-0_20 -
Evidence-based Dentistry Jun 2022Data sources PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Bibliography in Dentistry and Cochrane Library. The grey... (Meta-Analysis)
Meta-Analysis Review
Data sources PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Bibliography in Dentistry and Cochrane Library. The grey literature was searched using the System for Information on Grey Literature in Europe database. Abstracts from the Annual Session of the International Association for Dental Research and its regional subgroups (1990-2020) were searched. Theses and dissertations (full texts) were searched in the ProQuest and Capes databases. Unpublished and ongoing studies were searched in clinical trial databases (Current Controlled Trials, International Clinical Trials Registry Platform, ClinicalTrials.gov, Registro Brasileiro de Ensaios Clínicos and EU Clinical Trials Register).Study selection In total, 14 randomised clinical trials comparing the clinical performance of composite resin restorations in posterior teeth placed with the incremental or the bulk-filling techniques were evaluated.Data extraction and synthesis Relevant information on the research project, participants, interventions and outcomes was collected using extraction forms by three study authors. Data extraction was pilot-tested using a sample of four studies to ensure that the data were consistent with the specific research question. To avoid overlapping, multiple reports of the same study with different follow-ups were extracted into a single form.Results Considering the primary and secondary outcomes (retention/fracture rate, anatomical form, surface texture, colour match, marginal adaption, marginal discoloration, caries and postoperative sensitivity), it is possible to state that there was no difference between incremental or bulk fill resin composite techniques in Class II and I cavities.Conclusions A systematic review and meta-analysis with moderated quality of evidence bulk fill and incremental techniques showed similar clinical performance on posterior resin composite restorations.
Topics: Brazil; Caribbean Region; Composite Resins; Databases, Factual; Dental Caries; Dental Restoration, Permanent; Humans
PubMed: 35750739
DOI: 10.1038/s41432-022-0264-9 -
The Cochrane Database of Systematic... Apr 2021Bronchiectasis is characterised by excessive sputum production, chronic cough, and acute exacerbations and is associated with symptoms of dyspnoea and fatigue, which... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Bronchiectasis is characterised by excessive sputum production, chronic cough, and acute exacerbations and is associated with symptoms of dyspnoea and fatigue, which reduce exercise tolerance and impair quality of life. Exercise training in isolation or in conjunction with other interventions is beneficial for people with other respiratory diseases, but its effects in bronchiectasis have not been well established.
OBJECTIVES
To determine effects of exercise training compared to usual care on exercise tolerance (primary outcome), quality of life (primary outcome), incidence of acute exacerbation and hospitalisation, respiratory and mental health symptoms, physical function, mortality, and adverse events in people with stable or acute exacerbation of bronchiectasis.
SEARCH METHODS
We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, and the World Health Organization trials portal, from their inception to October 2020. We reviewed respiratory conference abstracts and reference lists of all primary studies and review articles for additional references.
SELECTION CRITERIA
We included randomised controlled trials in which exercise training of at least four weeks' duration (or eight sessions) was compared to usual care for people with stable bronchiectasis or experiencing an acute exacerbation. Co-interventions with exercise training including education, respiratory muscle training, and airway clearance therapy were permitted if also applied as part of usual care.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened and selected trials for inclusion, extracted outcome data, and assessed risk of bias. We contacted study authors for missing data. We calculated mean differences (MDs) using a random-effects model. We used the GRADE approach to assess the certainty of evidence.
MAIN RESULTS
We included six studies, two of which were published as abstracts, with a total of 275 participants. Five studies were undertaken with people with clinically stable bronchiectasis, and one pilot study was undertaken post acute exacerbation. All studies included co-interventions such as instructions for airway clearance therapy and/or breathing strategies, provision of an educational booklet, and delivery of educational sessions. The duration of training ranged from six to eight weeks, with a mix of supervised and unsupervised sessions conducted in the outpatient or home setting. No studies of children were included in the review; however we identified two studies as currently ongoing. No data were available regarding physical activity levels or adverse events. For people with stable bronchiectasis, evidence suggests that exercise training compared to usual care improves functional exercise tolerance as measured by the incremental shuttle walk distance, with a mean difference (MD) between groups of 87 metres (95% confidence interval (CI) 43 to 132 metres; 4 studies, 161 participants; low-certainty evidence). Evidence also suggests that exercise training improves six-minute walk distance (6MWD) (MD between groups of 42 metres, 95% CI 22 to 62; 1 study, 76 participants; low-certainty evidence). The magnitude of these observed mean changes appears clinically relevant as they exceed minimal clinically important difference (MCID) thresholds for people with chronic lung disease. Evidence suggests that quality of life improves following exercise training according to St George's Respiratory Questionnaire (SGRQ) total score (MD -9.62 points, 95% CI -15.67 to -3.56 points; 3 studies, 160 participants; low-certainty evidence), which exceeds the MCID of 4 points for this outcome. A reduction in dyspnoea (MD 1.0 points, 95% CI 0.47 to 1.53; 1 study, 76 participants) and fatigue (MD 1.51 points, 95% CI 0.80 to 2.22 points; 1 study, 76 participants) was observed following exercise training according to these domains of the Chronic Respiratory Disease Questionnaire. However, there was no change in cough-related quality of life as measured by the Leicester Cough Questionnaire (LCQ) (MD -0.09 points, 95% CI -0.98 to 0.80 points; 2 studies, 103 participants; moderate-certainty evidence), nor in anxiety or depression. Two studies reported longer-term outcomes up to 12 months after intervention completion; however exercise training did not appear to improve exercise capacity or quality of life more than usual care. Exercise training reduced the number of acute exacerbations of bronchiectasis over 12 months in people with stable bronchiectasis (odds ratio 0.26, 95% CI 0.08 to 0.81; 1 study, 55 participants). After an acute exacerbation of bronchiectasis, data from a single study (N = 27) suggest that exercise training compared to usual care confers little to no effect on exercise capacity (MD 11 metres, 95% CI -27 to 49 metres; low-certainty evidence), SGRQ total score (MD 6.34 points, 95%CI -17.08 to 29.76 points), or LCQ score (MD -0.08 points, 95% CI -0.94 to 0.78 points; low-certainty evidence) and does not reduce the time to first exacerbation (hazard ratio 0.83, 95% CI 0.31 to 2.22).
AUTHORS' CONCLUSIONS
This review provides low-certainty evidence suggesting improvement in functional exercise capacity and quality of life immediately following exercise training in people with stable bronchiectasis; however the effects of exercise training on cough-related quality of life and psychological symptoms appear to be minimal. Due to inadequate reporting of methods, small study numbers, and variation between study findings, evidence is of very low to moderate certainty. Limited evidence is available to show longer-term effects of exercise training on these outcomes.
Topics: Adult; Bias; Breathing Exercises; Bronchiectasis; Cough; Disease Progression; Dyspnea; Exercise; Exercise Tolerance; Hospitalization; Humans; Mental Health; Physical Endurance; Physical Functional Performance; Quality of Life; Respiration Disorders; Walk Test
PubMed: 33822364
DOI: 10.1002/14651858.CD013110.pub2 -
International Journal of Surgery... Nov 2023Hepatocellular carcinoma (HCC) is the third-most lethal malignant tumor worldwide. The rapid development of immunotherapy utilizing immune checkpoint inhibitors for... (Meta-Analysis)
Meta-Analysis
Clinico-characteristics of patients which correlated with preferable treatment outcomes in immunotherapy for advanced hepatocellular carcinoma: a systematic review and meta-analysis.
BACKGROUND AND AIMS
Hepatocellular carcinoma (HCC) is the third-most lethal malignant tumor worldwide. The rapid development of immunotherapy utilizing immune checkpoint inhibitors for advanced HCC patients has been witnessed in recent years, along with numerous randomized clinical trials demonstrating the survival benefits for these individuals. This systematic review and meta-analysis aimed to identify specific clinico-pathological characteristics of advanced HCC patients that may lead to preferable responses to immunotherapy in terms of overall survival (OS), progression-free survival (PFS), and objective response rate (ORR).
METHODS
The included clinical trials were retrieved from PubMed, Embase, the Cochrane library, and the Web of Science databases published in English between 1 January 2002 and 20 October 2022. A systematic review and meta-analysis for first-line and second-line phase II/III studies were conducted on immunotherapy for patients with advanced HCC by using OS as the primary outcome measure, and PFS and ORR as the secondary outcome measures to obtain clinico-pathological characteristics of patients which might be preferable responses to programmed death-1 (PD-1) and programmed cell death-Ligand 1 (PD-L1) inhibitors. Toxicity and specific treatment-related adverse events (TRAEs) were also determined.
RESULTS
After screening 1392 relevant studies, 12 studies were included in this systematic review and meta-analysis to include 5948 patients. Based on the analysis of interaction, the difference in OS after first-line immunotherapy between the subgroups of viral hepatitis [hazard ratio (HR)=0.73 vs 0.87, P for interaction=0.02] and macrovascular invasion and/or extrahepatic spread (HR=0.73 vs 0.89, P for interaction=0.02) were significant. The difference in PFS between the subgroups of viral hepatitis was highly significant (pooled HR=0.55 vs 0.81, P for interaction=0.007). After second-line immunotherapy, the difference in ORR between the subgroups of Barcelona Clinic Liver Cancer was significant (pooled ES=0.12 vs 0.23, P for interaction=0.04). Compared with PD-L1 inhibitors, PD-1 inhibitors may have a higher probability to cause TRAEs. Diarrhea, increased aspartate aminotransferase, and hypertension were the top three TRAEs.
CONCLUSIONS
This systematic review and meta-analysis represents the first pilot study aimed at identifying crucial clinico-pathological characteristics of patients with advanced HCC that may predict favorable treatment outcomes in terms of OS, PFS, and ORR to immunotherapy. Findings suggest that patients with viral hepatitis positivity (especially hepatitis B virus) and macrovascular invasion and/or extrahepatic spread may benefit more in OS when treated with PD-1/PD-L1 immune checkpoint inhibitors.
Topics: Humans; Carcinoma, Hepatocellular; B7-H1 Antigen; Immune Checkpoint Inhibitors; Pilot Projects; Programmed Cell Death 1 Receptor; Liver Neoplasms; Treatment Outcome; Immunotherapy; Hepatitis, Viral, Human; Lung Neoplasms
PubMed: 37598406
DOI: 10.1097/JS9.0000000000000652 -
European Journal of Obstetrics,... Dec 2023Botulinum toxin (BoNT) administration has been proposed in the gynecologic field for pelvic, vulvar and vaginal disorders. On this regard, we aimed assessing the... (Review)
Review
INTRODUCTION
Botulinum toxin (BoNT) administration has been proposed in the gynecologic field for pelvic, vulvar and vaginal disorders. On this regard, we aimed assessing the therapeutic effectiveness and safety of BoNT usage in the treatment of vaginal, vulvar and pelvic pain disorders.
METHODS
We searched for all the original articles without date restriction until 31.12.2021. We included all the original articles which administered botulinum toxin in the vulva or vagina of women suffering from vaginismus, dyspareunia, and chronic pelvic pain. Only English language studies and those performed in humans were eligible. We excluded all case reports and pilot study from the qualitative analysis, although we accurately evaluated them. 22 original studies were finally included in the systematic review.
RESULTS
Botulinum toxin injection was found to be effective in improving vulvar and vaginal dyspareunia, vaginismus, and chronic pelvic pain. No irreversible side effects were detected. Major side effects reported were transient urinary or fecal incontinence, constipation and rectal pain. The risk of bias assessment proved original articles to be of medium quality. No metanalysis could have been performed since lack of congruency in the definition of pathology and methods of botulinum toxin administration.
CONCLUSION
Data extraction pointed out different endpoints and different methods of analysis. Studies focus on different types of participants and use various techniques and timing. According to the best evidence available, different techniques provide evidence about positive outcomes, with the need for a standardized protocol.
Topics: Female; Humans; Dyspareunia; Vaginismus; Pilot Projects; Botulinum Toxins; Vulva; Pelvic Pain; Chronic Pain; Pelvic Floor; Vagina; Botulinum Toxins, Type A
PubMed: 38353087
DOI: 10.1016/j.ejogrb.2023.10.028 -
Systematic Reviews Dec 2023The living systematic review (LSR) approach is based on ongoing surveillance of the literature and continual updating. Most currently available guidance documents...
BACKGROUND AND OBJECTIVE
The living systematic review (LSR) approach is based on ongoing surveillance of the literature and continual updating. Most currently available guidance documents address the conduct, reporting, publishing, and appraisal of systematic reviews (SRs), but are not suitable for LSRs per se and miss additional LSR-specific considerations. In this scoping review, we aim to systematically collate methodological guidance literature on how to conduct, report, publish, and appraise the quality of LSRs and identify current gaps in guidance.
METHODS
A standard scoping review methodology was used. We searched MEDLINE (Ovid), EMBASE (Ovid), and The Cochrane Library on August 28, 2021. As for searching gray literature, we looked for existing guidelines and handbooks on LSRs from organizations that conduct evidence syntheses. The screening was conducted by two authors independently in Rayyan, and data extraction was done in duplicate using a pilot-tested data extraction form in Excel. Data was extracted according to four pre-defined categories for (i) conducting, (ii) reporting, (iii) publishing, and (iv) appraising LSRs. We mapped the findings by visualizing overview tables created in Microsoft Word.
RESULTS
Of the 21 included papers, methodological guidance was found in 17 papers for conducting, in six papers for reporting, in 15 papers for publishing, and in two papers for appraising LSRs. Some of the identified key items for (i) conducting LSRs were identifying the rationale, screening tools, or re-revaluating inclusion criteria. Identified items of (ii) the original PRISMA checklist included reporting the registration and protocol, title, or synthesis methods. For (iii) publishing, there was guidance available on publication type and frequency or update trigger, and for (iv) appraising, guidance on the appropriate use of bias assessment or reporting funding of included studies was found. Our search revealed major evidence gaps, particularly for guidance on certain PRISMA items such as reporting results, discussion, support and funding, and availability of data and material of a LSR.
CONCLUSION
Important evidence gaps were identified for guidance on how to report in LSRs and appraise their quality. Our findings were applied to inform and prepare a PRISMA 2020 extension for LSR.
Topics: Humans; Publishing; Bias; Checklist; Research Report; MEDLINE
PubMed: 38098023
DOI: 10.1186/s13643-023-02396-x -
Dermatologic Therapy Nov 2020Androgenetic alopecia (AGA) is the most common disease associated with hair loss in both females and males. Given the high prevalence of AGA and limited therapeutic... (Review)
Review
Androgenetic alopecia (AGA) is the most common disease associated with hair loss in both females and males. Given the high prevalence of AGA and limited therapeutic methods and the high cost of hair transplantation and ease of use or platelet-rich plasma (PRP) therapies, this systematic review study was conducted to evaluate the effect of PRP on AGA of women. In this systematic review study, English-language articles were searched on PubMed, ISI web of knowledge, and Google Scholar by the end of 2019 with a combination of keywords. Finally, six articles were evaluated. The total number of subjects in this systematic review study was 92 people in six studies. All studies were clinical trials. Most of the studied had been conducted as a pilot study. Follow-up period for patients varied from 6 to 12 months. Except for one study, other studies have reported a positive therapeutic effect for PRP. The major limitation of the studies was the pilot nature and small sample size of these studies. According to the limited studies included in this systematic review, PRP treatment had a positive effect on the improvement of AGA, increasing hair density, and improving hair diameter in affected women.
Topics: Alopecia; Female; Hair; Humans; Male; Pilot Projects; Platelet-Rich Plasma; Treatment Outcome
PubMed: 32588941
DOI: 10.1111/dth.13835