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Annals of the American Thoracic Society Mar 2024The American Thoracic Society convened an international multidisciplinary panel to develop clinical practice guidelines for the treatment of systemic... (Meta-Analysis)
Meta-Analysis
The American Thoracic Society convened an international multidisciplinary panel to develop clinical practice guidelines for the treatment of systemic sclerosis-associated interstitial lung disease (SSc-ILD). To conduct a systematic review and evaluate the literature to determine whether patients with SSc-ILD should be treated with nintedanib alone or with the combination of nintedanib plus mycophenolate. Literature searches were conducted across MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases through June 2022 for studies using nintedanib or nintedanib plus mycophenolate to treat patients with SSc-ILD. Mortality, disease progression, quality of life, and adverse event data were extracted, and meta-analysis was performed when possible. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to assess the quality of evidence. For nintedanib therapy alone, the systematic review included three total studies and revealed that disease progression was less in the nintedanib arm (the annual rate of decline in forced vital capacity [FVC] was 44.5 ml less, the absolute change from baseline was 46.4 ml less, and FVC% predicted was 1.2% less in the nintedanib arm) compared with placebo. However, gastrointestinal side effects and treatment discontinuation were double in the nintedanib arm compared with placebo. For combination therapy, the systematic review also included three total studies and revealed that changes in the annual rate of decline in FVC favored combination therapy over placebo (mean difference, 79.1 ml). Combination therapy was, however, associated with increased gastrointestinal adverse effects compared with placebo. The quality of evidence for all outcomes was very low as per GRADE. The use of nintedanib alone and in combination with mycophenolate in patients with SSc-ILD is associated with a significant reduction in disease progression compared with placebo but at the cost of increased gastrointestinal side effects and treatment discontinuation. The quality of evidence is very low.
Topics: Humans; Quality of Life; Immunosuppressive Agents; Disease Progression; Lung Diseases, Interstitial; Scleroderma, Systemic; Indoles
PubMed: 37773000
DOI: 10.1513/AnnalsATS.202301-081OC -
Scientific Reports May 2023This systematic review and meta-analysis aimed to comprehensively evaluate the factors associated with mortality and progressive disease in NTM-LD patients. We conducted... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis aimed to comprehensively evaluate the factors associated with mortality and progressive disease in NTM-LD patients. We conducted a literature search to identify the eligible studies, dated between January 1, 2007, and April 12, 2021. Forty-one studies with total 10,452 patients were included. The overall all-cause mortality rate was 20% (95% CI 17-24%). The overall rates of clinical and radiographic progressive disease were 46% (95% CI 39-53%) and 43% (95% CI 31-55%), respectively. Older age, male sex, history of TB, diabetes, chronic heart disease, malignancy, systemic immunosuppression, chronic liver disease, presence of cavity, consolidative radiologic features, acid-fast bacillus (AFB) smear positivity, hypoalbuminemia, anemia, increasing platelet count, high CRP, and high ESR were significantly associated with increased all-cause mortality, whereas increasing body mass index (BMI), hemoptysis, and treatment with rifamycin regimen (in M. xenopi) were significantly associated with decreased all-cause mortality in multivariable analysis. History of TB, Aspergillus co-infection, cough, increased sputum, weight loss, presence of cavity, and AFB smear positivity were significantly associated with increased clinical progression with treatment, while older age and low BMI were significantly associated with decreased clinical progression in multivariable analysis. Older age, interstitial lung disease, presence of cavity, consolidative radiologic feature, anemia, high CRP, and leukocytosis were significantly associated with increased radiographic progression after adjusting for covariates. Older age, history of tuberculosis, presence of cavity, consolidative radiologic features, AFB smear positivity, anemia, and high C-reactive protein were common significant factors associated with the all-cause mortality and clinical or radiographic progressive disease of NTM-LD. These factors are thought to directly affect NTM-LD related mortality. The future prediction models for the prognosis of NTM-LD should be established considering these factors.
Topics: Humans; Male; Retrospective Studies; Mycobacterium Infections, Nontuberculous; Lung Diseases; Pneumonia; Disease Progression
PubMed: 37147519
DOI: 10.1038/s41598-023-34576-z -
The Journal of the American Academy of... Dec 2020Osteonecrosis of the femoral head (ONFH) is a cause of hip pain and early joint arthrosis in the young patient. Nonarthroplasty interventions aim to decompress vascular... (Meta-Analysis)
Meta-Analysis
Addition of Bone Marrow Stem Cells Therapy Achieves Better Clinical Outcomes and Lower Rates of Disease Progression Compared With Core Decompression Alone for Early Stage Osteonecrosis of the Femoral Head: A Systematic Review and Meta-Analysis.
BACKGROUND
Osteonecrosis of the femoral head (ONFH) is a cause of hip pain and early joint arthrosis in the young patient. Nonarthroplasty interventions aim to decompress vascular congestion in the femoral head and stimulate new bone growth to prevent progression and collapse. Therefore, the purpose of this study is to evaluate the available evidence on the effect of adjuvant bone marrow stem cells (BMSCs) for early stage ONFH.
METHODS
We performed a systematic review of the MEDLINE, PubMed, Embase, and Cochrane databases in search of published reports comparing the core decompression (CD) with/without adjuvant BMSCs for ONFH. The cohort was divided into two groups: (1) CD with BMSCs (intervention) and (2) CD alone (control subject). The various outcome parameters including hip pain and function, progression of ONFH, rate of revision surgeries, and complications were analyzed. Data were extracted and aggregated for meta-analysis. Cases with staging beyond Ficat II, UPENN II, or ARCO II were excluded.
RESULTS
Of the published reports, 16 met our inclusion criteria with an aggregated 583 hips in the intervention and 468 hips in the control subject groups, respectively. Addition of bone marrow cells to CD resulted in lower hip pain score (VAS) (MD = -10.88, 95% CI = -16.84 to -4.92, P = 0.003) and higher HHS score (MD = 5.59, 95% CI = 1.13 to 10.04, P = 0.01) compared with CD alone at the 24-month follow-up. For rates of progression to higher stages, 138 progressed in the intervention group compared with 202 in the control subject group (P = 0.0002). Finally, subsequent patients who required total hip arthroplasty surgery were lower in the intervention group (22.5% versus 42.3%, P = 0.001).
CONCLUSIONS
Despite heterogeneous and poor data, there is evidence that addition of bone marrow cells to CD appears to result in better clinical outcomes and lower rates of disease progression compared with cored decompression alone.
LEVEL OF EVIDENCE
Therapeutic Level III.
Topics: Bone Marrow Cells; Decompression, Surgical; Disease Progression; Femur Head; Femur Head Necrosis; Humans; Treatment Outcome
PubMed: 32118614
DOI: 10.5435/JAAOS-D-19-00816 -
Alimentary Pharmacology & Therapeutics Mar 2011Non-alcoholic fatty liver disease (NAFLD) has become the most prevalent cause of liver disease in Western countries. The development of non-alcoholic steatohepatitis... (Review)
Review
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) has become the most prevalent cause of liver disease in Western countries. The development of non-alcoholic steatohepatitis (NASH) and fibrosis identifies an at-risk group with increased risk of cardiovascular and liver-related deaths. The identification and management of this at-risk group remains a clinical challenge.
AIM
To perform a systematic review of the established and emerging strategies for the diagnosis and staging of NAFLD.
METHODS
Relevant research and review articles were identified by searching PubMed, MEDLINE and EMBASE.
RESULTS
There has been a substantial development of non-invasive risk scores, biomarker panels and radiological modalities to identify at-risk patients with NAFLD without recourse to liver biopsy on a routine basis. These modalities and algorithms have improved significantly in their diagnosis and staging of fibrosis and NASH in patients with NAFLD, and will likely impact on the number of patients undergoing liver biopsy.
CONCLUSIONS
Staging for NAFLD can now be performed by a combination of radiological and laboratory techniques, greatly reducing the requirement for invasive liver biopsy.
Topics: Biomarkers; Disease Progression; Fatty Liver; Hepatitis; Humans; Non-alcoholic Fatty Liver Disease; Risk Factors
PubMed: 21198708
DOI: 10.1111/j.1365-2036.2010.04556.x -
Neurotoxicology Jul 2017Epilepsy is a neurological condition that affects more than 50 million individuals worldwide. It presents as unpredictable, temporary and recurrent seizures often having... (Review)
Review
Epilepsy is a neurological condition that affects more than 50 million individuals worldwide. It presents as unpredictable, temporary and recurrent seizures often having negative physical, psychological and social consequences. To inform disease prevention and management strategies, a comprehensive systematic review of the literature on risk factors for the onset and natural progression of epilepsy was conducted. Computerized bibliographic databases for systematic reviews, meta-analyses, observational studies and genetic association studies published between 1990 and 2013 describing etiological risk factors for epilepsy was searched. The quality of systematic reviews was validated using the AMSTAR tool and articles were reviewed by two referees. A total of 16,958 articles went through stage one review of abstracts and titles. A total of 76 articles on genetic and non-genetic risk factors for the onset and progression of epilepsy met the eligibility criteria for data extraction. Dozens of risk factors were significantly associated with onset of epilepsy. Inconsistent levels of evidence for risk of onset included family history of epilepsy, history of febrile seizures, alcohol consumption, CNS and other infections, brain trauma, head injury, perinatal stroke, preterm birth and three genetic markers. Limited evidence showed that symptomatic epilepsy, focal seizures/syndromes, slow waves on EEG, higher seizure frequency, high stress or anxiety, and lack of sleep decreased the odds of seizure remission. High quality studies were rare and while a large body of work exists, relatively few systematic reviews were found.
Topics: Age of Onset; Databases, Bibliographic; Disease Progression; Epilepsy; Humans; Network Meta-Analysis; Risk Factors
PubMed: 27000515
DOI: 10.1016/j.neuro.2016.03.011 -
Journal of Renal Nutrition : the... Jul 2020Low-potassium diets are recommended to reduce serum potassium (Sk) and prevent complications of chronic kidney disease (CKD), but evidence underpinning this... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Low-potassium diets are recommended to reduce serum potassium (Sk) and prevent complications of chronic kidney disease (CKD), but evidence underpinning this recommendation has not been systematically reviewed and synthesized. We conducted a systematic review comparing change in Sk, CKD progression, and mortality between those on a low-potassium versus unrestricted potassium diet.
METHODS
We searched Medline, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, and Clinicaltrials.org from inception to 3 April 2018. We included randomized and observational studies that compared these outcomes in adults with CKD who ate a restricted versus unrestricted amount of dietary potassium. We pooled mean change in Sk and adjusted hazard ratios of disease progression and mortality using random-effects meta-analyses.
RESULTS
We identified 5,563 articles, of which seven studies (3,489 participants) met our inclusion criteria. We found very low-quality evidence that restricted (1,295 mg/d) versus unrestricted (1,570 mg/d) dietary potassium lowered Sk by -0.22 mEq/L (95% confidence interval [CI]: -0.33, -0.10; I = 0%). Lower (1,725 mg/d) versus higher (4,558 mg/d) dietary potassium was not significantly associated with disease progression (hazard ratio [HR]: 1.14; 95% CI: 0.77, 1.70; I = 57%). Lower (1,670 mg/d), compared with higher (4,414 mg/d) dietary potassium intake was associated with a 40% reduction in mortality hazard (HR: 0.60; 95% CI: 0.40, 0.89; I = 56%).
CONCLUSIONS
Very-low-quality evidence supports consensus that dietary potassium restriction reduces Sk in normokalemia and is associated with a reduced risk of death in those with CKD. High-quality randomized controlled trials are needed.
Topics: Diet; Disease Progression; Humans; Potassium, Dietary; Renal Insufficiency, Chronic
PubMed: 31734057
DOI: 10.1053/j.jrn.2019.09.009 -
Revista Medica de Chile Dec 2019Aging constitutes a series of physical, physiological and cognitive changes, affecting independence in the activities of daily living. During this stage,...
Aging constitutes a series of physical, physiological and cognitive changes, affecting independence in the activities of daily living. During this stage, neurodegenerative diseases and cognitive impairment are common. Cognitive Reserve allows to face neuropathological changes and maintain cognitive function in the presence of brain damage. However, there are cases where a high cognitive reserve fails to attenuate and delay the effects of neuropathology, allowing the progression of cognitive damage to advanced stages. The objective of this systematic review is to identify evidence where high cognitive reserve does not limit the effects of cognitive impairment. Results indicate that the protective effect of cognitive reserve occurs only in the presence of minimal cognitive impairment, but not at later stages.
Topics: Activities of Daily Living; Cognition; Cognitive Dysfunction; Cognitive Reserve; Disease Progression; Humans
PubMed: 33660743
DOI: 10.4067/S0034-98872019001201594 -
Phytomedicine : International Journal... Jan 2023Ophiocordyceps sinensis (OS), a medicinal fungus, has been made into OS preparations, which are frequently used as adjunctive therapy for patients with Diabetic Kidney... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ophiocordyceps sinensis (OS), a medicinal fungus, has been made into OS preparations, which are frequently used as adjunctive therapy for patients with Diabetic Kidney Disease (DKD) in China. It is necessary to assess the efficacy and safety of OS preparations in the adjunctive treatment of DKD by conducting a systematic review and meta-analysis.
OBJECTIVE
Ophiocordyceps sinensis preparations were evaluated for their efficacy and safety as adjunctive therapy to conventional drugs (angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)) for DKD.
METHODS
We searched seven electronic literature databases for randomized controlled trials (RCTs) comparing ACEI/ARB and OS combined with ACEI/ARB from inception up to March 2022. Two reviewers extracted data and assessed the risk of bias independently. Evidence certainty was rated using the GRADE system. Standardized mean difference (SMD) or mean difference (MD) was pooled with random effects models and was reported with corresponding 95% confidence intervals (CIs). Meta-analysis, sensitivity analysis and Egger's test were performed using R software (version 14.2) (PROSPERO registration no. CRD42021248634).
RESULTS
Thirty eight RCTs involving 3167 patients met the inclusion criteria. No trials were reported with outcomes about kidney disease progression and cardiovascular events. In meta-analysis, compared with the control group of ACEI/ARB alone, OS combined with ACEI/ARB can achieve better effects in the treatment of DKD on reducing serum creatinine (Scr) [MD =-11.48 95% CI [-15.78, -7.18], p < 0.01], blood urea nitrogen (BUN) [MD= -1.00, 95% CI [-1.44, -0.55], p < 0.01], β2-microglobulin (β2-MG) [SMD= -1.32, 95% CI [-2.27, -0.37], p < 0.01], cystatin C (CysC) [MD=-0.64, 95% CI [-0.83, -0.45], p < 0.01], 24-h urine proteinuria (24hUP) [SMD= -1.99, 95% CI [-2.68; -1.31], p < 0.01], urine microalbumin (UALB) [MD= -37.41, 95% CI [-44.76, -30.06], p < 0.01] and decreasing urinary albumin excretion rate (UAER) [MD= -24.11, 95% CI [-30.54, -17.68], p < 0.01] and albumin creatinine ratio (ACR) [SMD = 1.01, 95% CI [-1.73, -0.29], p < 0.01]. The OS adjuvant treatment also improved outcomes of blood pressure, blood glucose, blood lipid, inflammation and oxidative stress. No significant change in fasting blood glucose (FPG), glycated hemoglobin (HbA1c), malondialdehyde (MDA), and transforming growth factor beta 1 (TGF-β1) was detected. Yet, no significant difference was found about the adverse events between the two groups.
CONCLUSIONS
Ophiocordyceps sinensis preparation combined with ACEI/ARB has beneficial influence on renal function, decrease proteinuria, dyslipidemia, and even oxidative stress and inflammation in DKD patients. However, there is no trial that evaluated outcomes of kidney disease progression and cardiovascular events. Future study should move beyond surrogate endpoints to actual cardiovascular or renal outcome benefits with an aim to explore effects of OS preparation in the long-term.
Topics: Humans; Diabetic Nephropathies; Cordyceps; Proteinuria; Disease Progression; Cardiovascular Diseases; Inflammation; Albumins; Diabetes Mellitus
PubMed: 36375237
DOI: 10.1016/j.phymed.2022.154531 -
Psycho-oncology Jan 2013Increasing proportions of patients diagnosed with cancer will become long-term survivors (≥ 5 years post-diagnosis). However, survivors may continue to experience... (Review)
Review
BACKGROUND
Increasing proportions of patients diagnosed with cancer will become long-term survivors (≥ 5 years post-diagnosis). However, survivors may continue to experience negative effects of cancer and/or treatment, including fear of recurrence (FoR). This review aims to provide an overview of current knowledge on FoR, including determinants and consequences in long-term cancer survivors, and to outline methodological and conceptual challenges that should be addressed in future research.
METHODS
Multiple databases including PUBMED, EMBASE, and PsycINFO were searched to identify relevant articles. Seventeen articles were included. Data were extracted by two reviewers and summarized following a systematic scheme.
RESULTS
Even years after initial diagnosis, cancer survivors suffer from FoR. Most studies report low or moderate mean FoR scores, suggesting that FoR is experienced in modest intensity by most survivors. Studies including long-term and short-term survivors indicate no significant change of FoR over time. Lower level of education, lower level of optimism, and being Hispanic or White/Caucasian were found to be associated with higher levels of FoR. Significant negative associations were reported between FoR and quality of life as well as psychosocial well-being. All but three studies were conducted in the USA. General cut-offs for severity/clinical significance have not been defined yet.
CONCLUSIONS
FoR at modest intensity is experienced by most long-term cancer survivors. Future studies should address determinants and consequences of FoR in more detail. Validated instruments providing cut-offs for severity/clinical significance of FoR should be developed and utilized. Efficient interventions should be implemented to reduce detrimental effects of FoR.
Topics: Disease Progression; Fear; Humans; Neoplasm Recurrence, Local; Neoplasms; Quality of Life; Survivors
PubMed: 22232030
DOI: 10.1002/pon.3022 -
Ophthalmology Jul 2019We set out to describe the natural history of keratoconus. We included untreated patients, and our key outcome measures were vision, refraction, and corneal curvature. (Meta-Analysis)
Meta-Analysis
PURPOSE
We set out to describe the natural history of keratoconus. We included untreated patients, and our key outcome measures were vision, refraction, and corneal curvature.
CLINICAL RELEVANCE
Keratoconus affects 86 in 100 000 people, causing visual loss due to increasing irregular corneal astigmatism, and the quality of life declines in patients. Interventions are used to stabilize the disease or improve vision, including corneal cross-linking (CXL) and grafting, but these carry risks. Detailed knowledge of the natural history of keratoconus is fundamental in making informed decisions on when their benefits outweigh these risks.
METHODS
We included prospective or retrospective studies of pediatric or adult patients who reported 1 or more of visual acuity, refraction, and corneal curvature measures: steep keratometry (K), mean keratometry (K), or maximum keratometry (K), thinnest pachymetry, corneal transplantation rates, corneal scarring incidence, and patient-reported outcome measures (PROMs). Databases analyzed included Medline, Embase, CENTRAL, and CINAHL. Searches were carried out until October 2018. Bias assessment was carried out using the Joanna Briggs Institute model of evidence-based healthcare.
RESULTS
Our search yielded 3950 publication titles, of which 41 were included in our systematic review and 23 were incorporated into the meta-analysis. Younger patients and those with greater K demonstrated more steepening of K at 12 months. The meta-analysis for K demonstrated a significant increase in K of 0.7 diopters (D) at 12 months (95% confidence interval [CI], 0.31-1.14; P = 0.003). Our meta-regression model predicted that patients had 0.8 D less K steepening over 12 months for every 10-year increase in age (P = 0.01). Patients were predicted to have 1 D greater K steepening for every 5 D of greater baseline K (P = 0.003). At 12 months, there was a significant increase in the average K of 0.4 D (95% CI, 0.18-0.65; P = 0.004).
CONCLUSIONS
We report the first systematic review and meta-analysis of keratoconus natural history data including 11 529 eyes. Younger patients and those with K steeper than 55 D at presentation have a significantly greater risk of progression of keratoconus. Closer follow-up and a lower threshold for cross-linking should be adopted in patients younger than 17 years and steeper than 55 D K.
Topics: Disease Progression; Humans; Keratoconus; Prospective Studies; Retrospective Studies
PubMed: 30858022
DOI: 10.1016/j.ophtha.2019.02.029