-
Journal of Cardiovascular... Sep 2023Left bundle branch area pacing (LBBP) is a novel conduction system pacing method to achieve effective physiological pacing and an alternative to cardiac... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Left bundle branch area pacing (LBBP) is a novel conduction system pacing method to achieve effective physiological pacing and an alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) for patients with heart failure with reduced ejection fraction (HFrEF). We conduted this meta-analysis and systemic review to review current data comparing BVP and LBBP in patients with HFrEF and indications for CRT.
METHODS
We searched PubMed/Medline, Web of Science, and Cochrane Library from the inception of the database to November 2022. All studies that compared LBBP with BVP in patients with HFrEF and indications for CRT were included. Two reviewers performed study selection, data abstraction, and risk of bias assessment. We calculated risk ratios (RRs) with the Mantel-Haenszel method and mean difference (MD) with inverse variance using random effect models. We assessed heterogeneity using the I index, with I > 50% indicating significant heterogeneity.
RESULTS
Ten studies (9 observational studies and 1 randomized controlled trial; 616 patients; 15 centers) published between 2020 and 2022 were included. We observed a shorter fluoroscopy time (MD: 9.68, 95% confidence interval [CI]: 4.49-14.87, I = 95%, p < .01, minutes) as well as a shorter procedural time (MD 33.68, 95% CI: 17.80-49.55, I = 73%, p < .01, minutes) during the implantation of LBBP CRT compared to conventional BVP CRT. LBBP was shown to have a greater reduction in QRS duration (MD 25.13, 95% CI: 20.06-30.20, I = 51%, p < .01, milliseconds), a greater left ventricular ejection fraction improvement (MD: 5.80, 95% CI: 4.81-6.78, I = 0%, p < .01, percentage), and a greater left ventricular end-diastolic diameter reduction (MD: 2.11, 95% CI: 0.12-4.10, I = 18%, p = .04, millimeter). There was a greater improvement in New York Heart Association function class with LBBP (MD: 0.37, 95% CI: 0.05-0.68, I = 61%, p = .02). LBBP was also associated with a lower risk of a composite of heart failure hospitalizations (HFH) and all-cause mortality (RR: 0.48, 95% CI: 0.25-0.90, I = 0%, p = .02) driven by reduced HFH (RR: 0.39, 95% CI: 0.19-0.82, I = 0%, p = .01). However, all-cause mortality rates were low in both groups (1.52% vs. 1.13%) and similar (RR: 0.98, 95% CI: 0.21-4.68, I = 0%, p = .87).
CONCLUSION
This meta-analysis of primarily nonrandomized studies suggests that LBBP is associated with a greater improvement in left ventricular systolic function and a lower rate of HFH compared to BVP. There was uniformity of these findings in all of the included studies. However, it would be premature to conclude based solely on the current meta-analysis alone, given the limitations stated. Dedicated, well-designed, randomized controlled trials and observational studies are needed to elucidate better the comparative long-term efficacy and safety of LBBP CRT versus BIV CRT.
Topics: Humans; Cardiac Resynchronization Therapy; Heart Failure; Stroke Volume; Ventricular Function, Left; Ventricular Septum; Treatment Outcome; Bundle of His; Electrocardiography; Cardiac Pacing, Artificial
PubMed: 37548113
DOI: 10.1111/jce.16013 -
Frontiers in Neurology 2018Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits. To synthesiz findings of...
Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits. To synthesiz findings of differences in kinematics and muscle activity between stroke survivors and healthy adults performing reach-to-target tasks. A systematic review with identification of studies, data extraction, and potential risk of bias was completed independently by two reviewers. Online databases were searched from their inception to November 2017 to find studies of reach-to-target in and healthy adults. risk-of-bias was assessed using the Down's and Black Tool. Synthesis : (a) meta-analysis of kinematic characteristics utilizing the standardized mean difference (SMD) [95% confidence intervals]; and (b), narrative synthesis of muscle activation. Forty-six studies met the review criteria but 14 had insufficient data for extraction. Consequently, 32 studies were included . Potential risk-of-bias was low for one study, unclear for 30, and high for one. Reach-to-target was investigated with 618 and 429 healthy adults. found, in all areas of workspace, that : greater movement times (seconds) e.g., SMD 2.57 [0.89, 4.25]; lower peak velocity (millimeters/second) e.g., SMD -1.76 [-2.29, -1.24]; greater trunk displacement (millimeters) e.g. SMD 1.42 [0.90, 1.93]; e.g., SMD 0.77 [0.32, 1.22] and reduced movement smoothness e.g., SMD 0.92 [0.32, 1.52]. In ipsilateral and contralateral workspace, : larger errors in accuracy e.g., SMD 0.70 [0.39, 1.01]. In contralateral workspace, stroke survivors had: reduced elbow extension and shoulder flexion (degrees) e.g., elbow extension SMD -1.10 [-1.62, -0.58] and reduced shoulder flexion SMD -1.91 [-1.96, -0.42]. Narrative synthesis of muscle activation found that , exhibited: delayed muscle activation; reduced coherence between muscle pairs; and use of a greater percentage of muscle power. This first-ever meta-analysis of the kinematic differences between people with stroke and healthy adults performing reach-to-target found statistically significant differences for 21 of the 26 comparisons. .
PubMed: 29988530
DOI: 10.3389/fneur.2018.00472 -
Vector Borne and Zoonotic Diseases... Dec 2023is a zoonotic intracellular pathogen that requires parasitism in eukaryotic cells to reproduce. In recent years, tsutsugamushi disease reported in many places... (Meta-Analysis)
Meta-Analysis
is a zoonotic intracellular pathogen that requires parasitism in eukaryotic cells to reproduce. In recent years, tsutsugamushi disease reported in many places nationwide has crossed the Yangtze River, continuously, spreading to the North China. Now this phenomenon has aroused people's attention. In this study, meta-analysis was used to analyze the infection of rodents (vectors) in China, to clarify the transmission rule of . This study included literature from six databases (PubMed, Web of Science, Science Direct, Wanfang, CNKI, and VIP). A total of 55 articles were included in the study from 610 retrieved articles. The total infection rate of in rodents was 5.5% (1206/20,620, 95% confidence interval [CI]: 0.0553-0.0617). The prevalence of in rodents before 2013 (7.73%, 95% CI: 4.11-12.37) was higher than after 2013 (2.11%, 95% CI: 0.64-4.41). spread among a variety of rodents, among which (13.3%, 95% CI: 4.33-26.26), (5.69%, 95% CI: 1.37-12.72), and (5.32%, 95% CI: 2.26-9.58) infection rate was higher. Kawasaki (8.32%, 95% CI: 1.42-20.17), Karp (7.36%, 95% CI: 2.62-14.22), Kato (2.54%, 95% CI: 0.08-8.28), and Gilliam (2.13%, 95% CI: 0.42-5.09) were the main prevalent genotypes in China. The prevalence of in rodents was seasonal, increasing gradually in summer (2.39%, 95% CI: 0.46-5.77), peaking in autumn (4.59%, 95% CI: 1.15-10.16), and then declining. The positive rate of immunofluorescence assay (25.07%, 95% CI: 8.44-46.88) was the highest among the detection methods, and it was statistically significant ( < 0.05). Based on the subgroup of geographical factors and climatic factors, the probability of infection in rodents was the highest when the temperature >19℃ (8.20%, 95% CI: 1.22-20.52), the altitude <100 millimeters (7.23%, 95% CI: 3.45-12.26), the precipitation >700 millimeters (12.22%, 95% CI: 6.45-19.50), and the humidity 60-70% (7.80%, 95% CI: 4.17-12.44). Studies have shown that rodents carrying are common. People should prevent and control rodents in life and monitor rodents carrying for a long time.
Topics: Animals; Humans; Orientia tsutsugamushi; Prevalence; Trombiculidae; Scrub Typhus; Murinae; China
PubMed: 37625029
DOI: 10.1089/vbz.2023.0057 -
The Cochrane Database of Systematic... 2004Encapsulation of a filtering bleb following trabeculectomy may lead to elevation of intraocular pressure, prompting further medical or surgical intervention. It has been... (Review)
Review
BACKGROUND
Encapsulation of a filtering bleb following trabeculectomy may lead to elevation of intraocular pressure, prompting further medical or surgical intervention. It has been suggested that needling of an encapsulated bleb may be effective in re-establishing drainage and lowering intraocular pressure.
OBJECTIVES
The objective of this review is to assess the effects of needling encapsulated blebs on intraocular pressure.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group trials register) on The Cochrane Library (Issue 2 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to May 2003) and LILACS (Latin American and Caribbean Health Sciences ) (June 2003). There were no language or date restrictions in the searches.
SELECTION CRITERIA
We included randomised and quasi-randomised in which bleb needling was compared with any form of antiglaucoma medication in people with encapsulated trabeculectomy blebs. The primary outcome was mean intraocular pressure measured in millimetres of mercury at day one, one week, one month and at last available follow-up.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.
MAIN RESULTS
One trial, which randomised 25 eyes to either needling or medical treatment, met the inclusion criteria. At one day post-treatment, mean intraocular pressure was lower in the needling group (16.28 mm Hg, standard deviation 5.9) than the medical group (19.45 mm Hg, standard deviation 3.75). The difference was not statistically significant. At all other follow-up points, mean intraocular pressure was consistently higher in the needling group than the medical group, although the differences were not statistically significant. However, only one needled bleb remained successful at the end of follow-up compared to 10 out of the 11 blebs managed conservatively. This difference was statistically highly significant.
REVIEWERS' CONCLUSIONS
Evidence from one small trial suggests that needling of encapsulated trabeculectomy blebs is not better than medical treatment in reducing intraocular pressure.
Topics: Blister; Filtering Surgery; Glaucoma; Humans; Intraocular Pressure; Paracentesis; Trabeculectomy
PubMed: 15106211
DOI: 10.1002/14651858.CD003658.pub2 -
Physics in Medicine and Biology Sep 2013Computed tomography (CT) is the modality of choice for imaging the lungs in vivo. Sub-millimeter isotropic images of the lungs can be obtained within seconds, allowing... (Review)
Review
Computed tomography (CT) is the modality of choice for imaging the lungs in vivo. Sub-millimeter isotropic images of the lungs can be obtained within seconds, allowing the detection of small lesions and detailed analysis of disease processes. The high resolution of thoracic CT and the high prevalence of lung diseases require a high degree of automation in the analysis pipeline. The automated segmentation of pulmonary structures in thoracic CT has been an important research topic for over a decade now. This systematic review provides an overview of current literature. We discuss segmentation methods for the lungs, the pulmonary vasculature, the airways, including airway tree construction and airway wall segmentation, the fissures, the lobes and the pulmonary segments. For each topic, the current state of the art is summarized, and topics for future research are identified.
Topics: Automation; Blood Vessels; Humans; Image Processing, Computer-Assisted; Lung; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 23956328
DOI: 10.1088/0031-9155/58/17/R187 -
Otolaryngology--head and Neck Surgery :... Aug 2023Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted... (Review)
Review
OBJECTIVE
Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted by many factors. However, some third-party payors have implemented policies to authorize coverage for ESS in a sinus-by-sinus manner based on a minimal measurement of millimeters of mucosal thickening or sinus opacification in the corresponding sinus that is being surgically addressed. Our objective was to determine whether such policies are based on scientific evidence that in patients with medically recalcitrant CRS, a minimum measurement of mucosal thickening or sinus opacification is a predictor of CRS in that sinus or improved outcomes after ESS on a sinus-by-sinus basis.
DATA SOURCES
Medline, Embase, Scopus, and Web of Science databases, from inception through May 2022.
REVIEW METHODS
A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed.
RESULTS
We identified 6070 abstracts which were screened and from which 112 studies ultimately underwent a full-text review. From these studies, we found that none investigated (or provided evidence of) whether any minimal degree of radiographic mucosal thickening or sinus opacification predicted CRS or better outcomes after ESS in a sinus-specific manner.
CONCLUSION
We were unable to find evidence supporting a minimum millimeter measurement of mucosal thickening or sinus opacification as predictors of CRS or better post-ESS outcomes in a sinus-specific manner in patients with medically recalcitrant CRS. The extent of ESS for CRS should be determined through personalized medical decision-making that considers all patient-specific factors.
Topics: Humans; Rhinitis; Paranasal Sinuses; Sinusitis; Endoscopy; Chronic Disease
PubMed: 36807128
DOI: 10.1002/ohn.297 -
World Neurosurgery Oct 2021To assess the global sagittal balance of spine (GSBS) in asymptomatic controls. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the global sagittal balance of spine (GSBS) in asymptomatic controls.
METHODS
PubMed, Scopus, Cochrane library, and Web of Science searched up to July 2020. Studies were screened for the GSB parameters including T1 pelvic angle (TPA), spinosacral angle (SSA), sagittal vertical axis (SVA), C7/sacrofemoral distance ratio (Barrey index), odontoid hip axis (OD-HA), and Full Balance Index (FBI) as measured in asymptomatic participants. A meta-analysis was performed to synthesize pooled estimates. Heterogeneity and publication bias were assessed.
RESULTS
Overall, 76 studies were identified including 12,169 participants (54.7% female) with mean age ranges from 12.0 to 72.9 years old. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (standard deviation) normative values were: 1) age ˃18 years, SSA (°), 127.6 (0.89); SVA absolute value (millimeters), 13.1 (1.13); TPA (°), 9.8 (1.13); T1SPI (°), -4.3 (0.57); and Barrey index absolute value, 0.51 (0.3). The mean value of the OD-HA (°) was reported 2.9 (1.6), and the FBI average value was less than 5°. 2) Age ≤18 years, SSA (°), 132.1 (8.3); SVA absolute value (millimeters), 11.9 (2.0); and Barrey index, -0.7 (8.3). A significant difference was observed between the 2 age groups based on SVA and SSA.
CONCLUSIONS
This paper presents normative data on TPA, SSA, SVA, Barrey index, OD-HA, and FBI as a reference for evaluating/measuring a GSB of spine in asymptomatic controls.
Topics: Adolescent; Adult; Aged; Child; Female; Healthy Volunteers; Humans; Male; Middle Aged; Postural Balance; Reference Values; Spine; Young Adult
PubMed: 34314909
DOI: 10.1016/j.wneu.2021.07.036 -
International Orthodontics Mar 2022To evaluate the effectiveness of autologous platelet concentrates (APCs) as adjuncts on accelerating orthodontic tooth movement (OTM) of the human subjects undergoing... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness of autologous platelet concentrates (APCs) as adjuncts on accelerating orthodontic tooth movement (OTM) of the human subjects undergoing orthodontic treatment and to critically appraise the available literature.
METHODS AND MATERIALS
Five electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane Central Register of Controlled Trials) were searched from 2000 up to May 2021 to retrieve eligible randomized controlled trials (RCTs) investigating patients who underwent orthodontic treatment that involved OTM of maxillary and mandibular incisors and canines. All the enrolled cases were treated with APCs and had no local or systemic interfering factors. The quality of the included studies was assessed using the modified JADAD scale. The effect sizes were assessed using mean difference (MD). The heterogeneity analysis was conducted using (I) statistic at α=0.10.
RESULTS
Finally, seven RCTs were included in the qualitative, and two RCTs were included in the quantitative analysis. The meta-analysis was performed regarding the effect of injectable platelet-rich fibrin (I-PRF) on the rate of canine tooth movement in millimeters at different intervals of the 1, 2, and 3 months. In the 1 month, I-PRF (WMD:0.12mm, CI95% -5.01 to 5.24, I=90%) did not significantly affect OTM. In the 2 month, I-PRF (WMD:0.66mm, CI95% 0.60 to 0.73, I=10%) significantly increased the OTM. However, in the 3 month, I-PRF did not significantly increase the OTM (WMD:0.54mm, CI95% -1.38 to 2.47, I=67%).
CONCLUSIONS
According to the low certainty of evidence about this topic, providing a definite conclusion is not possible. However, applying I-PRF seems to be efficient in accelerating the OTM of the canines. Further high-quality studies with larger sample sizes will be indispensable to validate this conclusion.
Topics: Cuspid; Humans; Incisor; Platelet-Rich Fibrin; Randomized Controlled Trials as Topic; Tooth Movement Techniques
PubMed: 34866025
DOI: 10.1016/j.ortho.2021.10.004 -
Journal of the American Dental... May 2017Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic periodontitis.
TYPES OF STUDIES REVIEWED
The authors performed a systematic search by using PubMed (MEDLINE), Scopus, Scientific Electronic Library Online, and Cochrane Central Register of Controlled Trials. The authors selected randomized controlled clinical trials in which the investigators evaluated the probing depth (PD) and clinical attachment level (CAL) in test groups by using CHX as an adjuvant and in control groups and subject to mechanical periodontal therapy (scaling and root planing [SRP] 4-6 visits or 24 hours).
RESULTS
The literature search resulted in 8 articles, which the authors then assessed for quality. After testing for heterogeneity, the authors performed a meta-analysis only in the SRP group with 4 to 6 visits. Results were positive for both PD and CAL with use of CHX. However, the summary measure was significant (P < .05) only for PD at 40 to 60 days (0.33 millimeters; 95% confidence interval, 0.08 to 0.58 mm) and 180 days (0.24 mm; 95% confidence interval, 0.02 to 0.47 mm) of follow-up, showing positive results for the use of CHX at those times. Although those differences were statistically significant, they could be interpreted as clinically slight.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Adjunctive use of CHX mouthrinse with mechanical SRP resulted in slightly greater PD reduction than did SRP alone. Clinicians must consider the small additional gain in PD reduction, negligible effect on CAL, and potential for tooth staining when using CHX as an adjunct to SRP in treating chronic periodontitis.
Topics: Chlorhexidine; Chronic Periodontitis; Combined Modality Therapy; Dental Scaling; Humans; Mouthwashes; Root Planing
PubMed: 28284417
DOI: 10.1016/j.adaj.2017.01.021 -
Journal of the American Dental... Jun 2022In this systematic review, the authors aimed to answer the following question: Do vital teeth differ in the level of external root resorption induced by means of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In this systematic review, the authors aimed to answer the following question: Do vital teeth differ in the level of external root resorption induced by means of orthodontic treatment compared with root-filled teeth?
TYPES OF STUDIES REVIEWED
The search strategy was performed in 6 electronic databases and in gray literature for articles published until July 29, 2021. Two reviewers independently assessed potentially eligible studies according to the following criteria: studies that evaluated patients undergoing fixed orthodontic therapy and compared the mean difference in millimeters of orthodontically induced external root resorption in endodontically treated teeth with the vital contralateral tooth. Only randomized, quasi-randomized, nonrandomized, cohort, case-control, or cross-sectional studies were considered eligible. There were no restrictions on language or publication time. Two reviewers also independently extracted data on the characteristics of the included studies, methods, and results, and performed risk-of-bias analysis using the Meta-Analysis of Statistics Assessment and Review instrument. Estimates of interest were calculated using random-effects meta-analyses. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.
RESULTS
Eleven studies were included in the quantitative synthesis. Endodontically treated teeth had a lower level of root resorption (mean difference, 0.45 mm; 95% CI, -0.69 to -0.21 mm). However, the level of certainty of the evidence was considered very low owing to confounding factors.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Endodontically treated teeth may have a lower level of orthodontically induced root resorption than vital teeth, but the evidence is still uncertain about this outcome. Furthermore, owing to the small effect size, this difference might not be clinically significant (up to 1 mm).
Topics: Case-Control Studies; Cross-Sectional Studies; Humans; Root Resorption; Tooth Root; Tooth, Nonvital
PubMed: 35287942
DOI: 10.1016/j.adaj.2021.11.012