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Modern Rheumatology Aug 2023The objective of this study is to provide evidence for the revision of clinical practice guidelines for the management of antineutrophil cytoplasmic antibody... (Meta-Analysis)
Meta-Analysis
Systematic review and meta-analysis for 2023 clinical practice guidelines of the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis for the management of ANCA-associated vasculitis.
OBJECTIVES
The objective of this study is to provide evidence for the revision of clinical practice guidelines for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis by the Japan Research Committee for Intractable Vasculitis.
METHODS
PubMed, CENTRAL, and the Japan Medical Abstracts Society databases were searched for articles published between 2015 and 2020 to update the systematic review for existing clinical questions, while PubMed, CENTRAL, EMBASE, and the Japan Medical Abstracts Society were searched for articles published between 2000 and 2020 to conduct a systematic review for newly developed clinical questions. The certainty of evidence was assessed with the GRADE approach.
RESULTS
For remission induction, when used in conjunction with cyclophosphamide or rituximab, reduced-dose glucocorticoid lowered the risk of serious adverse events compared to standard-dose glucocorticoid. Avacopan improved sustained remission at 12 months compared to high-dose glucocorticoid. Addition of plasma exchange to remission induction therapy did not reduce the risk of death, end-stage kidney disease, or relapse. For remission maintenance, rituximab reduced the risk of relapse compared to azathioprine. Long-term rituximab or azathioprine reduced the risk of relapse compared to short-term rituximab or azathioprine, respectively.
CONCLUSIONS
This systematic review provided evidence required to develop the 2023 clinical practice guideline for the management of ANCA-associated vasculitis.
Topics: Humans; Azathioprine; Immunosuppressive Agents; Rituximab; Glucocorticoids; Japan; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Remission Induction; Antibodies, Antineutrophil Cytoplasmic; Recurrence
PubMed: 36112482
DOI: 10.1093/mr/roac114 -
Joint Bone Spine Dec 2023Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV), namely granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV), namely granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis constitute a group of rare systemic vasculitides, affecting small vessels. Genders are equally affected, with symptoms most commonly presenting during and/or after the fifth decade of life, but AAV may also present in younger individuals. As advanced maternal age is becoming common and safe over the last decades, it is now more feasible for middle-aged women suffering from AAV to get pregnant. Although adverse pregnancy outcomes have been thoroughly investigated in other systemic diseases, the exact prevalence of pregnancy complications and unfavorable outcomes in pregnant women with AAV has not been systematically evaluated.
METHODS
We researched PubMed, Scopus, Cochrane Library and Cinahl databases until September, 2022. Three blinded investigators extracted data and assessed the risk of bias. A random effects model was used for the analysis. The outcomes studied were pre-term delivery, intrauterine growth restriction (IUGR) neonates and disease flare.
RESULTS
We included six studies with 92 pregnancies in patients with AAV. The prevalence of pre-term delivery, IUGR neonates and disease flare were 18% (CI: 0.10-0.30, P=non-significant), 20% (CI: 0.11-0.33, P=non-significant) and 28% (CI: 0.09-0.59, P<0.01), respectively.
CONCLUSION
The analysis demonstrated higher occurrence of adverse outcomes in pregnant women suffering from AAV accompanied by an increased risk of disease flare during pregnancy. These findings underline the importance of preconception counseling and the necessity of close monitoring in these patients similarly to other systemic inflammatory diseases.
Topics: Middle Aged; Infant, Newborn; Female; Humans; Male; Pregnancy; Granulomatosis with Polyangiitis; Churg-Strauss Syndrome; Pregnancy Outcome; Symptom Flare Up; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Antineutrophil Cytoplasmic
PubMed: 37419307
DOI: 10.1016/j.jbspin.2023.105609 -
Obesity Reviews : An Official Journal... Mar 2023We aimed to explore associations between the accessibility of fast-food restaurants (FFRs) and weight-related outcomes in children and adolescents through a systematic... (Meta-Analysis)
Meta-Analysis Review
We aimed to explore associations between the accessibility of fast-food restaurants (FFRs) and weight-related outcomes in children and adolescents through a systematic review and meta-analysis of studies. We searched three databases for studies published before October 21, 2022. Study quality was assessed using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analysis was performed, and the leave-one-out method was used for sensitivity analysis. A total of 60 studies were included. According to our analysis, FFRs within a smaller buffer radius from residences or that provide unhealthy foods may have a more significant influence on children's and adolescents' weight. Children of younger ages and girls may have a higher possibility of being overweight due to FFRs. Though we could hardly avoid bias, the estimates in low-and middle-income countries (only six studies) are much higher than those in high-income countries (54 studies). More research analyses based on microscope data and individual economic levels are needed. This study yields quantitative results, provides policymakers and urban planners with a theoretical support for building resilient and sustainable human settlements, and promotes the translation of research findings from public health to environmental planning.
Topics: Female; Humans; Child; Adolescent; Overweight; Restaurants; Cross-Sectional Studies; Pediatric Obesity; Schools; Fast Foods
PubMed: 36519593
DOI: 10.1111/obr.13536 -
American Journal of Orthodontics and... Dec 2021This systematic review aimed to identify, evaluate, and provide a synthesis of the available literature on the proximal enamel thickness (PET) of permanent teeth. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This systematic review aimed to identify, evaluate, and provide a synthesis of the available literature on the proximal enamel thickness (PET) of permanent teeth.
METHODS
The eligibility criteria were studies that assessed the PET of the permanent teeth. A search of studies in Medline (via PubMed), the Cochrane Library, Scopus, Web of Science, Embase, and Lilacs databases that measured PET was conducted until August 31, 2020. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias for systematic reviews involving cross-sectional studies. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach. PET data generated from the systematic review were summarized by random-effects inverse-generic meta-analysis.
RESULTS
From 1388 potentially eligible studies, 11 were considered for systematic review and meta-analysis. The measurement of PET was done with radiographs, microscopes, microtomographs, or profilometers. In total, 4019 mesial and distal surfaces involving 2118 teeth were assessed. All included studies showed low to moderate risk of bias, whereas GRADE revealed that the level of evidence was low. Greater mesial and distal enamel thickness was observed for the premolars and molars, whereas it was least for the mandibular central incisors. The least difference of 0.02 mm (95% confidence interval [CI], -0.07 to 0.11 and -0.06 to 0.09, respectively) between mesial and distal sides was observed for the maxillary and mandibular second molars, whereas the maximum difference of 0.12 mm (95% CI, 0.07-0.17 and 0.07-0.16, respectively) was observed for the maxillary central incisors and maxillary first premolars. The meta-analysis indicated a moderate level of heterogeneity (I of 45%). The funnel plot revealed minimal publication bias.
CONCLUSIONS
The summary effect of the meta-analysis revealed that the thickness of the enamel on the distal aspect was greater than on the mesial aspect by an average of 0.10 mm (95% CI, 0.09-0.12). This finding would be of relevance to all disciplines of dentistry and especially for the clinician planning interproximal reduction, a procedure that is routinely done for clear aligner therapy.
Topics: Cross-Sectional Studies; Dental Caries; Dental Enamel; Dentition, Permanent; Humans; Molar
PubMed: 34420845
DOI: 10.1016/j.ajodo.2021.05.007 -
Oral Diseases Nov 2023To systematically identify and summarise current research on the utility of confocal microscopy in oral squamous cell carcinoma and oral epithelial dysplasia in oral... (Review)
Review
OBJECTIVE
To systematically identify and summarise current research on the utility of confocal microscopy in oral squamous cell carcinoma and oral epithelial dysplasia in oral potentially malignant disorders.
METHODS
Databases Medline, Embase, Evidence-Based Medicine, and Web of Science were searched with articles screened and included if their primary objective was the use of a confocal microscope in diagnosis of oral cancer or epithelial dysplasia, in vivo or ex vivo.
RESULTS AND DISCUSSION
Twenty-eight relevant studies were identified of which 21 studies included oral squamous cell carcinoma specimens. Fifteen studies included in vivo use. The studies included both qualitative and fluorescence confocal microscope and reflectance confocal microscope analysis along with quantitative analysis of carcinoma and dysplasia. Thirteen studies reported the predictive value of their confocal device in the diagnosis of dysplasia and carcinoma. The quantitative software-based studies show promise in objectifying the diagnostic process for identifying abnormalities within the microstructure of the oral mucosa.
CONCLUSIONS
There was heterogeneity in the criteria for diagnosis of dysplasia and oral squamous cell carcinoma with experience levels of assessors impacting method efficacy. Both qualitative and quantitative confocal assessment methodologies have been explored, the latter highlighting the potential of future machine-augmented diagnostic precision.
Topics: Humans; Mouth Neoplasms; Carcinoma, Squamous Cell; Squamous Cell Carcinoma of Head and Neck; Mouth Diseases; Precancerous Conditions; Microscopy, Confocal; Head and Neck Neoplasms
PubMed: 35765235
DOI: 10.1111/odi.14291 -
PLoS Neglected Tropical Diseases 2013Strongyloidiasis is frequently under diagnosed since many infections remain asymptomatic and conventional diagnostic tests based on parasitological examination are not... (Review)
Review
BACKGROUND
Strongyloidiasis is frequently under diagnosed since many infections remain asymptomatic and conventional diagnostic tests based on parasitological examination are not sufficiently sensitive. Serology is useful but is still only available in reference laboratories. The need for improved diagnostic tests in terms of sensitivity and specificity is clear, particularly in immunocompromised patients or candidates to immunosuppressive treatments. This review aims to evaluate both conventional and novel techniques for the diagnosis of strongyloidiasis as well as available cure markers for this parasitic infection.
METHODOLOGY/PRINCIPAL FINDINGS
The search strategy was based on the data-base sources MEDLINE, Cochrane Library Register for systematic review, EmBase, Global Health and LILACS and was limited in the search string to articles published from 1960 to August 2012 and to English, Spanish, French, Portuguese and German languages. Case reports, case series and animal studies were excluded. 2003 potentially relevant citations were selected for retrieval, of which 1649 were selected for review of the abstract. 143 were eligible for final inclusion.
CONCLUSIONS
Sensitivity of microscopic-based techniques is not good enough, particularly in chronic infections. Furthermore, techniques such as Baermann or agar plate culture are cumbersome and time-consuming and several specimens should be collected on different days to improve the detection rate. Serology is a useful tool but it might overestimate the prevalence of disease due to cross-reactivity with other nematode infections and its difficulty distinguishing recent from past (and cured) infections. To evaluate treatment efficacy is still a major concern because direct parasitological methods might overestimate it and the serology has not yet been well evaluated; even if there is a decline in antibody titres after treatment, it is slow and it needs to be done at 6 to 12 months after treatment which can cause a substantial loss to follow-up in a clinical trial.
Topics: Animals; Clinical Laboratory Techniques; Drug Monitoring; Humans; Parasitology; Sensitivity and Specificity; Strongyloides; Strongyloidiasis
PubMed: 23350004
DOI: 10.1371/journal.pntd.0002002 -
Burns : Journal of the International... Jun 2016Cutaneous burns associated with microscope-use are perceived to be uncommon adverse events in microsurgery. Currently, it is unknown what factors are associated with... (Review)
Review
Cutaneous burns associated with microscope-use are perceived to be uncommon adverse events in microsurgery. Currently, it is unknown what factors are associated with these iatrogenic events. In this report, we describe the case of a 1-year-old patient who suffered a full thickness skin burn from a surgical microscope after a L4-S1 laminectomy. Additionally, we present a systematic review of the literature that assessed the preoperative risk, outcome, and management of iatrogenic microscope skin burns. Lastly, a summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse events was reviewed and analyzed for clinical cases of microscope thermal injuries. The systematic literature review identified only seven articles related to microsurgery-related cutaneous burns. From these seven studies, 15 clinical cases of iatrogenic skin burns were extracted for analysis. The systematic review of the FDA MAUDE database revealed only 60 cases of cutaneous burns associated with surgical microscopes since 2004. Few cases of microscope burns have been described in the literature; this report is, to our knowledge, one of the first comprehensive reports of this iatrogenic event in the literature.
Topics: Burns; Cytoreduction Surgical Procedures; Female; Humans; Iatrogenic Disease; Infant; Laminectomy; Lipoma; Lumbosacral Region; Magnetic Resonance Imaging; Meningomyelocele; Microscopy; Spinal Canal; Surgical Equipment
PubMed: 26777456
DOI: 10.1016/j.burns.2015.08.014 -
Digestive Diseases (Basel, Switzerland) 2023Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by watery diarrhoea and a normal radiological and endoscopic appearance. Concern regarding... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by watery diarrhoea and a normal radiological and endoscopic appearance. Concern regarding a potential association between drug exposure and MC has recently emerged. We sought to systematically review and summarize the evidence for the potential association.
METHODS
A systematic review and meta-analysis were performed to evaluate the incidence of MC associated with exposure to drug. The PubMed and Embase databases were searched to identify potential studies for inclusion.
RESULTS
Twelve case-control studies were included in the meta-analysis. The results showed exposure to NSAID (OR, 1.64; 95% CI: 1.14-2.37; p < 0.001), PPI (OR, 2.36; 95% CI: 1.59-3.52; p < 0.001), SSRI (OR, 2.16; 95% CI: 1.5-3.13; p < 0.001), or aspirin (OR, 2.84; 95% CI: 1.4-5.76; p < 0.001) was related to the incidence of MC; however, such relationships in PPI and SSRI may be modulated by the selection of controls. Furthermore, we did not found a positive association with other drug exposure and MC.
CONCLUSION
This meta-analysis indicated that NSAID, PPI, SSRI, or aspirin consumption may increase the risk for MC. Further studies exploring drug-induced microscopic colitis should include control groups with diarrhoea and not only healthy controls.
Topics: Humans; Colitis, Microscopic; Colitis; Diarrhea; Anti-Inflammatory Agents, Non-Steroidal; Aspirin
PubMed: 36067746
DOI: 10.1159/000526809 -
European Journal of Clinical... Apr 2020Odontogenic myxoma (OM) is a rare neoplasm, which originates from odontogenic ectomesenchyme. There is no study in the literature that analyses the best standards for OM...
BACKGROUND
Odontogenic myxoma (OM) is a rare neoplasm, which originates from odontogenic ectomesenchyme. There is no study in the literature that analyses the best standards for OM diagnosis and how the treatment modalities may influence the recurrence rates.
OBJECTIVE
To evaluate the best standards for odontogenic myxoma (OM) diagnosis and treatment, and how these may influence the recurrence rates.
STUDY DESIGN
Two independent researchers performed a systematic review in many databases. Fifty-two eligible studies were included for qualitative analysis. Bias analysis was conducted according to Oxford Centre for Evidence-Based Medicine.
RESULTS
A total of 1363 OM cases were reported on, and female gender with average age of 27 years is the most common patient profile. Conventional microscopic findings were observed in 93.43% of the reported cases. In 57.49% of the cases, multilocular radiographic appearance was present, followed by unilocular appearance (32.87%). Posterior mandible was the site with the major prevalence, while surgical resection was the most common treatment modality, followed by enucleation. Recurrence rates for both treatment modalities were approximately close (13.04% and 25.0%, respectively).
CONCLUSION
The correct diagnosis of OM relies on the association of clinical, radiographic and microscopic findings. About imaging examinations, panoramic radiography and computed tomography are sufficient for the evaluation of OM. Recurrence rates were closely among the two most used surgery treatments. So according to some clinical-radiological aspects, conservative surgery may be preferred than aggressive surgery modalities.
Topics: Bias; Humans; Jaw Neoplasms; Magnetic Resonance Imaging; Myxoma; Neoplasm Recurrence, Local; Odontogenic Tumors; Radiography, Panoramic; Tomography, X-Ray Computed
PubMed: 32048275
DOI: 10.1111/eci.13214 -
International Journal of Surgery... Sep 2023Despite retrospective studies comparing anatomical liver resection (AR) and non-anatomical liver resection (NAR), the efficacy and benefits of AR for hepatocellular... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite retrospective studies comparing anatomical liver resection (AR) and non-anatomical liver resection (NAR), the efficacy and benefits of AR for hepatocellular carcinoma remain unclear.
MATERIALS AND METHODS
The authors systemically reviewed MEDLINE, Embase, and Cochrane Library for propensity score matched cohort studies that compared AR and NAR for hepatocellular carcinoma. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Secondary outcomes were recurrence patterns and perioperative outcomes.
RESULTS
Overall, 22 propensity score matched studies (AR, n =2,496; NAR, n =2590) were included. AR including systemic segmentectomy was superior to NAR regarding the 3-year and 5-year OS. AR showed significantly better 1-year, 3-year, and 5-year RFS than NAR, with low local and multiple intrahepatic recurrence rates. In the subgroup analyses of tumour diameter less than or equal to 5 cm and tumours with microscopic spread, the RFS in the AR group was significantly better than that in the NAR group. Patients with cirrhotic liver in the AR group showed comparable 3-year and 5-year RFS with the NAR group. Postoperative overall complications were comparable between AR and NAR.
CONCLUSIONS
This meta-analysis demonstrated that AR showed better OS and RFS with a low local and multiple intra-hepatic recurrence rate than NAR, especially in patients with tumour diameter less than or equal to 5 cm and non-cirrhotic liver.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Retrospective Studies; Hepatectomy; Propensity Score; Postoperative Complications; Neoplasm Recurrence, Local
PubMed: 37247010
DOI: 10.1097/JS9.0000000000000503