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Annals of Hematology Jul 2022Hematological malignancies (HM) have been, until recently, viewed as contraindications to extracorporeal membrane oxygenation (ECMO) due to bleeding and infectious... (Meta-Analysis)
Meta-Analysis Review
Hematological malignancies (HM) have been, until recently, viewed as contraindications to extracorporeal membrane oxygenation (ECMO) due to bleeding and infectious complications. However, conflicting literature regarding whether ECMO should be used for patients with HM still exists. We conducted a random effects meta-analysis to investigate the outcomes of patients with HM on ECMO. We searched Medline, Embase, Scopus, and Cochrane through 10 October 2021. Risk of bias and certainty of evidence were assessed using the JBI checklists and GRADE approach respectively. Thirteen observational studies (422 patients with HM, 9778 controls without HM) were included. The pooled in-hospital mortality for patients with HM and those with hematopoietic stem cell transplants for HM indications needing ECMO were 79.1% (95%CI: 70.2-86.9%) and 87.7% (95%CI: 80.4-93.8%), respectively. Subgroup analyses found that mortality was higher in adults than children (85.1% vs 67.9%, p = 0.003), and in Asia compared to North America and Europe (93.8% vs 69.6%, p < 0.001). Pooled ECMO duration was 10.0 days (95%CI: 7.5-12.5); pooled ICU and hospital lengths of stay were 19.8 days (95%CI: 12.4-27.3) and 43.9 days (95%CI: 29.4-58.4) respectively. Age (regression coefficient [B]: 0.008, 95%CI: 0.003-0.014), proportion of males (B: 1.799, 95%CI: 0.079-3.519), and ECMO duration (B: - 0.022, 95%CI: - 0.043 to - 0.001) were significantly associated with higher mortality. In-hospital mortality of patients with HM who needed ECMO was 79.1%, with better outcomes in children, and in North America and Europe. ECMO should not be regarded as routine support therapy in these patients but can be carefully considered on a case-by-case basis.
Topics: Adult; Asia; Child; Europe; Extracorporeal Membrane Oxygenation; Hematologic Neoplasms; Hospital Mortality; Humans; Male
PubMed: 35622097
DOI: 10.1007/s00277-022-04855-2 -
Cornea Nov 2017To review and compare the published reports of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping... (Comparative Study)
Comparative Study Meta-Analysis Review
Systematic Review and Meta-Analysis of Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Endothelial Keratoplasty/Descemet Stripping Automated Endothelial Keratoplasty.
PURPOSE
To review and compare the published reports of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty (DSEK/DSAEK) procedures with regard to endothelial cell density/loss, best spectacle-corrected visual acuity, central corneal thickness, subjective outcomes (patient's reported satisfaction/preference), and postoperative complications.
METHODS
A thorough search was conducted in the databases including AMED, EMBASE, Cochrane Database of Systematic Reviews, and MEDLINE without date restrictions. Systematic reviews, meta-analysis, randomized controlled trials, case series, and audits comparing DMEK and DSAEK were included.
RESULTS
DMEK is superior to DSAEK for the following outcomes: visual acuity, central corneal thickness, and patient satisfaction. There was a statistically significant difference in the mean spectacle-corrected visual acuity at 6 months for DMEK (mean = 0.161, SD = 0.129) and DSAEK eye (mean = 0.293, SD = 0.153) conditions; t (297) = 8.042, P < 0.0001. The pooled mean difference was -0.13 (95% confidence interval, -0.16 to -0.09) and I = 44%, indicating better visual acuity for DMEK. Mean postoperative endothelial cell density showed statistically no significant difference in the mean values for DMEK (mean = 1855, SD = 442) and DSAEK eye (mean = 1872, SD = 429) conditions; t (336) = 0.375, P = 0.708. A higher proportion of patients prefer DMEK to DSAEK. However, DSAEK is superior to DMEK with respect to the need for rebubbling as the rebubbling rate was higher in the DMEK group.
CONCLUSIONS
Although DMEK is associated with a higher rate of rebubbling, better visual outcomes were seen in DMEK.
Topics: Cell Count; Corneal Diseases; Corneal Endothelial Cell Loss; Descemet Stripping Endothelial Keratoplasty; Endothelium, Corneal; Graft Survival; Humans; Patient Preference; Visual Acuity
PubMed: 28834814
DOI: 10.1097/ICO.0000000000001320 -
Cornea May 2015Ex vivo cultured limbal epithelial transplantation (CLET) with amniotic membrane (AM) as the substrate is a relatively new type of surgical therapy in treating limbal... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Ex vivo cultured limbal epithelial transplantation (CLET) with amniotic membrane (AM) as the substrate is a relatively new type of surgical therapy in treating limbal stem cell deficiency (LSCD). We summarize available evidence for determining the efficiency of this technique by a systematic review and meta-analysis.
METHODS
Searching the following electronic databases, MEDLINE, EMBASE, and the Cochrane Library, we analyzed the selected articles in 5 main aspects: donor screening, culture methods, evidence of cultivated stem cells, subjective symptoms, and adverse events through systematic review. Specifically, meta-analysis was used in evaluating improvements in ocular surface and visual acuity.
RESULTS
A total of 18 articles involving 572 eyes of 562 patients were available. The rate of success and 2-line improvement in best-corrected visual acuity (BCVA) was 67% [95% confidence interval (CI), 0.59-0.75; I = 60%] and 62% (95% CI, 0.57-0.66; I = 37.7%), respectively; and no difference was found both in success rate [odds ratio (OR), 1.35; 95% CI, 0.63-2.89; I = 46%] and visual acuity outcome (OR, 1.53; 95% CI, 0.67-3.45; I = 42.1%) between autograft and allograft.
CONCLUSIONS
CLET is efficacious in patients with LSCD, and no difference both in success rate and visual acuity outcome between autograft and allograft was found. Overall safety profile was good, with most side effects being transient and amenable to subsequent treatments. The long-term results of autograft and allograft will inform future treatment algorithms and techniques with random control trials and better-designed analysis.
Topics: Amnion; Cells, Cultured; Corneal Diseases; Epithelial Cells; Humans; Limbus Corneae; Stem Cell Transplantation; Stem Cells; Tissue Scaffolds; Transplantation, Autologous
PubMed: 25789694
DOI: 10.1097/ICO.0000000000000398 -
European Urology Focus Sep 2022Staging, restaging, and surveillance of urothelial carcinoma (UC) is challenging due to suboptimal accuracy of standard of care imaging modalities. Prostate-specific... (Review)
Review
CONTEXT
Staging, restaging, and surveillance of urothelial carcinoma (UC) is challenging due to suboptimal accuracy of standard of care imaging modalities. Prostate-specific membrane antigen (PSMA) imaging may serve to improve characterisation of UC.
OBJECTIVE
To appraise available literature regarding cellular, imaging, and prognostic implications of PSMA for UC.
EVIDENCE ACQUISITION
A systematic review was performed considering all available literature (including conference abstracts) published from 1990 to 2020 and reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines following registration in PROSPERO (CRD42020186744). All relevant texts relating to immunohistochemical analysis and PSMA-based imaging in UC were included and collated. Additionally, FOLH1 (gene encoding PSMA) expression according to The Cancer Genome Atlas (TCGA) database was analysed as well as according to consensus and TCGA molecular classification subtypes and subsequently compared with clinical outcomes.
EVIDENCE SYNTHESIS
PSMA expression across UC tumour tissue was heterogeneous (0-100%) but appeared to decrease with increased grade and stage. The TCGA analysis demonstrated loss of FOLH1 expression with increasing T stage (p = 0.0180) and N stage (p = 0.0269), and reduced FOLH1 expression was associated with worse disease-free survival. PSMA expression in UC neovasculature was variable but mostly increased (44-100%). Eleven reports of PSMA-based imaging for UC were identified, reporting on 18 patients. PSMA positron emission tomography (PET) imaging was positive in 17 out of 18 patients. The included literature review data were limited by mostly low-quality, retrospective studies.
CONCLUSIONS
Tissue PSMA, or FOLH1 expression, may inversely be associated with pathological and survival outcomes in localised UC. PSMA PET imaging may improve detection of metastatic disease and response to systemic therapy due to PSMA expression in neovasculature. Available evidence is limited; thus, larger, prospective studies are required to confirm early results and define populations that benefit most.
PATIENT SUMMARY
In this systematic review, we assess the potential role of prostate-specific membrane antigen in urothelial cancer. We found that its utility is in expression of blood vessels surrounding metastasis. We conclude that it may be beneficial in detecting metastasis and response to systemic therapies.
Topics: Male; Humans; Carcinoma, Transitional Cell; Prostate; Prognosis; Retrospective Studies; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Urinary Bladder Neoplasms
PubMed: 34429271
DOI: 10.1016/j.euf.2021.07.016 -
Advances in Rheumatology (London,... Mar 2024Osteoarthritis (OA) affects the entire joint, causing structural changes in articular cartilage, subchondral bone, ligaments, capsule, synovial membrane, and... (Meta-Analysis)
Meta-Analysis
Effects of intra-articular injection of platelet-rich plasma on the inflammatory process and histopathological characteristics of cartilage and synovium in animals with osteoarthritis: a systematic review with meta-analysis.
BACKGROUND
Osteoarthritis (OA) affects the entire joint, causing structural changes in articular cartilage, subchondral bone, ligaments, capsule, synovial membrane, and periarticular muscles that afflicts millions of people globally, leading to persistent pain and diminished quality of life. The intra-articular use of platelet-rich plasma (PRP) is gaining recognition as a secure therapeutic approach due to its potential regenerative capabilities. However, there is controversial clinical data regarding efficacy of PRP for OA treatment. In this context, gathering scientific evidence on the effects of PRP in treating OA in animal models could provide valuable insights into understanding its impact on aspects like cartilage health, synovial tissue integrity, and the inflammatory process in affected joints. Thus, the objective of this study was to assess the effects of PRP injections on inflammation and histopathological aspects of cartilage and synovium in animal models of OA through a comprehensive systematic review with meta-analysis.
METHODS
A electronic search was conducted on Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases for relevant articles published until June 2022. A random-effects meta-analysis was employed to synthesize evidence on the histological characteristics of cartilage and synovium, as well as the inflammatory process. The GRADE approach was utilized to categorize the quality of evidence, and methodological quality was assessed using SYRCLE's RoB tool.
RESULTS
Twenty-one studies were included in the review, with twelve of them incorporated into the meta-analysis. PRP treatment demonstrated superior outcomes compared to the control group in terms of cartilage histology (very low quality; p = 0.0002), synovium histology (very low quality; p < 0.0001), and reductions in proinflammatory markers, including IL-1 (low quality; p = 0.002), IL-6 (very low quality; p < 0.00001), and TNF-α (very low; p < 0.00001). However, PRP treatment did not yield a significant impact on PDGF-A levels (very low quality; p = 0.81).
CONCLUSION
PRP appears capable of reducing proinflammatory markers (IL-1, IL-6, TNF-α) and mitigating cartilage and synovium damage in animals with OA. However, the levels of evidence of these findings are low to very low. Therefore, more rigorous studies with larger samples are needed to improve the quality of evidence.
PROSPERO REGISTRATION
CRD42022250314.
Topics: Animals; Humans; Tumor Necrosis Factor-alpha; Interleukin-6; Quality of Life; Osteoarthritis; Synovial Membrane; Injections, Intra-Articular; Cartilage, Articular; Platelet-Rich Plasma; Interleukin-1
PubMed: 38553767
DOI: 10.1186/s42358-024-00364-0 -
Ecotoxicology and Environmental Safety Jul 2023Membrane-based separation processes has been recently of significant global interest compared to other conventional separation approaches due to possessing undeniable... (Review)
Review
The roles of artificial intelligence techniques for increasing the prediction performance of important parameters and their optimization in membrane processes: A systematic review.
Membrane-based separation processes has been recently of significant global interest compared to other conventional separation approaches due to possessing undeniable advantages like superior performance, environmentally-benign nature and simplicity of application. Computational simulation of fluids has shown its undeniable role in modeling and simulation of numerous physical/chemical phenomena including chemical engineering, chemical reaction, aerodynamics, drug delivery and plasma physics. Definition of fluids can be occurred using the Navier-Stokes equations, but solving the equations remains an important challenge. In membrane-based separation processes, true perception of fluid's manner through disparate membrane modules is an important concern, which has been significantly limited applying numerical/computational procedures such s computational fluid dynamics (CFD). Despite this noteworthy advantage, the optimization of membrane processes using CFD is time-consuming and expensive. Therefore, combination of artificial intelligence (AI) and CFD can result in the creation of a promising hybrid model to accurately predict the model results and appropriately optimize membrane processes and phase separation. This paper aims to provide a comprehensive overview about the advantages of commonly-employed ML-based techniques in combination with the CFD to intelligently increase the optimization accuracy and predict mass transfer and the unfavorable events (i.e., fouling) in various membrane processes. To reach this objective, four principal strategies of AI including SL, USL, SSL and ANN were explained and their advantages/disadvantages were discussed. Then after, prevalent ML-based algorithm for membrane-based separation processes. Finally, the application potential of AI techniques in different membrane processes (i.e., fouling control, desalination and wastewater treatment) were presented.
Topics: Artificial Intelligence; Computer Simulation; Algorithms; Water Purification; Hydrodynamics
PubMed: 37262969
DOI: 10.1016/j.ecoenv.2023.115066 -
Acta Anaesthesiologica Scandinavica May 2021The number of studies measuring breakdown products of the glycocalyx in plasma has increased rapidly during the past decade. The purpose of the present systematic review... (Review)
Review
BACKGROUND
The number of studies measuring breakdown products of the glycocalyx in plasma has increased rapidly during the past decade. The purpose of the present systematic review was to assess the current knowledge concerning the association between plasma concentrations of glycocalyx components and structural assessment of the endothelium.
METHODS
We performed a literature review of Pubmed to determine which glycocalyx components change in a wide variety of human diseases and conditions. We also searched for evidence of a relationship between plasma concentrations and the thickness of the endothelial glycocalyx layer as obtained by imaging methods.
RESULTS
Out of 3,454 publications, we identified 228 that met our inclusion criteria. The vast majority demonstrate an increase in plasma glycocalyx products. Sepsis and trauma are most frequently studied, and comprise approximately 40 publications. They usually report 3-4-foldt increased levels of glycocalyx degradation products, most commonly of syndecan-1. Surgery shows a variable picture. Cardiac surgery and transplantations are most likely to involve elevations of glycocalyx degradation products. Structural assessment using imaging methods show thinning of the endothelial glycocalyx layer in cardiovascular conditions and during major surgery, but thinning does not always correlate with the plasma concentrations of glycocalyx products. The few structural assessments performed do not currently support that capillary permeability is increased when the plasma levels of glycocalyx fragments in plasma are increased.
CONCLUSIONS
Shedding of glycocalyx components is a ubiquitous process that occurs during both acute and chronic inflammation with no sensitivity or specificity for a specific disease or condition.
Topics: Capillary Permeability; Endothelium, Vascular; Glycocalyx; Humans; Plasma; Sepsis; Syndecan-1
PubMed: 33595101
DOI: 10.1111/aas.13797 -
Journal of Affective Disorders Apr 2023Growing evidence suggests that epigenetic modification is vital in biological processes of depression. Findings from studies exploring the associations between DNA... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Growing evidence suggests that epigenetic modification is vital in biological processes of depression. Findings from studies exploring the associations between DNA methylation and depression have been inconsistent.
METHODS
A systematical search of EMBASE, PubMed, Web of Science, and PsycINFO databases was conducted to include studies focusing on the associations between DNA methylation and depression (up to November 1st 2021) according to PRISMA guidelines with registration in PROSPERO (CRD42021288664).
RESULTS
A total of 47 studies met inclusion criteria and 31 studies were included in the meta-analysis. This meta-analysis found that genes hypermethylation, including BDNF (OR: 1.15, 95%CI: 1.01-1.32, I = 90 %), and NR3C1 (OR: 1.43, 95%CI: 1.09-1.87, I = 88 %) was associated with increased risk of depression. Significant association of SLC6A4 hypermethylation with depression was only found in the subgroup of using original data (OR: 1.09, 95%CI: 1.01-1.19, I = 52 %). BDNF hypermethylation could increase the risk of depression only in the Asian population (OR: 1.18, 95%CI: 1.01-1.40, I = 91 %), and significant associations of NR3C1 hypermethylation with depression were found in the group for depressive symptoms (OR: 1.34, 95%CI: 1.08-1.67, I = 85 %), but not for depressive disorder (OR: 1.89, 95%CI: 0.54-6.55, I = 94 %).
LIMITATIONS
More studies are needed to explore the factors that might influence the estimates owing to the contextual heterogeneity of the pooling of included studies.
CONCLUSIONS
It is noted that DNA hypermethylation, namely BDNF and NR3C1, is associated with increased risk of depression. The findings in this study could provide some material evidence for preventing and diagnosing of depression.
Topics: Humans; Brain-Derived Neurotrophic Factor; Depression; DNA Methylation; Epigenesis, Genetic; Serotonin Plasma Membrane Transport Proteins
PubMed: 36717033
DOI: 10.1016/j.jad.2023.01.079 -
Journal of Cardiothoracic and Vascular... Apr 2021To review studies that have evaluated the effects of liberal or restrictive red cell transfusion thresholds on clinical outcomes in patients requiring extracorporeal... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review studies that have evaluated the effects of liberal or restrictive red cell transfusion thresholds on clinical outcomes in patients requiring extracorporeal membrane oxygenation (ECMO) support for cardiac or respiratory failure.
DESIGN
A systematic review and meta-analysis.
SETTING AND PARTICIPANTS
The study comprised 1,070 patients from observational studies and randomized controlled trials analyzing transfusion policies in venoarterial (VA) and venovenous (VV) ECMO adult populations.
MEASUREMENTS AND MAIN RESULTS
Eligible studies were identified by searching the Cochrane Central Register of Controlled Trials, Medline, and EMBASE until March 4, 2020, using a combination of subject headings and text words. Risk of bias assessment was performed to assess study quality according to the ROBINS-I tool and the case series studies appraisal checklist. There was high risk of bias in the studies analyzed, and none had methodologic adequacy. Three studies analyzed VA ECMO and VV ECMO patients separately. Five datasets were related exclusively or mostly to VA ECMO. Four were retrospective analyses, and one was conducted as a prospective observational study; the median transfusion threshold reported was 8 g/dL, with a mean mortality of 52%. Eight datasets were related either exclusively or mostly to VV ECMO. Six were retrospective and two were prospective observational studies; the median transfusion threshold was 8 g/dL, and the mean mortality rate was 33%.
CONCLUSIONS
The present study did not resolve uncertainty as to transfusion management in ECMO, although several studies (most of them in VV ECMO) demonstrated that a restrictive threshold has acceptable outcomes in single-center cohorts.
Topics: Adult; Erythrocyte Transfusion; Extracorporeal Membrane Oxygenation; Humans; Observational Studies as Topic; Respiratory Insufficiency; Retrospective Studies
PubMed: 33046363
DOI: 10.1053/j.jvca.2020.08.068 -
Pediatric Critical Care Medicine : a... Jan 2022To present the recommendations and consensus statements with supporting literature for plasma and platelet transfusions in critically ill neonates and children...
Plasma and Platelet Transfusions Strategies in Neonates and Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass or Neonates and Children Supported by Extracorporeal Membrane Oxygenation: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding.
OBJECTIVES
To present the recommendations and consensus statements with supporting literature for plasma and platelet transfusions in critically ill neonates and children undergoing cardiac surgery with cardiopulmonary bypass or supported by extracorporeal membrane oxygenation from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding.
DESIGN
Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children.
SETTING
Not applicable.
PATIENTS
Critically ill neonates and children following cardiopulmonary bypass or supported by extracorporeal membrane oxygenation.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
A panel of nine experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill neonates and children following cardiopulmonary bypass or supported by extracorporeal membrane oxygenation. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed one good practice statement, two recommendations, and three expert consensus statements.
CONCLUSIONS
Whereas viscoelastic testing and transfusion algorithms may be considered, in general, evidence informing indications for plasma and platelet transfusions in neonatal and pediatric patients undergoing cardiac surgery with cardiopulmonary bypass or those requiring extracorporeal membrane oxygenation support is lacking.
Topics: Anemia; Blood Component Transfusion; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Critical Care; Critical Illness; Erythrocyte Transfusion; Evidence-Based Medicine; Extracorporeal Membrane Oxygenation; Hemorrhage; Humans; Infant, Newborn; Plasma; Platelet Transfusion
PubMed: 34989703
DOI: 10.1097/PCC.0000000000002856