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Environmental Science and Pollution... Mar 2023Vascular endothelial dysfunction is an early stage to cardiovascular diseases (CVDs), but whether air pollution exposure has an effect on it remains unknown. We... (Meta-Analysis)
Meta-Analysis Review
Vascular endothelial dysfunction is an early stage to cardiovascular diseases (CVDs), but whether air pollution exposure has an effect on it remains unknown. We conducted a systematic review and meta-analysis to summarize epidemiological evidence between air pollution and endothelial dysfunction. We searched the database of PubMed, EMBASE, the Cochrane Library, and Web of Science up to November 10, 2022. Fixed and random effect models were used to pool the effect change or percent change (% change) and 95% confidence interval (95% CI) of vascular function associated with particulate matter (PM) and gaseous pollutants. I statistics, funnel plot, and Egger's test were used to evaluate heterogeneity and publication bias. There were 34 articles included in systematic review, and 25 studies included in meta-analysis. For each 10 µg/m increment in short-term PM exposure, augmentation index (AIx) and pulse wave velocity (PWV) increased by 2.73% (95% CI: 1.89%, 3.57%) and 0.56% (95% CI: 0.22%, 0.89%), and flow-mediated dilation (FMD) decreased by 0.17% (95% CI: - 0.33%, - 0.00%). For each 10 µg/m increment in long-term PM exposure, FMD decreased by 0.99% (95% CI: - 1.41%, - 0.57%). The associations between remaining pollutants and outcomes were not statistically significant. The effect of short-term PM exposure on FMD change was stronger in population with younger age, lower female proportion, higher mean body mass index and higher PM exposure. Cardiac or vasoactive medication might attenuate this effect. Our study provides evidence that PM exposure had adverse impact on vascular endothelial function, indicating the importance of air quality improvement for early CVD prevention.
Topics: Female; Humans; Air Pollutants; Pulse Wave Analysis; Environmental Exposure; Air Pollution; Particulate Matter; Cardiovascular Diseases; Environmental Pollutants
PubMed: 36702984
DOI: 10.1007/s11356-023-25156-9 -
Critical Care Medicine Feb 2023To conduct a systematic review and meta-analysis to determine whether targeting a higher mean arterial pressure (MAP) compared with a lower MAP in adults with shock... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To conduct a systematic review and meta-analysis to determine whether targeting a higher mean arterial pressure (MAP) compared with a lower MAP in adults with shock results in differences in patient important outcomes.
DATA SOURCES
We searched MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov through May 2021.
STUDY SELECTION
Titles and abstracts were screened independently and in duplicate to identify potentially eligible studies, then full text for final eligibility. We included parallel-group randomized controlled trials in adult patients with a diagnosis of shock requiring vasoactive medications. The higher MAP group was required to receive vasoactive medications to target a higher MAP as established by study authors, whereas the lower MAP group received vasoactive medications to target lower MAP.
DATA EXTRACTION
In triplicate, reviewers independently extracted data using a prepiloted abstraction form. Statistical analyses were conducted using the RevMan software Version 5.3.
DATA SYNTHESIS
Six randomized controlled trials (n = 3,690) met eligibility criteria. Targeting a higher MAP (75-85 mm Hg) compared with lower MAP of 65 mm Hg resulted in no difference in mortality (relative risk [RR], 1.06; 95% CI, 0.98-1.15; I2 = 0%; p = 0.12; moderate certainty. Targeting a higher MAP resulted in no difference in the risk of undergoing renal replacement therapy (RR, 0.96; 95% CI, 0.83-1.11; I2 = 24%; p = 0.57; moderate certainty); however, a subgroup analysis comparing patients with and without chronic hypertension demonstrated that a higher MAP may reduce the risk of undergoing renal replacement therapy (RR, 0.83; 95% CI, 0.71-0.98; I2 = 0%; p = 0.02).
CONCLUSIONS
In conclusion, our systematic review and meta-analysis demonstrated with moderate certainty that there is no difference in mortality when a higher MAP is targeted in critically ill adult patients with shock. Further studies are needed to determine the impact of mean arterial pressure on need for renal replacement therapy in this population.
Topics: Humans; Adult; Arterial Pressure; Critical Illness; Randomized Controlled Trials as Topic; Patient Reported Outcome Measures
PubMed: 36661452
DOI: 10.1097/CCM.0000000000005726 -
Head & Neck Mar 2023This systematic review and meta-analysis investigates the objective evidence regarding outcomes in head and neck free flap surgeries using vasoactive agents in the... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis investigates the objective evidence regarding outcomes in head and neck free flap surgeries using vasoactive agents in the perioperative period. A search was performed in PubMed, Cochrane, Web of Science, and Scopus databases. Inclusion criteria were clinical studies in which vasopressors were used in head and neck free flap surgery during the intraoperative and perioperative period. Eighteen studies (n = 5397) were included in the qualitative analysis and nine (n = 4381) in the meta-analysis. There was no difference in flap failure outcomes with perioperative vasopressor use in head and neck free flap surgery (n = 4015, OR = 0.93, 95% CI [0.60, 1.44]). When patients received vasopressors perioperatively, there was an associated decrease in flap-specific complications (n = 3881, OR = 0.69, 95% CI [0.55, 0.87]). Intraoperative vasopressor use does not negatively impact free tissue transfer outcomes in head and neck surgery and may reduce overall free flap complications.
Topics: Humans; Free Tissue Flaps; Plastic Surgery Procedures; Head and Neck Neoplasms; Intraoperative Period; Vasoconstrictor Agents; Postoperative Complications; Hemodynamics; Retrospective Studies
PubMed: 36618003
DOI: 10.1002/hed.27289 -
Cureus Jul 2022The role of neurogenic inflammation in various systemic diseases has been well established, but there is a dearth of studies and evidence regarding its role in... (Review)
Review
The role of neurogenic inflammation in various systemic diseases has been well established, but there is a dearth of studies and evidence regarding its role in periodontitis. This study aimed to systematically review the evidence in establishing the role of neurogenic inflammation in chronic periodontitis. Databases such as PubMed, Scopus, and Google Scholar were reviewed. We analyzed studies of any design that compared and evaluated the presence of neuropeptides such as substance P, calcitonin gene-related peptide, neurokinin A, neuropeptide Y, and vasoactive intestinal polypeptide in systemically healthy patients with and without periodontitis. We screened 2,495 articles and abstracts electronically and manually, which yielded 191 articles relevant to our study. Full-text examination of these 191 articles led to the final inclusion of 14 publications. Most studies here confirmed an association between various neuropeptides and periodontitis, but there is a high heterogeneity between the studies, making it necessary to clarify the mechanism between these two. Although most studies included in this review found a positive association between neurogenic inflammation and periodontitis, the evidence is of moderate to low quality.
PubMed: 35978739
DOI: 10.7759/cureus.26889 -
The Heart Surgery Forum May 2022This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic valve implantation (TAVI). (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic valve implantation (TAVI).
MEASUREMENTS
All relevant studies were searched from Pubmed, EMbase, Web of Science, and the Cochrane Library (January 1, 2016, to June 1, 2021). The main outcomes of this literature meta-analysis were 30-day mortality, procedural time, new pacemaker implantation, total stay in the hospital, use of the vasoactive drug, and intra-and postoperative complications and emergencies, including conversion to open, myocardial infarction, pulmonary complication, vascular complication, renal injury/failure, stroke, transesophageal echocardiography, life-threatening/major bleeding, cardiac tamponade, and emergency PCI. Pooled risk ratio (RR) and mean difference (MD) together with a 95% confidence interval (CI) were calculated.
RESULTS
A total of 17 studies, including 20938 patients, in the final analysis, fulfilled the inclusion criteria. Intra-and postoperative complications (myocardial infarction, vascular complication, renal injury/failure, stroke, and cardiac tamponade) undergoing TAVI in severe AS patients under GA do not offer a significant difference compared with LA. No differences were observed between LA and GA for new pacemaker implantation, total stay in the hospital, transesophageal echocardiography, and emergency PCI. LA has lower mortality compared with GA (RR 0.69, P = 0.600), pulmonary complications (RR 0.54, P = 0.278), life-threatening/major bleeding (RR 0.85, P = 0.855), and lower times of conversion to open (RR 0.22, P = 0.746). LA has many advantages, including a shorter procedure duration (MD=-0.38, P = 0.000) and reduction of the use of the vasoactive drug (RR 0.57, P = 0.000).
CONCLUSIONS
For TAVI, both LA with or without sedation and GA are feasible and safe. LA appears a feasible alternative to GA for AS patients undergoing TAVI.
Topics: Anesthesia, General; Anesthesia, Local; Aortic Valve Stenosis; Cardiac Tamponade; Humans; Myocardial Infarction; Percutaneous Coronary Intervention; Postoperative Complications; Stroke; Transcatheter Aortic Valve Replacement
PubMed: 35787764
DOI: 10.1532/hsf.4631 -
Critical Care Medicine Oct 2022Hepatorenal syndrome (HRS) is associated with high rates of morbidity and mortality. Evidence examining commonly used drug treatments remains uncertain. We assessed the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Hepatorenal syndrome (HRS) is associated with high rates of morbidity and mortality. Evidence examining commonly used drug treatments remains uncertain. We assessed the comparative effectiveness of inpatient treatments for HRS by performing a network meta-analysis of randomized clinical trials (RCTs).
DATA SOURCES
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Medline In-Process & Other Non-Indexed Citations, Scopus, and Web of Science from inception.
STUDY SELECTION AND DATA EXTRACTION
Pairs of reviewers independently identified eligible RCTs that enrolled patients with type 1 or 2 HRS. Pairs of reviewers independently extracted data.
DATA SYNTHESIS
We assessed risk of bias using the Cochrane tool for RCTs and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. Our main outcomes are all-cause mortality, HRS reversal, and serious adverse events. Of 3,079 citations, we included 26 RCTs examining 1,736 patients. Based on pooled analysis, terlipressin increases HRS reversal compared with placebo (142 reversals per 1,000 [95% CI, >87.7 to >210.9]; high certainty). Norepinephrine (112.7 reversals per 1,000 [95% CI, 52.6 to >192.3]) may increase HRS reversal compared with placebo (low certainty). The effect of midodrine+octreotide (67.8 reversals per 1,000 [95% CI, <2.8 to >177.4]; very low) on HRS reversal is uncertain. Terlipressin may reduce mortality compared with placebo (93.7 fewer deaths [95% CI, 168.7 to <12.5]; low certainty). Terlipressin probably increases the risk of serious adverse events compared with placebo (20.4 more events per 1,000 [95% CI, <5.1 to >51]; moderate certainty).
CONCLUSIONS
Terlipressin increases HRS reversal compared with placebo. Terlipressin may reduce mortality. Until access to terlipressin improves, initial norepinephrine administration may be more appropriate than initial trial with midodrine+octreotide. Our review has the potential to inform future guideline and practice in the treatment of HRS.
Topics: Hepatorenal Syndrome; Humans; Midodrine; Network Meta-Analysis; Norepinephrine; Octreotide; Terlipressin; Treatment Outcome; Vasoconstrictor Agents
PubMed: 35777925
DOI: 10.1097/CCM.0000000000005595 -
Journal of Critical Care Oct 2022to critically appraise and synthesize the evidence on the effects of vitamin C-based regimens for patients with sepsis or septic shock. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
to critically appraise and synthesize the evidence on the effects of vitamin C-based regimens for patients with sepsis or septic shock.
METHODS
a broad search was performed on May 2021 to identify randomized clinical trials (RCTs) assessing vitamin C-based regimens as adjuvant therapy for adults with sepsis or septic shock. We used the Cochrane Risk of Bias table to assess the methodological quality of the included RCTs and the GRADE approach to evaluate the evidence certainty.
RESULTS
We included 20 RCTs (2124 participants). Evidence from low to very low certainty showed that vitamin C compared to placebo may reduce all-cause mortality up to 28 days (relative risk [RR] 0.60, 95% confidence interval (CI) 0.45 to 0.80, 4 RCTs, 335 participants). Considering the other comparisons (vitamin C alone or combined with thiamine and/or hydrocortisone, compared to placebo, standard care or hydrocortisone), there were a little to no difference or very uncertain evidence for adverse events, SOFA score, ICU length of stay, acute kidney injury, mechanical ventilation- and vasoactive drugs-free days up to 28 days.
CONCLUSION
Further RCTs with higher methodological quality, an increased number of participants and assessing clinically relevant outcomes are needed to provide better decision-making guidance.
PROSPERO REGISTER
CRD42021251786.
Topics: Adult; Ascorbic Acid; Humans; Hydrocortisone; Randomized Controlled Trials as Topic; Sepsis; Shock, Septic
PubMed: 35763993
DOI: 10.1016/j.jcrc.2022.154099 -
Neurology International May 2022(1) Background: Reversible cerebral vasoconstriction syndrome (RCVS) encompasses a clinical and radiological diagnosis characterized by recurrent thunderclap headache,... (Review)
Review
(1) Background: Reversible cerebral vasoconstriction syndrome (RCVS) encompasses a clinical and radiological diagnosis characterized by recurrent thunderclap headache, with or without focal deficits due to multifocal arterial vasoconstriction and dilation. RCVS can be correlated to pregnancy and exposure to certain drugs. Currently, the data on prevalence of RCVS in the postpartum period is lacking. We aim to investigate the prevalence of RCVS in the postpartum period and the rate of hemorrhagic complications of RCVS among the same group of patients; (2) Methods: We conducted the metanalysis by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-Analyses and Systematic Reviews of Observational Studies in Epidemiology (MOOSE) protocol. To analyze the Bias, we used the Ottawa Newcastle scale tool. We included only full-text observational studies conducted on humans and written in English. We excluded Literature Reviews, Systematic Reviews, and Metanalysis. Additionally, we excluded articles that did not document the prevalence of RCVS in the postpartum period (3). Results: According to our analysis, the Prevalence of RCVS in the postpartum period was 129/1083 (11.9%). Of these, 51/100 (52.7%) patients had hemorrhagic RCVS vs. 49/101 (49.5%) with non-hemorrhagic RCVS. The rates of Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH) were (51.6% and 10.7%, respectively. ICH seems to be more common than.; (4) Conclusions: Among patients with RCVS, the prevalence in PP patients is relativity high. Pregnant women with RCVS have a higher recurrence of hemorrhagic vs. non-hemorrhagic RCVS. Regarding the type of Hemorrhagic RCVS, ICH is more common than SAH among patients in the postpartum period. Female Sex, history of migraine, and older age group (above 45) seem to be risk factors for H-RCVS. Furthermore, recurrence of RCVS is associated with a higher age group (above 45). Recurrence of RCVS is more commonly idiopathic than being triggered by vasoactive drugs in the postpartum period.
PubMed: 35736621
DOI: 10.3390/neurolint14020040 -
Clinical Nutrition ESPEN Jun 2022The term enteral feeding intolerance (FI) is frequently used in clinical practice and the literature, yet there is no standardised definition. FI is often quoted as a... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
The term enteral feeding intolerance (FI) is frequently used in clinical practice and the literature, yet there is no standardised definition. FI is often quoted as a reason for failure to meet enteral nutrition (EN) targets but the lack of a consensus definition precludes accurate estimates of prevalence, predictors and clinical outcomes associated with FI. A systematic review was performed of studies in adult critical care patients to evaluate the definitions, relative risk, predictors and clinical outcomes of FI and to propose a uniform definition.
METHODS
Database searches were completed in MEDLINE Ovid, Embase, CINAHL, PsycINFO, Google Scholar, NHS Evidence, Scopus and Web of Science. The search was performed in January and February 2021. Studies were included if they had an interventional, observational cohort or case-control study design and contained a definition of FI in critically ill adults. The following data were extracted from each included article: 1) study design; 2) study objective; 3) inclusion criteria; 4) population and setting; 5) sample size; 6) definition of FI; 7) prevalence of FI; 8) predictors of FI; 9) clinical outcome measures associated with FI. Studies were grouped based on the symptoms used to define FI with random effects meta-analysis.
RESULTS
89 unique studies containing a definition of FI were identified. Studies were categorised according to definition of FI into 3 groups: 1) Gastric residual volume (GRV) and/or gastrointestinal (GI) symptoms (n = 74); 2) Ability to achieve EN target (n = 5); 3) Composite definitions (n = 10). Meta-analysis showed a relative risk of FI of 0.55 [95% CI 0.45, 0.68] (p < 0.00001). The most frequently reported predictors of FI were use of vasoactive drugs, sedation or use of muscle relaxants, intra-abdominal pressure and APACHE II score.
CONCLUSIONS
FI is inconsistently defined in the literature but is reportedly common amongst critically ill adults. FI is most frequently defined by the presence of raised GRV and GI symptoms. However, studies show GRV to correlate poorly with delayed gastric emptying and this review demonstrated no correlation between GRV threshold and prevalence of FI. A standardised definition of FI is essential for future research and clinical practice. We propose a definition of FI including a failure to reach EN targets in addition to presence of GI symptoms.
PROTOCOL REGISTRATION
PROSPERO number CRD42020211879. Registered 29th September 2020.
Topics: Adult; Case-Control Studies; Critical Care; Critical Illness; Enteral Nutrition; Gastrointestinal Diseases; Humans; Infant, Newborn; Prevalence
PubMed: 35623881
DOI: 10.1016/j.clnesp.2022.04.014 -
Clinical Nutrition ESPEN Jun 2022Cardiovascular diseases represent the leading cause of death worldwide, in addition to having a direct negative impact on quality of life, functional capacity and... (Review)
Review
BACKGROUND
Cardiovascular diseases represent the leading cause of death worldwide, in addition to having a direct negative impact on quality of life, functional capacity and nutritional status. Studies show high prevalence of malnutrition in patients undergoing cardiac surgery. It is known that cardiac surgery can also lead to changes in nutritional status, through surgical trauma, systemic inflammation and, often, delay in the initiation of nutritional support. On the other hand, the role of nutritional support as a driver of clinical outcomes in different surgical populations is well described in the literature.
OBJECTIVE
To review the literature in order to assess the effect of perioperative oral or enteral nutritional support on clinical outcomes of cardiac patients undergoing cardiac surgery.
METHODOLOGY
The search was conducted in February 2021 in the following databases: EMBASE, PubMed/MEDLINE, Scopus and Web of Science. Randomized clinical trials (RCT) and retrospective studies were selected, carried out with patients with heart disease, undergoing cardiac surgery and aged 18 years or over. The Outcomes of interest were: length of hospital stay, length of stay in the ICU, time on ventilatory support, mortality rate, clinical complications and use of vasoactive drugs in the postoperative period.
RESULTS
Ten studies were included in this systematic review, of which 7 were RCTs and 3 were cohorts. The most prevalent surgery was myocardial revascularization. Six studies evaluated oral nutritional support, two enteral nutritional support and two analyzed both. Two studies found a significant reduction in the length of hospital and ICU staying associated with preoperative intake of carbohydrate-based beverages. Only one study observed a significant reduction in the requirement for ventilatory support after cardiac surgery, after preoperative carbohydrate-based drinks and early postoperative enteral nutrition. There was no influence of nutritional support on mechanical ventilation length and mortality.
CONCLUSION
Most studies showed that nutritional support did not reduce hospital and ICU staying. Nutritional support benefits were demonstrated in studies that offered preoperative oral carbohydrate drinks. No association was observed between nutritional support and duration of mechanical ventilation or mortality rate. Most studies did not find any influence of nutritional support on the need and/or dosage of vasoactive drugs in the postoperative period of cardiac surgery.
Topics: Carbohydrates; Cardiac Surgical Procedures; Enteral Nutrition; Humans; Malnutrition; Nutritional Support
PubMed: 35623827
DOI: 10.1016/j.clnesp.2022.03.003