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Advances in Radiation Oncology 2023The aim of this study was to comprehensively review all studies examining clinical outcomes of craniospinal irradiation with proton radiotherapy for medulloblastoma (MB)... (Review)
Review
PURPOSE
The aim of this study was to comprehensively review all studies examining clinical outcomes of craniospinal irradiation with proton radiotherapy for medulloblastoma (MB) to determine whether theoretical dosimetric advantages have translated into superior clinical outcomes (including survival and toxicities) compared with traditional photon-based techniques.
METHODS AND MATERIALS
We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles reporting on clinical outcomes of pediatric and/or adult patients with MB treated with proton radiotherapy were included. Evidence quality was assessed using a modified Newcastle Ottawa scale and GRADE score.
RESULTS
Thirty-five studies were included, with a total of 2059 patients reported (representing an estimated 630-654 unique patients). None of the studies were randomized, 12 were comparative, 9 were prospective, 3 were mixed, and 22 were retrospective. Average mean/median follow-up was 5.0 years (range, 4 weeks to 12.6 years). The majority of studies (n = 19) reported on treatment with passive scatter proton beams exclusively. Average study quality was 6.0 out of 9 (median, 6; standard deviation, 1.6). Nine studies scored ≥8 out of 9 on the modified Newcastle Ottawa Scale; an overall "moderate" GRADE score was assigned. Well-designed comparative cohort studies with adequate follow-up demonstrate superior neurocognitive outcomes, lower incidence of hypothyroidism (23% vs 69%), sex hormone deficiency (3% vs 19%), greater heights, and reduced acute toxicities in patients treated with protons compared to photons. Overall survival (up to 10 years), progression-free survival (up to 10 years), brain stem injury, and other endocrine outcomes were similar to those reported for photon radiation. There was insufficient evidence to make conclusions on endpoints of quality of life, ototoxicity, secondary malignancy, alopecia, scoliosis, cavernomas, and cerebral vasculopathy.
CONCLUSIONS
Moderate-grade evidence supports proton radiotherapy as a preferred treatment for craniospinal irradiation of MB based on equivalent disease control and comparable-to-improved toxicity versus photon beam radiation therapy.
PubMed: 37008255
DOI: 10.1016/j.adro.2023.101189 -
Frontiers in Aging Neuroscience 2023Health cognitive promotion and protection is a critical topic. With the world's aging population and rising life expectancy, there will be many people living with highly...
BACKGROUND
Health cognitive promotion and protection is a critical topic. With the world's aging population and rising life expectancy, there will be many people living with highly age-related dementia illnesses. Cardiovascular disease (CVD) and dementia share the same risk factors, such as unhealthy lifestyles and metabolic factors. These recognized risks associated with CVD and dementia frequently co-occur. CVD risk models may have a close association with dementia and cognitive decline. So, this systematic review aimed to determine whether CVD risk models were connected with dementia or cognitive decline and compare the predictive ability of various models.
METHODS
PubMed, Web of Science, PsychINFO, Embase, Cochrane Library, CNKI, Sinomed, and WanFang were searched from 1 January 2014 until 16 February 2023. Only CVD risk models were included. We used the Newcastle-Ottawa scale (NOS) for the quality assessment of included cohort studies and the Agency for Healthcare Research and Quality (AHRQ) for cross-sectional studies. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement's guidelines were followed in this systematic study.
RESULTS
In all, 9,718 references were screened, of which 22 articles were included. A total of 15 CVD risk models were summarized. Except for the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index, the other 14 CVD risk models were associated with dementia and cognitive decline. In comparison, different CVD risk models and domain-specific cognitive function correlation variation depended on cohort characteristics, risk models, cognitive function tests, and study designs. Moreover, it needed to be clarified when comparing the predicting performance of different CVD risk models.
CONCLUSION
It is significant for public health to improve disease risk prediction and prevention and mitigate the potential adverse effects of the heart on the brain. More cohort studies are warranted to prove the correlation between CVD risk models and cognitive function. Moreover, further studies are encouraged to compare the efficacy of CVD risk models in predicting cognitive disorders.
PubMed: 37904838
DOI: 10.3389/fnagi.2023.1257367 -
The Journals of Gerontology. Series A,... Feb 2024Falls are a common cause of injury, hospitalization, functional decline, and residential care admission among older adults. Cardiovascular disorders are recognized risk... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Falls are a common cause of injury, hospitalization, functional decline, and residential care admission among older adults. Cardiovascular disorders are recognized risk factors for falls. This systematic review assesses the association between cardiovascular disorders and falls in older adults.
METHODS
Systematic searches were conducted on MEDLINE and Embase, encompassing all literature published prior to December 31, 2022. Included studies addressed persons aged 50 years and older, and assessed the association between cardiovascular disorders and falls or the efficacy of cardiovascular-based interventions to reduce falls. Two reviewers independently extracted data and assessed study quality utilizing a modified Newcastle-Ottawa scale for observational studies, and the Cochrane Risk of Bias 2 tool for interventional studies. A systematic narrative analysis of all cardiovascular outcomes, and meta-analyses of unadjusted odds ratios (ORs) were performed.
RESULTS
One hundred and eighty-four studies were included: 181 observational and 3 interventional. Several cardiovascular disorders, including stroke, coronary artery disease, valvular heart disease, arterial stiffness, arrhythmia, orthostatic hypotension, and carotid sinus hypersensitivity, were consistently associated with falls. In meta-analysis of unadjusted ORs, the largest positive pooled associations with falls during a 12-month reporting interval were for stroke (OR: 1.90, 95% confidence interval [CI]: 1.70-2.11), peripheral arterial disease (OR: 1.82, 95% CI: 1.12-2.95), atrial fibrillation (OR: 1.52, 95% CI: 1.27-1.82), and orthostatic hypotension (OR: 1.39, 95% CI: 1.18-1.64).
CONCLUSIONS
Several cardiovascular disorders are associated with falls. These results suggest the need to incorporate cardiovascular assessments for patients with falls. This review informed the cardiovascular recommendations in the new World Guidelines for falls in older adults.Clinical Trials Registration Number: CRD42021272245.
Topics: Humans; Middle Aged; Aged; Hypotension, Orthostatic; Accidental Falls; Cardiovascular Diseases; Risk Factors; Stroke
PubMed: 37738307
DOI: 10.1093/gerona/glad221 -
Experimental Brain Research Sep 2023Ocular microtremor (OMT) is the smallest of three involuntary fixational micro eye movements, which has led to it being under researched in comparison. The link between...
Ocular microtremor (OMT) is the smallest of three involuntary fixational micro eye movements, which has led to it being under researched in comparison. The link between OMT and brain function generates a strong rationale for further study as there is potential for its use as a biomarker in populations with neurological injury and disease. This structured review focused on populations previously studied, instrumentation used for measurement, commonly reported OMT outcomes, and recommendations concerning protocol design and future studies. Current methods of quantifying OMT will be reviewed to analyze their efficacy and efficiency and guide potential development and understanding of novel techniques. Electronic databases were systematically searched and compared with predetermined inclusion criteria. 216 articles were identified in the search and screened by two reviewers. 16 articles were included for review. Findings showed that piezoelectric probe is the most common method of measuring OMT, with fewer studies involving non-invasive approaches, such as contact lenses and laser imaging. OMT frequency was seen to be reduced during general anesthesia at loss of consciousness and in neurologically impaired participants when compared to healthy adults. We identified the need for a non-invasive technique for measuring OMT and highlight its potential in clinical applications as an objective biomarker for neurological assessments. We highlight the need for further research on the clinical validation of OMT to establish its potential to identify or predict a meaningful clinical or functional state, specifically, regarding accuracy, precision, and reliability of OMT.
Topics: Adult; Humans; Consciousness; Eye; Face; Reproducibility of Results
PubMed: 37632535
DOI: 10.1007/s00221-023-06691-w -
International Journal of Cardiology.... Dec 2021Coronary artery disease (CAD) and osteoporosis both cause significant morbidity and mortality. Recent interest in inflammation and the bone-vascular axis suggests a... (Review)
Review
Coronary artery disease (CAD) and osteoporosis both cause significant morbidity and mortality. Recent interest in inflammation and the bone-vascular axis suggests a mechanistic link between the two conditions. This review and meta-analysis was conducted to examine the potential association between low bone mineral density (BMD) and CAD in adults. Two authors searched for studies that examined the association between low BMD and CAD. Risk of bias assessment was conducted using the modified Newcastle Ottawa score. Ten studies were selected from the 2258 unique records identified. Pooled analysis showed a significant association between low BMD and CAD (OR 1.65, 95%CI 1.37-2.39, p < 0.01). Subgroup analysis investigating males and females separately was not significant. The subgroup analyses looking for any differences across geographic locations and differences between coronary imaging modalities were also negative. Studies with adjusted ORs (n = 4) were also pooled (OR 3.01, 95%CI 0.91-9.99, p = 0.07). Low BMD is associated with CAD; however, it is unclear whether this result is confounded by common risk factors given the heterogeneity between study populations and methodologies. Further large-scale epidemiological studies are required.
PubMed: 34746361
DOI: 10.1016/j.ijcha.2021.100891 -
Clinical and Experimental Medicine Nov 2022Alterations in cardiac and renal biomarkers have been reported in coronavirus disease 19 (COVID-19). We conducted a systematic review and meta-analysis to investigate... (Meta-Analysis)
Meta-Analysis Review
Alterations in cardiac and renal biomarkers have been reported in coronavirus disease 19 (COVID-19). We conducted a systematic review and meta-analysis to investigate serum concentrations of hydroxybutyrate dehydrogenase (HBDH), a combined marker of myocardial and renal injury, in hospitalized COVID-19 patients with different disease severity and survival status. We searched PubMed, Web of Science and Scopus, between December 2019 and April 2021, for studies reporting HBDH in COVID-19. Risk of bias was assessed using the Newcastle-Ottawa scale, publication bias was assessed with the Begg's and Egger's tests, and certainty of evidence was assessed using GRADE. In 22 studies in 15,019 COVID-19 patients, serum HBDH concentrations on admission were significantly higher in patients with high disease severity or non-survivor status when compared to patients with low severity or survivor status (standardized mean difference, SMD = 0.90, 95% CI 0.74 to 1.07, p < 0.001; moderate certainty of evidence). Extreme between-study heterogeneity was observed (I = 93.5%, p < 0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and the direction of the effect size were not substantially modified. A significant publication bias was observed. In meta-regression, the SMD of HBDH concentrations was significantly associated with markers of inflammation, sepsis, liver damage, non-specific tissue damage, myocardial injury, and renal function. Higher HBDH concentrations were significantly associated with higher COVID-19 severity and mortality. This biomarker of cardiac and renal injury might be useful for risk stratification in COVID-19. (PROSPERO registration number: CRD42021258123).
Topics: Humans; Biomarkers; COVID-19; Hydroxybutyrate Dehydrogenase; Severity of Illness Index
PubMed: 34799779
DOI: 10.1007/s10238-021-00777-x -
Cureus Feb 2020Introduction Several studies have found celiac disease may be associated with a variety of cardiac manifestations. Atrial fibrillation (AF) is one of the most common...
Introduction Several studies have found celiac disease may be associated with a variety of cardiac manifestations. Atrial fibrillation (AF) is one of the most common arrhythmias that can cause significant morbidity. However, the risk of atrial fibrillation in patients with celiac disease according to epidemiological studies remains unclear. The aim of this meta-analysis study is to assess the risk of atrial fibrillation in patients diagnosed with celiac disease compared to controls. Methods A systematic literature review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through December 2017 to identify studies that evaluated the risk of atrial fibrillation in patients with celiac disease. We included randomized controlled trial, cross sectional and cohort studies that reported the odds ratio, relative risk, hazard ratio, and standardized incidence ratio comparing the risk of developing atrial fibrillation among patients with celiac disease, versus patients without celiac disease as control. The Newcastle-Ottawa scale was used to determine the quality of the studies. Effect estimates from individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results Celiac disease is an autoimmune condition. This inflammatory state predisposes patients to develop AF. After a review of the literature, four observational studies with a total of 64,397 participants were enrolled. The association between celiac disease and increased risk of atrial fibrillation was significant, with a pooled OR of 1.38 (95% CI: 1.01-1.88). No publication bias as assessed by the funnel plots and Egger's regression asymmetry test with p = 0.54. However, the heterogeneity of the included studies was high (I2 = 96). Conclusion A significant association between celiac disease and risk of atrial fibrillation was reported in this study. There is a 38% increased risk of atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and celiac disease. Some of the limitations of this study are that all were observational studies, some were medical registry-based and there was high heterogeneity between studies.
PubMed: 32206461
DOI: 10.7759/cureus.6997 -
Current Journal of Neurology Oct 2023Parkinson's disease (PD) is a progressive neuro-degenerative disease and olfactory dysfunction is considered as an important issue in these patients. The prevalence of... (Review)
Review
Parkinson's disease (PD) is a progressive neuro-degenerative disease and olfactory dysfunction is considered as an important issue in these patients. The prevalence of olfactory dysfunction in patients with PD was reported variously in previous studies. Therefore, we designed this systematic review and meta-analysis to estimate the pooled prevalence of olfactory dysfunction in patients with PD. Two expert researchers systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, references of the papers, and conference abstracts. The titles and abstracts of the potential studies were evaluated after deleting the duplicates. We extracted data regarding the total number of participants, first author, publication year, the country of origin, mean age, mean disease duration, female/male, number with olfactory dysfunction, and name of the test. We evaluated the risk of potential bias by the Newcastle-Ottawa Quality Assessment Scale (adapted for cross-sectional studies). All statistical analyses were done using Stata software. To determine heterogeneity between the findings of included studies, inconsistency (I) was calculated. We applied random effect model when I was more than 50%. P-value less than 0.05 was considered significant. The literature search revealed 1546 studies; after deleting duplicates, 894 remained. Finally, twelve studies remained for meta-analysis. Studies were published between years of 2009 to 2021, the sample size of studies ranged between 30 and 2097, and the mean age ranged between 61 and 70 years. The pooled prevalence of olfactory dysfunction in patients with PD was estimated as 64% [95% confidence interval (CI): 44-84, I = 99.7%, P < 0.001]. The pooled prevalence of olfactory dysfunction using Sniffin's test was 67% (95% CI: 51-83) and using other tests was 60% (95% CI: 28-92). The results of this systematic review and meta-analysis showed that the pooled prevalence of olfactory dysfunction in patients with PD was 64% which should be considered by physicians.
PubMed: 38425360
DOI: 10.18502/cjn.v22i4.14530 -
Frontiers in Aging Neuroscience 2023It is still uncertain whether the risk of dementia and cognitive impairment is related to thyroid disease. we carried out a meta-analysis and systematic review...
INTRODUCTION
It is still uncertain whether the risk of dementia and cognitive impairment is related to thyroid disease. we carried out a meta-analysis and systematic review (PROSPERO: CRD42021290105) on the associations between thyroid disease and the risks of dementia and cognitive impairment.
METHODS
We searched PubMed, Embase, and Cochrane Library for studies published up to August 2022. The overall relative risk (RRs) and its 95% confidence interval (CIs) were calculated in the random-effects models. Subgroup analyses and meta-regression were conducted to explore the potential source of heterogeneity among studies. We tested and corrected for publication bias by funnel plot-based methods. The Newcastle-Ottawa Scale (NOS) or Agency for Healthcare Research and Quality (AHRQ) scale were used to evaluate the study quality of longitudinal studies and cross-sectional studies, respectively.
RESULTS
A total of 15 studies were included in our meta-analysis. Our meta-analysis showed that hyperthyroidism (RR = 1.14, 95% CI = 1.09-1.19) and subclinical hyperthyroidism (RR = 1.56, 95% CI = 1.26-1.93) might be associated with an elevated risk for dementia, while hypothyroidism (RR = 0.93, 95% CI = 0.80-1.08) and subclinical hypothyroidism (RR = 0.84, 95% CI = 0.70-1.01) did not affect the risk.
DISCUSSION
Hyperthyroidism and subclinical hyperthyroidism are predictors of dementia.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, Identifier: CRD42021290105.
PubMed: 36993905
DOI: 10.3389/fnagi.2023.1137584 -
Cureus May 2023Oral squamous cell carcinoma is the leading type of cancer in Southeast Asian countries and many parts of the world. Many factors increase the risk of oral cancer, like... (Review)
Review
Oral squamous cell carcinoma is the leading type of cancer in Southeast Asian countries and many parts of the world. Many factors increase the risk of oral cancer, like tobacco, betel nuts, alcohol consumption, sharp teeth, infections, and other factors. Oral health-related issues have been reported in many studies of oral cancer, but there is a need to understand the role of the same as a risk factor. The systematic review and meta-analysis were conducted to assess the role of oral health as a risk factor in oral cancer. The population diagnosed with oral cancer (P) of all age groups and both gender, exposure (E) is oral health (includes poor oral hygiene, periodontal disease, and other oral diseases excluding oral potentially malignant disorders (OPMD)), the comparator (C), is patients without oral health issues, outcome (O) is the role of poor oral health as a risk factor for oral cancer. A systematic review and meta-analysis were conducted. The databases used for the search were PubMed, Cochrane Database, Embase, Scopus, and Google Scholar. The unpublished reports, reviews, and grey literature were considered. Case-control studies were included assessing poor oral health as a risk factor with odds ratio as an effective measure. Newcastle Ottawa Scale for risk of bias in the case-control study was considered. The study results showed that tooth loss odds ratio (OR)=1.13, CI (0.99-1.26), I value of 71.7%, Oral hygiene OR=1.29, CI (1.04-1.54), I value of 19.7% and in periodontal diseases OR=2.14 CI (1.70-2.58), I value of 75.3% had a higher risk of developing oral cancer. The risk factors for tooth loss and periodontal disease showed moderate heterogenicity and less heterogenicity for oral hygiene. Poor oral health factors such as periodontal disease, poor oral hygiene, and loss of teeth show higher odds of oral cancer than the control. The periodontal disease shows the highest odds than other factors. These risk factors can be considered for the primordial prevention of oral cancer.
PubMed: 37398714
DOI: 10.7759/cureus.39786