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Clinical Hypertension Sep 2023In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies... (Review)
Review
In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies widely among studies because of differences in the definition of hypertension and the methods of used to measure blood pressure (BP), i.e., peri-dialysis or ambulatory BP monitoring (ABPM). Recently, ABPM has become the gold standard for diagnosing hypertension in dialysis patients. Home BP monitoring can also be a good alternative to ABPM, emphasizing BP measurement outside the hemodialysis (HD) unit. One thing for sure is pre- and post-dialysis BP measurements should not be used alone to diagnose and manage hypertension in dialysis patients. The exact target of BP and the relationship between BP and all-cause mortality or cause-specific mortality are unclear in this population. Many observational studies with HD cohorts have almost universally reported a U-shaped or even an L-shaped association between BP and all-cause mortality, but most of these data are based on the BP measured in HD units. Some data with ABPM have shown a linear association between BP and mortality even in HD patients, similar to the general population. Supporting this, the results of meta-analysis have shown a clear benefit of BP reduction in HD patients. Therefore, further research is needed to determine the optimal target BP in the dialysis population, and for now, an individualized approach is appropriate, with particular emphasis on avoiding excessively low BP. Maintaining euvolemia is of paramount importance for BP control in dialysis patients. Patient heterogeneity and the lack of comparative evidence preclude the recommendation of one class of medication over another for all patients. Recently, however, β-blockers could be considered as a first-line therapy in dialysis patients, as they can reduce sympathetic overactivity and left ventricular hypertrophy, which contribute to the high incidence of arrhythmias and sudden cardiac death. Several studies with mineralocorticoid receptor antagonists have also reported promising results in reducing mortality in dialysis patients. However, safety issues such as hyperkalemia or hypotension should be further evaluated before their use.
PubMed: 37653470
DOI: 10.1186/s40885-023-00240-x -
Journal of Hypertension May 2023There are limited studies using ambulatory blood pressure monitoring (ABPM) to assess blood pressure (BP) status in young patients with chronic kidney disease (CKD) on... (Meta-Analysis)
Meta-Analysis
Prevalence of masked hypertension and its association with left ventricular hypertrophy in children and young adults with chronic kidney disease: a systematic review and meta-analysis.
OBJECTIVES
There are limited studies using ambulatory blood pressure monitoring (ABPM) to assess blood pressure (BP) status in young patients with chronic kidney disease (CKD) on dialysis or after kidney transplantation. The aim of this meta-analysis is to estimate the prevalence of both white-coat hypertension (WCH) and masked hypertension, along with the prevalence of left ventricular hypertrophy (LVH), in children and young adults with CKD on dialysis or after kidney transplantation.
METHODS
We performed a systematic review and meta-analysis of observational studies assessing the prevalence of BP phenotypes using ABPM, in children and young adults with CKD stages 2-5d. Records were identified by search in databases (Medline, Web of Science, CENTRAL) and sources of grey literature, until 31 December 2021. A random-effects meta-analysis of proportions (double arcsine transformation) was conducted.
RESULTS
Ten studies were included in the systematic review, reporting data from 1140 individuals (children and young adults with CKD with a mean age of 13.79 ± 4.35 years). Masked hypertension and WCH were diagnosed in 301 and 76 patients, respectively. It was estimated an overall pooled masked hypertension prevalence of 27% [95% confidence interval (95% CI) 18-36, I2 = 87%] and an overall pooled WCH prevalence of 6% (95% CI 3-9, I2 = 78%). Among kidney transplant recipients, masked hypertension had a prevalence of 29% (95% CI 14-47, I2 = 86%). The prevalence of LVH was found 28% (95% CI 0.19-0.39) in a total of 238 CKD patients with ambulatory hypertension. In 172 CKD patients with masked hypertension, LVH was present in 49, with the estimated prevalence being 23% (95% CI 0.15-0.32).
CONCLUSION
Masked hypertension has a significant prevalence in children and young adults with CKD. Masked hypertension carries an adverse prognosis, with an increased risk of LVH, warranting clinical attention when assessing cardiovascular risk in this population. Therefore, ABPM and echocardiography is of high importance when assessing BP status in children with CKD.
PROTOCOL REGISTRATION NUMBER DOI
10.17605/OSF.IO/UKXAF.
Topics: Humans; Masked Hypertension; Blood Pressure Monitoring, Ambulatory; Prevalence; Hypertrophy, Left Ventricular; Hypertension; Renal Insufficiency, Chronic; Blood Pressure; White Coat Hypertension
PubMed: 36883474
DOI: 10.1097/HJH.0000000000003402 -
Clinical Journal of Sport Medicine :... Sep 2022Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates the effectiveness of BFR training relative to other forms of training on muscle strength, hypertrophy, and endurance.
DATA SOURCES
We performed systematic searches of MEDLINE, Embase, and PubMed and assessed the methodological quality of included studies using the Cochrane risk of bias tool.
MAIN RESULTS
We included 53 randomized controlled trials with 31 included in meta-analyses. For muscular strength comparing low-intensity BFR (LI-BFR) training with high-intensity resistance training (HIRT), the pooled mean difference (MD) for 1 repetition maximum was 5.34 kg (95% CI, 2.58-8.09; P < 0.01) favoring HIRT. When comparing LI-BFR training with HIRT for torque, the MD was 6.35 N·m (95% CI, 0.5-12.3; P = 0.04) also favoring HIRT. However, comparing LI-BFR with low-intensity resistance training (LIRT) for torque, there was a MD of 9.94 N·m (95% CI, 5.43-14.45; P < 0.01) favoring BFR training. Assessing muscle hypertrophy, the MD in cross-sectional area was 0.96 cm2 (95% CI, 0.21-1.7; P = 0.01) favoring pooled BFR training compared with nonocclusive training. Assessing endurance, V̇o2 maximum demonstrated a greater mean increase of 0.37 mL/kg/min (95% CI, -0.97 to 3.17; P = 0.64) in BFR endurance training compared with endurance training alone.
CONCLUSION
Blood flow restriction training produced increases in muscular strength, hypertrophy, and endurance. Comparing LI-BFR training with HIRT, HIRT was a significantly better training modality for increasing muscle hypertrophy and strength. However, LI-BFR was superior when compared with a similar low-intensity protocol. Blood flow restriction training is potentially beneficial to those unable to tolerate the high loads of HIRT; however, better understanding of its risk to benefit ratio is needed before clinical application.
LEVEL OF EVIDENCE
Level 1.
Topics: Blood Flow Restriction Therapy; Humans; Hypertrophy; Muscle Strength; Muscle, Skeletal; Regional Blood Flow; Resistance Training
PubMed: 36083329
DOI: 10.1097/JSM.0000000000000991 -
International Journal of Pediatric... Oct 2015Mometasone has been reported to improve the symptoms of nasal obstruction in children with adenoidal hypertrophy. This systematic review and meta-analysis were conducted... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Mometasone has been reported to improve the symptoms of nasal obstruction in children with adenoidal hypertrophy. This systematic review and meta-analysis were conducted to evaluate the role of mometasone on different nasal symptoms, otitis media with effusion, adenoid size, and quality of life in children with adenoidal hypertrophy.
METHODS
A comprehensive search of MEDLINE, EMBASE, CINAHL and COCHRANE Collaboration databases was undertaken. We identified all the randomized controlled trials (RCTs) in children with adenoidal hypertrophy that compared the effects of mometasone nasal spray and normal saline nasal spray on different outcomes. The deadline of the search was April 2015. The search was supplemented by hand searching of cross-references in the studies and reviews and by contacting the authors of various studies. Only English language RCTs were considered for the systematic review. The primary outcomes were improvement in symptoms of nasal obstruction, mouth breathing, rhinorrhea, snoring, cough, and total nasal symptoms. The secondary outcomes were improvement in otitis media with effusion, quality of life, and size of adenoid. Quality assessment of RCTs was performed using SIGN 50 and Cochrane risk of bias tools. Risk ratio (RR), weighted mean differences (WMD) and their 95% confidence intervals (CI) were calculated for dichotomous and continuous data, respectively. Random effects model was used for the analyses. Heterogeneity was measured by using the I(2) statistics and p value <0.05.
RESULTS
Our search generated 87 citations, of which eight RCTs met the inclusion criteria. The methodological quality of all the RCTs was poor. There was no significant difference between mometasone and control groups for the patient's characteristic and grades of different nasal symptoms, otitis media with effusion, obstructive sleep apnea, and quality of life at the basal level. There was also no significant difference in the number of patients with different symptoms at the basal level. After the administration of mometasone, there were significant improvements in grades of nasal obstruction, 0.8±0.5 versus 2.0±0.6, WMD -1.16 [-2.09, -0.23], snoring 0.3±0.4 versus 1.6±0.6, WMD -1.07 [-2.09, -0.05], total nasal symptoms 2.9±1.3 versus 6.9±1.5, WMD -4.09 [-6.64, -1.53], obstructive sleep apnea, 0.6±0.3 versus 1.4±0.4, WMD -0.95 [-1.74, -0.16], as well as the percentage of patients with nasal obstruction, snoring, obstructive sleep apnea, compared to control. There was tendency of improvement in rhinorrhea, and cough with mometasone. Compared to control, mometasone nasal spray significantly improved adenoid size or adenoid/choana ratio 50.9±8.8 versus 74.2±12.6, WMD -21.2 [-34.0, -8.4], change in adenoid/choana obstruction from the basal level (p=0.01), and percentage of patients with adenoid hypertrophy, 26% versus 92%, RR 0.29 [0.18, 0.48]. There was improvement in otitis media with effusion, 40% versus 72%, pure tone audiometry 5.2±11 versus 11.6±11dB, WMD -6.40dB [-12.65, -0.15], and quality of life with mometasone. Subgroup analyses showed that RCTs that followed blinding showed significantly less response compared to RCTs that did not follow it for most of the outcomes.
CONCLUSIONS
Mometasone caused improvements in outcomes of nasal obstruction, snoring, total nasal symptoms, pure tune audiometry, otitis media with effusion, adenoid size, and quality of life. The data is based on meta-analysis of RCTs of poor methodological quality. A high methodological quality, placebo controlled RCT of different doses and duration of administration of mometasone is required to evaluate its clear efficacy and safety in children with adenoid hypertrophy.
Topics: Adenoids; Anti-Inflammatory Agents; Child; Child, Preschool; Humans; Hypertrophy; Mometasone Furoate; Nasal Obstruction; Quality of Life; Treatment Outcome
PubMed: 26235732
DOI: 10.1016/j.ijporl.2015.07.009 -
Hepatobiliary & Pancreatic Diseases... Jun 2023Post-hepatectomy liver failure (PHLF) is the Achilles' heel of hepatic resection for colorectal liver metastases. The most commonly used procedure to generate... (Meta-Analysis)
Meta-Analysis
Simultaneous portal and hepatic vein embolization is better than portal embolization or ALPPS for hypertrophy of future liver remnant before major hepatectomy: A systematic review and network meta-analysis.
BACKGROUND
Post-hepatectomy liver failure (PHLF) is the Achilles' heel of hepatic resection for colorectal liver metastases. The most commonly used procedure to generate hypertrophy of the functional liver remnant (FLR) is portal vein embolization (PVE), which does not always lead to successful hypertrophy. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed to overcome the limitations of PVE. Liver venous deprivation (LVD), a technique that includes simultaneous portal and hepatic vein embolization, has also been proposed as an alternative to ALPPS. The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy, effectiveness, and safety of the three regenerative techniques.
DATA SOURCES
A systematic search for literature was conducted using the electronic databases Embase, PubMed (MEDLINE), Google Scholar and Cochrane.
RESULTS
The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days, respectively. Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts. There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort, but non-significant differences were observed when compared to the LVD cohort. Notably, the LVD cohort demonstrated a significantly better FLR/body weight (BW) ratio compared to both the ALPPS and PVE cohorts. Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort. The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.
CONCLUSIONS
LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy. Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.
Topics: Humans; Hepatectomy; Hepatic Veins; Network Meta-Analysis; Treatment Outcome; Liver; Portal Vein; Liver Neoplasms; Hepatomegaly; Hypertrophy; Embolization, Therapeutic; Ligation
PubMed: 36100542
DOI: 10.1016/j.hbpd.2022.08.013 -
Revista Da Associacao Medica Brasileira... Feb 2017The aim was to evaluate the effectiveness of the experimental synergists muscle ablation model to promote muscle hypertrophy, determine the period of greatest... (Review)
Review
OBJECTIVE:
The aim was to evaluate the effectiveness of the experimental synergists muscle ablation model to promote muscle hypertrophy, determine the period of greatest hypertrophy and its influence on muscle fiber types and determine differences in bilateral and unilateral removal to reduce the number of animals used in this model.
METHOD:
Following the application of the eligibility criteria for the mechanical overload of the plantar muscle in rats, nineteen papers were included in the review.
RESULTS:
The results reveal a greatest hypertrophy occurring between days 12 and 15, and based on the findings, synergist muscle ablation is an efficient model for achieving rapid hypertrophy and the contralateral limb can be used as there was no difference between unilateral and bilateral surgery, which reduces the number of animals used in this model.
CONCLUSION:
This model differs from other overload models (exercise and training) regarding the characteristics involved in the hypertrophy process (acute) and result in a chronic muscle adaptation with selective regulation and modification of fast-twitch fibers in skeletal muscle. This is an efficient and rapid model for compensatory hypertrophy.
Topics: Ablation Techniques; Animals; Hypertrophy; Models, Animal; Muscle Contraction; Muscle Denervation; Muscle, Skeletal; Rats; Tendons
PubMed: 28355378
DOI: 10.1590/1806-9282.63.02.164 -
Cancers Jan 2020Radioembolization with Y-microspheres has been reported to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth. The aim of the... (Review)
Review
Radioembolization with Y-microspheres has been reported to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth. The aim of the present systematic review was to summarize the evidence of contralateral liver hypertrophy and oncological outcome following unilateral treatment with radioembolization. A systematic literature search using the MEDLINE, EMBASE, and Cochrane libraries for studies published between 2008 and 2020 was performed. A total of 16 studies, comprising 602 patients, were included. The median kinetic growth rate per week of the contralateral liver lobe was 0.7% and declined slightly over time. The local tumor control was 84%. Surgical resection after radioembolization was carried out in 109 out of 362 patients (30%). Although the available data suggest that radioembolization prior to major hepatectomy is safe with a promising oncological outcome, the definitive role of radioembolization requires assessment within controlled clinical trials.
PubMed: 32012709
DOI: 10.3390/cancers12020294 -
Anticancer Research Sep 2023Otorhinolaryngology tradition is that tonsillectomy (TE) is conducted among children and adolescents for obstructive sleep apnea secondary to adenotonsillar hypertrophy... (Meta-Analysis)
Meta-Analysis Review
Tonsillectomy as Prevention of Tonsil and Base of Tongue Cancer: Systematic Review and Meta-analysis on the Immuno-Oncological Effect of One Among the Most Common Surgeries in the World.
Otorhinolaryngology tradition is that tonsillectomy (TE) is conducted among children and adolescents for obstructive sleep apnea secondary to adenotonsillar hypertrophy and in adults for chronic disease of the tonsils and adenoids (recurrent tonsillitis). Nevertheless, over the last 50 years, we have observed a decline in TE worldwide. As a result, there is an emerging concern of a correlated possible increased risk of tonsil cancer (TC) and other subtypes of oropharyngeal squamous cell carcinoma. Since the available data on such topics are limited and controversial, our aim was to elucidate the impact of TE on the incidence mainly of TC through a systematic review of the literature and a meta-analysis of the studies. After a thorough search, 7 retrospective studies were considered eligible for review and meta-analysis (MA). At MA, patients with a history of TE seem to show a reduced risk of TC but a higher predisposition for base of tongue (BOT) cancer (p<0.001): however, the elevated heterogeneity of the studies hampers drawing firm and convincing conclusions (statistical inconsistency >95%). In future, randomized control trials will be welcome to elucidate the prophylactic role of TE against TC and its real impact on BOT cancer.
Topics: Adolescent; Adult; Child; Humans; Palatine Tonsil; Tonsillectomy; Tongue Neoplasms; Retrospective Studies; Oropharyngeal Neoplasms; Tonsillar Neoplasms; Laryngeal Neoplasms; Head and Neck Neoplasms
PubMed: 37648322
DOI: 10.21873/anticanres.16575 -
American Journal of Rhinology & Allergy Jan 2023Various surgical interventions exist for treatment of inferior turbinate hypertrophy (ITH). Though mucosal-sparing techniques are generally preferred, there is lack of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Various surgical interventions exist for treatment of inferior turbinate hypertrophy (ITH). Though mucosal-sparing techniques are generally preferred, there is lack of consensus on the optimal technique.
OBJECTIVE
This systematic review sought to evaluate the evidence for treatment of bilateral nasal obstruction via inferior turbinate reduction (ITR) and provide a meta-analysis of expected results of various techniques.
METHODS
PubMed, Scopus, Cochrane Library databases were queried to include articles describing surgical treatment for ITH. Exclusion criteria were concurrent nasal procedures or non-mucosal ITH. Primary outcomes included visual analog scale for nasal obstruction, nasal cavity volume by acoustic rhinometry, and resistance by anterior rhinomanometry. Subgroup analyses assessed outcomes by rhinitis diagnosis and length of follow-up, and radiofrequency ablation (RFA) was compared to microdebrider-assisted turbinoplasty (MAIT).
RESULTS
A total of 1870 studies were identified with 62 meeting inclusion criteria. Reported techniques included turbinectomy, submucosal resection, RFA, MAIT, laser, or electrocautery.All techniques demonstrated significant improvements in nasal obstruction using the visual analog scale. Further comprehensive physiologic data for RFA, MAIT, and laser was available and, compared to baseline, these techniques resulted in significant improvements in nasal resistance, nasal cavity volume, and nasal airflow. Six studies directly compared RFA and MAIT with statistically similar results on VAS, nasal cavity volume, and resistance with median follow-up time of 3.5 months. Assessment of VAS congestion over time reveals peak benefit is achieved between 3-6 months follow-up.
CONCLUSIONS
All reviewed ITR techniques improve patient-reported nasal obstruction. RFA and MAIT provide comparable improvements in patient-reported and physiologic nasal airflow outcomes and while benefits are sustained long-term, the peak benefit for both techniques appears to be achieved within the first year.
Topics: Humans; Turbinates; Nasal Obstruction; Treatment Outcome; Rhinomanometry; Hypertrophy; Paranasal Sinus Diseases
PubMed: 36315624
DOI: 10.1177/19458924221134555 -
Journal of Strength and Conditioning... Mar 2023Monserdà-Vilaró, A, Balsalobre-Fernández, C, Hoffman, JR, Alix-Fages, C, and Jiménez, SL. Effects of concurrent resistance and endurance training using continuous or... (Meta-Analysis)
Meta-Analysis
Monserdà-Vilaró, A, Balsalobre-Fernández, C, Hoffman, JR, Alix-Fages, C, and Jiménez, SL. Effects of concurrent resistance and endurance training using continuous or intermittent protocols on muscle hypertrophy: Systematic review with meta-analysis. J Strength Cond Res 37(3): 688-709, 2023-The purpose of this systematic review with meta-analysis was to explore the effects of concurrent resistance and endurance training (CT) incorporating continuous or intermittent endurance training (ET) on whole-muscle and type I and II muscle fiber hypertrophy compared with resistance training (RT) alone. Randomized and nonrandomized studies reporting changes in cross-sectional area at muscle fiber and whole-muscle levels after RT compared with CT were included. Searches for such studies were performed in Web of Science, PubMed, Scopus, SPORTDiscus, and CINAHL electronic databases. The data reported in the included studies were pooled in a random-effects meta-analysis of standardized mean differences (SMDs). Twenty-five studies were included. At the whole-muscle level, there were no significant differences for any comparison (SMD < 0.03). By contrast, RT induced greater type I and type II muscle fiber hypertrophy than CT when high-intensity interval training (HIIT) was incorporated alone (SMD > 0.33) or combined with continuous ET (SMD > 0.27), but not compared with CT incorporating only continuous ET (SMD < 0.16). The subgroup analyses of this systematic review and meta-analysis showed that RT induces greater muscle fiber hypertrophy than CT when HIIT is included. However, no CT affected whole-muscle hypertrophy compared with RT.
Topics: Humans; Endurance Training; Hypertrophy; Muscle Fibers, Skeletal; Muscle Strength; Muscle, Skeletal; Resistance Training
PubMed: 36508686
DOI: 10.1519/JSC.0000000000004304