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JBI Database of Systematic Reviews and... Sep 2015General anesthesia causes impairment of gas exchange in the lungs that results in decreased oxygenation of the blood; atelectasis is the principle cause of this impaired... (Review)
Review
Effectiveness of positive end-expiratory pressure, decreased fraction of inspired oxygen and vital capacity recruitment maneuver in the prevention of pulmonary atelectasis in patients undergoing general anesthesia: a systematic review.
BACKGROUND
General anesthesia causes impairment of gas exchange in the lungs that results in decreased oxygenation of the blood; atelectasis is the principle cause of this impaired gas exchange. Anesthesia delivery varies between providers and there is no standard practice to decrease the incidence of postoperative atelectasis.
OBJECTIVES
To assess the effectiveness of three identified interventions, either individually or combined, in the development of postoperative pulmonary atelectasis in patients undergoing general anesthesia.
TYPES OF PARTICIPANTS
The review considered participants over 18 years for inclusion. The American Society of Anesthesiologists classification of subjects was I, II or III. Participants underwent a variety of surgical procedures during which general anesthesia was administered. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: The review focused on the following interventions: positive end-expiratory pressure, decreased fraction of inspired oxygen content, and/or a vital capacity recruitment maneuver during general anesthesia in comparison to general anesthesia performed without the use of these interventions. TYPES OF STUDIES: Randomized controlled trials that evaluated the effectiveness of any of the proposed interventions, individually or in combination, in the prevention of postoperative atelectasis during general anesthesia were considered for inclusion. TYPES OF OUTCOMES: This review considered studies that reported the incidence of postoperative atelectasis. Atelectasis was measured by lung density measurements, in Hounsfield units, with computed tomography scans, decreased PaO2 levels (partial pressure of oxygen dissolved in arterial blood), and pulmonary function tests.
SEARCH STRATEGY
A three-step search strategy was utilized in this review. Studies published in English, without date limits, were considered for inclusion. Databases searched were: CINAHL, MEDLINE, ISI Web of Science, EMBASE, ProQuest Theses and Dissertations and ClinicalTrials.gov, (specifically the National Heart, Lung, and Blood Institute).
METHODOLOGICAL QUALITY
Two independent reviewers appraised articles for methodological quality using the JBI Critical Appraisal Checklist for Randomized Control/Pseudo-randomized Trials. All studies included in this review were of high methodological quality.
DATA EXTRACTION
Data was extracted by two independent reviewers from papers using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.
DATA SYNTHESIS
Meta-analysis was attempted using STATA 12 software; however, due to the heterogeneity of interventions and outcomes it was not possible to pool data. A narrative summary including tables have been used to report results and findings.
RESULTS AND CONCLUSIONS
This review included ten studies with a total of 427 participants aged from 18-78. Although a decreased inspired oxygen content (less than 60%) was shown to be effective individually at decreasing the incidence of postoperative atelectasis, this intervention in combination with a vital capacity recruitment maneuver (+40cm H20 for 15 seconds, and positive end-expiratory pressure, +10cm H2O) was shown to be statistically significant (relative risk=1.149; 95% confidence interval= 1.018, 1.297; p= 0.024).
IMPLICATIONS FOR PRACTICE
Anesthesia providers should utilize multiple interventions at their disposal to combat the formation and effects of atelectasis for their patients undergoing general anesthesia. Positive end-expiratory pressure following a vital capacity recruitment maneuver can virtually eliminate atelectasis formation even in the presence of a high inspired oxygen content.
IMPLICATIONS FOR RESEARCH
The majority of atelectasis occurs within minutes of induction and intubation; therefore, further research is needed for testing interventions during this specific time.
Topics: Aged; Anesthesia, General; Blood Gas Analysis; Female; Humans; Lung; Oxygen; Positive-Pressure Respiration; Postoperative Complications; Pulmonary Atelectasis; Respiratory Insufficiency; Tidal Volume; Vital Capacity
PubMed: 26455945
DOI: 10.11124/jbisrir-2015-1410 -
Clinical Oral Investigations Aug 2023To determine the prevalence of postoperative pain after endodontic treatment using low (LC) and high (HC) concentrations of sodium hypochlorite (NaOCl). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To determine the prevalence of postoperative pain after endodontic treatment using low (LC) and high (HC) concentrations of sodium hypochlorite (NaOCl).
MATERIALS AND METHODS
Six databases and the grey literature were searched to identify randomized clinical trials that evaluated postoperative pain after endodontic treatment using NaOCl. NaOCl concentrations were dichotomized into 'LC' (0.5% to 3%) and 'HC' (≥ 5%) and a proportion meta-analysis was applied to determine the postoperative pain prevalence: overall and according to pain intensity and postoperative time. The prevalence of patients using pain control medication was also determined. A significance level of 5% and a random effect model were applied for data analysis. Between-study heterogeneity was assessed by I index. Risk of bias (RoB) was assessed using the Cochrane Risk-of-Bias 2.0 tool. The certainty of evidence was assessed using the GRADE approach.
RESULTS
Ten studies were included in the review and eight in the meta-analysis. The overall prevalence of postoperative pain was 45% in LC and 39% in HC. The prevalence of pain in LC and HC after 24 h was 25% and 40%, respectively. After 48 h, the prevalence decreased to 10% in LC and 25% in HC. 'Absent pain' was the most prevalent score. The prevalence of patients who used medication was 9% in LC and 15% in HC. Three studies were classified as 'high RoB', five as 'low RoB', and two as 'some concerns'. The certainty of evidence was very low.
CONCLUSIONS
The overall prevalence of postoperative pain after endodontic treatment using LC and HC of NaOCl was 45% and 39%, respectively.
CLINICAL RELEVANCE
Postoperative pain is common after endodontic treatment using NaOCl, but tends to decrease over time.
Topics: Humans; Sodium Hypochlorite; Prevalence; Root Canal Irrigants; Pain Management; Pain, Postoperative
PubMed: 37466716
DOI: 10.1007/s00784-023-05151-7 -
Journal of Trace Elements in Medicine... Sep 2023Inflammation is an initiating cause of infectious and non-infectious diseases. Studies have shown that selenium (Se) has anti-inflammatory effects. However, its' effects... (Meta-Analysis)
Meta-Analysis Review
Inflammation is an initiating cause of infectious and non-infectious diseases. Studies have shown that selenium (Se) has anti-inflammatory effects. However, its' effects on serum c-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) plasma concentrations are equivocal. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs), evaluating the effects of per oral (PO) and intravenous (IV) Se supplementation on CRP, TNF-α, and IL-6. A systematic search was conducted using four databases, including PubMed, Google Scholar, Cochrane Library, and Scopus to find randomized clinical trials, published up to April 2023. From 19476 papers, after screening and removing duplicate articles, 24 studies were analyzed in the present meta-analysis. In the pooled analysis, PO Se administration showed no significant effect on CRP (WMD: 0.12; 95 % CI -0.11, 0.38; P-value= 0.30). However, IV Se supplementation had a significant negative association with CRP concentration (-2.24; 95 % CI: -4.24, -0.24; p-value: 0.02). Se administration had no significant association with TNF-α plasma concentration (9.64, 95 % CI: -0.59, 19.88, p-value= 0.06; and heterogeneity: 98 %). However, a significant positive association was present between Se and plasma TNF-α concentrations (0.15, 95 % CI: 0.14, 0.17, P-value<0.0001). Moreover, Se supplementation had a significant negative correlation with IL-6 plasma concentration in PO (-0.54; 95 % CI: -1.61, 0.52; P-value = 0.31) and IV administrations (-4.77; 95 % CI: -7.61, -1.93; P-value<0.0001), respectively. This study demonstrated that IV Se administration reduced CRP and IL-6 plasma concentrations. Conversely, IV Se supplementation increased TNF-α plasma concentration. It is evident that further, well-controlled clinical trials are required.
Topics: Humans; C-Reactive Protein; Interleukin-6; Tumor Necrosis Factor-alpha; Selenium; Dietary Supplements; Randomized Controlled Trials as Topic; Inflammation; Biomarkers
PubMed: 37257335
DOI: 10.1016/j.jtemb.2023.127199 -
Journal of Periodontal Research Apr 2022One of the most important families of proteases associated with periodontal disease is the family of the matrix metalloproteinases (MMPs). Their activity is regulated by... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
One of the most important families of proteases associated with periodontal disease is the family of the matrix metalloproteinases (MMPs). Their activity is regulated by tissue inhibitors of metalloproteinases (TIMPs), and an imbalance between MMP activity and regulation by TIMPs has been associated with the progression of periodontal disease. This strong interaction between TIMPs and MMPs might be an indication that TIMPs can be used as a biomarker to monitor periodontal disease progression in oral fluids. In particular, TIMP-1 is a frequently studied biomarker for periodontal diseases. Therefore, the aim of this systematic review was to evaluate the scientific literature regarding TIMP-1 concentrations in oral fluids of patients suffering from periodontitis or gingivitis in comparison to healthy individuals.
MATERIAL AND METHODS
PubMed/ MedLine and Web of Science databases were searched electronically. Studies that met the inclusion criteria were systematically evaluated and assessed for eligibility and risk of bias. Meta-analysis was performed through the random effects model to assess the association between periodontitis/gingivitis and TIMP-1 concentration in stimulated saliva, unstimulated saliva, and gingival crevicular fluid (GCF).
RESULTS
The search strategy provided a total of 322 studies of which 10 studies met all inclusion criteria. Two studies investigated TIMP-1 concentrations in GCF, three studies in unstimulated saliva, and five studies investigated TIMP-1 concentrations in stimulated saliva. Three studies revealed that TIMP-1 levels in oral fluids were significantly decreased in periodontal disease. Meta-analysis revealed that there is no statistically significant difference between TIMP-1 concentration in oral fluids of periodontitis/gingivitis patients in comparison to healthy individuals.
CONCLUSIONS
This systematic review with meta-analysis shows that periodontal diseases are not associated with a statistically significant change in TIMP-1 concentration in oral fluids.
Topics: Biomarkers; Gingival Crevicular Fluid; Gingivitis; Humans; Matrix Metalloproteinase 8; Periodontal Diseases; Tissue Inhibitor of Metalloproteinase-1
PubMed: 34850390
DOI: 10.1111/jre.12957 -
Research in Veterinary Science Oct 2017A systematic review and meta-analysis (MA) were performed to summarize all scientific evidence for the effects of castration in male beef cattle on welfare indicators... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis (MA) were performed to summarize all scientific evidence for the effects of castration in male beef cattle on welfare indicators based on cortisol concentration, average daily gain (ADG), and vocalization. We searched five electronic databases, conference proceedings, and experts were contacted electronically. The main inclusion criteria involved completed studies using beef cattle up to one year of age undergoing surgical and non-surgical castration that presented cortisol concentration, ADG, or vocalization as an outcome. A random effect MA was conducted for each indicator separately with the mean of the control and treated groups. A total of 20 publications reporting 26 studies and 162 trials were included in the MA involving 1814 cattle. Between study heterogeneity was observed when analysing cortisol (I=56.7%) and ADG (I=79.6%). Surgical and non-surgical castration without drug administration compared to uncastrated animals showed no change (P≥0.05) in cortisol level. Multimodal therapy for pain did not decrease (P≥0.05) cortisol concentration after 30min when non-surgical castration was performed. Comparison between surgical castration, with and without anaesthesia, showed a tendency (P=0.077) to decrease cortisol levels after 120min of intervention. Non-surgical and surgical castration, performed with no pain mitigation, increased and tended to increase the ADG by 0.814g/d (P=0.001) and by 0.140g/d (P=0.091), respectively, when compared to a non-castrated group. Our MA study demonstrates an inconclusive result to draw recommendations on preferred castration practices to minimize pain in beef cattle.
Topics: Animals; Cattle; Hydrocortisone; Male; Orchiectomy; Pain Management; Vocalization, Animal; Weight Gain
PubMed: 28755556
DOI: 10.1016/j.rvsc.2017.07.014 -
Human Reproduction Update 2013BACKGROUND Oxidative stress might be associated with polycystic ovary syndrome (PCOS), but relatively small studies published to date do not permit reaching a definitive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND Oxidative stress might be associated with polycystic ovary syndrome (PCOS), but relatively small studies published to date do not permit reaching a definitive conclusion. We aimed at conducting a systematic review and meta-analysis of studies evaluating circulating markers of oxidative stress in patients with PCOS. METHODS We conducted a systematic review of studies reporting circulating markers of oxidative stress in women with PCOS and controls published up to June 2012, using Entrez PubMed and EMBASE online facilities. Meta-analysis calculated standardized mean differences (SMDs) and 95% confidence intervals (95CI). RESULTS From 1633 potential studies identified electronically, 68 studies, including 4933 PCOS patients and 3671 controls, were selected. For each of nine circulating markers of oxidative stress, an individual meta-analysis was conducted. Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4). Similar results were found when restricting the analyses to studies in which patients and controls were matched for age and body mass index. CONCLUSIONS Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess. This finding suggests that oxidative stress may participate in the pathophysiology of this common disorder.
Topics: Aryldialkylphosphatase; Biomarkers; Body Mass Index; Female; Humans; Malondialdehyde; Oxidative Stress; Polycystic Ovary Syndrome
PubMed: 23303572
DOI: 10.1093/humupd/dms059 -
Oxidative Medicine and Cellular... 2022Elevated serum low-density lipoproteins (LDL), the substrate for the formation of atherogenic oxidized LDLs (oxLDL), are a causal factor for atherosclerotic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Elevated serum low-density lipoproteins (LDL), the substrate for the formation of atherogenic oxidized LDLs (oxLDL), are a causal factor for atherosclerotic cardiovascular disease (ASCVD). Statins are well known to decrease LDL particle concentration and reduce ASCVD morbidity and mortality.
OBJECTIVE
To perform a meta-analysis of the effects of statins (i.e., type, dose, and duration of treatment) on serum levels of oxLDL and on immunoglobulin M (IgM) and immunoglobulin G (IgG) antibody levels against oxLDL.
METHODS
PubMed, Scopus, Embase, and Web of Science were searched up to February 5th, 2021, for randomized controlled trials (RCT) evaluating the effect of statins on oxLDL and anti-oxLDL antibody levels. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V2 software. To evaluate the influence of each study on the overall effect size, a sensitivity analysis was performed using the leave-one-out method. Evaluation of the funnel plot, Begg's rank correlation, and Egger's weighted regression tests was used to assess the presence of publication bias in the meta-analysis.
RESULTS
A total of 28 RCTs including 4019 subjects were finally included in the meta-analysis. The results indicated a significant decrease in circulating concentrations of oxLDL after treatment with statins (SMD: -2.150, 95% CI: -2.640, -1.697, < 0.001). Subgroup analysis found no significant effect of the intensity of statin treatment or statin lipophilicity on the reduction of circulating concentrations of oxLDL. An additional meta-analysis of 3 trials showed that statins did not change the serum levels of IgM and IgG antibodies to oxLDL.
CONCLUSION
Statin therapy decreases serum oxLDL concentrations but does not affect circulating levels of anti-oxLDL antibodies.
Topics: Atherosclerosis; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Immunoglobulin G; Immunoglobulin M; Lipoproteins, LDL
PubMed: 35958018
DOI: 10.1155/2022/7850659 -
International Journal of Environmental... Dec 2023Exposure to aflatoxin B1 can be associated with reproductive toxicity, accompanied by decreased sperm concentration in animal models. The aim of this meta-analysis was... (Meta-Analysis)
Meta-Analysis Review
Exposure to aflatoxin B1 can be associated with reproductive toxicity, accompanied by decreased sperm concentration in animal models. The aim of this meta-analysis was to determine the correlation between aflatoxin B1 exposure and sperm concentrations of male rodents (both mice and rats). According to inclusion and exclusion criteria, 8 articles were selected to assess in the current meta-analysis. The random effects and pooled analysis indicated that sperm concentration was decreased in mice [MD sperm = -20.79×10/sperm/g testis (95%CI =-1.3 to -50.5)] and in rats [-24.34×10/sperm/g testis (95%CI: -7.60 to -44.35)] after exposure to aflatoxin B1 compared with control groups. A significant heterogeneity was found among studies (for mice I=99.7%, %, <0.000 and rats =I=98.8, <0.000). The findings of present meta-analysis showed the association between aflatoxin B1 exposure and a decrease in sperm concentration in rodents.
Topics: Male; Rats; Mice; Animals; Aflatoxin B1; Rodentia; Semen; Spermatozoa; Testis
PubMed: 36001895
DOI: 10.1080/09603123.2022.2113766 -
Human Reproduction (Oxford, England) Jun 2021Are there temporal trends of sperm concentration (SC) and total sperm count (TSC) in Chinese healthy males from 1981 to 2019?
STUDY QUESTION
Are there temporal trends of sperm concentration (SC) and total sperm count (TSC) in Chinese healthy males from 1981 to 2019?
SUMMARY ANSWER
Our result indicated a temporal decrease in SC and TSC among 327 373 healthy Chinese men in the recent four decades.
WHAT IS KNOWN ALREADY
A review of 61 papers reported a temporal decline in SC and TSC from 1938 to 1990. This trend was later confirmed by a systematic review of 185 published papers from 1981 to 2013. However, the majority of the included individuals were from western countries. In China, whether SC and TSC have declined remains controversial.
STUDY DESIGN, SIZE, DURATION
This systematic review of published articles used data extracted from Pubmed, Science Direct, Embase, China-National-Knowledge-Infrastructure (CNKI) and Wanfang Data to assess changes in SC and TSC in China from 1981 to 2019.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A total of 111 studies including 327 373 individuals who provided semen samples from 1981 to 2019 were extracted for the present analysis. Study selection and data extraction were performed by two independent researchers. The trends in SC and TSC were analysed using liner-regression and meta-regression before and after adjusting for potential covariates. Moreover, subgroups, categorised based on geographic region, fertility status or recruitment source, were also analysed.
MAIN RESULTS AND THE ROLE OF CHANCE
SC declined significantly (slope liner-regression = -0.748 million/ml/year; P = 0.005; slope meta-regression = -0.824 million/ml/year; P < 0.001) between 1981 and 2019 in China. Trends for TSC was similar to that for SC (slope liner-regression = -2.073 million/year; P = 0.032; slope meta-regression = -2.188 million/year; P = 0.003). In subgroup meta-regression analyses, males with definite fertility had continuous declines in SC (slope northern group=-2.268, P = 0.009; slope southern group=-1.014, P = 0.009) and TSC (slope northern group=-9.675, P = 0.010; slope southern group=-3.215, P = 0.042). However, in the unselected group, where fertility status was unknown, the obvious downward trend in SC was only seen in males from Northern regions (slope = -0.836, P = 0.003). Another subgroup analysis demonstrated that obvious decreases in SC (slope = -1.432, P < 0.001) and TSC (slope=-4.315, P = 0.001) were only seen in volunteer groups but not in pre-pregnancy examination groups and other recruitment groups. The results changed minimally in multiple sensitivity analyses.
LIMITATIONS, REASONS FOR CAUTION
The validity of the meta-analysis results was limited mainly by the quality of the included studies. Additionally, our study spanned many decades and the recommended criteria for some semen parameter assessments have significantly changed, which may bring about some unavoidable bias. Moreover, the data remain insufficient especially in some provinces of China.
WIDER IMPLICATIONS OF THE FINDINGS
The present study is the first study to report significant decreases in SC and TSC in 327 373 healthy Chinese men between 1981 and 2019, indicating a serious reproductive health warning. Further studies on the causes of the declines are urgently needed.
STUDY FUNDING/COMPETING INTEREST(S)
D.Z. is supported by the National Natural Science Funding of China, Natural Science Funding of Shaanxi Province, Science Funding of Health Department, Shaanxi Province, Fundamental Research Funds for the Central University and the Project of Independent Innovative Experiment for Postgraduates in Medicine in Xi'an Jiaotong University. The authors have no conflicts of interests to declare.
TRIAL REGISTRATION NUMBER
N/A.
Topics: China; Female; Humans; Male; Pregnancy; Semen; Semen Analysis; Sperm Count; Sperm Motility
PubMed: 34046659
DOI: 10.1093/humrep/deab124