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Journal of Vascular Surgery May 2024Post implantation syndrome (PIS) is an early systemic inflammatory response following endovascular aortic repair (EVAR). The response is variable in patients and the...
OBJECTIVE
Post implantation syndrome (PIS) is an early systemic inflammatory response following endovascular aortic repair (EVAR). The response is variable in patients and the clinical significance of PIS upon outcomes is unknown. This study aims to evaluate the incidence, risk factors, and prognostic implication of PIS.
METHODS
Systematic literature review and analysis was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines of PubMed, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Eligible English-language studies regarding PIS after infrarenal EVAR were included, after removing duplicates.
RESULTS
After screening, 31 studies were included. A total of 2847 patients were reviewed, with mean age of 70.7 years, of which 2012 (90.4%) were male, with a pooled mean follow-up of 26.1 months. PIS was reported in 25.3% of cases, with mean aneurysm diameter of 56.4 cm. Polytetrafluoroethylene (PTFE) grafts were utilized in 794 patients (27.9%) with polyester in 1839 (64.6%). White blood cell count, C-reactive protein, interleukin (IL)-6, IL-8, and IL-10 levels were all significantly elevated postoperatively. Thirty-day outcomes included type I endoleak rate of 0.8%, type II endoleak rate of 1.7%, reintervention rate of 0.35%, and mortality rate of 0.25%. Subgroup pooled analysis of patients with PIS (n = 309) vs No-PIS (n = 691) revealed that polyester (n = 642), rather than PTFE (n = 234) grafts, were associated with a higher rate of PIS (94.8% vs 3.7%; P = .0001), White blood cell count was higher in the PIS group both preoperatively (7.61 vs 6.76 × 10/L; P = .04) and postoperatively (15.0 vs 9.8 × 10/L; P = .0007) and IL-6 levels were higher in the PIS group postoperatively (98.6 vs 25.2 pg/mL; P = .02). Aneurysm diameter and amount of chronic or new thrombus within the aneurysm sac was not identified as a risk factor for PIS. Pooled outcomes of patients with PIS vs No-PIS demonstrated a significantly higher rate of 30-day mortality (0.6% vs 0%; P = .03) and major adverse cardiac events (5.8% vs 0.43%; P < .0001) without any differences seen in reintervention or 30-day type I or type II endoleaks.
CONCLUSIONS
This systematic review suggests that polyester grafts are strongly associated with PIS compared with PTFE. Interestingly, this report is suggestive of an association between 30-day mortality and major adverse cardiac events and PIS. Given these clinical sequelae, consideration for use of PTFE over polyester grafts to reduce the incidence of PIS may be a simple step to improve overall outcome. Further, exploration of the relationship between inflammatory mediators associated with PIS and mortality and cardiac complications may engender deeper understanding of risks, leading to eventual mitigation of harm for patients experiencing PIS.
Topics: Humans; Male; Aged; Female; Endovascular Aneurysm Repair; Blood Vessel Prosthesis Implantation; Endoleak; Treatment Outcome; Aortic Aneurysm, Abdominal; Endovascular Procedures; Risk Factors; Polyesters; Polytetrafluoroethylene; Retrospective Studies
PubMed: 38122858
DOI: 10.1016/j.jvs.2023.12.029 -
Neuroradiology Feb 2024To comprehensively summarize the clinical data and CT/MRI characteristics of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA).
PURPOSE
To comprehensively summarize the clinical data and CT/MRI characteristics of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA).
METHODS
Twenty-seven lesions from 25 study articles identified through a systematic review and three lesions from our institution associated with TL-LGNPPA were evaluated.
RESULTS
The mean age of the patients at diagnosis was 35.7 years, and the male-to-female ratio was nearly half. The chief complaint was nasal obstruction, followed by epistaxis. All patients underwent excision. None of the patients had neck nodes or distant metastases. All patients survived with no locoregional/distant recurrence during 3-93 months of follow-up. All lesions were located at the posterior edge of the nasal septum, attached to the nasopharyngeal parietal wall, and showed no laterality. The mean lesion diameter was 1.7 cm. The margins of lesions were well-defined and lobulated, followed by well-defined smooth margins. None of lesions were associated with parapharyngeal space or skull base destruction. All lesions were iso- and low-density on non-contrast CT. Adjacent skull base sclerosis was detected in 63.6% of lesions. High signal intensity on T2-weighted imaging and mostly iso-signal intensity on T1-weighted imaging compared to muscle tissue. Most lesions were heterogeneous and exhibited moderate contrast enhancement. Relatively large lesions (≥1.4 cm) tended to be more lobulated than smooth margins compared to relatively small lesions (<1.4 cm) (p = 0.016).
CONCLUSION
We summarized the clinical and radiological features of TL-LGNPPA to facilitate accurate diagnosis and appropriate management.
Topics: Adult; Female; Humans; Male; Adenocarcinoma, Papillary; Magnetic Resonance Imaging; Thyroid Gland
PubMed: 38103083
DOI: 10.1007/s00234-023-03254-2 -
Pacing and Clinical Electrophysiology :... Jan 2024This meta-analysis compares His-Purkinje system pacing (HPSP), a novel cardiac resynchronization therapy (CRT) technique that targets the intrinsic conduction system of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis compares His-Purkinje system pacing (HPSP), a novel cardiac resynchronization therapy (CRT) technique that targets the intrinsic conduction system of the heart, with conventional biventricular pacing (BiVP) in heart failure (HF) patients with left ventricular (LV) dysfunction and dyssynchrony.
METHODS
We searched multiple databases up to May 2023 and identified 18 studies (five randomized controlled trials and 13 observational studies) involving 1291 patients. The outcome measures were QRS duration, left ventricular ejection fraction (LVEF) improvement, left ventricular end-diastolic diameter (LVEDD) change, HF hospitalization, and New York Heart Association (NYHA) functional class improvement. We used a random-effects model to calculate odds ratios (OR), and mean differences (MD) with 95% confidence intervals (CI). We also assessed the methodological quality of the studies.
RESULTS
The mean LVEF was 30.7% and the mean follow-up duration was 8.1 months. Among LBBP, HBP, and BiVP, HBP provided the shortest QRS duration [MD: -18.84 ms, 95% CI: -28.74 to -8.94; p = 0.0002], while LBBP showed the greatest improvement in LVEF [MD: 5.74, 95% CI: 2.74 to 7.46; p < 0.0001], LVEDD [MD: -5.55 mm, 95% CI: -7.51 to -3.59; p < 0.00001], and NYHA functional class [MD: -0.58, 95% CI: -0.80 to --0.35; p < 0.00001]. However, there was no significant difference in HF hospitalization between HPSP and BiVP.
CONCLUSION
LBBP as modality of HPSP demonstrated superior outcomes in achieving electrical ventricular synchrony and systolic function, as well as alleviating HF symptoms, compared to other pacing techniques.
Topics: Humans; Cardiac Resynchronization Therapy; Stroke Volume; Ventricular Function, Left; Treatment Outcome; Heart Failure; Bundle of His; Electrocardiography; Cardiac Pacing, Artificial
PubMed: 38071452
DOI: 10.1111/pace.14892 -
Journal of the Association of Medical... Nov 2023We sought to systematically review the existing research on pyogenic liver abscesses to determine what data exist on antibiotic treatment durations.
BACKGROUND
We sought to systematically review the existing research on pyogenic liver abscesses to determine what data exist on antibiotic treatment durations.
METHODS
We conducted a systematic review and meta-analysis of contemporary medical literature from 2000 to 2020, searching for studies of pyogenic liver abscesses. The primary outcome of interest was mean antibiotic treatment duration, which we pooled by random-effects meta-analysis. Meta-regression was performed to examine characteristics influencing antibiotic durations.
RESULTS
Sixteen studies (of 3,933 patients) provided sufficient data on antibiotic durations for pooling in meta-analysis. Mean antibiotic durations were highly variable across studies, from 8.4 (SD 5.3) to 68.9 (SD 30.3) days. The pooled mean treatment duration was 32.7 days (95% CI 24.9 to 40.6), but heterogeneity was very high ( = 100%). In meta-regression, there was a non-significant trend towards decreased mean antibiotic treatment durations over later study years (-1.14 days/study year [95% CI -2.74 to 0.45], = 0.16). Mean treatment duration was not associated with mean age of participants, percentage of infections caused by spp, percentage of patients with abscesses over 5 cm in diameter, percentage of patients with multiple abscesses, and percentage of patients receiving medical management. No randomized trials have compared treatment durations for pyogenic liver abscess, and no observational studies have reported outcomes according to treatment duration.
CONCLUSIONS
Among studies reporting on antibiotic durations for pyogenic liver abscess, treatment practices are highly variable. This variability does not seem to be explained by differences in patient, pathogen, abscess, or management characteristics. Future RCTs are needed to guide optimal treatment duration for patients with this complex infection.
PubMed: 38058494
DOI: 10.3138/jammi-2023-0004 -
Heart Rhythm O2 Nov 2023Left bundle branch area pacing (LBBAP) may offer greater physiological benefits than traditional biventricular pacing (BiVP). However, there are limited data comparing...
BACKGROUND
Left bundle branch area pacing (LBBAP) may offer greater physiological benefits than traditional biventricular pacing (BiVP). However, there are limited data comparing the efficacy of LBBAP vs BiVP in patients with systolic heart failure (HF).
OBJECTIVE
The purpose of this meta-analysis was to compare the feasibility and electromechanical and clinical outcomes of both LBBAP and BiVP.
METHODS
We conducted a systematic review of studies retrieved from various databases including PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Control Trials (CENTRAL) published up to May 22, 2023. The risk ratio (RR) and standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively.
RESULTS
We included 12 studies with a total of 3004 patients (LBBAP = 1242, BiVP = 1762). Pooled results showed that LBBAP resulted in a significant increase in left ventricular ejection fraction (SMD 0.40, 95% CI 0.25, 0.54, .00001), echocardiographic response (RR 1.19, 95% CI 1.10 to 1.29, .0001), improvement in New York Heart Association functional class (SMD -0.44, 95% CI -0.65 to -0.23, .0001), QRS duration reduction (SMD -0.90, 95% CI -1.14 to -0.66, .00001), left ventricular end-diastolic diameter reduction (SMD -0.31, 95% CI -0.57 to -0.05, .02), fewer HF hospitalizations (RR 0.72, 95% CI 0.62, 0.85, .0001), and improved survival (RR 0.73, 95% CI 0.58, 0.92, .007). In addition, LBBAP was associated with shorter fluoroscopy time (SMD -0.94, 95% CI -1.42 to -0.47, .0001) and lower pacing threshold at implantation (SMD -1.03, 95% CI -1.32 to -0.74, .00001) and at 6 months (SMD -1.44, 95% CI -2.11 to -0.77, .0001) as compared with BiVP.
CONCLUSION
Compared with BiVP, LBBAP was associated with better electromechanical and clinical outcomes, including left ventricular ejection fraction, QRS duration, echocardiographic response, New York Heart Association functional class, HF hospitalization, and all-cause mortality in patients with systolic HF.
PubMed: 38034886
DOI: 10.1016/j.hroo.2023.06.011 -
Cardiovascular Journal of Africa Nov 2023As the impact of angiotensin receptor/neprilysin inhibitor (ARNI) on cardiac function in acute myocardial infarction (AMI) patients is unclear in clinical therapy, we...
AIM
As the impact of angiotensin receptor/neprilysin inhibitor (ARNI) on cardiac function in acute myocardial infarction (AMI) patients is unclear in clinical therapy, we conducted this research to investigate the actual effects of improving cardiac function with ARNI in AMI patients.
METHODS
Publications were checked up to June 2022. Standardised mean differences (SMD) and 95% confidence intervals (CI) were utilised for assessing the size of the effect of continuous variables. To assess the magnitude of the effect of dichotomous variables, a relative risk (RR) with 95% CI was used.
RESULTS
ARNI could improve left ventricular ejection fraction (SMD = 0.40; 95% CI: 0.23 - 0.58), while lowering left ventricular end-diastolic volume (SMD = -0.43, 95% CI: -0.78 to -0.08), left ventricular end-systolic volume (SMD = -0.39, 95% CI: -0.66 to -0.11) and left ventricular enddiastolic diameter (SMD = -0.49; 95% CI: -0.65 to -0.33). Besides, it could decrease the rates of major adverse cardiac events (RR = 0.55; 95% CI: 0.43 - 0.69) and heart failure (RR = 0.42; 95% CI: 0.31 - 0.58).
CONCLUSION
ARNI could greatly improve cardiac function in AMI patients.
PubMed: 38032681
DOI: 10.5830/CVJA-2023-028 -
European Journal of Vascular and... Apr 2024Large abdominal aortic aneurysms (AAAs) present a significant mortality risk. While numerous medical interventions have been proposed, no drugs have convincingly reduced... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Large abdominal aortic aneurysms (AAAs) present a significant mortality risk. While numerous medical interventions have been proposed, no drugs have convincingly reduced AAA progression, rupture rates, or repair risk. This systematic review and meta-analysis aimed to assess the impact of re-purposed drugs or dietary supplements on slowing expansion rates, reducing the risk of rupture, or minimising the risk of repair for individuals with AAA.
METHODS
A systematic search was conducted in five databases. Both observational studies and randomised controlled trials were included. Unpublished data from two screening trials were incorporated. Risk of bias was assessed using the Newcastle-Ottawa scale and revised Cochrane risk of bias tool. Meta-analyses were performed for each identified drug subclass and were stratified by overall risk of bias. Results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Of 7 484 screened studies, 39 met the inclusion criteria. No studies on dietary supplements were included. A total of 84 cohorts were derived from the included studies, and twelve distinct drug groups underwent meta-analyses. Two drug groups, metformin and statins, were statistically significant in slowing AAA growth. No low risk of bias studies were included for these two drug groups, and the results had very high heterogeneity (I > 80%). Both groups had a GRADE certainty of very low. Metformin, excluding high risk of bias studies, presented an estimated mean growth difference of AAA diameter between users and non-users of -0.73 mm/year, whilst statins had an overall estimated mean difference of -0.84 mm/year.
CONCLUSION
This systematic review and meta-analysis suggests that metformin and statins may provide some effect in slowing AAA progression. However, no definitive evidence was found for any of the investigated drugs included in this study. Further research is needed to identify effective medical treatments for AAA progression with more robust methodology.
Topics: Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Metformin; Aortic Aneurysm, Abdominal
PubMed: 38013062
DOI: 10.1016/j.ejvs.2023.11.037 -
Current Problems in Cardiology Feb 2024To evaluate the effect of exercise rehabilitation on the left ventricular (LV) function in patients with heart failure (HF). (Meta-Analysis)
Meta-Analysis Review
AIMS
To evaluate the effect of exercise rehabilitation on the left ventricular (LV) function in patients with heart failure (HF).
METHODS
PubMed, Cochrane Library and Embase were searched until May 2023. Randomized controlled trials (RCTs) providing data on changes in LV function, comparing exercise to no-exercise controls with HF of any type, were included.
RESULTS
A total of 16 studies including 1443 participants were included. LV end-diastolic diameter (LVEDD) was significantly improved in the exercise group [mean differences (MD), -2.67; 95 % confidence interval (CI) (-4.88, -0.46); P=0.02], but left atrial volume index (LAVI), left ventricular end-systolic diameter (LVESD), E/e' E/A, end-diastolic volume (EDV), end-systolic volume (ESV), left ventricular ejection fraction (LVEF) and LV mass were unaltered compared to the non-exercise group. High intensity interval training (HIIT) or with moderate exercise (MT) led to improvement in LVEDD [MD, 3.62; 95 %CI (2.55, 4.69); P<0.00001], but not LAVI, E/e' and E/A. Sensitivity and subgroup analyses showed that the location, the type of HF and study duration may be the source of heterogeneity in LVEF. Age appears to be a source of heterogeneity in EDV and ESV. The Egger test indicated no significant publication bias.
CONCLUSIONS
Exercise can partially improve LV function in patients with HF, with improvements appearing to be dependent on study quality, the type of HF, and race. However, there are some indicators that do not seem to improve or are even worse than the control group. Among all exercise modalities, HIIT shows the greatest benefit for HF patients.
Topics: Humans; Ventricular Function, Left; Cardiac Rehabilitation; Heart Failure; Stroke Volume; Exercise Therapy
PubMed: 37993005
DOI: 10.1016/j.cpcardiol.2023.102210 -
Pacing and Clinical Electrophysiology :... Jan 2024This meta-analysis evaluated long-term efficacy and safety of cryoballoon ablation (CB) of atrial fibrillation (AF). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This meta-analysis evaluated long-term efficacy and safety of cryoballoon ablation (CB) of atrial fibrillation (AF).
METHODS
PubMed, Cochrane Library, and Web of Science were searched until July 31, 2023, for published works investigating efficacy and safety of CB of AF in which mean/median follow-up time was not less than 36 months. Safety was assessed by adverse events. Efficacy was assessed by AF recurrence, defined as any atrial arrhythmias lasting more than 30 s.
RESULTS
A total of 19 clinical studies were included. After an average of 58.1 months of follow-up, the overall AF recurrence rate was about 37%. The predictors of recurrence were duration of AF (HR 1.00; 95% CI [1.00 ∼ 1.01]), early recurrence of atrial fibrillation (HR 3.96; 95%CI [1.12 ∼ 14.02]), left atrial diameter (HR 1.04; 95%CI [1.02 ∼ 1.06]), and persistent AF (HR1.47; 95% CI [1.19 ∼ 1.82]). In terms of safety, the incidence of transient phrenic paralysis (PNP) was the highest, about 3%; followed by vascular complications (about 2%); pseudoaneurysm, permanent PNP, and all-cause death was (about 1%); and pericardial effusion and stroke / TIA was very low.
CONCLUSION
CB is associated with low rates of severe complications and reasonable success rates.
Topics: Humans; Atrial Fibrillation; Cryosurgery; Treatment Outcome; Pulmonary Veins; Recurrence; Catheter Ablation
PubMed: 37988273
DOI: 10.1111/pace.14881 -
Obstetrics and Gynecology Jan 2024To estimate the effect of medical management on the size of ovarian endometriomas. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the effect of medical management on the size of ovarian endometriomas.
DATA SOURCE
Online databases were searched from inception to October 2022, including Ovid MEDLINE, Ovid EMBASE, PubMed, EBM Reviews-Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and Web of Science.
METHODS OF STUDY SELECTION
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we included all English-language, full-text articles that reported on change in endometrioma size (either diameter or volume) after medical interventions. Studies evaluating surgical interventions or postoperative recurrence were excluded. All screening and data extraction were performed independently by two authors. Risk of bias assessment was performed with either the Cochrane Risk of Bias Tool for randomized controlled trials or a modified Newcastle-Ottawa Scale for observational studies.
TABULATION, INTEGRATION, AND RESULTS
After removal of duplicates, 9,332 studies were screened, with 33 full-text articles deemed eligible for inclusion. In the meta-analysis, dienogest showed significant reduction in cyst diameter (reduction 1.32 cm, 95% CI, 0.91-1.73, eight studies, n=418 cysts) and volume (mean difference of log-transformed volume 1.35, 95% CI, 0.87-1.83, seven studies, n=282 cysts). Similarly, significant reductions were seen with the oral contraceptive pill (OCP) (1.06 cm, 95% CI, 0.59-1.53, nine studies, n=455), gonadotropin-releasing hormone (GnRH) agonists (1.17 cm, 95% CI, 0.42-1.92, four studies, n=128 cysts), norethindrone acetate (0.6 cm, 95% CI, 0.27-0.94, two studies, n=88 cysts), and danazol (1.95 cm, 95% CI, 1.18-2.73, two studies, n=34 cysts). Norethindrone acetate with aromatase inhibitor was also effective in reducing endometrioma volume (mean difference of log-transformed volume 1.47, 95% CI, 0.16-2.78, two studies, n=34 cysts).
CONCLUSION
Medical management with dienogest, OCPs, GnRH agonists, norethindrone acetate, norethindrone acetate with aromatase inhibitor, or danazol can reduce the size of ovarian endometriomas.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD 42022363319.
Topics: Female; Humans; Endometriosis; Danazol; Norethindrone Acetate; Aromatase Inhibitors; Gonadotropin-Releasing Hormone; Cysts
PubMed: 37944155
DOI: 10.1097/AOG.0000000000005444