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Heliyon Feb 2024Drug-coated balloon (DCB) is a novel approach to avoiding stent-related complications and has proven effective for the treatment of in-stent restenosis (ISR) and small...
BACKGROUND
Drug-coated balloon (DCB) is a novel approach to avoiding stent-related complications and has proven effective for the treatment of in-stent restenosis (ISR) and small vessels. However, its role in the treatment of de novo lesions in large vessels is less settled.
AIMS
To estimate the efficacy and safety of drug-coated balloon versus stent in the treatment of de novo lesions in large coronary arteries.
METHODS
We searched the literature until April 2023. We judged the safety of DCB based on major adverse cardiovascular events (MACEs), cardiac death, all-cause mortality, non-fatal myocardial infarction, target lesion revascularization (TLR), and bleeding event; and efficacy according to late lumen loss (LLL), minimum lumen diameter (MLD). We conducted subgroup analyses according to stent type and whether urgent PCI was required.
RESULTS
A total of 10 RCTs were included. Overall, LLL (mean difference (MD) = -0.19, 95 % confidence interval (CI): -0.32 to -0.06, P = 0.003) was lower in the DCB group than in the Stent arm. This effect was consistent in subgroup analysis regardless of stent type and disease type. In terms of safety indicators, there were no significant differences between DCB and stent. The subgroup analyses found that safety indicators showed no significant differences between DCB and drug-eluting stent (DES), but TLR was lower in the DCB than in the bare metal stent (BMS). Moreover, in ST-elevation myocardial infarction (STEMI), safety indicators and LLL showed no significant differences between DCB and DES, but MLD in the DCB was smaller. While in patients with excluded STEMI, MACE and TLR was lower in the DCB compared with the overall stent.
CONCLUSIONS
DCB could be a promising alternative for treating de novo lesions in large coronary arteries with satisfactory efficacy and low risk, superior to BMS and not inferior to DES, with a trend toward lower late lumen loss.
PubMed: 38333846
DOI: 10.1016/j.heliyon.2024.e25264 -
Annals of Intensive Care Feb 2024The prevalence of hyperdynamic left ventricular (LV) systolic function in septic patients and its impact on mortality remain controversial. In this systematic review and...
PURPOSE
The prevalence of hyperdynamic left ventricular (LV) systolic function in septic patients and its impact on mortality remain controversial. In this systematic review and meta-analysis, we investigated the prevalence and association of hyperdynamic LV systolic function with mortality in patients with sepsis.
METHODS
We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. Primary outcomes were the prevalence of hyperdynamic LV systolic function in adult septic patients and the associated short-term mortality as compared to normal LV systolic function. Hyperdynamic LV systolic function was defined using LV ejection fraction (LVEF) of 70% as cutoff. Secondary outcomes were heart rate, LV end-diastolic diameter (LVEDD), and E/e' ratio.
RESULTS
Four studies were included, and the pooled prevalence of hyperdynamic LV systolic function was 18.2% ([95% confidence interval (CI) 12.5, 25.8]; I = 7.0%, P < 0.0001). Hyperdynamic LV systolic function was associated with higher mortality: odds ratio of 2.37 [95%CI 1.47, 3.80]; I = 79%, P < 0.01. No difference was found in E/e' (P = 0.43) between normal and hyperdynamic LV systolic function, while higher values of heart rate (mean difference: 6.14 beats/min [95%CI 3.59, 8.69]; I = 51%, P < 0.0001) and LVEDD (mean difference: - 0.21 cm [95%CI - 0.33, - 0.09]; I = 73%, P < 0.001) were detected in patients with hyperdynamic LV systolic function.
CONCLUSION
The prevalence of hyperdynamic LV systolic function is not negligible in septic patients. Such a finding is associated with significantly higher short-term mortality as compared to normal LV systolic function.
PubMed: 38308701
DOI: 10.1186/s13613-024-01255-9 -
Cardiovascular Drugs and Therapy Jan 2024Although a number of studies involving small-vessel de novo coronary disease showed clinical benefits of drug-coated balloons (DCB), the role of DCB in large vessel... (Review)
Review
PURPOSE
Although a number of studies involving small-vessel de novo coronary disease showed clinical benefits of drug-coated balloons (DCB), the role of DCB in large vessel lesions is still unclear.
METHODS
We searched main electronic databases for randomized controlled trials (RCTs) comparing DCB with stents for large vessel de novo coronary artery disease. The primary endpoint was major cardiovascular adverse events (MACE), composite cardiovascular death (CD), myocardial infarction (MI), or target lesion revascularization (TLR).
RESULTS
This study included 7 RCTs with 770 participants. DCB were associated with a marked risk reduction in MACE [Risk Ratio (RR): 0.48; 95% confidence interval [CI]: 0.24 to 0.97; P = 0.04], TLR (RR: 0.53; 95% CI: 0.25 to 1.14; P = 0.10), and late lumen loss [standard mean difference (SMD): -0.57; 95% CI: -1.09 to -0.05; P = 0.03] as compared with stents. There is no significant difference in MI (RR: 0.58; 95% CI: 0.21 to 1.54; P = 0.27), CD (RR: 0.33; 95% CI: 0.06 to 1.78; P = 0.19), and minimal lumen diameter (SMD: -0.34; 95% CI: -0.72 to 0.05; P = 0.08) between groups. In subgroup analyses, the risk reduction of MACE persisted in patients with chronic coronary syndrome (RR: 0.25; 95% CI: 0.07 to 0.89; P = 0.03), and patients receiving DCB vs. bare metal stent (RR: 0.19; 95% CI: 0.05 to 0.73; P = 0.01). In addition, there was no significant difference between the DCB group and the drug eluting stent group for MACE (RR: 0.69; 95% CI: 0.30 to 1.60; P = 0.38).
CONCLUSION
DCB may be an effective therapeutic option in patients with large vessel de novo coronary artery disease.
PubMed: 38270690
DOI: 10.1007/s10557-024-07548-2 -
Diagnostics (Basel, Switzerland) Jan 2024The nodule diameter was commonly used to predict the invasiveness of pulmonary adenocarcinomas in pure ground-glass nodules (pGGNs). However, the diagnostic performance... (Review)
Review
Predicting the Invasiveness of Pulmonary Adenocarcinomas in Pure Ground-Glass Nodules Using the Nodule Diameter: A Systematic Review, Meta-Analysis, and Validation in an Independent Cohort.
The nodule diameter was commonly used to predict the invasiveness of pulmonary adenocarcinomas in pure ground-glass nodules (pGGNs). However, the diagnostic performance and optimal cut-off values were inconsistent. We conducted a meta-analysis to evaluate the diagnostic performance of the nodule diameter for predicting the invasiveness of pulmonary adenocarcinomas in pGGNs and validated the cut-off value of the diameter in an independent cohort. Relevant studies were searched through PubMed, MEDLINE, Embase, and the Cochrane Library, from inception until December 2022. The inclusion criteria comprised studies that evaluated the diagnostic accuracy of the nodule diameter to differentiate invasive adenocarcinomas (IAs) from non-invasive adenocarcinomas (non-IAs) in pGGNs. A bivariate mixed-effects regression model was used to obtain the diagnostic performance. Meta-regression analysis was performed to explore the heterogeneity. An independent sample of 220 pGGNs (82 IAs and 128 non-IAs) was enrolled as the validation cohort to evaluate the performance of the cut-off values. This meta-analysis finally included 16 studies and 2564 pGGNs (761 IAs and 1803 non-IAs). The pooled area under the curve, the sensitivity, and the specificity were 0.85 (95% confidence interval (CI), 0.82-0.88), 0.82 (95% CI, 0.78-0.86), and 0.73 (95% CI, 0.67-0.78). The diagnostic performance was affected by the measure of the diameter, the reconstruction matrix, and patient selection bias. Using the prespecified cut-off value of 10.4 mm for the mean diameter and 13.2 mm for the maximal diameter, the mean diameter showed higher sensitivity than the maximal diameter in the validation cohort (0.85 vs. 0.72, < 0.01), while there was no significant difference in specificity (0.83 vs. 0.86, = 0.13). The nodule diameter had adequate diagnostic performance in differentiating IAs from non-IAs in pGGNs and could be replicated in a validation cohort. The mean diameter with a cut-off value of 10.4 mm was recommended.
PubMed: 38248024
DOI: 10.3390/diagnostics14020147 -
Asian Cardiovascular & Thoracic Annals Mar 2024Abdominal aortic aneurysm (AAA) is a cardiovascular disease characterized by a high mortality rate when ruptured. Some studies suggest a potential inverse correlation... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Abdominal aortic aneurysm (AAA) is a cardiovascular disease characterized by a high mortality rate when ruptured. Some studies suggest a potential inverse correlation between AAA and diabetes patients, especially those undergoing metformin treatment. However, this relationship remains unclear. This paper offers a systematic review and meta-analysis with the objective of clarifying the influence of metformin on AAA.
METHODS
A search for relevant articles was performed across multiple databases including PubMed, ScienceDirect, Cochrane and Scopus. The focus was on studies that examined the comparative effects of metformin and non-metformin treatments on AAA patients. Data from appropriate studies were consolidated to estimate the effects. Our study encompassed 11 articles, comprising 13 cohorts that compared metformin ( = 32,250) with a control group ( = 116,339).
RESULTS
The random effects meta-analysis revealed that metformin was associated with a slower growth rate (weighted mean difference (WMD) -0.86 mm; 95% CI: -1.21 to -0.52; < 0.01; I: 81.4%) and fewer AAA-related events (OR: 0.54; 95% CI: 0.34 to 0.86; = 0.01; I: 60.9%). The findings suggest that metformin may be linked to a reduced risk of aortic aneurysm. A meta-regression analysis indicated that the association between metformin and AAA growth was significantly influenced by male gender ( = 0.027), but not by age ( = 0.801), hypertension ( = 0.256), DM ( = 0.689), smoking history ( = 0.786), use of lipid-lowering agents ( = 0.715), or baseline diameter ( = 0.291).
CONCLUSION
These results hint at a potential role for metformin in limiting annual AAA growth, AAA-related events, and the risk of AAA.
Topics: Humans; Male; Metformin; Risk Factors; Diabetes Mellitus; Cardiovascular Diseases; Aortic Aneurysm, Abdominal
PubMed: 38239055
DOI: 10.1177/02184923231225794 -
Cureus Dec 2023Circumscribed choroidal hemangioma (CCH) is a sort of non-malignant hamartomatous tumor that occurs in the choroidal layer of the eye. It is a rare condition that... (Review)
Review
Circumscribed choroidal hemangioma (CCH) is a sort of non-malignant hamartomatous tumor that occurs in the choroidal layer of the eye. It is a rare condition that affects people between their second and fourth decades of life, leading to significant deterioration of vision. One of the most catastrophic consequences of CCH is exudative retinal detachment (ERD), which has a severe impact on vision. This review aims to comprehensively assess the safety and efficacy of photodynamic therapy (PDT) using verteporfin as a therapeutic approach. Using the eligibility criteria, we analyzed the findings of 18 published articles from PubMed, Web of Science, Scopus, and Cochrane. The standard PDT protocol was used in all included studies, except two (one used half-dose, the other one used the double-dose) with an average of 1-2 sessions. PDT induced substantial tumor regression, with a mean thickness range from 0 to 2.3 mm. However, this contrasted with a previous study that reported a thickness of 3.46 mm as an indication of PDT failure. The mean tumor diameter varied from 4.8 mm to total tumor flattening. A suboptimal effect with a mean diameter ranging from 6mm to 8mm was found in two clinical studies. Significant improvement in vision was observed during the last follow-up, ranging from a normalization of Best Corrected Visual Acuity (BCVA) 20/20 to 20/80; counting finger vision persisted in two patients even after treatment. PDT successfully achieved complete subretinal fluid (SRF) resolution in 14 studies and resolved ERD in nine articles. Most studies did not report serious adverse events, but some reported macular atrophy, microcystic degeneration of the retina, transient visual disturbances, Retinal pigmented epithelium (RPE) metaplasia, and cystic degeneration of the retina. This systemic review demonstrated PDT's effectiveness and safety as a first-line management modality for CCH. Photodynamic therapy efficiently induced tumor regression, resulting in a notable reduction in both tumor diameter and thickness, with optimal efficacy to improve vision and resolution of the consequences of CCH, such as SRF and ERD.
PubMed: 38222120
DOI: 10.7759/cureus.50461 -
Phlebology Jun 2024Third generation lasers with longer wavelengths (>1900 nm) have been introduced, in recent years, for the treatment of varicose veins. The possible advantage of the new... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Third generation lasers with longer wavelengths (>1900 nm) have been introduced, in recent years, for the treatment of varicose veins. The possible advantage of the new generation lasers is that they allow complete damage to the vein wall using a lower Power in Watts (W: J/sec) and a lower linear energy density (LEED: J/cm). The aim of this work is to evaluate the results present in the literature regarding efficacy and safeness of the new generation lasers for the treatment of varicose veins.
METHODS
Published articles were searched on PubMed database and on Cochrane Library, entering the keywords "1940 nm or 1920 nm laser AND varicose veins laser thermoablation (EVLA)." The primary endpoint of the study was to value rate of occlusion and adverse events at the short term follow-up. The search yielded a total of 14 studies. In the end, only six studies were judge eligibility.
RESULTS
The studies were heterogenous in their documentation, EVLA, duplex ultrasound protocol and result reporting. A total of 540 limbs of 377 patients were treated with endovenous laser ablation (EVLA) with laser 1920-1940 nm. The treated veins had a mean diameter of 0.74 ± 0.17 cm and a mean length of 27.87 ± 20.63 cm. The pooled estimates of immediate occlusion rate was of 99.8% (95% CI: 97.9% to 100.0) with high heterogeneity (I = 60%; 95% PI: 89.7% to 100%), while at short-term follow-up was of 98.2% (95% CI: 94.0% to 100.0%) with higher heterogeneity (I:79%; 95% PI: 77.1% to 100.0%). EHIT occurred in 7 cases (pooled estimate: 0.7%). The other adverse events rate reported were 1% of hyperpigmentation, 2.8% of neurological complications, 0.6% thrombophlebitis and 1.9% of bruising/hematoma. The pooled mean estimates of LEED was equal to 38.2 J/cm (95% CI: 26.3 to 50.1 J/cm) although with a very large heterogeneity (I = 100%).
CONCLUSIONS
The overall success rate of EVLA was high. The analysis of these studies suggests that using lower parameters (Power and linear administered energy) may have no effect on the treatment success rate. Short-term results demonstrate comparable occlusion rates respect the second-generation lasers. Instead, data suggest a low complication rates. Short-term results demonstrate comparable complications rates respect the second-generation lasers (1300-1470 nm). Randomized studies with longer follow-up are required to evaluate the EVLA 1900 nm procedure further.
Topics: Humans; Varicose Veins; Laser Therapy; Male; Female; Endovascular Procedures
PubMed: 38199976
DOI: 10.1177/02683555241227017 -
Clinical Oral Investigations Dec 2023To assess the clinical outcomes of zirconia dental implants based on an updated systematic literature review. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess the clinical outcomes of zirconia dental implants based on an updated systematic literature review.
METHODS
An electronic search was performed in three databases, last updated in June 2023, supplemented by hand searching. The eligibility criteria were clinical studies reporting patients rehabilitated with zirconia implants. The cumulative survival rate (CSR) of implants was calculated. A meta-analysis for marginal bone loss (MBL) under different follow-up times and a meta-regression assessing the relationship between mean MBL and follow-up were done.
RESULTS
Twenty-five studies were included (4017 implants, 2083 patients). Seven studies had follow-up longer than 60 months. 172 implants failed, after a mean of 12.0 ± 16.1 months (min-max 0.3-86.0), of which 47 early failures, and 26 due to implant fracture, the majority in narrow-diameter implants. The 10-year CSR was 95.1%. Implants with coronal part prepared by drills presented statistically significant lower survival than non-prepared implants (p < 0.001). Two-piece implants presented lower survival than one-piece implants (p = 0.017). Implants discontinued from the market presented lower survival than the commercially available ones (p < 0.001). The difference in survival was not significant between implants in maxilla and mandible (p = 0.637). The mean MBL fluctuated between 0.632 and 2.060 mm over long periods of observation (up until 132 months). There was an estimated MBL increase of 0.005 mm per additional month of follow-up.
CONCLUSION
Zirconia implants present high 10-year CSR and short-term low MBL. The review was registered in PROSPERO (CRD42022342055).
CLINICAL RELEVANCE
The clinical outcomes observed for zirconia dental implants are very promising, although these have not yet been extensively studied as titanium alloy implants.
Topics: Humans; Dental Implants; Treatment Outcome; Dental Restoration Failure; Zirconium; Titanium; Dental Prosthesis Design
PubMed: 38135804
DOI: 10.1007/s00784-023-05401-8 -
Frontiers in Medicine 2023The progression of early stage non-small cell lung cancer (NSCLC) is closely related to epidermal growth factor receptor (EGFR) mutation status. The purpose of this...
Distinguishing EGFR mutant subtypes in stage IA non-small cell lung cancer using the presence status of ground glass opacity and final histologic classification: a systematic review and meta-analysis.
BACKGROUND
The progression of early stage non-small cell lung cancer (NSCLC) is closely related to epidermal growth factor receptor (EGFR) mutation status. The purpose of this study was to systematically investigate the relationship between EGFR mutation status and demographic, imaging, and ultimately pathologic features in patients with NSCLC.
METHODS
A complete literature search was conducted using the PubMed, Web of Science, EMBASE, and Cochrane Library databases to discover articles published by May 15, 2023 that were eligible. The relationship between EGFR mutation status and specific demographic, imaging, and ultimately pathologic features in patients with NSCLC was evaluated using pooled odds ratios (ORs) and their 95% confidence intervals (CIs). The standardized mean difference (SMD) with 95% CIs was the appropriate statistic to summarize standard deviations (SDs) means for continuous variables.
RESULTS
A total of 9 studies with 1789 patients were included in this analysis. The final findings suggested that patients with a greater age, female gender, and non-smoking status would have a relatively higher incidence of EGFR mutations. Additionally, the risk of EGFR mutations increased with larger tumor diameter, tumor imaging presentation of mixed ground glass opacity (mGGO), and tumor pathological findings of minimally invasive adenocarcinoma (MIA) or invasive adenocarcinoma (IAC). Significantly, malignancies presenting as MIA are more likely to contain L858R point mutations (OR = 1.80; 95% CI: 1.04-3.13; = 0.04) rather than exon 19 deletions (OR = 1.81; 95% CI: 0.95-3.44; = 0.07).
CONCLUSION
This meta-analysis showed that imaging parameters and histological classifications of pulmonary nodules may be able to predict stage IA NSCLC genetic changes.
PubMed: 38126071
DOI: 10.3389/fmed.2023.1268846 -
Pakistan Journal of Pharmaceutical... Nov 2023This study assesses the efficacy and safety of dapagliflozin in Chinese patients with heart failure through a systematic review of randomized controlled trials from... (Meta-Analysis)
Meta-Analysis
This study assesses the efficacy and safety of dapagliflozin in Chinese patients with heart failure through a systematic review of randomized controlled trials from PubMed and the China National Knowledge Infrastructure databases. Focusing on 977 patients across eight trials, the meta-analysis used Review Manager 5.4.1 for data analysis. Key findings include a significant reduction in N-terminal pro-B-type natriuretic peptide levels (standardized mean difference: -2.88, 95% CI: -4.31 to -1.44, p<0.001) and an increase in left ventricular ejection fraction (weighted mean difference: 5.10, 95% CI: 2.32 to 10.32, p<0.001). However, changes in left ventricular end-diastolic diameter were not significant (weighted mean difference: -1.33, 95% CI: -2.80 to 0.15, p=0.08) and the relative risk of adverse reactions was comparable between the control and observation groups (RR: 1.17, 95% CI: 0.82 to 1.68, p=0.38). Overall, dapagliflozin demonstrates good efficacy and safety in treating heart failure in this population.
Topics: Humans; Stroke Volume; Ventricular Function, Left; Heart Failure; Benzhydryl Compounds
PubMed: 38124408
DOI: No ID Found