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Clinical Ophthalmology (Auckland, N.Z.) 2023Scheimpflug Pentacam Tomography is becoming crucial in the diagnosis and monitoring of keratoconus, as well as in pre- and post-corneal refractive care, but there are... (Review)
Review
Scheimpflug Pentacam Tomography is becoming crucial in the diagnosis and monitoring of keratoconus, as well as in pre- and post-corneal refractive care, but there are still some inconsistencies surrounding its evidence base diagnostic outcome. Therefore, this study aimed at employing meta-analysis to systematically evaluate the keratometric, pachymetric, and pachymetric progression indices used in the diagnosis of Keratoconus. The review protocol was registered with PROSPERO (Identifier: CRD4202310058) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, MEDLINE, Web of Science, and EMBASE were used for data search, followed by a quality appraisal of the included studies using the revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2). Meta-analysis was conducted using the meta (6.5.0) and metafor (4.2.0) packages in R version 4.3.0, as well as Stata. A total of 32 studies were included in the analysis. All keratometry (K) readings (flattest meridian, K1; steepest meridian, K2, maximum, Kmax) were significantly steeper in keratoconic compared to normal eyes: [MD (95% CI)], K1 [2.67 (1.81; 3.52)], K1-back [-0.71 (-1.03; -0.39)], K1-front [4.06 (2.48; 5.63)], K2 [4.32 (2.89; 5.75)], K2-back [-1.25 (-1.68; -0.82)], K2-front [4.82 (1.88; 7.76)], Kmax [7.57 (4.80; 10.34)], and Kmean [2.80 (1.13; 4.47)]. Additionally, corneal thickness at the center, CCT [-61.19 (-73.79; -48.60)] and apex, pachy-apex [-41.86 (-72.64; -11.08)] were significantly thinner in keratoconic eyes compared to normal eyes. The pooled estimates for pachymetric progression index (PPI): PPImin [0.66 (0.43; 0.90)], PPImax [1.26 (0.87; 1.64)], PPIavg [0.90 (0.68; 1.12)], and Ambrosio relational thickness (ART): ARTmax [-242.77 (-288.86; -196.69)], and ARTavg [-251.08 (-308.76; -195.39)] revealed significantly more rapid pachymetric progression in keratoconic eyes than in normal eyes. The Pentacam Scheimpflug-derived keratometric, pachymetric, and pachymetric progression indices are good predictors in discriminating KC from normal eyes.
PubMed: 38143558
DOI: 10.2147/OPTH.S436492 -
Journal of Clinical Medicine Oct 2023Exercise therapy as part of the clinical management of patients with neuromuscular diseases (NMDs) is complicated by the limited insights into its efficacy. There is an... (Review)
Review
Exercise therapy as part of the clinical management of patients with neuromuscular diseases (NMDs) is complicated by the limited insights into its efficacy. There is an urgent need for sensitive and non-invasive quantitative muscle biomarkers to monitor the effects of exercise training. Therefore, the objective of this systematic review was to critically appraise and summarize the current evidence for the sensitivity of quantitative, non-invasive biomarkers, based on imaging and electrophysiological techniques, for measuring the effects of physical exercise training. We identified a wide variety of biomarkers, including imaging techniques, i.e., magnetic resonance imaging (MRI) and ultrasound, surface electromyography (sEMG), magnetic resonance spectroscopy (MRS), and near-infrared spectroscopy (NIRS). Imaging biomarkers, such as muscle maximum area and muscle thickness, and EMG biomarkers, such as compound muscle action potential (CMAP) amplitude, detected significant changes in muscle morphology and neural adaptations following resistance training. MRS and NIRS biomarkers, such as initial phosphocreatine recovery rate (V), mitochondrial capacity (Q), adenosine phosphate recovery half-time (ADP t), and micromolar changes in deoxygenated hemoglobin and myoglobin concentrations (Δ[deoxy(Hb + Mb)]), detected significant adaptations in oxidative metabolism after endurance training. We also identified biomarkers whose clinical relevance has not yet been assessed due to lack of sufficient study.
PubMed: 37959299
DOI: 10.3390/jcm12216834 -
Scientific Reports Mar 2023A systematic review and meta-analysis was conducted to determine the effects of resistance training under hypoxic conditions (RTH) on muscle hypertrophy and strength... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis was conducted to determine the effects of resistance training under hypoxic conditions (RTH) on muscle hypertrophy and strength development. Searches of PubMed-Medline, Web of Science, Sport Discus and the Cochrane Library were conducted comparing the effect of RTH versus normoxia (RTN) on muscle hypertrophy (cross sectional area (CSA), lean mass and muscle thickness) and strength development [1-repetition maximum (1RM)]. An overall meta-analysis and subanalyses of training load (low, moderate or high), inter-set rest interval (short, moderate or long) and severity of hypoxia (moderate or high) were conducted to explore the effects on RTH outcomes. Seventeen studies met inclusion criteria. The overall analyses showed similar improvements in CSA (SMD [CIs] = 0.17 [- 0.07; 0.42]) and 1RM (SMD = 0.13 [0.0; 0.27]) between RTH and RTN. Subanalyses indicated a medium effect on CSA for longer inter-set rest intervals and a small effect for moderate hypoxia and moderate loads favoring RTH. Moreover, a moderate effect for longer inter-set rest intervals and a trivial effect for severe hypoxia and moderate loads favoring RTH was found on 1RM. Evidence suggests that RTH employed with moderate loads (60-80% 1RM) and longer inter-set rest intervals (≥ 120 s) enhances muscle hypertrophy and strength compared to normoxia. The use of moderate hypoxia (14.3-16% FiO) seems to be somewhat beneficial to hypertrophy but not strength. Further research is required with greater standardization of protocols to draw stronger conclusions on the topic.
Topics: Humans; Animals; Resistance Training; Gastropoda; Hypertrophy; Hypoxia; Muscles
PubMed: 36871095
DOI: 10.1038/s41598-023-30808-4 -
Digestive Endoscopy : Official Journal... Apr 2018Flexible endoscopy has developed from a diagnostic tool for tissue biopsy sampling to a treatment tool for endoscopic resection of neoplasms in the digestive tract. In... (Review)
Review
Flexible endoscopy has developed from a diagnostic tool for tissue biopsy sampling to a treatment tool for endoscopic resection of neoplasms in the digestive tract. In the near future, one of the advanced endoscopic techniques, endoscopic full-thickness resection (EFTR), is expected to be a feasible endoscopic procedure. In the present review, systematic review of conventional exposed EFTR was carried out. Search queries were (endoscopic full-thickness resection or EFTR) (over-the-scope clip or OTSC) (Overstitch System) from 2015 to 2017. Four retrospective, single-center studies with regard to conventional EFTR were identified. With regard to indication for conventional exposed EFTR, gastrointestinal stromal tumor was a good indication for EFTR. Mean tumor size of all four studies was 20.71 mm. In two studies, endoclips were used to close the resected opening without any complications, but the other two studies reported complications such as delayed perforation even using OTSC. Procedure times were reported from a minimum of 40 min to a maximum of 105 min. We also refer to introduction of a newly developed procedure of EFTR (non-exposed EFTR), and development of a new suturing device in Japan.
Topics: Adult; Aged; Endoscopic Mucosal Resection; Female; Forecasting; Gastric Mucosa; Gastrointestinal Neoplasms; Humans; Japan; Male; Middle Aged; Minimally Invasive Surgical Procedures; Retrospective Studies; Risk Assessment; Stomach Neoplasms; Survival Rate; Suture Techniques; Treatment Outcome
PubMed: 29658644
DOI: 10.1111/den.13042 -
International Journal of Environmental... Sep 2020We aimed to synthesise the results of previous studies addressing the impact of overweight and obesity on plantar pressure in children and adolescents. An electronic...
We aimed to synthesise the results of previous studies addressing the impact of overweight and obesity on plantar pressure in children and adolescents. An electronic search of scientific literature was conducted using PubMed, Cochrane and Scopus database, with keywords: "plantar pressure" AND "children" AND "obesity"; "plantar pressure" AND "adolescents" AND "obesity", "plantar pressure" AND "children" AND "overweight", "plantar pressure" AND "adolescents" AND "overweight". Twenty-two articles were included in the review and the following data were recorded: authors, publication year, type of technology (systems, software) for the determination of plantar pressure, study characteristics. Most of the articles used dynamic plantar pressure determination with only four using static plantar pressure measurement. Using ultrasonography with static plantar pressure determination, the correlation between structural and functional changes in the feet of obese children. In overweight and obese children and adolescents, important findings were recorded: higher contact area, increased maximum force beneath the lateral and medial forefoot, increased pressure-time integral beneath the midfoot and 2nd-5th metatarsal regions. Significantly increased foot axis angle and significantly flatter feet were observed in obese subjects in comparison to their normal-weight counterparts. The obese children presented increased midfoot fat pad thickness, with decreased sensitivity of the whole foot and midfoot.
Topics: Adolescent; Body Mass Index; Child, Preschool; Female; Foot; Foot Bones; Humans; Male; Obesity; Overweight; Pressure; Ultrasonography
PubMed: 32927870
DOI: 10.3390/ijerph17186600 -
Arthroscopy : the Journal of... Feb 2015The purpose of this study was to perform a systematic review, meta-analysis, and meta-regression of all Level I and Level II studies comparing the clinical or structural... (Meta-Analysis)
Meta-Analysis Review
Clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears with and without platelet-rich product supplementation: a meta-analysis and meta-regression.
PURPOSE
The purpose of this study was to perform a systematic review, meta-analysis, and meta-regression of all Level I and Level II studies comparing the clinical or structural outcomes, or both, after rotator cuff repair with and without platelet-rich product (PRP) supplementation.
METHODS
A literature search of the PubMed and EMBASE databases was performed to identify all Level I or II studies comparing the clinical or structural outcomes, or both, after arthroscopic repair of full-thickness rotator cuff tears with (PRP+ group) and without (PRP- group) PRP supplementation. Data included outcome scores (American Shoulder and Elbow Surgeons [ASES], University of California Los Angeles [UCLA], Constant, Simple Shoulder Test [SST] and visual analog scale [VAS] scores) and retears diagnosed with imaging studies. Meta-analyses compared preoperative, postoperative, and gain in outcome scores and relative risk ratios for retears. Meta-regression compared the effect of PRP treatment on outcome scores and retear rates according to 6 covariates. Minimum effect sizes that were detectable with 80% power were also calculated for each study.
RESULTS
Eleven studies were included in this review and a maximum of 8 studies were used for meta-analyses according to data availability. There were no statistically significant differences between the PRP+ and PRP- groups for overall outcome scores or retear rates (P > .05). Overall gain in the Constant score was decreased when liquid PRP was injected over the tendon surface compared with PRP application at the tendon-bone interface (-6.88 points v +0.78 points, respectively; P = .046); however, this difference did not reach the previously reported minimum clinically important difference (MCID) for Constant scores. When the initial tear size was greater than 3 cm in anterior-posterior length, the PRP+ group exhibited decreased retear rates after double-row repairs when compared with the PRP- group (25.9% v 57.1%, respectively; P = .046). Sensitivity power analyses revealed that most included studies were only powered to detect large differences in outcome scores between groups.
CONCLUSIONS
There were no statistically significant differences in overall gain in outcome scores or retear rates between treatment groups. Gain in Constant scores was significantly increased when PRPs were applied at the tendon-bone interface when compared with application over the top of the repaired tendon. Retear rates were significantly decreased when PRPs were used for the treatment of tears greater than 3 cm in anterior-posterior length using a double-row technique. Most of the included studies were only powered to detect large differences in outcome scores between treatment groups. In addition, an increased risk for selection, performance, and attrition biases was found.
LEVEL OF EVIDENCE
Level II, meta-analysis of Level I and Level II studies.
Topics: Arthroscopy; Humans; Platelet-Rich Plasma; Rotator Cuff; Rotator Cuff Injuries; Rupture; Tendon Injuries; Treatment Outcome; Wound Healing
PubMed: 25450417
DOI: 10.1016/j.arthro.2014.09.007 -
Cardiovascular Revascularization... Mar 2022Intravascular lithotripsy (IVL) is a recently introduced therapeutic modality in the management of calcified coronary lesions (CCAD). IVL delivers sonic pressure waves... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intravascular lithotripsy (IVL) is a recently introduced therapeutic modality in the management of calcified coronary lesions (CCAD). IVL delivers sonic pressure waves to modulate calcium, hence promote vessel compliance and optimize stent deployment.
METHODS
We performed a comprehensive literature search for studies that evaluated the utility of adjunctive IVL. The primary outcomes of our study were the clinical success, defined as the ability of IVL to produce residual diameter stenosis <50% (RDS < 50%) after stenting with no evidence of in-hospital major adverse cardiac events, and the angiographic success, defined as success in facilitating stent delivery with RDS < 50% and without serious angiographic complications. The secondary outcomes included post-IVL and post-stenting changes in lumen area, calcium angle, and the maximum calcium thickness. Proportional analysis was used for binary data and mean difference was used for continuous data. All meta-analyses were conducted using a random-effect model and 95% confidence intervals (CIs) were included.
RESULTS
A total of eight single-arm observational studies, including 980 patients (1011 lesions), were included. 48.8% of the patients presented with acute coronary syndrome. Severe calcifications were present in 97% of lesions. Clinical success was achieved in 95.4% of patients (95%CI:92.9%-97.9%). Angiographic success was achieved in 97% of patients (95%CI:95%-99%). There was an overall increase in postprocedural lumen area as well as significant reduction of calcium angle and maximum calcium thickness.
CONCLUSIONS
IVL seems to have excellent efficacy and safety in the management of CCAD. However, adequately powered RCTs are needed to evaluate IVL compared to other calcium/plaque modifying techniques.
Topics: Calcium; Humans; Lithotripsy; Stents; Treatment Outcome; Vascular Calcification
PubMed: 34024748
DOI: 10.1016/j.carrev.2021.05.009 -
Archives of Gerontology and Geriatrics Sep 2023Resistance training (RT) consists of planned exercise programs to increase muscle strength capacity through neural and structural adaptations, such as changes in the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Resistance training (RT) consists of planned exercise programs to increase muscle strength capacity through neural and structural adaptations, such as changes in the geometric arrangement of muscle fibers. This study aimed to analyze the influence of RT on muscle architecture in older people.
METHODS
This PROSPERO-registered systematic review and meta-analysis (identification number CRD42022340477) followed the PRISMA guidelines. Four electronic databases were searched for eligible randomized controlled trials (RCTs) that observed older individuals submitted to RT programs that reported muscle architecture outcomes.
RESULTS
Seventeen RCTs met the eligibility criteria with a total of 488 participants. The main results of the meta-analysis showed that RT interventions had a significant effect on the thickness of the medial gastrocnemius (SMD = 0.12; 95% CI: - 0.07 to 0.17; p < 0.00001; I = 0%).
CONCLUSION
Based on available evidence, studies included in this review showed improvement in maximum isometric force, pennation angle, fascicle length, thickness, and muscle activation after RT interventions. In turn, the meta-analysis suggested a potential for improving the thickness of the medial gastrocnemius after the intervention. However, any clinical implications drawn from the analyses should be interpreted with caution, as these findings are substantially limited due to a low number of included studies and a potential heterogeneity between studies.
Topics: Humans; Aged; Resistance Training; Randomized Controlled Trials as Topic; Exercise; Muscle, Skeletal; Muscle Strength
PubMed: 37043838
DOI: 10.1016/j.archger.2023.105020 -
Heart (British Cardiac Society) Dec 2013The genetic basis of familial hypertrophic cardiomyopathy (HCM) is well described, but the relation between genotype and clinical phenotype is still poorly characterised. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The genetic basis of familial hypertrophic cardiomyopathy (HCM) is well described, but the relation between genotype and clinical phenotype is still poorly characterised.
OBJECTIVE
To summarise and critically review the current literature on genotype-phenotype associations in patients with HCM and to perform a meta-analysis on selected clinical features.
DATA SOURCES
PubMed/Medline was searched up to January 2013. Retrieved articles were checked for additional publications.
SELECTION CRITERIA
Observational, cross-sectional and prospectively designed English language human studies that analysed the relationship between the presence of mutations in sarcomeric protein genes and clinical parameters.
DATA EXTRACTION AND ANALYSIS
The pooled analysis was confined to studies reporting on cohorts of unrelated and consecutive patients in which at least two sarcomere genes were sequenced. A random effect meta-regression model was used to determine the overall prevalence of predefined clinical features: age at presentation, gender, family history of HCM, family history of sudden cardiac death (SCD), and maximum left ventricular wall thickness (MLVWT). The I(2) statistic was used to estimate the proportion of total variability in the prevalence data attributable to the heterogeneity between studies.
RESULTS
Eighteen publications (corresponding to a total of 2459 patients) were selected for the pooled analysis. The presence of any sarcomere gene mutation was associated with a younger age at presentation (38.4 vs 46.0 years, p<0.0005), a family history of HCM (50.6% vs 23.1%, p<0.0005), a family history of SCD (27.0% vs 14.9%, p<0.0005) and greater MLVWT (21.0 vs 19.3 mm, p=0.03). There were no differences when the two most frequently affected genes, MYBPC3 and MYH7, were compared. A total of 53 family studies were also included in the review. These were characterised by pronounced variability and the majority of studies reporting on outcomes analysed small cross-sectional cohorts and were unsuitable for pooled analyses.
CONCLUSIONS
The presence of a mutation in any sarcomere gene is associated with a number of clinical features. The heterogeneous nature of the disease and the inconsistency of study design precludes the establishment of more precise genotype-phenotype relationships. Large scale studies examining the relation between genotype, disease severity, and prognosis are required.
Topics: Cardiac Myosins; Cardiomyopathy, Hypertrophic; DNA; Genetic Association Studies; Genetic Predisposition to Disease; Genotype; Global Health; Humans; Mutation; Phenotype; Prevalence; Troponin
PubMed: 23674365
DOI: 10.1136/heartjnl-2013-303939 -
American Journal of Obstetrics &... May 2021The aim of this systematic review and meta-analysis was to define the means and the upper limits of normal for endometrial thickness and uterine measurements in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review and meta-analysis was to define the means and the upper limits of normal for endometrial thickness and uterine measurements in uncomplicated pregnancies at different postpartum periods.
DATA SOURCES
A search was conducted in the Medline, Embase, Cinahl, and Clinicaltrials.gov databases up to January 30, 2020.
STUDY ELIGIBILITY CRITERIA
We included studies reporting sonographic parameters of the uterus in the normal postpartum period.
METHODS
The continuous variables were expressed as means with standard deviations. The upper limits of normal were defined as the 95th percentile. Clinically significant differences in the uterine measurements between subgroups were defined as ≥2 cm; significant differences in the uterine volume were defined as >10%. The primary outcome was the endometrial thickness; others sonographic parameters that were analyzed were the uterine anteroposterior diameter, longitudinal diameter, width, and volume.
RESULTS
A total of 5260 articles were identified. Of these, 80 were assessed for their eligibility for inclusion and 32 studies were included in this systematic review. These studies included 3106 women (55% multiparas and 82% with vaginal deliveries) who underwent transabdominal and/or transvaginal ultrasound from the first postpartum day to a maximum of 6 weeks postpartum. The upper limit of normal (95th percentile) for the endometrial thickness was 25 mm by 7 days postpartum and this continued to decrease (18 mm at 14 days, 12 mm at 4 weeks, and 9 mm at 6 weeks) in a similar manner for all the women regardless of parity or mode of delivery. All the other uterine measurements also gradually decreased during the puerperium for all the women regardless of parity or mode of delivery.
CONCLUSION
These upper limits of normal for the postpartum endometrium and uterine measurements in uncomplicated pregnancies provide clinical guidance for the sonographic evaluation of women with complicated postpartum courses.
Topics: Delivery, Obstetric; Female; Humans; Postpartum Period; Pregnancy; Prospective Studies; Ultrasonography; Uterus
PubMed: 33493704
DOI: 10.1016/j.ajogmf.2021.100318