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Journal of Gastrointestinal and Liver... Jun 2024Endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology is an important tool in the diagnosis of hepatobiliary malignancies. However, reported... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology is an important tool in the diagnosis of hepatobiliary malignancies. However, reported sensitivity of brush cytology is suboptimal and differs markedly per study. The aim of this study is to analyze the optimal technique of endobiliary brushing during ERCP.
METHODS
A systematic review and meta-analysis according was performed using Pubmed, Embase and Cochrane library, and reported reported according to the PRISMA guidelines. The intervention reported should involve ERCP, performed by the endoscopist with a comparison of different brushing techniques. The primary outcome was sensitivity for malignancy. Studies published up to December 2022 were included. Percutaneous techniques and cytological or laboratory techniques for processing of material were excluded. Bias was assessed using the Quadas-2 tool. Pooled sensitivity rates and Forest plots were analyzed for the primary outcome.
RESULTS
A total of 16 studies were included. Three studies reported on brushing before or after dilation of a biliary stricture. No improvement in sensitivity was found. Five studies reported on alternative brush designs. This did not lead to improved sensitivity. Seven studies reported on the aspiration and analysis of bile fluid, which resulted in a 16% increase in sensitivity (95% CI 4-29%). One study reported an increased in the number of brush passes to the stricture, providing an increase in sensitivity of 20%. Substantial heterogeneity between studies was found, both methodological and statistical.
CONCLUSIONS
Increasing the number of brush-passes and sending bile fluid for cytology increases the sensitivity of biliary brushings during ERCP. Dilation before brushing or alternative brush designs did not increase sensitivity.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Sensitivity and Specificity; Bile Duct Neoplasms; Cytodiagnosis; Bile Ducts
PubMed: 38944859
DOI: 10.15403/jgld-5376 -
Journal of Gastrointestinal and Liver... Jun 2024Mammoplasty, a common cosmetic procedure involving breast augmentation and reduction surgeries, has gained global popularity. Recently, attention has shifted towards...
BACKGROUND AND AIMS
Mammoplasty, a common cosmetic procedure involving breast augmentation and reduction surgeries, has gained global popularity. Recently, attention has shifted towards understanding the prevalence and significance of gastrointestinal (GI) symptoms following mammoplasty. This systematic review aims to consolidate existing literature to provide a comprehensive overview of the type and frequency of GI problems associated with various mammoplasty procedures.
METHODS
A systematic search of PubMed and Scopus databases was conducted until January 22, 2024, identifying observational and interventional studies examining GI symptoms post-mammoplasty. Inclusion criteria covered human studies, while exclusion criteria ensured specificity. Two independent investigators performed screening, and data extraction included study characteristics, surgical procedures, anesthesia methods, and interventions.
RESULTS
Nineteen studies, involving 2,487 subjects, were included in the review. Breast reconstruction emerged as the most studied procedure, followed by breast reduction, augmentation, mastectomy, and breast cancer surgery. Predominant GI symptoms included nausea and vomiting, with varying rates across mammoplasty types. Anesthesia modality influenced symptomatology, with general, local, and combined anesthesia associated with GI disturbances. Antiemetics, notably ondansetron and droperidol, showed variable efficacy. Non-pharmacological approaches, such as preoperative hypnosis, were explored for symptom management.
CONCLUSIONS
Our systematic review reveals insights into GI symptoms post-mammoplasty, emphasizing the common occurrence of symptoms such as nausea and vomiting, alongside less frequent manifestations such as constipation, dry mouth, retching, abdominal pain, and tightness. Variations in symptom prevalence were noted across diverse mammoplasty surgeries, anesthesia methods, and the use of antiemetics, underscoring the complex nature of post-mammoplasty GI disturbances.
Topics: Humans; Mammaplasty; Female; Postoperative Nausea and Vomiting; Gastrointestinal Diseases; Adult; Prevalence
PubMed: 38944853
DOI: 10.15403/jgld-5598 -
Journal of Gastrointestinal and Liver... Jun 2024Colonoscopy has a vital role in the diagnosis of inflammatory bowel disease (IBD), as well as in the estimation of disease severity, monitoring response to therapy, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Colonoscopy has a vital role in the diagnosis of inflammatory bowel disease (IBD), as well as in the estimation of disease severity, monitoring response to therapy, and surveillance for neoplasia. We performed a systematic review of randomised trials of various bowel preparations for colonoscopy in IBD.
METHODS
We searched various electronic databases (PubMed, Embase, and CENTRAL) for studies reporting about the use of various strategies to improve colonoscopy preparation in IBD. We included only randomized clinical trials (RCTs). A network meta-analysis was done using a frequentist approach to compare the effectiveness of various bowel preparations. The risk of bias was assessed using Cochrane risk of bias tool 2.0. Other outcome parameters like compliance, tolerance, acceptance, and adverse effects were assessed qualitatively.
RESULTS
Seven RCTs reporting about 960 patients were included. On comparison with 4 liter (L) of poliethylen glycol (PEG), oral sulfate solution (OR=1.1, 95%CI: 0.65-1.86); PEG2L/Ascorbate (OR=0.98, 95%CI: 0.65-1.48); PEG1L (OR=1, 95%CI: 0.55-1.81); PEG2L plus bisacodyl (OR=1.08, 95%CI: 0.71-1.65); PEG4L plus simethicone (OR=1, 95%CI: 0.67-1.50); PEG/ sodium picosulfate and magnesium citrate (SPMC) 1.5L (OR=0.99, 95%CI: 0.55-1.78); SPMC 2L (OR=1.09, 95%CI: 0.61-1.97) had similar effectiveness. Three RCTs reported compliance, five RCTs reported tolerance, two studies reported patient acceptance and five RCTs reported data on the willingness of patients to repeat the procedure in the future. Low-volume preparations had better compliance, tolerance, acceptance, and willingness to repeat. No difference in additional outcomes like change in disease activity after colonoscopy, procedure-related outcomes after colonoscopy like cecal intubation rate, and change in electrolyte levels were found.
CONCLUSION
Various bowel preparations had similar effectiveness in respect to colonoscopy preparation in IBD patients. Low-volume preparations have better compliance, tolerance, and acceptance. The systematic review was limited by a small number of included RCTs.
Topics: Humans; Colonoscopy; Randomized Controlled Trials as Topic; Cathartics; Inflammatory Bowel Diseases; Network Meta-Analysis
PubMed: 38944852
DOI: 10.15403/jgld-5433 -
International Journal of Geriatric... Jul 2024Rates of dementia are increasing in migrant populations, however, there is evidence that they remain underrepresented in older adult healthcare services. Barriers and... (Review)
Review
BACKGROUND
Rates of dementia are increasing in migrant populations, however, there is evidence that they remain underrepresented in older adult healthcare services. Barriers and facilitators to accessing dementia care have been explored from the viewpoint of migrants and caregivers, however, no review has synthesised the literature pertaining to clinicians' viewpoints. This review aimed to explore clinician perspectives as to the barriers and facilitators in assessing and diagnosing dementia in migrant populations.
METHODS
A systematic review of the literature was conducted. Databases included EMBASE, CINAHL, PsycINFO, MEDLINE and ProQuest. Qualitative studies from the perspective of European clinicians were included. The methodological quality of each study was assessed using the Critical Appraisals Programme Tool (CASP). The analysis adopted a thematic synthesis approach.
RESULTS
The review included 11 qualitative studies relating to the diagnosis of dementia in migrants. The quality of the studies was generally high, although few studies reported on the relationship between the researcher and the participants. The data related more to the barriers in diagnosing dementia, and few facilitators were found. Four themes were constructed: (1) service access (2) perceptions of migrant beliefs (3) relationships and (4) quality of the diagnostic process.
CONCLUSIONS
The review is limited by the small number of studies available. The findings highlight significant clinical concerns in the diagnosis of migrants, in particular the underrepresentation of migrants within services and the barriers to access they may face. The quality of the diagnostic process was often thought to be undermined by a lack of culturally sensitive assessment tools. Further research on the use of an interpreter in diagnosing dementia is needed.
Topics: Humans; Dementia; Health Services Accessibility; Transients and Migrants; Attitude of Health Personnel; Europe; Qualitative Research; Health Personnel
PubMed: 38944812
DOI: 10.1002/gps.6118 -
BMC Infectious Diseases Jun 2024An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF).... (Meta-Analysis)
Meta-Analysis
BACKGROUND
An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy.
METHODS
This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42023452139). A PRISMA-compliant systematic review and meta-analysis was performed. Six English and four Chinese databases were comprehensively searched up to June, 2023. RCTs of azithromycin sequential therapy plus inhaled terbutaline were selected. The revised Cochrane risk of bias tool for randomized trials (RoB2) was used to evaluate the methodological quality of all studies, and meta-analysis was performed using Stata 15.0 with planned subgroup and sensitivity analyses. Publication bias was evaluated by a funnel plot and the Harbord' test. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations.
RESULTS
A total of 1,938 pediatric patients from 20 RCTs were eventually included. The results of meta-analysis showed that combined therapy was able to significantly increase total effectiveness rate (RR = 1.20, 95%CI 1.15 to 1.25), forced expiratory volume in one second (SMD = 1.14, 95%CIs, 0.98 to 1.29), the ratio of forced expiratory volume in one second/forced vital capacity (SMD = 2.16, 95%CIs, 1.46 to 2.86), peak expiratory flow (SMD = 1.17, 95%CIs, 0.91 to 1.43). The combined therapy was associated with a 23% increased risk of adverse reactions compared to azithromycin therapy alone, but no significant differences were found. Harbord regression showed no publication bias (P = 0.148). The overall quality of the evidence ranged from moderate to very low.
CONCLUSIONS
This first systematic review and meta-analysis suggested that azithromycin sequential therapy plus inhaled terbutaline was safe and beneficial for children with MPP. In addition, the combined therapy represented significant improvement of PVF. Due to lack of high-quality evidence, our results should be confirmed by adequately powered RCTs in the future.
Topics: Humans; Azithromycin; Terbutaline; Pneumonia, Mycoplasma; Child; Anti-Bacterial Agents; Mycoplasma pneumoniae; Drug Therapy, Combination; Administration, Inhalation; Treatment Outcome; Randomized Controlled Trials as Topic; Child, Preschool
PubMed: 38944667
DOI: 10.1186/s12879-024-09564-x -
Clinical Radiology May 2024Radiomics involves the extraction of quantitative data from medical images to facilitate the diagnosis, prognosis, and staging of tumors. This study provides a...
Systematic review and meta-analysis of the prognostic value of F-Fluorodeoxyglucose (F-FDG) positron emission tomography (PET) and/or computed tomography (CT)-based radiomics in head and neck cancer.
AIM
Radiomics involves the extraction of quantitative data from medical images to facilitate the diagnosis, prognosis, and staging of tumors. This study provides a comprehensive overview of the efficacy of radiomics in prognostic applications for head and neck cancer (HNC) in recent years. It undertakes a systematic review of prognostic models specific to HNC and conducts a meta-analysis to evaluate their predictive performance.
MATERIALS AND METHODS
This study adhered rigorously to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for literature searches. The literature databases, including PubMed, Embase, Cochrane, and Scopus were systematically searched individually. The methodological quality of the incorporated studies underwent assessment utilizing the radiomics quality score (RQS) tool. A random-effects meta-analysis employing the Harrell concordance index (C-index) was conducted to evaluate the performance of all radiomics models.
RESULTS
Among the 388 studies retrieved, 24 studies encompassing a total of 6,978 cases were incorporated into the systematic review. Furthermore, eight studies, focusing on overall survival as an endpoint, were included in the meta-analysis. The meta-analysis revealed that the estimated random effect of the C-index for all studies utilizing radiomics alone was 0.77 (0.71-0.82), with a substantial degree of heterogeneity indicated by an I of 80.17%.
CONCLUSIONS
Based on this review, prognostic modeling utilizing radiomics has demonstrated enhanced efficacy for head and neck cancers; however, there remains room for improvement in this approach. In the future, advancements are warranted in the integration of clinical parameters and multimodal features, balancing multicenter data, as well as in feature screening and model construction within this field.
PubMed: 38944542
DOI: 10.1016/j.crad.2024.05.016 -
Fertility and Sterility Jun 2024As part of the 2023 International Evidence-based PCOS Guideline, this meta-analysis investigated the inclusion of Anti-Müllerian Hormone (AMH) in the diagnostic... (Review)
Review
IMPORTANCE
As part of the 2023 International Evidence-based PCOS Guideline, this meta-analysis investigated the inclusion of Anti-Müllerian Hormone (AMH) in the diagnostic criteria for Polycystic Ovary Syndrome (PCOS).
OBJECTIVE
A systematic review and three meta-analyses were performed to answer the following three questions: 1) Is AMH effective to diagnose PCOS in adult women? 2) Is AMH effective to diagnose PCOS in adolescents? 3) Is AMH effective to diagnose PCOM?
DATA SOURCES
Searches were conducted in six databases until July 31st 2023.
STUDY SELECTION AND SYNTHESIS
Eligible studies were those conducted in humans, published in English and reported sensitivity, specificity, and/or area under the curve. Extracted data included study population, age, body mass index (BMI), AMH assay, cut off value of AMH, sensitivity, specificity, and area under the curve (AUC). Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Random effects model were used to test diagnostic accuracy.
MAIN OUTCOMES
Pooled sensitivity and specificity to use AMH for PCOS diagnosis in adults and adolescents, and for detecting PCOM in adults.
RESULTS
Eighty-two studies were included. The adult AMH-PCOS meta-analyses (n = 68) showed a pooled sensitivity and specificity of 0.79 [95% CI 0.76; 0.82; I = 86%] and 0.87 [95% CI 0.84; 0.89; I = 91%]. The adolescent AMH-PCOS meta-analysis (n = 11) showed a pooled sensitivity and specificity of 0.66 [95% CI 0.58; 0.73; I = 74%] and 0.78 [95% CI 0.71; 0.83; I = 45%]. The adult AMH-PCOM meta-analysis (n = 7) showed a pooled sensitivity and specificity of 0.79 [95% CI 0.72; 0.85; I = 94%] and 0.87 [95% CI 0.78; 0.93; I = 94%].
CONCLUSION AND RELEVANCE
This study investigated the most profound change in the 2023 International Evidence-based PCOS Guideline, which now recommends AMH for defining PCOM in adults, in accordance with the diagnostic algorithm. AMH alone is insufficient for PCOS diagnosis and is nonspecific for PCOM in adolescents. Multiple factors influence AMH levels and caused heterogeneity and limitations in this study. Consequently, no international cut off value could be recommended, emphasizing the need for research on more individualized cut offs.
PubMed: 38944177
DOI: 10.1016/j.fertnstert.2024.05.163 -
Diseases of the Esophagus : Official... Jun 2024Hiatus hernias (HH) are a common cause of symptoms and complications, with considerable variation in anatomy, function, diagnosis and treatment. We undertook the first...
Hiatus hernias (HH) are a common cause of symptoms and complications, with considerable variation in anatomy, function, diagnosis and treatment. We undertook the first systematic review to appraise how HH are diagnosed and classified in the literature, using randomized controlled trials as a sample. A search was performed in July 2021of the PubMed, EMBASE and Cochrane Central Register of Controlled Trials, and 2832 articles were identified and 64 were included. Median Jadad score was 2. Studies demonstrated considerable variation in diagnosis, classification and minimum surgical steps. The commonest classifications before surgery were axial length and the Type I-IV classification, variably assessed by endoscopy and contrast swallow. Intra-operatively, the commonest classification was type I-IV. A minority used more than one classification, or alternatives such as defect size and Hill classification. Most studies reported minimum steps, but these varied. Only a minority reported criteria for diagnosing recurrence. Using randomized controlled trials to appraise the highest quality evidence in the literature, we found considerable variation and inconsistency in the way HH are diagnosed and classified. This lack of a 'common language' has significant impacts for the generalizability of evidence, study synthesis and design. We propose the development of an internationally accepted classification. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.
PubMed: 38944029
DOI: 10.1093/dote/doae051 -
Journal of Psychiatric Research Jun 2024Depression is a growing public health concern, and exercise is an adjunctive treatment modality to improve depression, but the optimal form of exercise and the optimal... (Review)
Review
Optimal exercise modality and dose to improve depressive symptoms in adults with major depressive disorder: A systematic review and Bayesian model-based network meta-analysis of RCTs.
Depression is a growing public health concern, and exercise is an adjunctive treatment modality to improve depression, but the optimal form of exercise and the optimal dose are still unclear. This systematic review examined the efficacy of four major types of exercise (aerobic, resistance, mixed, and mind-body) on depression, as well as the dose-response relationship between total and specific exercise and depressive symptoms. We included randomized controlled trials that included participants aged 18 years or older with a diagnosis of major depressive disorder or a depressive symptom score above a threshold as determined by a validated screening measure, implemented one or more exercise therapy groups, and assessed depressive symptoms at baseline and follow-up. Forty-six studies (3164 patients) were included in the meta-analysis. Aerobic (standardised mean difference (SMD) = -0.93; 95% CI: -1.25 to -0.62) and mind-body exercise (SMD) = -0.81; 95% CI: -1.19 to -0.42) improved depressive symptoms better compared to controls, followed by mixed (SMD = -0.77; 95% CI: -1.20 to -0.34) and resistance exercise (SMD = -0.76; 95% CI: -1.24 to -0.28). This dose-response meta-analysis showed a U-shaped curve between exercise dose and depressive symptoms. The minimum effective dose was estimated to be 320 metabolic equivalent (METs) -min per week and the optimal response was 860 METs-min per week. These findings lead us to advocate that clinicians carefully select the appropriate dose of exercise based on the patient's individual characteristics and needs, in conjunction with psychological care interventions.
PubMed: 38944017
DOI: 10.1016/j.jpsychires.2024.06.031 -
Reproductive Biomedicine Online Feb 2024In 15-30% of couples with infertility, no abnormalities are found after the initial diagnostic work-up. The aim of this study was to investigate the prevalence of... (Review)
Review
In 15-30% of couples with infertility, no abnormalities are found after the initial diagnostic work-up. The aim of this study was to investigate the prevalence of endometriosis in patients with unexplained infertility undergoing diagnostic laparoscopy in the current era of improved imaging and assisted reproductive technology. A systematic search of PubMed, Embase and Cochrane Central was conducted to identify all studies reporting on pelvic pathologies found by laparoscopy in couples diagnosed with unexplained infertility. Normal ovulatory cycles, normal semen analysis and an infertility period of ≥12 months were the minimum requirements for a study population to be included. The prevalence of endometriosis was 44%, and most lesions were classified as minimal or mild (74%). The prevalence rates of tubal factors and adhesions were 20% and 16%, respectively. The detection rate for pelvic abnormalities was higher in women with prior fertility treatment (75%) compared with women without prior fertility treatment (53%). Despite the significant improvements in imaging for the diagnosis of endometriosis and tubal factors over the last decades, the prevalence rates of endometriosis and tubal abnormalities remain high in patients with unexplained infertility. The high prevalence of endometriosis in this population is important for decision-making in patients who also suffer from pain symptoms suggestive of endometriosis.
PubMed: 38943813
DOI: 10.1016/j.rbmo.2024.103848