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Frontiers in Pediatrics 2021Human respiratory physiology changes significantly in high altitude settings and these changes are particularly marked during sleep. It is estimated that 170 million...
BACKGROUND
Human respiratory physiology changes significantly in high altitude settings and these changes are particularly marked during sleep. It is estimated that 170 million people live above 2,500 m in environments where normal sleep parameters differ from those established at sea level or low altitude.
METHODS
We conducted a systematic review of publications reporting sleep studies in healthy children living at high altitude. For this purpose, data from PubMed, EMBASE, SciELO and Epistemomikos bases were retrieved up to August 2021.
RESULTS
Six articles met specified inclusion criteria; all reporting data were from South America involving 245 children (404 sleep studies) in children aged 0.6 months to 18 years, at altitudes between 2,560 to 3,775 m. The main results were: (1) Central apnea index decreased as the age increased. (2) The obstructive apnea/hypopnea index showed a bimodal profile with an increase in young infants up to age of 4 months, decreasing to 15 months of age, and then a second peak in children aged 4 to 9 years of age, dropping in older schoolchildren and adolescents. (3) Periodic breathing in the first months of life is more marked with increasing altitude and decreases with age.
CONCLUSIONS
There are few studies of sleep physiology in children living at high altitude. The international parameters defining normal apnea indices currently used at low altitude cannot be applied to high altitude settings. The interpretation of sleep studies in children living at high altitude is complex because there are important developmental changes across childhood and a wide range of altitude locations. More normative data are required to determine thresholds for respiratory pathology at a variety of high altitude settings.
PubMed: 35295318
DOI: 10.3389/fped.2021.798310 -
Nutrients Jun 2023The aim of this systematic review with meta-analysis was to examine the influence of exogenous factors related to nutritional and hydration strategies and environmental... (Meta-Analysis)
Meta-Analysis
Influence of Exogenous Factors Related to Nutritional and Hydration Strategies and Environmental Conditions on Fatigue in Endurance Sports: A Systematic Review with Meta-Analysis.
The aim of this systematic review with meta-analysis was to examine the influence of exogenous factors related to nutritional and hydration strategies and environmental conditions, as modulators of fatigue, including factors associated with performance fatigability and perceived fatigability, in endurance tests lasting 45 min to 3 h. A search was carried out using four databases: PubMed, Web of Science, SPORTDiscus, and EBSCO. A total of 5103 articles were screened, with 34 included in the meta-analysis. The review was registered with PROSPERO (CRD42022327203) and adhered to the PRISMA guidelines. The study quality was evaluated according to the PEDro score and assessed using Rosenthal's fail-safe N. Carbohydrate (CHO) intake increased the time to exhaustion ( < 0.001) and decreased the heart rate (HR) during the test ( = 0.018). Carbohydrate with protein intake (CHO + PROT) increased lactate during the test ( = 0.039). With respect to hydration, dehydrated individuals showed a higher rate of perceived exertion (RPE) ( = 0.016) and had a higher body mass loss ( = 0.018). In hot conditions, athletes showed significant increases in RPE ( < 0.001), HR ( < 0.001), and skin temperature ( = 0.002), and a decrease in the temperature gradient ( < 0.001) after the test. No differences were found when athletes were subjected to altitude or cold conditions. In conclusion, the results revealed that exogenous factors, such as nutritional and hydration strategies, as well as environmental conditions, affected fatigue in endurance sports, including factors associated with performance fatigability and perceived fatigability.
Topics: Humans; Carbohydrates; Fatigue; Nutritional Status; Physical Endurance; Sports
PubMed: 37375605
DOI: 10.3390/nu15122700 -
Frontiers in Psychiatry 2023To conduct a systematic review and meta-analysis of observational studies of brain MRI, this paper assesses the effects of long-term exposure to high-altitude on brain...
PURPOSE
To conduct a systematic review and meta-analysis of observational studies of brain MRI, this paper assesses the effects of long-term exposure to high-altitude on brain structures in healthy people.
METHODS
Observational studies related to high-altitude, brain and MRI were systematically searched based on data retrieved from PubMed, Embase and Cochrane Library. The timescale for collecting literature was from the establishment of the databases to 2023. NoteExpress 3.2 was used to manage the literature. Two investigators performed literature screening and data extraction based on inclusion criteria, exclusion criteria, and literature quality. The quality of the literature was assessed using the NOS Scale. Finally, meta-analysis of included studies was performed using Reviewer Manager 5.3.
RESULTS
Initially, 3,626 articles were retrieved. After screening, 16 articles ( = 756 participants) were included in the systematic review, and meta-analysis was performed on 6 articles ( = 350 participants). The overall quality of the included articles was at medium level, with a mean NOS score of 5.62. The results of meta-analysis showed that the differences between the HA group and LA group were not statistically significant, in total GM volume (MD: -0.60, 95% CI: -16.78 to 15.58, = 0.94), WM volume (MD: 3.05, 95% CI: -15.72 to 21.81, = 0.75) and CSF volume (MD: 5.00, 95% CI: -11.10 to 21.09, = 0.54).The differences between HA and LA in FA values of frontotemporal lobes were not statistically significant: right frontal lobe (MD: -0.02, 95% CI: -0.07 to 0.03, = 0.38), left frontal lobe (MD: 0.01, 95% CI: -0.02 to 0.04, = 0.65), right temporal lobe (MD: -0.00, 95% CI: -0.03 to 0.02, = 0.78) and left temporal lobe (MD: -0.01, 95% CI: -0.04 to 0.02, = 0.62). However, there were significant differences in GM volume, GM density and FA values in local brain regions between HA group and LA group.
CONCLUSION
Compared with LA area, there were no significant differences in total GM, WM and CSF volumes in healthy people living at high-altitude area for long-term, while there were significant differences in GM volume and FA values in local brain regions. Long-term exposure to high-altitude area caused the adaptive structural changes in local brain regions. Since heterogeneity existed between the studies, further studies are needed to uncover the effects of high-altitude on brain of healthy people.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: CRD42023403491.
PubMed: 37435401
DOI: 10.3389/fpsyt.2023.1196113 -
The Cochrane Database of Systematic... Feb 2023The term central sleep apnoea (CSA) encompasses diverse clinical situations where a dysfunctional drive to breathe leads to recurrent respiratory events, namely apnoea... (Review)
Review
BACKGROUND
The term central sleep apnoea (CSA) encompasses diverse clinical situations where a dysfunctional drive to breathe leads to recurrent respiratory events, namely apnoea (complete absence of ventilation) and hypopnoea sleep (insufficient ventilation) during sleep. Studies have demonstrated that CSA responds to some extent to pharmacological agents with distinct mechanisms, such as sleep stabilisation and respiratory stimulation. Some therapies for CSA are associated with improved quality of life, although the evidence on this association is uncertain. Moreover, treatment of CSA with non-invasive positive pressure ventilation is not always effective or safe and may result in a residual apnoea-hypopnoea index.
OBJECTIVES
To evaluate the benefits and harms of pharmacological treatment compared with active or inactive controls for central sleep apnoea in adults.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was 30 August 2022.
SELECTION CRITERIA
We included parallel and cross-over randomised controlled trials (RCTs) that evaluated any type of pharmacological agent compared with active controls (e.g. other medications) or passive controls (e.g. placebo, no treatment or usual care) in adults with CSA as defined by the International Classification of Sleep Disorders 3rd Edition. We did not exclude studies based on the duration of intervention or follow-up. We excluded studies focusing on CSA due to periodic breathing at high altitudes.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were central apnoea-hypopnoea index (cAHI), cardiovascular mortality and serious adverse events. Our secondary outcomes were quality of sleep, quality of life, daytime sleepiness, AHI, all-cause mortality, time to life-saving cardiovascular intervention, and non-serious adverse events. We used GRADE to assess certainty of evidence for each outcome.
MAIN RESULTS
We included four cross-over RCTs and one parallel RCT, involving a total of 68 participants. Mean age ranged from 66 to 71.3 years and most participants were men. Four trials recruited people with CSA associated with heart failure, and one study included people with primary CSA. Types of pharmacological agents were acetazolamide (carbonic anhydrase inhibitor), buspirone (anxiolytic), theophylline (methylxanthine derivative) and triazolam (hypnotic), which were given for between three days and one week. Only the study on buspirone reported a formal evaluation of adverse events. These events were rare and mild. No studies reported serious adverse events, quality of sleep, quality of life, all-cause mortality, or time to life-saving cardiovascular intervention. Carbonic anhydrase inhibitors versus inactive control Results were from two studies of acetazolamide versus placebo (n = 12) and acetazolamide versus no acetazolamide (n = 18) for CSA associated with heart failure. One study reported short-term outcomes and the other reported intermediate-term outcomes. We are uncertain whether carbonic anhydrase inhibitors compared to inactive control reduce cAHI in the short term (mean difference (MD) -26.00 events per hour, 95% CI -43.84 to -8.16; 1 study, 12 participants; very low certainty). Similarly, we are uncertain whether carbonic anhydrase inhibitors compared to inactive control reduce AHI in the short term (MD -23.00 events per hour, 95% CI -37.70 to 8.30; 1 study, 12 participants; very low certainty) or in the intermediate term (MD -6.98 events per hour, 95% CI -10.66 to -3.30; 1 study, 18 participants; very low certainty). The effect of carbonic anhydrase inhibitors on cardiovascular mortality in the intermediate term was also uncertain (odds ratio (OR) 0.21, 95% CI 0.02 to 2.48; 1 study, 18 participants; very low certainty). Anxiolytics versus inactive control Results were based on one study of buspirone versus placebo for CSA associated with heart failure (n = 16). The median difference between groups for cAHI was -5.00 events per hour (IQR -8.00 to -0.50), the median difference for AHI was -6.00 events per hour (IQR -8.80 to -1.80), and the median difference on the Epworth Sleepiness Scale for daytime sleepiness was 0 points (IQR -1.0 to 0.00). Methylxanthine derivatives versus inactive control Results were based on one study of theophylline versus placebo for CSA associated with heart failure (n = 15). We are uncertain whether methylxanthine derivatives compared to inactive control reduce cAHI (MD -20.00 events per hour, 95% CI -32.15 to -7.85; 15 participants; very low certainty) or AHI (MD -19.00 events per hour, 95% CI -30.27 to -7.73; 15 participants; very low certainty). Hypnotics versus inactive control Results were based on one trial of triazolam versus placebo for primary CSA (n = 5). Due to very serious methodological limitations and insufficient reporting of outcome measures, we were unable to draw any conclusions regarding the effects of this intervention.
AUTHORS' CONCLUSIONS
There is insufficient evidence to support the use of pharmacological therapy in the treatment of CSA. Although small studies have reported positive effects of certain agents for CSA associated with heart failure in reducing the number of respiratory events during sleep, we were unable to assess whether this reduction may impact the quality of life of people with CSA, owing to scarce reporting of important clinical outcomes such as sleep quality or subjective impression of daytime sleepiness. Furthermore, the trials mostly had short-term follow-up. There is a need for high-quality trials that evaluate longer-term effects of pharmacological interventions.
Topics: Male; Adult; Humans; Aged; Female; Sleep Apnea, Central; Carbonic Anhydrase Inhibitors; Buspirone; Apnea; Triazolam; Theophylline; Acetazolamide; Heart Failure; Hypnotics and Sedatives; Disorders of Excessive Somnolence
PubMed: 36861808
DOI: 10.1002/14651858.CD012922.pub2 -
Alzheimer's & Dementia : the Journal of... Apr 2024The prevalence of cerebral smallvessel disease (SVD) and vascular dementia according to workplace or domestic exposure to hazardous substances is unclear. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The prevalence of cerebral smallvessel disease (SVD) and vascular dementia according to workplace or domestic exposure to hazardous substances is unclear.
METHODS
We included studies assessing occupational and domestic hazards/at-risk occupations and SVD features. We pooled prevalence estimates using random-effects models where possible, or presented a narrative synthesis.
RESULTS
We included 85 studies (n = 47,743, mean age = 44·5 years). 52/85 reported poolable estimates. SVD prevalence in populations exposed to carbon monoxide was 81%(95% CI = 60-93%; n = 1373; results unchanged in meta-regression), carbon disulfide73% (95% CI = 54-87%; n = 131), 1,2-dichloroethane 88% (95% CI = 4-100%, n = 40), toluene 82% (95% CI = 3-100%, n = 64), high altitude 49% (95% CI = 38-60%; n = 164),and diving 24% (95% CI = 5-67%, n = 172). We narratively reviewed vascular dementia studies and contact sport, lead, military, pesticide, and solvent exposures as estimates were too few/varied to pool.
DISCUSSION
SVD and vascular dementia may be associated with occupational/domestic exposure to hazardous substances. CRD42021297800.
Topics: Humans; Adult; Dementia, Vascular; Cerebral Small Vessel Diseases; Hazardous Substances; Magnetic Resonance Imaging
PubMed: 38270898
DOI: 10.1002/alz.13647 -
Frontiers in Plant Science 2021Climate change is impacting crop performance and agricultural systems around the world with implications for farmers and consumers. We carried out a systematic review to...
Climate change is impacting crop performance and agricultural systems around the world with implications for farmers and consumers. We carried out a systematic review to synthesize evidence regarding the effects of environmental factors associated with climate change and management conditions associated with climate adaptation on the crop quality of a culturally-relevant perennial crop, coffee ( and ). Seventy-three articles were identified that addressed the study's research question including 42 articles on environmental factors, 20 articles on management conditions, and 11 articles on both. While variation was found between studies, findings highlight that coffee quality is vulnerable to changes in light exposure, altitude, water stress, temperature, carbon dioxide, and nutrient management. Both increases as well as decreases were found in secondary metabolites and sensory attributes that determine coffee quality in response to shifts in environmental and management conditions. The most consistent evidence identified through this systematic review includes the following two trends: (1) increased altitude is associated with improved sensory attributes of coffee and; (2) increased light exposure is associated with decreased sensory attributes of coffee. Research gaps were found regarding the effects of shifts in carbon dioxide, water stress, and temperature on the directionality (increase, decrease, or non-linear) of coffee quality and how this varies with location, elevation, and management conditions. This systematic review further identified the following research needs: (1) long-term studies that examine the interactive effects of multiple environmental factors and management conditions on coffee quality; (2) studies that examine the interaction between sensory attributes and secondary metabolites that determine coffee quality and; (3) studies on the feasibility of various climate-adaptation strategies for mitigating the effects of climate change on coffee quality. Evidence-based innovations are needed to mitigate climate impacts on coffee quality toward enhanced sustainability and resilience of the coffee sector from farm to cup.
PubMed: 34691093
DOI: 10.3389/fpls.2021.708013 -
Plants (Basel, Switzerland) Apr 2021The early life-history stages of plants, such as germination and seedling establishment, depend on favorable environmental conditions. Changes in the environment at high... (Review)
Review
The early life-history stages of plants, such as germination and seedling establishment, depend on favorable environmental conditions. Changes in the environment at high altitude and high latitude regions, as a consequence of climate change, will significantly affect these life stages and may have profound effects on species recruitment and survival. Here, we synthesize the current knowledge of climate change effects on treeline, tundra, and alpine plants' early life-history stages. We systematically searched the available literature on this subject up until February 2020 and recovered 835 potential articles that matched our search terms. From these, we found 39 studies that matched our selection criteria. We characterized the studies within our review and performed a qualitative and quantitative analysis of the extracted meta-data regarding the climatic effects likely to change in these regions, including projected warming, early snowmelt, changes in precipitation, nutrient availability and their effects on seed maturation, seed dormancy, germination, seedling emergence and seedling establishment. Although the studies showed high variability in their methods and studied species, the qualitative and quantitative analysis of the extracted data allowed us to detect existing patterns and knowledge gaps. For example, warming temperatures seemed to favor all studied life stages except seedling establishment, a decrease in precipitation had a strong negative effect on seed stages and, surprisingly, early snowmelt had a neutral effect on seed dormancy and germination but a positive effect on seedling establishment. For some of the studied life stages, data within the literature were too limited to identify a precise effect. There is still a need for investigations that increase our understanding of the climate change impacts on high altitude and high latitude plants' reproductive processes, as this is crucial for plant conservation and evidence-based management of these environments. Finally, we make recommendations for further research based on the identified knowledge gaps.
PubMed: 33919792
DOI: 10.3390/plants10040768 -
Annals of Clinical and Translational... Jan 2021X-linked Charcot-Marie-Tooth type 1 (CMTX1) is an inherited peripheral neuropathy caused by mutations in the gap junction beta 1 (GJB1) gene, which encodes the...
OBJECTIVE
X-linked Charcot-Marie-Tooth type 1 (CMTX1) is an inherited peripheral neuropathy caused by mutations in the gap junction beta 1 (GJB1) gene, which encodes the connexin32 protein. A small number of patients with GJB1 mutations present with episodic neurological dysfunction and reversible white matter lesions, which has not been adequately reported. Here, we aim to enable clinicians to further understand this particular situation through systematically reviewing all published relevant cases.
METHODS
We conducted a comprehensive search of the PubMed electronic database for medical literature relevant to CMTX1 patients with episodic neurological dysfunction and then fully analyzed the general information, clinical manifestations, and characteristics of magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and nerve conduction study (NCS).
RESULTS
We identified 47 cases of CMTX1 associated with episodic central nervous system (CNS) dysfunction from 38 publications. CMTX1 patients experienced episodic CNS deficits at a young age, ranging from infancy to 26 years, and 45 (95.7%) of them were male. The CNS symptoms manifested as facial, lingual, or limb weakness in 44 (93.6%), dysarthria or dysphagia in 39 (83.0%), facial or limb numbness in 15 (31.9%), and ataxia in 10 (21.3%) patients. The duration of episodic symptoms ranged from 3 minutes to 6 months. Thirty (63.8%) CMTX1 cases have reported obvious predisposing factors, among which the most common factors were infection or fever (27.7%), travel to high altitude (12.8%), and intensive exercise (8.5%). As for brain MRI, most abnormal signals were found in bilateral deep white matter (88.9%) and corpus callosum (80.0%). In addition, most of the NCS results were abnormal, including prolonged latency, reduced amplitude, and slowed conduction velocity. The motor nerve conduction velocity (MNCV) of median nerve was the most detectable and valuable, ranging from 25 to 45 m/s.
INTERPRETATION
We have reported the most comprehensive summary of the demographic and clinical profile from 47 CMTX1 patients with episodic CNS deficits and provided new insight into the phenotype spectrum of CMTX1. We hope that our study can help clinicians make early diagnosis and implement the best prevention and treatment strategies for CMTX1 patients with episodic CNS deficits.
Topics: Central Nervous System Diseases; Charcot-Marie-Tooth Disease; Female; Humans; Male
PubMed: 33314704
DOI: 10.1002/acn3.51271 -
The American Journal of Tropical... May 2021Rhinosporidiosis is a chronic mucosal infection caused by Rhinosporidium seeberi, an aquatic protistan parasite. It presents as nasal or ocular polypoidal or... (Comparative Study)
Comparative Study
Rhinosporidiosis is a chronic mucosal infection caused by Rhinosporidium seeberi, an aquatic protistan parasite. It presents as nasal or ocular polypoidal or vascularized masses. It is endemic in tropical and subtropical areas, especially in South Asia; R. seeberi´s endemicity in the Americas is often overlooked. The objective of this study was to describe the demographic and clinical characteristics of patients with rhinosporidiosis in the Americas, its management, and patient outcomes. This study is a systematic review of cases of human rhinosporidiosis in the Americas reported in the literature from 1896 to February 28, 2019. This review screened 1,994 reports, of which 115 were eligible for further analysis. The selected reports described 286 cases of human rhinosporidiosis between 1896 and 2019. Cases were diagnosed in Brazil (32.2%), Colombia (24.4%), Paraguay (12.6%), and the United States (11.9%). The majority of the cases (91%) occurred in geographic areas with altitudes < 1,000 m above sea level and in areas with median temperatures ≥ 25°C (67.3%). Most of the patients presented nasal (65%) and ocular involvement (35%). Surgical treatment was provided for 99.6% of patients, but 19.8% of them recurred. This review describes the under-recognized geographic distribution and clinical presentation of rhinosporidiosis in the Americas and highlights clinical differences to cases in Asia, specifically in reference to a higher prevalence of ocular disease and higher relapse rates.
Topics: Americas; Humans; Rhinosporidiosis; Symptom Assessment
PubMed: 33999851
DOI: 10.4269/ajtmh.20-1411 -
Sports Medicine - Open May 2022Match analysis has evolved exponentially over the past decades in team sports resulting in a significant number of published systematic reviews and meta-analyses. An...
BACKGROUND
Match analysis has evolved exponentially over the past decades in team sports resulting in a significant number of published systematic reviews and meta-analyses. An umbrella review of the available literature is needed to provide an integrated overview of current knowledge and contribute to more robust theoretical explanations of team performance.
METHODS
The Web of Science (all databases), PubMed, Cochrane Library (Cochrane Database of Systematic Reviews), Scopus, and SPORTDiscus databases were searched for relevant publications prior to 19 February 2021. Appraisal of the methodological quality of included articles was undertaken using the tool for Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2). Twenty-four studies were reviewed that met the following criteria: (1) contained relevant data from match analyses in team ball sports; (2) were defined as systematic reviews or/and meta-analyses; and (3) were written in the English language.
RESULTS
The overall methodological quality of the 24 included reviews, obtained through the AMSTAR-2, revealed very low confidence ratings (Critically Low, n = 12) for the results of most systematic reviews of match analyses in team ball sports. Additionally, the results showed that research is focused mainly on four levels of analysis: (1) dyadic (microlevel); (2) individual (molecular level; predominant); (3) group (mesolevel), and (4) team dynamics (macrolevel). These levels of analysis included tactical, technical, physical, and psychosocial variables. Team performance was contextualized at two levels, with reference to: (1) match context (e.g. match status, match location, match period, quality of opposition) and (2) sociodemographic and environmental constraints (sex, age groups, competitive level, altitude, temperature, pitch surface).
CONCLUSIONS
The evolution of methods for match analysis in team ball sports indicates that: (1) an individual-level performance analysis was predominant; (2) the focus on intermediate levels of analysis, observing performance in dyadic and group interactions, has received less attention from researchers; (3) neglected areas of research include psychosocial aspects of team sports and women's performance; and (4) analyses of match contexts need greater depth.
REGISTRATION
The protocol was registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols with the number 202080067 and the DOI number https://doi.org/10.37766/inplasy2020.8.0067 .
PubMed: 35553279
DOI: 10.1186/s40798-022-00454-7