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Spinal Cord Jul 2022Systematic Review. (Review)
Review
STUDY DESIGN
Systematic Review.
OBJECTIVES
To review systematically the clinical evidence of the effectiveness of various intermittent catheter cleaning methods that have been proposed as methods to prepare catheters for reuse.
METHODS
A keyword search in Medline, Excerpta Medica dataBASE, the Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials, was undertaken to identify all English, Russian and German language literature evaluating the effectiveness of various intermittent catheter cleaning methods. Studies selected for review included analytical experimental, prospective cohort and cross-sectional. Cleaning methods reviewed included heat-based sterilization, chemical cleaning solutions, mechanical abrasion, photocatalytic sterilization, and combined methods.
RESULTS
Overall, 12 studies were included. Heat-based sterilization and mechanical abrasion methods were either not effective or damaged the physical properties of catheters. Two studies reported evidence that their chemical cleaning methods (i.e., soaked catheters in a 70% alcohol solution for 5 min or combined approach detergent wash followed by soaking in Milton sterilizing fluid also known as the Milton method) both preserved the structural integrity of their catheters and were bactericidal.
CONCLUSIONS
Numerous cleaning methods resulted in the destruction of catheters. However, there are two reported cleaning methods, submersion for 5 min in 70% alcohol and the "Milton method", that eliminate bacterial colonization while leaving the physical properties of the catheters unchanged. While these cleaning methods are promising, each was published in just one study, therefore higher-powered / longitudinal studies confirming the safety and efficacy of these cleaning methods must be obtained before current clinical recommendations can be modified.
Topics: Catheterization; Catheters; Cross-Sectional Studies; Humans; Prospective Studies; Spinal Cord Injuries
PubMed: 35066573
DOI: 10.1038/s41393-021-00740-3 -
Health Technology Assessment... Dec 2013The principal diagnosis/indication for this assessment is chronic diarrhoea due to bile acid malabsorption (BAM). Diarrhoea can be defined as the abnormal passage of... (Review)
Review
SeHCAT [tauroselcholic (selenium-75) acid] for the investigation of bile acid malabsorption and measurement of bile acid pool loss: a systematic review and cost-effectiveness analysis.
BACKGROUND
The principal diagnosis/indication for this assessment is chronic diarrhoea due to bile acid malabsorption (BAM). Diarrhoea can be defined as the abnormal passage of loose or liquid stools more than three times daily and/or a daily stool weight > 200 g per day and is considered to be chronic if it persists for more than 4 weeks. The cause of chronic diarrhoea in adults is often difficult to ascertain and patients may undergo several investigations without a definitive cause being identified. BAM is one of several causes of chronic diarrhoea and results from failure to absorb bile acids (which are required for the absorption of dietary fats and sterols in the intestine) in the distal ileum.
OBJECTIVE
For people with chronic diarrhoea with unknown cause and in people with Crohn's disease and chronic diarrhoea with unknown cause (i.e. before resection): (1) What are the effects of selenium-75-homocholic acid taurine (SeHCAT) compared with no SeHCAT in terms of chronic diarrhoea, other health outcomes and costs? (2) What are the effects of bile acid sequestrants (BASs) compared with no BASs in people with a positive or negative SeHCAT test? (3) Does a positive or negative SeHCAT test predict improvement in terms of chronic diarrhoea, other health outcomes and costs?
DATA SOURCES
A systematic review was conducted to summarise the evidence on the clinical effectiveness of SeHCAT for the assessment of BAM and the measurement of bile acid pool loss. Search strategies were based on target condition and intervention, as recommended in the Centre for Reviews and Dissemination (CRD) guidance for undertaking reviews in health care and the Cochrane Handbook for Diagnostic Test Accuracy Reviews. The following databases were searched up to April 2012: MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; EMBASE; the Cochrane Databases; Database of Abstracts of Reviews of Effects; Health Technology Assessment (HTA) Database; and Science Citation Index. Research registers and conference proceedings were also searched.
REVIEW METHODS
Systematic review methods followed the principles outlined in the CRD guidance for undertaking reviews in health care and the National Institute for Health and Care Excellence (NICE) Diagnostic Assessment Programme interim methods statement. In the health economic analysis, the cost-effectiveness of SeHCAT for the assessment of BAM, in patients with chronic diarrhoea, was estimated in two different populations. The first is the population of patients with chronic diarrhoea with unknown cause and symptoms suggestive of diarrhoea-predominant irritable bowel syndrome (IBS-D) and the second population concerns patients with Crohn's disease without ileal resection with chronic diarrhoea. For each population, three models were combined: (1) a short-term decision tree that models the diagnostic pathway and initial response to treatment (first 6 months); (2) a long-term Markov model that estimates the lifetime costs and effects for patients initially receiving BAS; and (3) a long-term Markov model that estimates the lifetime costs and effects for patients initially receiving regular treatment (IBS-D treatment in the first population and Crohn's treatment in the second population). Incremental cost-effectiveness ratios were estimated as additional cost per additional responder in the short term (first 6 months) and per additional quality-adjusted life-year (QALY) in the long term (lifetime).
RESULTS
We found three studies assessing the relationship between the SeHCAT test and response to treatment with cholestyramine. However, the studies had small numbers of patients with unknown cause chronic diarrhoea, and they used different cut-offs to define BAM. For the short term (first 6 months), when trial of treatment is not considered as a comparator, the optimal choice depends on the willingness to pay for an additional responder. For lower values (between £1500 and £4600) the choice will be no SeHCAT in all scenarios; for higher values either SeHCAT 10% or SeHCAT 15% becomes cost-effective. For the lifetime perspective, the various scenarios showed widely differing results: in the threshold range of £20,000-30,000 per QALY gained we found as optimal choice either no SeHCAT, SeHCAT 5% (only IBS-D) or SeHCAT 15%. When trial of treatment is considered a comparator, the analysis showed that for the short term, trial of treatment is the optimal choice across a range of scenarios. For the lifetime perspective with trial of treatment, again the various scenarios show widely differing results. Depending on the scenario, in the threshold range of £20,000-30,000 per QALY gained, we found as optimal choice either trial of treatment, no SeHCAT or SeHCAT 15%.
CONCLUSIONS
In conclusion, the various analyses show that for both populations considerable decision uncertainty exists and that no firm conclusions can be formulated about which strategy is optimal. Standardisation of the definition of a positive SeHCAT test should be the first step in assessing the usefulness of this test. As there is no reference standard for the diagnosis of BAM and SeHCAT testing provides a continuous measure of metabolic function, diagnostic test accuracy (DTA) studies are not the most appropriate study design. However, in studies where all patients are tested with SeHCAT and all patients are treated with BASs, response to treatment can provide a surrogate reference standard; further DTA studies of this type may provide information on the ability of SeHCAT to predict response to BASs. A potentially more informative option would be multivariate regression modelling of treatment response (dependent variable), with SeHCAT result and other candidate clinical predictors as covariates. Such a study design could also inform the definition of a positive SeHCAT result.
STUDY REGISTRATION
The study is registered as PROSPERO CRD42012001911.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Adult; Bile Acids and Salts; Chronic Disease; Cost-Benefit Analysis; Crohn Disease; Diagnosis, Differential; Diarrhea; Humans; Irritable Bowel Syndrome; Malabsorption Syndromes; Models, Economic; Predictive Value of Tests; Taurocholic Acid; United Kingdom
PubMed: 24351663
DOI: 10.3310/hta17610 -
Bioprocess and Biosystems Engineering Oct 2023Most cold-adapted enzymes display high catalytic activity at low temperatures (20-25 °C) and can still maintain more than 40-50% of their maximum activity at lower... (Review)
Review
Most cold-adapted enzymes display high catalytic activity at low temperatures (20-25 °C) and can still maintain more than 40-50% of their maximum activity at lower temperatures (0-10 °C) but are inactivated after a moderate increase in temperature. The activity of some cold-adapted enzymes increases significantly in the presence of high salt concentrations and metal ions. Interestingly, we also observed that some cold-adapted enzymes have a wide range of optimum temperatures, exhibiting not only maximum activity under low-temperature conditions but also the ability to maintain high enzyme activity under high-temperature conditions, which is a novel feature of cold-adapted enzymes. This unique property of cold-adapted enzymes is generally attractive for biotechnological and industrial applications because these enzymes can reduce energy consumption and the chance of microbial contamination, thereby lowering the production costs and maintaining the flavor, taste and quality of foods. How high catalytic activity is maintained at low temperatures remains unknown. The relationship between the structure of cold-adapted enzymes and their activity, flexibility and stability is complex, and thus far, a unified explanation has not been provided. Herein, we systematically review the sources, catalytic characteristics and cold adaptation of enzymes from four enzymes categories systematically and discuss how these properties may be exploited in biotechnology. A thorough understanding of the properties, catalytic mechanisms, and engineering of cold-adapted enzymes is critical for future biotechnological applications in the detergent industry and food and beverage industries.
Topics: Biotechnology; Catalysis; Cold Temperature; Adaptation, Physiological; Enzymes
PubMed: 37486422
DOI: 10.1007/s00449-023-02904-2 -
Environmental Pollution (Barking, Essex... Oct 2023The overwhelming concerns of water pollution, industrial discharges and environmental deterioration by various organic and inorganic substances, including dyes, heavy... (Review)
Review
The overwhelming concerns of water pollution, industrial discharges and environmental deterioration by various organic and inorganic substances, including dyes, heavy metals, pesticides, pharmaceuticals, and detergents, intrinsically drive the search for urgent and efficacious decontamination techniques. This review illustrates the various approaches to remediation, their fundamentals, characteristics and demerits. In this manner, the advantageous implementation of nature-based adsorbents has been outlined and discussed. Different types of lignocellulosic compounds (cellulose, lignin, chitin, chitosan, starch) have been introduced, and the most used biopolymeric materials in bioremediation have been highlighted; their merits, synthesis methods, properties and performances in aqueous medium decontamination have been described. The literature assessment reveals the genuine interest and dependence of academic and industrial fields to valorize biopolymers in the adsorption of various hazardous substances. Yet, the full potential of this approach is still confined by certain constraints, such as the lack of reliable, substantial, and efficient extraction of biopolymers, as well as their modest and inconsistent physicochemical properties. The futuristic reliance on such biomaterials in all fields, rather than adsorption, is inherently reliable on in-depth investigations and understanding of their features and mechanisms, which can guarantee a real-world application and green technologies.
Topics: Polymers; Water; Adsorption; Decontamination; Water Pollutants, Chemical; Biopolymers; Metals, Heavy; Water Purification
PubMed: 37562526
DOI: 10.1016/j.envpol.2023.122349 -
Current Neuropharmacology 2024Tauroursodeoxycholic acid (TUDCA) is a naturally produced hydrophilic bile acid that has been used for centuries in Chinese medicine. Numerous recent and studies have...
BACKGROUND
Tauroursodeoxycholic acid (TUDCA) is a naturally produced hydrophilic bile acid that has been used for centuries in Chinese medicine. Numerous recent and studies have shown that TUDCA has neuroprotective action in various models of retinal disorders.
OBJECTIVE
To systematically review the scientific literature and provide a comprehensive summary on the neuroprotective action and the mechanisms involved in the cytoprotective effects of TUDCA.
METHODS
A systematic review was conducted in accordance with the PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Systematic literature search of United States National Library of Medicine (PubMed), Web of Science, Embase, Scopus and Cochrane Library was performed, which covered all original articles published up to July 2022. The terms, "TUDCA" in combination with "retina", "retinal protection", "neuroprotection" were searched. Possible biases were identified with the adopted SYRCLE's tool.
RESULTS
Of the 423 initially gathered studies, 24 articles met inclusion/exclusion criteria for full-text review. Six of them were experiments, 17 studies reported data and one study described both and data. The results revealed the effect of TUDCA on different retinal diseases, such as retinitis pigmentosa (RP), diabetic retinopathy (DR), retinal degeneration (RD), retinal ganglion cell (RGC) injury, Leber's hereditary optic neuropathy (LHON), choroidal neovascularization (CNV), and retinal detachment (RDT). The quality scores of the studies were ranged from 5 to 7 points (total 10 points), according to SYRCLE's risk of bias tool. Both and data suggested that TUDCA could effectively delay degeneration and apoptosis of retinal neurons, preserve retinal structure and function, and its mechanism of actions might be related with inhibiting apoptosis, decreasing inflammation, attenuating oxidative stress, suppressing endoplasmic reticulum (ER) stress, and reducing angiogenesis.
CONCLUSION
This systematic review demonstrated that TUDCA has neuroprotective effect on and models of retinal disorders, reinforcing the currently available evidence that TUDCA could be a promising therapeutic agent in retinal diseases treatment. However, well designed clinical trials are necessary to appraise the efficacy of TUDCA in clinical setting.
Topics: Taurochenodeoxycholic Acid; Animals; Neuroprotective Agents; Humans; Retinal Diseases; Disease Models, Animal
PubMed: 37691227
DOI: 10.2174/1570159X21666230907152207 -
International Journal of Colorectal... May 2023Symptomatic internal hemorrhoids affect up to 40% of people in Western society. Patients with grade I-III hemorrhoids, who fail lifestyle and medical management, may... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Symptomatic internal hemorrhoids affect up to 40% of people in Western society. Patients with grade I-III hemorrhoids, who fail lifestyle and medical management, may benefit from office-based procedures. As per the American Society of Colon and Rectum Surgeons (ASCRS), rubber band ligation (RBL) is the first-line office-based treatment. Polidocanol sclerotherapy is a relatively new approach for these patients. The aim of this systematic review is to compare the efficacy of RBL and polidocanol sclerotherapy with the treatment of symptomatic grade I-III internal hemorrhoids.
METHODS
The systematic review was completed by searching MEDLINE, Embase, and CENTRAL databases from inception to August 2022 for prospective studies comparing RBL and polidocanol sclerotherapy or evaluating the efficacy of polidocanol sclerotherapy alone for adult (> 18 years) patients with grade I-III internal hemorrhoids. Treatments were evaluated for therapeutic success and post-procedure morbidity.
RESULTS
Of 155 citations obtained, 10 studies (3 comparative and 7 single-arm studies) and 4 abstracts (2 comparative and 2 single arm) were included in the study. The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48-7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15-1.82, p = 0.31).
CONCLUSION
This study highlights that polidocanol sclerotherapy may be associated with higher therapeutic success in patients with symptomatic grade I-III internal hemorrhoids. Further evaluations in the form of randomized trials are required to evaluate patient populations, which may benefit more from sclerotherapy.
Topics: Adult; Humans; Sclerotherapy; Polidocanol; Hemorrhoids; Prospective Studies; Ligation; Disease Management; Treatment Outcome
PubMed: 37133577
DOI: 10.1007/s00384-023-04394-w -
The American Journal of Sports Medicine Jun 2013Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available.
PURPOSE
To assess the comparative effectiveness and safety of injection therapies in patients with lateral epicondylitis.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
Randomized controlled trials comparing different injection therapies for lateral epicondylitis were included provided they contained data for change in pain intensity (primary outcome). Trials were assessed using the Cochrane risk of bias tool. Network (random effects) meta-analysis was applied to combine direct and indirect evidence within and across trial data using the final end point reported in the trials, and results for the arm-based network analyses are reported as standardized mean differences (SMDs).
RESULTS
Seventeen trials (1381 participants; 3 [18%] at low risk of bias) assessing injection with 8 different treatments-glucocorticoid (10 trials), botulinum toxin (4 trials), autologous blood (3 trials), platelet-rich plasma (2 trials), and polidocanol, glycosaminoglycan, prolotherapy, and hyaluronic acid (1 trial each)-were included. Pooled results (SMD [95% confidence interval]) showed that beyond 8 weeks, glucocorticoid injection was no more effective than placebo (-0.04 [-0.45 to 0.35]), but only 1 trial (which did not include a placebo arm) was at low risk of bias. Although botulinum toxin showed marginal benefit (-0.50 [-0.91 to -0.08]), it caused temporary paresis of finger extension, and all trials were at high risk of bias. Both autologous blood (-1.43 [-2.15 to -0.71]) and platelet-rich plasma (-1.13 [-1.77 to -0.49]) were also statistically superior to placebo, but only 1 trial was at low risk of bias. Prolotherapy (-2.71 [-4.60 to -0.82]) and hyaluronic acid (-5.58 [-6.35 to -4.82]) were both more efficacious than placebo, whereas polidocanol (0.39 [-0.42 to 1.20]) and glycosaminoglycan (-0.32 [-1.02 to 0.38]) showed no effect compared with placebo. The criteria for low risk of bias were only met by the prolotherapy and polidocanol trials.
CONCLUSION
This systematic review and network meta-analysis of randomized controlled trials found a paucity of evidence from unbiased trials on which to base treatment recommendations regarding injection therapies for lateral epicondylitis.
Topics: Blood Transfusion, Autologous; Botulinum Toxins; Glucocorticoids; Humans; Hyaluronic Acid; Platelet-Rich Plasma; Polidocanol; Polyethylene Glycols; Randomized Controlled Trials as Topic; Sclerosing Solutions; Tennis Elbow; Viscosupplements
PubMed: 22972856
DOI: 10.1177/0363546512458237 -
BMC Pregnancy and Childbirth Mar 2023The aim of this systematic review and meta-analysis was to introduce the relatively novel method of ultrasound-guided local lauromacrogol injection (USG-LLI) followed by... (Meta-Analysis)
Meta-Analysis
Comparison of clinical safety and efficacy of ultrasound-guided local lauromacrogol injection versus uterine artery embolization in the treatment of caesarean scar pregnancy: a systematic review and meta-analysis.
BACKGROUND
The aim of this systematic review and meta-analysis was to introduce the relatively novel method of ultrasound-guided local lauromacrogol injection (USG-LLI) followed by dilatation and curettage for caesarean scar pregnancy (CSP) and to investigate the clinical safety and efficacy between uterine artery embolization (UAE) and USG-LLI in the treatment of CSP.
METHODS
The relevant literature and articles about USG-LLI, UAE and CSP published in eight electronic databases were searched to extract the primary outcomes for the selected articles. Review Manager Software(RevMan) V.5.2 was used for quantitative data synthesis and data analysis. Forest plots, sensitivity analysis and bias analysis were also performed on the included articles.
RESULTS
Of 10 studies included in our search, 623 patients were in the USG-LLI group and 627 patients were in the UAE groups. There were no significant differences between the two groups in terms of success rate, blood loss and time to human chorionic gonadotropin (hCG) normalization. However, USG-LLI group patients than UAE group patients had a shorter duration of hospital stay (mean difference [MD] = -1.97; 95% confidence intervals [CI] -2.63 to -1.31; P < 0.05; I = 95%), shorter restored menses (MD = -4.84; 95%CI -5.78 to -3.90; P < 0.05; I = 95%), and lower complication rates [odds ratio(OR) = 0.21; 95%CI:0.15 to 0.30; P < 0.05]; and cheaper on expenses of hospitalization (MD = -8028.29; 95%CI -10,311.18 to -5745.40; P < 0.05; I = 100%).
CONCLUSIONS
The results demonstrate that USG-LLI is comparable in curative effect and success rates with UAE in the therapy of CSP, but patients in the USG-LLI group seem to have fewer complications rates, shorter duration of hospital stays and lower costs.
Topics: Female; Pregnancy; Humans; Polidocanol; Cicatrix; Uterine Artery Embolization; Ultrasonography, Interventional; Cesarean Section
PubMed: 36882695
DOI: 10.1186/s12884-023-05455-2 -
Infectious Diseases Now Jun 2022While the World Health Organization has recommended preoperative washing with plain or antimicrobial soap for surgical site infection (SSI) prevention, it has not... (Meta-Analysis)
Meta-Analysis Review
What is the benefit of preoperative washing with chlorhexidine gluconate-impregnated cloths on the incidence of surgical site infections? A systematic review and meta-analysis.
OBJECTIVES
While the World Health Organization has recommended preoperative washing with plain or antimicrobial soap for surgical site infection (SSI) prevention, it has not formulated recommendations on use of chlorhexidine gluconate (CHG)-impregnated cloths. The purpose of this systematic review was to evaluate the benefit of preoperative bathing with CHG-cloths on SSI incidence.
PATIENTS AND METHODS
Publications were searched on Medline, CENTRAL, Web of Science, Clinical Trial between 01/01/1990 and 30/06/2018. Randomized controlled trials (RCT), quasi-randomized, case-control and cohort studies on patients with surgery (Population) having preoperative bathing with CHG-cloths (Intervention) or antiseptic soap, plain soap, placebo, no washing, no instruction (Comparator) were included. The main outcome was SSI occurrence. The results were synthetized using the Odds-Ratio (OR) and 95% confidence interval [95%CI]. Study quality was assessed using the Cochrane and Newcastle-Ottawa tools and evidence quality with the GRADE method. Statistics were calculated on RevMan5.3.
RESULTS
All in all, 1108 publications were identified and 3 were included in the meta-analysis. OR of the 2 cohort studies was 0.25 [95%CI: 0.13-0.50] for use of CHG-cloths the evening and the morning before intervention versus non-compliance with preoperative washing. OR of the RCT was 0.12 [95%CI: 0.02-1.00] for use of CHG-cloths the evening and the morning before intervention versus a shower with antibacterial soap the evening before the intervention. Study quality was moderate.
CONCLUSIONS
While the available studies show a benefit for CHG-cloths on SSI occurrence in orthopaedic surgery, there is no comparison with usual practices. Further studies are needed to confirm the benefit of CHG-cloths for preoperative washing.
Topics: Chlorhexidine; Humans; Incidence; Preoperative Care; Soaps; Surgical Wound Infection
PubMed: 35172215
DOI: 10.1016/j.idnow.2022.01.007 -
Archives of Microbiology Sep 2019Proteases, one of the largest groups of industrial enzymes occupy a major share in detergent industry. To meet the existing demands, proteases with efficient catalytic...
Proteases, one of the largest groups of industrial enzymes occupy a major share in detergent industry. To meet the existing demands, proteases with efficient catalytic properties are being explored from bacteria residing in extreme habitats. Alkaline proteases are also considered as promising candidates for industrial sectors due to the activity and stability under alkaline and harsh environment. Therefore, a systematic review on experimental studies of bacterial proteases was conducted with emphasis on purification, characterization, cloning and expression and their suitability as detergent additive. Relevant searches using a combination of filters/keywords were performed in the online databases; PubMed, Science Direct, Scopus and Web of Science. Over thousands of research papers, 71 articles in Scopus, 48 articles in Science Direct, 18 articles in PubMed and 8 articles in Web of Science were selected with regard to bacterial extracellular proteases till date. Selected articles revealed majority of the studies conducted between the years 2015 and 17 and were focused on purification of proteases from bacteria. Among microbes, a total of 41 bacterial genera have been explored with limited studies from extreme habitats. Majority of the studies have reported the involvement of subtilisin-like serine proteases with effective properties for detergent industries. The studies revealed shifting of trend from purification to cloning to genetic engineering to meet the industrial demands. The present systematic review describes the proteases from extremophilic bacteria and use of biotechnological techniques such as site-directed mutagenesis and codon optimization to engineer enzymes with better hot spots in the active sites to meet industrial challenges.
Topics: Bacteria; Biotechnology; Detergents; Industrial Microbiology; Serine Proteases
PubMed: 31025057
DOI: 10.1007/s00203-019-01662-8