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Nutrition, Metabolism, and... Mar 2017The generation of reactive oxygen species (ROS) plays an important role in the etiology of several pathological conditions. High levels of 8-hydroxy-2-deoxyguanosine... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
The generation of reactive oxygen species (ROS) plays an important role in the etiology of several pathological conditions. High levels of 8-hydroxy-2-deoxyguanosine (8-OHdG), a biomarker of oxidative damage of DNA, have been found in patients with heart failure (HF). We performed a meta-analysis of the literature to investigate the association between 8-OHdG levels and HF.
METHODS AND RESULTS
A systematic search was performed in the PubMed, Web of Science, Scopus, EMBASE databases and studies evaluating 8-OHdG levels in HF patients and controls were included. Differences between cases and controls were expressed as standard mean difference (SMD) or mean difference (MD) with pertinent 95% confidence intervals (95%CI). Impact of clinical and demographic features on effect size was assessed by meta-regression. Six studies (446 HF patients and 140 controls) were included in the analysis. We found that HF patients showed higher 8-OHdG levels than controls (SMD:0.89, 95%CI: 0.68, 1.10). The difference was confirmed both in studies in which 8-OHdG levels were assessed in urine (MD:6.28 ng/mg creatinine, 95%CI: 4.01, 8.56) and in blood samples (MD:0.36 ng/ml, 95%CI: 0.04, 0.69). Interestingly, 8-OHdG levels progressively increased for increasing New York Heart Association (NYHA) class. Meta-regression models showed that none of clinical and demographic variables impacted on the difference in 8-OHdG levels among HF patients and controls.
CONCLUSIONS
8-OHdG levels are higher in HF patients HF than in controls, with a progressive increase for increasing NYHA class. However, larger prospective studies are needed to test 8-OHdG as a biomarker of HF severity and progression.
Topics: 8-Hydroxy-2'-Deoxyguanosine; Biomarkers; Chi-Square Distribution; DNA Damage; Deoxyguanosine; Heart Failure; Humans; Myocardium; Oxidative Stress; Predictive Value of Tests; Prognosis; Risk Factors; Severity of Illness Index; Stroke Volume; Up-Regulation; Ventricular Function, Left
PubMed: 28065503
DOI: 10.1016/j.numecd.2016.10.009 -
HPB : the Official Journal of the... Nov 2012Currently, laparoscopic distal pancreatectomy (LDP) is regarded as a safe and effective surgical approach for lesions in the body and tail of the pancreas. This review... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Currently, laparoscopic distal pancreatectomy (LDP) is regarded as a safe and effective surgical approach for lesions in the body and tail of the pancreas. This review compares outcomes of the laparoscopic technique with those of open distal pancreatectomy (ODP) and assesses the efficacy, safety and feasibility of each type of procedure.
METHODS
Comparative studies published between January 1996 and April 2012 were included. Studies were selected based on specific inclusion and exclusion criteria. Evaluated endpoints were operative outcomes, postoperative recovery and postoperative complications.
RESULTS
Fifteen non-randomized comparative studies that recruited a total of 1456 patients were analysed. Rates of conversion from LDP to open surgery ranged from 0% to 30%. Patients undergoing LDP had less intraoperative blood loss [weighted mean difference (WMD) -263.36.59 ml, 95% confidence interval (CI) -330.48 to -196.23 ml], fewer blood transfusions [odds ratio (OR) 0.28, 95% CI 0.11-0.76], shorter hospital stay (WMD -4.98 days, 95% CI -7.04 to -2.92 days), a higher rate of splenic preservation (OR 2.98, 95% CI 2.18-3.91), earlier oral intake (WMD -2.63 days, 95% CI -4.23 to 1.03 days) and fewer surgical site infections (OR 0.37, 95% CI 0.18-0.75). However, there were no differences between the two approaches with regard to operation time, time to first flatus and the occurrence of pancreatic fistula and other postoperative complications.
CONCLUSIONS
Laparoscopic resection results in improved operative and postoperative outcomes compared with open surgery according to the results of the present meta-analyses. It may be a safe and feasible option for patients with lesions in the body and tail of the pancreas. However, randomized controlled trials should be undertaken to confirm the relevance of these early findings.
Topics: Chi-Square Distribution; Humans; Laparoscopy; Odds Ratio; Pancreatectomy; Pancreatic Diseases; Postoperative Complications; Recovery of Function; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 23043660
DOI: 10.1111/j.1477-2574.2012.00531.x -
World Journal of Gastroenterology Jul 2015To perform a systematic review and meta-analysis on robotic-assisted vs laparoscopic liver resections. (Meta-Analysis)
Meta-Analysis Review
AIM
To perform a systematic review and meta-analysis on robotic-assisted vs laparoscopic liver resections.
METHODS
A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria: (1) studies comparing robotic and laparoscopic liver resection; (2) studies reporting at least one perioperative outcome; and (3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy rates.
RESULTS
A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time (MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital stay.
CONCLUSION
Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay.
Topics: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Chi-Square Distribution; Female; Hepatectomy; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Odds Ratio; Operative Time; Postoperative Complications; Risk Factors; Robotic Surgical Procedures; Time Factors; Treatment Outcome
PubMed: 26217097
DOI: 10.3748/wjg.v21.i27.8441 -
Heart (British Cardiac Society) Dec 2017Atrial fibrillation (AF) is an emerging global epidemic associated with significant morbidity and mortality. Whilst other chronic cardiovascular conditions have... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Atrial fibrillation (AF) is an emerging global epidemic associated with significant morbidity and mortality. Whilst other chronic cardiovascular conditions have demonstrated enhanced patient outcomes from coordinated systems of care, the use of this approach in AF is a comparatively new concept. Recent evidence has suggested that the integrated care approach may be of benefit in the AF population, yet has not been widely implemented in routine clinical practice. We sought to undertake a systematic review and meta-analysis to evaluate the impact of integrated care approaches to care delivery in the AF population on outcomes including mortality, hospitalisations, emergency department visits, cerebrovascular events and patient-reported outcomes.
METHODS
PubMed, Embase and CINAHL databases were searched until February 2016 to identify papers addressing the impact of integrated care in the AF population. Three studies, with a total study population of 1383, were identified that compared integrated care approaches with usual care in AF populations.
RESULTS
Use of this approach was associated with a reduction in all-cause mortality (OR 0.51, 95% CI 0.32 to 0.80, p=0.003) and cardiovascular hospitalisations (OR 0.58, 95% CI 0.44 to 0.77, p=0.0002) but did not significantly impact on AF-related hospitalisations (OR 0.82, 95% CI 0.56 to 1.19, p=0.29) or cerebrovascular events (OR 1.00, 95% CI 0.48 to 2.09, p=1.00).
CONCLUSIONS
The use of the integrated care approach in AF is associated with reduced cardiovascular hospitalisations and all-cause mortality. Further research is needed to identify optimal settings, methods and components of delivering integrated care to the burgeoning AF population.
Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Cause of Death; Cerebrovascular Disorders; Chi-Square Distribution; Delivery of Health Care, Integrated; Female; Hospitalization; Humans; Male; Middle Aged; Odds Ratio; Risk Factors; Treatment Outcome
PubMed: 28490616
DOI: 10.1136/heartjnl-2016-310952 -
Journal of Vascular Surgery Jul 2018Long-term patency of arteriovenous fistulas (AVFs) is critical for hemodialysis vascular access. We compared the efficacy of a one-stage vs two-stage approach to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Long-term patency of arteriovenous fistulas (AVFs) is critical for hemodialysis vascular access. We compared the efficacy of a one-stage vs two-stage approach to brachiobasilic AVF creation by primarily investigating primary and secondary patency rates. We hypothesize that the two-stage is superior to the one-stage procedure in terms of efficacy and safety.
METHODS
This review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed on MEDLINE, EMBASE, Google Scholar, and Cochrane Database. Risk of bias and quality assessment scores were both performed based on previously validated tool.
RESULTS
The systematic search revealed a total of 242 publications for possible inclusion. On the basis of title and abstract review, two randomized controlled trials and nine case-cohort series fit our inclusion criteria. There were no statistically significant differences in failure rates (pooled risk ratio [RR], 1.10; 95% confidence interval [CI], 0.79-1.55; P = .25), 1-year primary patency rates (RR, 1.31; 95% CI, 0.83-2.06; P = .24), 1-year secondary patency rates (RR, 0.97; 95% CI, 0.54-1.77) and 2-year secondary patency rates (RR, 1.19; 95% CI, 0.54-2.63; P = .67) between both groups. However, the two-stage procedure had significantly improved 2-year primary patency rates (RR, 2.50; 95% CI, 1.66-3.74; P < .00001). There were no differences in steal syndrome, hematoma, infection, pseudoaneuryms, or stenosis, although there was a trend toward an increased incidence of postoperative thrombosis (RR, 1.81; 95% CI, 0.95-3.45; P = .07) in one-stage procedures.
CONCLUSIONS
With improved 2-year primary patency rates and the absence of significant differences in complications, this study suggests potential benefit of a two-stage over a one-stage procedure for brachiobasilic AVF creation. However, rather than being a definitive answer, our results merely highlight the continuing need for an adequately powered, well-designed, randomized controlled trial to interrogate this question further.
Topics: Adult; Aged; Arteriovenous Shunt, Surgical; Brachial Artery; Chi-Square Distribution; Female; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Odds Ratio; Renal Dialysis; Risk Factors; Time Factors; Treatment Outcome; Upper Extremity; Vascular Patency; Veins
PubMed: 29937034
DOI: 10.1016/j.jvs.2018.03.428 -
BMC Cardiovascular Disorders Jul 2017The association between patent foramen ovale (PFO) and migraine with aura (MA) is well established. However, the benefits of PFO closure are less certain in patients... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The association between patent foramen ovale (PFO) and migraine with aura (MA) is well established. However, the benefits of PFO closure are less certain in patients with migraine without aura (MwoA).
METHODS
We systematically searched Pubmed for pertinent clinical studies published from January 2000 to July 2015. The primary end-point was the elimination or significant improvement of migraine symptoms after PFO closure.
RESULTS
Upon screening an initial list of 315 publications, we identified eight studies that included 546 patients. Overall, our analysis indicated a significant improvement of migraine in 81% of MA cases compared to only 63% of MwoA cases. The summary odds ratio was 2.5 (95% confidence interval 1.09-5.73), and the benefits of PFO closure were significantly greater for patients with MA compared to patients with MwoA (P = 0.03).
CONCLUSIONS
The presence of aura provides a reference standard for the clinical selection of patients with migraine for PFO closure intervention.
Topics: Adult; Cardiac Catheterization; Chi-Square Distribution; Female; Foramen Ovale, Patent; Humans; Male; Middle Aged; Migraine with Aura; Migraine without Aura; Odds Ratio; Patient Selection; Risk Factors; Time Factors; Treatment Outcome
PubMed: 28747203
DOI: 10.1186/s12872-017-0644-9 -
BMC Cancer Oct 2019Studies on relationship between tubal ligation and endometrial cancer have led to contradictory findings. In several studies, however, a reduced endometrial cancer risk... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Studies on relationship between tubal ligation and endometrial cancer have led to contradictory findings. In several studies, however, a reduced endometrial cancer risk was suggested following tubal ligation. Therefore, a systematic review and meta-analysis was conducted to examine the relationship between tubal ligation and endometrial cancer risk.
METHODS
In this systematic review and meta-analysis, PubMed/Medline, Web of Science, Scopus, Embase, and Google Scholar were searched for relevant studies published up to May 30th, 2018. We compared endometrial cancer risk in women with and without tubal ligation in retrieved studies.
RESULTS
Two hundred nine studies were initially retrieved from the data bases. After exclusion of duplicates and studies which did not meet inclusion criteria, ten cohort and case-control studies, including 6,773,066 cases, were entered into the quantitative meta-analysis. There was 0.90% agreement between two researchers who searched and retrieved the studies. The summary OR (SOR) was reported using a random effect model. Begg's test suggested that there was no publication bias, but a considerable heterogeneity was observed (I = 95.4%, P = 0.001). We pooled the raw number of tables cells (i.e. a, b, c, and d) of eight studies. The SOR suggested that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.577, 95% CI = 0.420-0.792). Also, given the rare nature of endometrial cancer (< 5%), different effect sizes were considered as comparable measures of risk. Therefore we pooled ten studies and SOR of these studies revealed that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.696, 95% CI = 0.425-0.966). Besides that, we pooled eight studies in which adjusted effect sizes were reported and a subsequent analysis revealed that the summary estimate of adjusted odds ratio (SAOR) was significant (SAOR = 0.862, 95% CI = 0.698-1.026).
CONCLUSIONS
This study revealed a protective effect of tubal ligation on endometrial cancer risk (approximately 42% lower risk of cancer). It is recommended that studies should be designed to reveal mechanisms of this relationship.
Topics: Adolescent; Adult; Aged; Chi-Square Distribution; Endometrial Neoplasms; Female; Humans; Incidence; Middle Aged; Odds Ratio; Risk; Sterilization, Tubal; Young Adult
PubMed: 31604465
DOI: 10.1186/s12885-019-6174-3 -
European Journal of Preventive... May 2014Several studies have reported racial/ethnic variation in out-of-hospital cardiac arrest (OOHCA) characteristics, which engendered varying conclusions. We performed a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several studies have reported racial/ethnic variation in out-of-hospital cardiac arrest (OOHCA) characteristics, which engendered varying conclusions. We performed a systematic review and meta-analysed the evidence for differences in OOHCA survival when considering the patient's race and/or ethnicity.
METHODS
We searched Medline and EMBASE databases up to and including 1 Oct 2011 for studies investigating racial/ethnic differences in OOHCA characteristics, supplemented by manual searches of bibliographies of relevant studies. We selected studies of any relevant design that measured OOHCA characteristics and stratified them by ethnic group. Two independent reviewers extracted information on the study population, including: race and/or ethnicity, location, age and OOHCA variables as per the Utsein template. We performed a meta-analysis of the studies comparing the black and white patients.
RESULTS
1701 potentially relevant articles were identified in our systematic search. Of these, 22 articles describing original studies were reviewed after fulfilling our inclusion criteria. Although 19 studies (18 within the United States (US)) compared the black and white population, only 15 fulfilled our quality assessment criteria and were meta-analysed. Compared to white patients, black patients were less likely to receive bystander cardiopulmonary resuscitation (OR = 0.66, 95%CI = 0.55-0.78), have a witnessed arrest (OR = 0.77, 95%CI = 0.72-0.83) or have an initial ventricular fibrillation/ventricular tachycardia arrest rhythm (OR = 0.66, 95%CI = 0.58-0.76). Black patients had lower rates of survival following hospital admission (OR = 0.59, 95%CI = 0.48-0.72) and discharge (OR = 0.74, 95%CI = 0.61-0.90).
CONCLUSION
Our work highlights the significant discrepancy in OOHCA characteristics and patient survival in relation to the patient's race, with the black population faring less well across all stages. Most studies compared black and white populations within the US, so research elsewhere and with other ethnic groups is needed. This review exposes an inequality that demands urgent action.
Topics: Black or African American; Cardiopulmonary Resuscitation; Chi-Square Distribution; Emergency Medical Services; Health Services Accessibility; Health Status Disparities; Healthcare Disparities; Humans; Odds Ratio; Out-of-Hospital Cardiac Arrest; Patient Admission; Risk Factors; Time Factors; Treatment Outcome; United States; White People
PubMed: 22692471
DOI: 10.1177/2047487312451815 -
Kidney International May 2013In this era of organ donor shortage, live kidney donation has been proven to increase the donor pool; however, it is extremely important to make careful decisions in the... (Meta-Analysis)
Meta-Analysis Review
In this era of organ donor shortage, live kidney donation has been proven to increase the donor pool; however, it is extremely important to make careful decisions in the selection of possible live donors. A body mass index (BMI) above 35 is generally considered as a relative contraindication for donation. To determine whether this is justified, a systematic review and meta-analysis were carried out to compare perioperative outcome of live donor nephrectomy between donors with high and low BMI. A comprehensive literature search was performed in MEDLINE, Embase, and CENTRAL (the Cochrane Library). All aspects of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement were followed. Of 14 studies reviewed, eight perioperative donor outcome measures were meta-analyzed, and, of these, five were not different between BMI categories. Three found significant differences in favor of low BMI (29.9 and less) donors with significant mean differences in operation duration (16.9 min (confidence interval (CI) 9.1-24.8)), mean difference in rise in serum creatinine (0.05 mg/dl (CI 0.01-0.09)), and risk ratio for conversion (1.69 (CI 1.12-2.56)). Thus, a high body mass index (BMI) alone is no contraindication for live kidney donation regarding short-term outcome.
Topics: Body Mass Index; Chi-Square Distribution; Donor Selection; Humans; Kidney Transplantation; Laparoscopy; Living Donors; Nephrectomy; Odds Ratio; Postoperative Complications; Risk Factors; Time Factors; Treatment Outcome
PubMed: 23344469
DOI: 10.1038/ki.2012.485 -
Heart (British Cardiac Society) Aug 2016Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use information and communication technologies to enable remote exCR programme delivery can overcome common access barriers while preserving clinical supervision and individualised exercise prescription. This meta-analysis aimed to determine the benefits of telehealth exCR on exercise capacity and other modifiable cardiovascular risk factors compared with traditional exCR and usual care, among patients with coronary heart disease (CHD).
METHODS
CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed and PsycINFO were searched from inception through 31 May 2015 for randomised controlled trials comparing telehealth exCR with centre-based exCR or usual care among patients with CHD. Outcomes included maximal aerobic exercise capacity, modifiable cardiovascular risk factors and exercise adherence.
RESULTS
11 trials (n=1189) met eligibility criteria and were included in the review. Physical activity level was higher following telehealth exCR than after usual care. Compared with centre-based exCR, telehealth exCR was more effective for enhancing physical activity level, exercise adherence, diastolic blood pressure and low-density lipoprotein cholesterol. Telehealth and centre-based exCR were comparably effective for improving maximal aerobic exercise capacity and other modifiable cardiovascular risk factors.
CONCLUSIONS
Telehealth exCR appears to be at least as effective as centre-based exCR for improving modifiable cardiovascular risk factors and functional capacity, and could enhance exCR utilisation by providing additional options for patients who cannot attend centre-based exCR. Telehealth exCR must now capitalise on technological advances to provide more comprehensive, responsive and interactive interventions.
Topics: Cardiac Rehabilitation; Chi-Square Distribution; Exercise Therapy; Exercise Tolerance; Heart Diseases; Humans; Patient Compliance; Recovery of Function; Risk Factors; Telemedicine; Time Factors; Treatment Outcome
PubMed: 26936337
DOI: 10.1136/heartjnl-2015-308966