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Urology Jun 2024To determine whether neoadjuvant gemcitabine and cisplatin (GC) vs dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) before radical cystectomy... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether neoadjuvant gemcitabine and cisplatin (GC) vs dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) before radical cystectomy improves overall survival (OS), progression-free survival (PFS), and pathologic complete response (pCR) for patients with muscle-invasive bladder cancer with secondary analyses of pathological downstaging and toxicity.
MATERIALS AND METHODS
This systematic review and meta-analysis identified studies of patients with muscle-invasive bladder cancer treated with neoadjuvant GC compared to ddMVAC from PubMed, Web of Science, and EMBASE. Random-effect models for pooled log-transformed hazard ratios (HR) for OS and PFS and pooled odds ratios for pCR and downstaging were developed using the generic inverse variance method and Mantel-Haenszel method, respectively.
RESULTS
Ten studies were identified (4 OS, 2 PFS, and 6 pCR clinical endpoints). Neoadjuvant ddMVAC improved OS (HR 0.71 [95% confidence intervals 0.56; 0.90]), PFS (HR 0.76 [95% confidence intervals 0.60; 0.97]), and pathological downstaging (odds ratio 1.34 [95% confidence interval 1.01; 1.78]) as compared to GC. There was no significant difference between regimens for pCR rates (odds ratio 1.38 [95% confidence interval 0.90; 2.12]). Treatment toxicity was greater with ddMVAC. Limitations result from differences in number of ddMVAC cycles and patient selection between studies.
CONCLUSION
Neoadjuvant ddMVAC is associated with improved OS and PFS vs gemcitabine/cisplatin for patients with muscle-invasive bladder cancer before radical cystectomy. Although rates of pathological complete response were not significantly different, pathological downstaging correlated with OS. ddMVAC should be preferred over gemcitabine/cisplatin for patients with muscle-invasive bladder cancer who can tolerate its greater toxicity.
Topics: Urinary Bladder Neoplasms; Humans; Cisplatin; Neoadjuvant Therapy; Neoplasm Invasiveness; Antineoplastic Combined Chemotherapy Protocols; Gemcitabine; Deoxycytidine; Cystectomy; Doxorubicin; Vinblastine; Methotrexate; Chemotherapy, Adjuvant
PubMed: 38685388
DOI: 10.1016/j.urology.2024.04.034 -
Journal of Clinical Nursing Apr 2024Ascertain the impact of mandated use of early warning systems (EWSs) on the development of registered nurses' higher-order thinking. (Review)
Review
AIM
Ascertain the impact of mandated use of early warning systems (EWSs) on the development of registered nurses' higher-order thinking.
DESIGN
A systematic literature review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist (Page et al., 2021).
DATA SOURCES
CINAHL, Medline, Embase, PyscInfo.
REVIEW METHODS
Eligible articles were quality appraised using the MMAT tool. Data extraction was conducted independently by four reviewers. Three investigators thematically analysed the data.
RESULTS
Our review found that EWSs can support or suppress the development of nurses' higher-order thinking. EWS supports the development of higher-order thinking in two ways; by confirming nurses' subjective clinical assessment of patients and/or by providing a rationale for the escalation of care. Of note, more experienced nurses expressed their view that junior nurses are inhibited from developing effective higher-order thinking due to reliance on the tool.
CONCLUSION
EWSs facilitate early identification of clinical deterioration in hospitalised patients. The impact of EWSs on the development of nurses' higher-order thinking is under-explored. We found that EWSs can support and suppress nurses' higher-order thinking. EWS as a supportive factor reinforces the development of nurses' heuristics, the mental shortcuts experienced clinicians call on when interpreting their subjective clinical assessment of patients. Conversely, EWS as a suppressive factor inhibits the development of nurses' higher-order thinking and heuristics, restricting the development of muscle memory regarding similar presentations they may encounter in the future. Clinicians' ability to refine and expand on their catalogue of heuristics is important as it endorses the future provision of safe and effective care for patients who present with similar physiological signs and symptoms.
IMPACT
This research impacts health services and education providers as EWS and nurses' development of higher-order thinking skills are essential aspects of delivering safe, quality care.
NO PATIENT OR PUBLIC CONTRIBUTION
This is a systematic review, and therefore, comprises no contribution from patients or the public.
PubMed: 38661093
DOI: 10.1111/jocn.17178 -
Journal of Cachexia, Sarcopenia and... Apr 2024Cachexia, with weight loss (WL) as a major component, is highly prevalent in patients with cancer and indicates a poor prognosis. The primary objective of this study was... (Review)
Review
Cachexia, with weight loss (WL) as a major component, is highly prevalent in patients with cancer and indicates a poor prognosis. The primary objective of this study was to conduct a meta-analysis to estimate the risk of mortality associated with cachexia (using established WL criteria prior to treatment initiation) in patients with non-small-cell lung cancer (NSCLC) in studies identified through a systematic literature review. The review was conducted according to PRISMA guidelines. Embase® and PubMed were searched to identify articles on survival outcomes in adult patients with NSCLC (any stage) and cachexia published in English between 1 January 2016 and 10 October 2021. Two independent reviewers screened titles, abstracts and full texts of identified records against predefined inclusion/exclusion criteria. Following a feasibility assessment, a meta-analysis evaluating the impact of cachexia, defined per the international consensus criteria (ICC), or of pre-treatment WL ≥ 5% without a specified time interval, on overall survival in patients with NSCLC was conducted using a random-effects model that included the identified studies as the base case. The impact of heterogeneity was evaluated through sensitivity and subgroup analyses. The standard measures of statistical heterogeneity were calculated. Of the 40 NSCLC publications identified in the review, 20 studies that used the ICC for cachexia or reported WL ≥ 5% and that performed multivariate analyses with hazard ratios (HRs) or Kaplan-Meier curves were included in the feasibility assessment. Of these, 16 studies (80%; n = 6225 patients; published 2016-2021) met the criteria for inclusion in the meta-analysis: 11 studies (69%) used the ICC and 5 studies (31%) used WL ≥ 5%. Combined criteria (ICC plus WL ≥ 5%) were associated with an 82% higher mortality risk versus no cachexia or WL < 5% (pooled HR [95% confidence interval, CI]: 1.82 [1.47, 2.25]). Although statistical heterogeneity was high (I = 88%), individual study HRs were directionally aligned with the pooled estimate, and there was considerable overlap in CIs across included studies. A subgroup analysis of studies using the ICC (HR [95% CI]: 2.26 [1.80, 2.83]) or WL ≥ 5% (HR [95% CI]: 1.28 [1.12, 1.46]) showed consistent findings. Assessments of methodological, clinical and statistical heterogeneity indicated that the meta-analysis was robust. Overall, this analysis found that ICC-defined cachexia or WL ≥ 5% was associated with inferior survival in patients with NSCLC. Routine assessment of both weight and weight changes in the oncology clinic may help identify patients with NSCLC at risk for worse survival, better inform clinical decision-making and assess eligibility for cachexia clinical trials.
PubMed: 38650388
DOI: 10.1002/jcsm.13477 -
Sports Medicine - Open Apr 2024Branched-chain amino acid (BCAA) supplementation is one of the most popular strategies used by the general population and athletes to reduce muscle soreness and...
Attenuating Muscle Damage Biomarkers and Muscle Soreness After an Exercise-Induced Muscle Damage with Branched-Chain Amino Acid (BCAA) Supplementation: A Systematic Review and Meta-analysis with Meta-regression.
BACKGROUND
Branched-chain amino acid (BCAA) supplementation is one of the most popular strategies used by the general population and athletes to reduce muscle soreness and accelerate the recovery process of muscle damage biomarkers after an intense exercise or training session.
OBJECTIVES
This systematic review and meta-analysis investigated the effects of BCAA supplementation on muscle damage biomarkers and muscle soreness after exercise-induced muscle damage (EIMD).
METHODS
The systematic literature search for randomized controlled trials was conducted using seven databases, up to September 13th, 2022. The eligibility criteria for selecting studies were as follows: studies performed on healthy active participants, using BCAA at least once, controlled with a placebo or control group, performing resistance or endurance exercises, and followed up at least once post-EIMD. The methodological quality of the studies was assessed using the "SIGN RCT checklist". Random-effects meta-analyses were processed to compute the standardized mean difference (Hedges' g). Meta-regression analyses were completed with daily and total dosage and supplementation as continuous moderator variables.
RESULTS
Of the 18 studies included in this meta-analysis, 13 were of high quality and five were of acceptable quality. Our results revealed BCAA supplementation elicits a significant effect on reducing creatine kinase (CK) levels immediately (g = - 0.44; p = 0.006) and 72 h (g = - 0.99; p = 0.002), but not 24 h, 48 h, and 96 h post-EIMD. Additionally, a significant effect on delayed onset of muscle soreness (DOMS) was identified at 24 h (g = - 1.34; p < 0.001), 48 h (g = - 1.75; p < 0.001), 72 h (g = - 1.82; p < 0.001), and 96 h (g = - 0.82; p = 0.008), but not immediately post-EIMD. No significant effect was found on lactate dehydrogenase (LDH) levels at any time point. Meta-regression indicated higher daily and total dosages of BCAA, and longer supplementation periods were related to the largest beneficial effects on CK (total dosage and supplementation period) at 48 h, and on DOMS at 24 h (only daily dosage).
CONCLUSION
The overall effects of BCAA supplementation could be considered useful for lowering CK and DOMS after EIMD, but not LDH. The longer supplementation period prior to the EIMD could be more effective for CK and DOMS reduction.
PubMed: 38625669
DOI: 10.1186/s40798-024-00686-9 -
Nutrients Mar 2024Melatonin (N-acetyl-5 methoxytryptamine) is an indolic neurohormone that modulates a variety of physiological functions due to its antioxidant, anti-inflammatory, and... (Review)
Review
Melatonin (N-acetyl-5 methoxytryptamine) is an indolic neurohormone that modulates a variety of physiological functions due to its antioxidant, anti-inflammatory, and immunoregulatory properties. Therefore, the purpose of this study was to critically review the effects of melatonin supplementation in sports performance and circulating biomarkers related to the health status of highly trained athletes. Data were obtained by performing searches in the following three bibliography databases: Web of Science, PubMed, and Scopus. The terms used were "Highly Trained Athletes", "Melatonin", and "Sports Performance", "Health Biomarkers" using "Humans" as a filter. The search update was carried out in February 2024 from original articles published with a controlled trial design. The PRISMA rules, the modified McMaster critical review form for quantitative studies, the PEDro scale, and the Cochrane risk of bias were applied. According to the inclusion and exclusion criteria, 21 articles were selected out of 294 references. The dose of melatonin supplemented in the trials ranged between 5 mg to 100 mg administered before or after exercise. The outcomes showed improvements in antioxidant status and inflammatory response and reversed liver damage and muscle damage. Moderate effects on modulating glycemia, total cholesterol, triglycerides, and creatinine were reported. Promising data were found regarding the potential benefits of melatonin in hematological biomarkers, hormonal responses, and sports performance. Therefore, the true efficiency of melatonin to directly improve sports performance remains to be assessed. Nevertheless, an indirect effect of melatonin supplementation in sports performance could be evaluated through improvements in health biomarkers.
Topics: Humans; Melatonin; Antioxidants; Randomized Controlled Trials as Topic; Athletic Performance; Athletes; Biomarkers; Dietary Supplements
PubMed: 38613044
DOI: 10.3390/nu16071011 -
Sports Medicine - Open Apr 2024Previous studies reported differences in genotype frequency of the ACTN3 R577X polymorphisms (rs1815739; RR, RX and XX) in athletes and non-athletic populations. This...
BACKGROUND
Previous studies reported differences in genotype frequency of the ACTN3 R577X polymorphisms (rs1815739; RR, RX and XX) in athletes and non-athletic populations. This systematic review with meta-analysis assessed ACTN3 R577X genotype frequencies in power versus endurance athletes and non-athletes.
METHODS
Five electronic databases (PubMed, Web of Science, Scopus, Science Direct, SPORTDiscus) were searched for research articles published until December 31st, 2022. Studies were included if they reported the frequency of the ACTN3 R577X genotypes in power athletes (e.g., weightlifters) and if they included a comparison with endurance athletes (e.g., long-distance runners) or non-athletic controls. A meta-analysis was then performed using either fixed or random-effects models. Pooled odds ratios (OR) were determined. Heterogeneity was detected using I and Cochran's Q tests. Publication bias and sensitivity analysis tests were computed.
RESULTS
After screening 476 initial registrations, 25 studies were included in the final analysis (13 different countries; 14,541 participants). In power athletes, the RX genotype was predominant over the two other genotypes: RR versus RX (OR 0.70; 95% CI 0.57-0.85, p = 0.0005), RR versus XX (OR 4.26; 95% CI 3.19-5.69, p < 0.00001), RX versus XX (OR 6.58; 95% CI 5.66-7.67, p < 0.00001). The R allele was higher than the X allele (OR 2.87; 95% CI 2.35-3.50, p < 0.00001) in power athletes. Additionally, the frequency of the RR genotype was higher in power athletes than in non-athletes (OR 1.48; 95% CI 1.25-1.75, p < 0.00001). The RX genotype was similar in both groups (OR 0.84; 95% CI 0.71-1.00, p = 0.06). The XX genotype was lower in power athletes than in controls (OR 0.73; 95% CI 0.64-0.84, p < 0.00001). Furthermore, the R allele frequency was higher in power athletes than in controls (OR 1.28; 95% CI 1.19-1.38, p < 0.00001). Conversely, a higher frequency of X allele was observed in the control group compared to power athletes (OR 0.78; 95% CI 0.73-0.84, p < 0.00001). On the other hand, the frequency of the RR genotype was higher in power athletes than in endurance athletes (OR 1.27; 95% CI 1.09-1.49, p = 0.003). The frequency of the RX genotype was similar in both groups (OR 1.07; 95% CI 0.93-1.24, p = 0.36). In contrast, the frequency of the XX genotype was lower in power athletes than in endurance athletes (OR 0.63; 95% CI 0.52-0.76, p < 0.00001). In addition, the R allele was higher in power athletes than in endurance athletes (OR 1.32; 95% CI 1.11-1.57, p = 0.002). However, the X allele was higher in endurance athletes compared to power athletes (OR 0.76; 95% CI 0.64-0.90, p = 0.002). Finally, the genotypic and allelic frequency of ACTN3 genes were similar in male and female power athletes.
CONCLUSIONS
The pattern of the frequencies of the ACTN3 R577X genotypes in power athletes was RX > RR > XX. However, the RR genotype and R allele were overrepresented in power athletes compared to non-athletes and endurance athletes. These data suggest that the RR genotype and R allele, which is associated with a normal expression of α-actinin-3 in fast-twitch muscle fibers, may offer some benefit in improving performance development in muscle strength and power.
PubMed: 38609671
DOI: 10.1186/s40798-024-00711-x -
Journal of Strength and Conditioning... Jul 2024Ramos-Campo, DJ, Benito-Peinado, PJ, Caravaca, LA, Rojo-Tirado, MA, and Rubio-Arias, JÁ. Efficacy of split versus full-body resistance training on strength and muscle... (Meta-Analysis)
Meta-Analysis
Ramos-Campo, DJ, Benito-Peinado, PJ, Caravaca, LA, Rojo-Tirado, MA, and Rubio-Arias, JÁ. Efficacy of split versus full-body resistance training on strength and muscle growth: a systematic review with meta-analysis. J Strength Cond Res 38(7): 1330-1340, 2024-No previous study has systematically compared the effect of 2 resistance training routines commonly used to increase muscle mass and strength (i.e., split [Sp] and full-body [FB] routines). Our objective was to conduct a systematic review and meta-analysis following PRISMA guidelines to compare the effects on strength gains and muscle growth in healthy adults. 14 studies (392 subjects) that compared Sp and FB routines in terms of strength adaptations and muscle growth were included. Regarding the effects of the Sp or FB routine on both bench press and lower limbs strength, the magnitude of the change produced by both routines was similar (bench press: mean difference [MD] = 1.19; [-1.28, 3.65]; p = 0.34; k = 14; lower limb: MD = 2.47; [-2.11, 7.05]; p = 0.29; k = 14). Concerning the effect of the Sp vs. FB routine on muscle growth, similar effects were observed after both routines in the cross-sectional area of the elbow extensors (MD = 0.30; [-2.65, 3.24]; p = 0.84; k = 4), elbow flexors (MD = 0.17; [-2.54, 2.88]; p = 0.91; k = 5), vastus lateralis (MD = -0.08; [-1.82, 1.66]; p = 0.93; k = 5), or lean body mass (MD = -0.07; [-1.59, 1.44]; p = 0.92; k = 6). In conclusion, the present systematic review and meta-analysis provides solid evidence that the use of Sp or FB routines within a resistance training program does not significantly impact either strength gains or muscle hypertrophy when volume is equated. Consequently, individuals are free to confidently select a resistance training routine based on their personal preferences.
Topics: Humans; Resistance Training; Muscle Strength; Muscle, Skeletal; Lower Extremity; Muscle Development
PubMed: 38595233
DOI: 10.1519/JSC.0000000000004774 -
Sports Health Apr 2024Nontraumatic knee conditions are common in clinical practice. Existing pharmaceutical and immobilization approaches provide limited pain relief and functional... (Review)
Review
CONTEXT
Nontraumatic knee conditions are common in clinical practice. Existing pharmaceutical and immobilization approaches provide limited pain relief and functional enhancement. Low-intensity bloodflow restriction training (LI-BFRT) is being investigated as a nonpharmacological alternative; however, its efficacy is uncertain.
OBJECTIVE
To assess the effectiveness of LI-BFRT for nontraumatic knee conditions and compare it with high-intensity resistance training (HI-RT) and low-intensity resistance training (LI-RT).
DATA SOURCES
PubMed, EBSCO, Science Direct, Cochrane Library, China Knowledge Infrastructure, Wanfang Data, and VIP databases were searched until May 30, 2023.
STUDY SELECTION
Original randomized controlled trials involving nontraumatic knee joint conditions with interventions consisting mainly of LI-BFRT, HI-RT, or LI-RT. The results assessed mainly pain and muscle performance.
STUDY DESIGN
Systematic review and meta-analysis.
LEVEL OF EVIDENCE
Level 1.
DATA EXTRACTION
Sample characteristics, study design, country, disease, groups, evaluation time, duration, and outcomes were extracted.
RESULTS
A total of 13 randomized controlled trials were included in the systematic review. Compared with pretreatment, LI-BFRT significantly alleviated pain (weighted standardized mean difference [SMD], -1.33; 95% CI, -1.62 to -1.05), with better additional effects on hip muscle training (SMD, -3.14; 95% CI, -4.07 to -2.75). Compared with LI-RT, LI-BFRT significantly relieved pain in male patients (SMD, -1.47; 95% CI, -1.92 to -1.01). LI-BFRT significantly increased quadriceps cross-sectional area (SMD, 0.53; 95% CI, 0.27-0.78), knee extension strength (SMD, 0.84; 95% CI, 0.48-1.2), and leg press strength (SMD, 0.64; 95% CI, 0.34-0.94) compared with pretreatment. Its effects were superior to those of LI-RT and similar to those of HI-RT. However, sex differences in muscle strength improvement were observed.
CONCLUSION
In patients with nontraumatic knee joint conditions, LI-BFRT effectively alleviated pain, increased muscle cross-sectional area, and enhanced muscle strength. LI-BFRT showed pain relief comparable with that of LI-RT while surpassing LI-RT in muscle growth and strength improvement.
PubMed: 38587041
DOI: 10.1177/19417381241235147 -
Journal of Oral Rehabilitation Jul 2024The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant... (Review)
Review
INTRODUCTION
The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant for both patients and healthcare professionals. Clinicians and researchers have been encouraged to develop and apply core outcome sets (COS) to minimise the discrepancy between studies.
AIM
This systematic review is the first phase of the COS development project for clinical trials in temporomandibular disorders (COS-TMD). It aims to identify and synthesise the outcomes used in the randomised controlled trials (RCT) that evaluated the effectiveness of interventions used in TMD management.
MATERIALS AND METHODS
An electronic search was performed in several databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library and EMBASE. The eligibility criteria comprised RCT that applied any intervention to treat temporomandibular joint disorders or masticatory muscle disorders. The identified outcomes were categorised according to domains of the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT).
RESULTS
The electronic search resulted in 1606 studies. After removing duplicates and applying the eligibility criteria, 106 RCT were included. A total of 43 studies evaluated masticatory muscle disorders, 27 evaluated temporomandibular joint disorders, and 36 analysed mixed TMD.
CONCLUSIONS
The evaluation showed significant variability in the types of outcomes and their measurement instruments. In addition, some domains such as physical and emotional functioning, participant ratings of global improvement and adverse events have been neglected when determining the effectiveness of treatments for TMD.
Topics: Humans; Temporomandibular Joint Disorders; Outcome Assessment, Health Care; Treatment Outcome; Randomized Controlled Trials as Topic; Pain Measurement
PubMed: 38572886
DOI: 10.1111/joor.13692 -
Pediatric Physical Therapy : the... Apr 2024To investigate the effects of inspiratory strength training on respiratory muscle strength, pulmonary function, and walking capacity in children with cerebral palsy,... (Meta-Analysis)
Meta-Analysis
PURPOSE
To investigate the effects of inspiratory strength training on respiratory muscle strength, pulmonary function, and walking capacity in children with cerebral palsy, with Gross Motor Function Classification System I to III.
METHODS
Searches were conducted in CINAHL, LILACS, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases. The outcomes of interest were respiratory muscle strength, pulmonary function, and walking capacity. The quality was assessed by PEDro Scale. The Grading of Recommendations Assessment, Development, and Evaluation system was used to summarize the quality of evidence.
RESULTS
Inspiratory strength training increased the strength of inspiratory muscles and may increase the strength of the expiratory muscles. No changes were observed in pulmonary function or walking capacity.
CONCLUSIONS
This systematic review provides moderate-quality evidence that inspiratory strength training is effective for increasing inspiratory muscle strength in children with cerebral palsy. Benefits may be carried over to improving expiratory muscle strength but were not observed on pulmonary function or walking capacity.
Topics: Child; Humans; Cerebral Palsy; Walking; Muscle Strength; Resistance Training
PubMed: 38568267
DOI: 10.1097/PEP.0000000000001092