-
Medicine Jun 2024Neutrophil to lymphocyte ratio (NLR) has been considered a prognostic biomarker of mortality and other major cardiac events. This study investigates NLR's efficacy in... (Meta-Analysis)
Meta-Analysis
Neutrophil to lymphocyte ratio as a prognostic marker for cardiovascular outcomes in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention: A systematic review and meta-analysis.
BACKGROUND
Neutrophil to lymphocyte ratio (NLR) has been considered a prognostic biomarker of mortality and other major cardiac events. This study investigates NLR's efficacy in predicting in-hospital and long-term outcomes in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).
METHODS
Electronic databases (PUBMED, Cochrane CENTRAL, ERIC, Embase, Ovid, and Google Scholar) were searched till June 2022 to identify studies having STEMI patients who underwent PCI. Risk ratios and mean differences (MDs), along with their corresponding 95% confidence intervals (Cis) and standard deviations (SDs), were pooled using a random-effect model. This meta-analysis has been registered on Prospero (ID: CRD42022344072).
RESULTS
A total of 35 studies with 28,756 patients were included. Pooled estimates revealed an increased incidence of primary outcomes; in-hospital all-cause mortality (RR = 3.52; 95% CI = 2.93-4.24), long-term all-cause mortality (HR = 1.07; 95% CI = 1.00-1.14), (RR = 3.32; 95% CI = 2.57-4.30); in-hospital cardiovascular mortality (RR = 2.66; 95% CI = 2.04-3.48), long-term cardiovascular mortality (RR = 6.67; 95% CI = 4.06-10.95); in-hospital major adverse cardiovascular events (MACE) (RR = 1.31; 95% CI = 1.17-1.46), long-term MACE (RR = 2.92; 95% CI = 2.16-3.94); length of hospital stay (WMD = 0.60 days; 95% CI = 0.40-0.79) in patients with high NLR compared to those with a low NLR.
CONCLUSION
NLR might be a valuable tool for prognostication (in-hospital) and stratification of patients with STEMI who underwent PCI.
Topics: Humans; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Neutrophils; Prognosis; Lymphocytes; Biomarkers; Lymphocyte Count; Hospital Mortality
PubMed: 38941418
DOI: 10.1097/MD.0000000000038692 -
Medicine Jun 2024Healthy eating and weight control are recommended for cancer survivors; however, dietary interventions are not routinely offered to them. This study aimed to assess the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Healthy eating and weight control are recommended for cancer survivors; however, dietary interventions are not routinely offered to them. This study aimed to assess the effects of dietary interventions on survival, nutritional status, morbidity, dietary changes, health-related quality of life (QOL), and clinical measures in cancer survivors.
METHODS
Searches were conducted from October 1, 2018 to November 21, 2011 in the Medline, EMBASE, CENTRAL, Emcare, and DARE electronic databases. We included randomized controlled trials (RCTs) that involved individuals diagnosed with cancer, excluding conference abstracts, case studies, other reviews, and meta-analyses, and screened the articles.
RESULTS
Eight studies were included in this meta-analysis. We observed significant improvements in QOL and clinical data in 3 of 6 studies and in one study, respectively, significant weight loss on anthropometry in 2 of 5 studies, and dietary improvement in 4 of 5 studies of adult cancer survivors. However, we did not observe any benefits of dietary intervention for cancer survivors with undernutrition.
DISCUSSION
Dietary interventions for adult cancer survivors might contribute to improving their nutritional status; however, further clarification requires a study that standardizes the intervention method. Furthermore, RCTs are required to determine the effects on cancer survivors with undernutrition.
Topics: Humans; Cancer Survivors; Quality of Life; Nutritional Status; Randomized Controlled Trials as Topic; Neoplasms; Adult; Female
PubMed: 38941414
DOI: 10.1097/MD.0000000000038675 -
Medicine Jun 2024Chaihu-Shugan-San (CSS), a Traditional Chinese Medicine formula, has been widely used for treating depression since the Ming Dynasty, as recorded in Jingyue Quanshu, but... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chaihu-Shugan-San (CSS), a Traditional Chinese Medicine formula, has been widely used for treating depression since the Ming Dynasty, as recorded in Jingyue Quanshu, but its effectiveness and safety lack comprehensive and objective evaluation. Based on our meta-analysis, we aimed to adequately evaluate the efficacy and risk of CSS by considering the latest clinical literature.
METHODS
Multiple databases, including PubMed, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang, were used to collect clinical data. The quality of the included clinical studies was assessed using the Cochrane Risk of Bias Tool, and the data were meta-analyzed using Review Manager 5.0 and Stata 17. The data were obtained from a genome-wide association study, and Mendelian randomization (MR) was performed using R Software 4.3.2 with the TwoSampleMR and MR Pleiotropy RESidual Sum and Outlier packages.
RESULTS
A total of 15 studies with 1034 patients and 6 antidepressant drugs were included in this work. Meta-analyses revealed that drug combinations of CSS and antidepressants significantly improved depressive symptoms (weighted mean difference = -4.21; 95% confidence interval [CI]: -5.62--2.81), increased the effective rate (odds ratio [OR] = 3.82; 95% CI: 2.44-6.83), and reduced side effects (OR = -3.55; 95% CI: -5.66--1.43) compared with antidepressant monotherapy. Additionally, compared with antidepressant monotherapy, CSS alone exhibited fewer side effects (95% CI:-9.25--6.95). Like antidepressants, CSS also improved depressive symptoms (weighted mean difference = -0.05; 95% CI: -0.63--0.52) and increased the effective rate (OR = 1.07; 95% CI: 0.52-2.20). Additionally, MR was used to evaluate the safety of traditional antidepressants, as there was a causal association between amitriptyline and body mass index.
CONCLUSION
This analysis demonstrated that compared with traditional antidepressants, CSS combined with antidepressants was more effective and safer for treating depressed patients. MR showed that a causal relationship may exist between amitriptyline and body mass index. Therefore, clinicians should carefully consider the advantages and potential drawbacks of Traditional Chinese Medicine and classic drugs to serve patients better.
Topics: Humans; Antidepressive Agents; Depression; Plant Extracts; Drugs, Chinese Herbal; Treatment Outcome
PubMed: 38941409
DOI: 10.1097/MD.0000000000038668 -
Medicine Jun 2024Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of post-stroke dyskinesia. Although some studies suggested that AT and MT are effective and safe for dyskinesia, the effects, and safety remain uncertain due to lacking strong evidence. The purpose of this study is to investigate the efficacy and safety of AT combined with MT in the treatment of post-stroke dyskinesia.
METHODS
We searched the following databases: PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network, WANFANG, and China Biomedical Literature Database, from inception to 1 January 2023 to identify eligible studies. Total effective rate, the Fugl-Meyer assessment scale (FMA) upper and lower limb scores, modified Barthel index scores, Berg balance scale, modified Ashworth scale, and adverse reactions were adopted as outcome indicators. The Grading of Recommendations Assessment Development and Evaluation system was used by 2 independent reviewers to assess the quality of evidence for the outcome indicators included in the study. The statistical analysis was conducted by RevMan V.5.4 software.
RESULTS
A total of 24 randomized controlled studies included 2133 patients with post-stroke dyskinesia were included. The total effective rate of AT combined with MT was more advantageous in the treatment of post-stroke dyskinesia (relative risk = 1.31, 95% confidence interval [CI] [1.22-1.42], Z = 6.96, P < .0001). AT combined with MT was more advantageous for FMA upper limb score (mean difference [MD] = 6.67, 95% CI [5.21-8.13], Z = 8.97, P < .00001) and FMA lower limb score (MD = 3.72, 95% CI [2.81-4.63], Z = 7.98, P < .00001). Meta-analysis showed that AT combined with MT for post-stroke dyskinesia had a more advantageous modified Barthel index score (MD = 9.51, 95% CI [7.44-11.58], Z = 9.01, P < .00001).
CONCLUSION
AT combined with MT is effective in improving motor function and daily living ability of patients, especially in improving muscle spasms. However, these results should be regarded with caution given the low quality of evidence for the evaluation results.
Topics: Humans; Acupuncture Therapy; Stroke; Dyskinesias; Stroke Rehabilitation; Randomized Controlled Trials as Topic; Combined Modality Therapy; Treatment Outcome
PubMed: 38941386
DOI: 10.1097/MD.0000000000038733 -
Medicine Jun 2024Frailty has been identified as a risk factor for adverse outcomes in older adults with diabetes. This study aimed to investigate the impact of frailty on the prognosis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Frailty has been identified as a risk factor for adverse outcomes in older adults with diabetes. This study aimed to investigate the impact of frailty on the prognosis of older adults with diabetes through a systematic review and meta-analysis, with the goal of offering insights for clinical decision-making.
METHODS
PubMed, Web of Science, Embase, Cochrane were systematically searched from inception to September 10th, 2023. Reviewers independently selected studies, extracted data and evaluated the quality of studies. Stata 15.1 Software was used to perform the meta-analysis. The primary outcomes of this study were mortality, hospitalization and disability, and the secondary outcomes were diabetes complications (including nephropathy, microvascular complications, macroangiopathy, cardiovascular events, hypoglycemia) and urolithiasis.
RESULTS
A total of 14 studies were included in this study, with low risk of bias and moderate to good quality. The results showed that frailty increased the risk of mortality (HR 1.91, 95% CI 1.55-2.35, P < .001), hospitalization (HR 2.19, 95% CI 1.53-3.13, P < .001), and disability in older adults with diabetes (HR 3.84, 95% CI 2.35-6.28, P < .001). In addition, frailty was associated with diabetes complications (including nephropathy, microvascular complications, macroangiopathy, cardiovascular events, hypoglycemia), urolithiasis.
CONCLUSIONS
Frailty is an important predictor of adverse outcomes, such as mortality, hospitalization, and disability in older adults with diabetes. Accurate assessment of the frailty in older adults with diabetes can help improve the adverse outcomes of patients.
Topics: Humans; Aged; Frailty; Hospitalization; Diabetes Complications; Diabetes Mellitus; Risk Factors; Prognosis; Frail Elderly; Aged, 80 and over; Female; Male
PubMed: 38941383
DOI: 10.1097/MD.0000000000038621 -
Medicine Jun 2024This study aims to critically reassess existing systematic reviews (SR) on Traditional Chinese Exercises (TCE) for treating Chronic Obstructive Pulmonary Disease (COPD)....
This study aims to critically reassess existing systematic reviews (SR) on Traditional Chinese Exercises (TCE) for treating Chronic Obstructive Pulmonary Disease (COPD). The primary objectives include synthesizing available evidence, evaluating the methodological quality of reviews and overall evidence, and providing comprehensive insights into the effectiveness of different TCE types in managing COPD. Sinomed, CNKI, VIP, Wanfang, PubMed, Cochrane Library, and Web of Science were searched from inception to April 2023 for SR literature on the treatment of COPD with TCE. The extracted data from the included SRs encompassed various aspects such as general information, study population, intervention measures, meta-analysis results, and conclusions. The methodological quality of the included SRs was assessed using the AMSTAR II tool. Additionally, the GRADE tool was used to determine the evidence level of outcome indicators. This study included 17 SRs and 4 types of TCE. The CCA was 0.041, indicating a slight overlap between the primary studies. Notably, one study was rated as low quality on the AMSTAR II scale, while the rest were classified as critically low quality. The results from the GRADE evaluation revealed 26 pieces of very low-quality evidence, 55 pieces of low-quality evidence, and 17 pieces of moderate-quality evidence. The moderate-quality evidence suggests that Liuzijue effectively improves TCM syndrome scores in patients with COPD. Additionally, low-quality evidence suggests that Liuzijue improves patients' lung function (FEV1, FVC) and quality of life (CAT, MRC/mMRC). Similarly, low-quality evidence suggests that Baduanjin can improve patients' lung function (FEV1%, FVC) and quality of life (SGRQ). Low-quality evidence also suggests that Health Qigong can significantly improve patients' exercise endurance (6MWD). No SR reported TCE-related adverse reactions. TCE interventions are effective and safe in the treatment of COPD. Different types of TCE have varying effects on outcomes in COPD patients. However, these findings are limited by the generally low methodological and evidence quality of the included SRs. Therefore, it is strongly recommended to improve study designs to obtain higher-quality clinical evidence and to strictly follow SR protocols.
Topics: Pulmonary Disease, Chronic Obstructive; Humans; Systematic Reviews as Topic; Medicine, Chinese Traditional; Exercise Therapy; Quality of Life; Qigong; East Asian People
PubMed: 38941382
DOI: 10.1097/MD.0000000000038700 -
PloS One 2024Type 2 diabetes mellitus (T2DM) represents a significant worldwide health issue, experiencing an increasing incidence rate. Effective dietary strategies are vital for...
BACKGROUND
Type 2 diabetes mellitus (T2DM) represents a significant worldwide health issue, experiencing an increasing incidence rate. Effective dietary strategies are vital for T2DM management, but the optimal dietary patterns remain debated due to inconsistent research outcomes and single-outcome reporting. Network Meta-Analysis (NMA) provides a powerful approach for integrating data from randomized controlled trials (RCTs), enabling a detailed evaluation of the impact of different dietary patterns. This document presents our strategy for a systematic review and network meta-analysis, aimed at assessing the influence of key dietary patterns on glycemic control, lipid profiles, and weight management in individuals with Type 2 Diabetes Mellitus (T2DM).
MATERIALS AND METHODS
Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and network meta-analyses guidelines, we conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library, without language or date restrictions. Our objective is to assess the efficacy of various dietary interventions in managing Type 2 Diabetes Mellitus (T2DM). We used standardized mean differences for pairwise comparisons and a Bayesian framework for ranking interventions via Surface Under the Cumulative Ranking Curve (SUCRA). Key analyses include heterogeneity, transitivity, and sensitivity assessments, along with quality and risk evaluations using the Cochrane Collaboration's tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.
ETHICS AND DISSEMINATION
This systematic review and network meta-analysis involve aggregate data from previous trials, obviating the need for additional ethical approval. The search strategy will be executed starting October 2023, with all searches completed by December 2023, to encompass the most current studies available. Findings will be shared through academic conferences and peer-reviewed journals focused on diabetes care and nutrition.
TRIAL REGISTRATION
PROSPERO registration number CRD42023465791.
Topics: Diabetes Mellitus, Type 2; Humans; Systematic Reviews as Topic; Network Meta-Analysis; Diet; Meta-Analysis as Topic; Randomized Controlled Trials as Topic; Dietary Patterns
PubMed: 38941329
DOI: 10.1371/journal.pone.0306336 -
JMIR Research Protocols Jun 2024Artificial intelligence (AI) medical devices have the potential to transform existing clinical workflows and ultimately improve patient outcomes. AI medical devices have...
BACKGROUND
Artificial intelligence (AI) medical devices have the potential to transform existing clinical workflows and ultimately improve patient outcomes. AI medical devices have shown potential for a range of clinical tasks such as diagnostics, prognostics, and therapeutic decision-making such as drug dosing. There is, however, an urgent need to ensure that these technologies remain safe for all populations. Recent literature demonstrates the need for rigorous performance error analysis to identify issues such as algorithmic encoding of spurious correlations (eg, protected characteristics) or specific failure modes that may lead to patient harm. Guidelines for reporting on studies that evaluate AI medical devices require the mention of performance error analysis; however, there is still a lack of understanding around how performance errors should be analyzed in clinical studies, and what harms authors should aim to detect and report.
OBJECTIVE
This systematic review will assess the frequency and severity of AI errors and adverse events (AEs) in randomized controlled trials (RCTs) investigating AI medical devices as interventions in clinical settings. The review will also explore how performance errors are analyzed including whether the analysis includes the investigation of subgroup-level outcomes.
METHODS
This systematic review will identify and select RCTs assessing AI medical devices. Search strategies will be deployed in MEDLINE (Ovid), Embase (Ovid), Cochrane CENTRAL, and clinical trial registries to identify relevant papers. RCTs identified in bibliographic databases will be cross-referenced with clinical trial registries. The primary outcomes of interest are the frequency and severity of AI errors, patient harms, and reported AEs. Quality assessment of RCTs will be based on version 2 of the Cochrane risk-of-bias tool (RoB2). Data analysis will include a comparison of error rates and patient harms between study arms, and a meta-analysis of the rates of patient harm in control versus intervention arms will be conducted if appropriate.
RESULTS
The project was registered on PROSPERO in February 2023. Preliminary searches have been completed and the search strategy has been designed in consultation with an information specialist and methodologist. Title and abstract screening started in September 2023. Full-text screening is ongoing and data collection and analysis began in April 2024.
CONCLUSIONS
Evaluations of AI medical devices have shown promising results; however, reporting of studies has been variable. Detection, analysis, and reporting of performance errors and patient harms is vital to robustly assess the safety of AI medical devices in RCTs. Scoping searches have illustrated that the reporting of harms is variable, often with no mention of AEs. The findings of this systematic review will identify the frequency and severity of AI performance errors and patient harms and generate insights into how errors should be analyzed to account for both overall and subgroup performance.
TRIAL REGISTRATION
PROSPERO CRD42023387747; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387747.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
PRR1-10.2196/51614.
Topics: Humans; Randomized Controlled Trials as Topic; Artificial Intelligence; Algorithms; Systematic Reviews as Topic; Patient Harm; Equipment and Supplies; Research Design
PubMed: 38941147
DOI: 10.2196/51614 -
Alternative Therapies in Health and... Jun 2024Breast cancer is the most common cancer for women all over the world. MicroRNAs (miRNAs) are a type of small endogenous single-stranded RNA that are involved in various...
BACKGROUND
Breast cancer is the most common cancer for women all over the world. MicroRNAs (miRNAs) are a type of small endogenous single-stranded RNA that are involved in various cellular processes, including proliferation, differentiation, apoptosis, and metabolism. Over the past decade, numerous studies have demonstrated that the expression levels of miRNAs are dysregulated in many types of cancer, including breast cancer.
OBJECTIVE
To systematically evaluate both the diagnostic and prognostic value of miRNA expression in breast cancer by meta-analysis.
DESIGN
This was a meta-analysis. The research team performed a comprehensive narrative review by searching Pubmed, Medline, Embase, China National Knowledge Infrastructure, Wanfang, and other databases that were searched by computer from January 2010 to December 2020. The language was limited to English; the subject words were miRNA and breast cancer.
SETTING
This review took place in Jintang First People's Hospital, West China Hospital, Sichuan University, and Jingtang Hospital.
PRIMARY OUTCOME MEASURES
RevMan 5.3 software was implemented to carry out a meta-analysis of the data extracted in this paper. The outcome measures included (1) patient age, (2) patient tumor size, (3) lymph node metastasis, (4) estrogen receptor (ER) level (5) progesterone receptor (PR) level (6) human epidermal growth factor 2 (HER2) level (7) tumor-node-metastasis (TNM) stage (8) prognosis disease-free survival (DFS) level (9) overall survival (OS) level.
RESULTS
A total of 8 references and 1414 patients were contained in this research. Meta-analysis demonstrated that age: odds ratio (OR) =1.90, 95% confidence interval (CI) (0.30-12.09), P=0.50. Tumor size (>2 cm): OR=2.23, 95% CI (0.89-5.57), P = .09. Lymph node metastasis: OR=2.09, 95% CI (1.65-2.65), P < .00001. ER: OR=1.26, 95% CI (0.64-2.47), P = .5. PR: OR=0.96, 95% CI (0.86-1.07), P = .41. HER2 OR=1.79, 95% CI (0.42-7.64), P = .09. TNM stage (III vs. I/II) OR=0.89, 95% CI (0.71-1.10), P = .27. DFS: OR=8.49, 95% CI (2.72-26.45), P = .0002. OS: OR=5.99, 95% CI (2.60-13.79), P < .0001. High expression of miRNA was correlated with lymph node metastasis, DFS and OS in BC patients.
CONCLUSION
High expression of microRNA can be adopted as an important indicator for BC screening and has important value for the prognosis of BC patients. Circulating miRNAs could serve as potential targets for BC treatment.
PubMed: 38940799
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024This meta-analysis evaluates the diagnostic value of echocardiography for Acute Heart Failure (AHF) and its utility in urgent clinical situations, emphasizing its...
OBJECTIVE
This meta-analysis evaluates the diagnostic value of echocardiography for Acute Heart Failure (AHF) and its utility in urgent clinical situations, emphasizing its significance for accurate and timely diagnosis in critical care.
METHODS
Relevant studies from databases like PubMed and Embase were selected using terms such as 'Ultrasound' and 'acute heart failure'. Inclusion criteria focused on studies evaluating echocardiographic diagnosis in adult patients presenting with symptoms suggestive of AHF. Quality assessment was performed using RevMan 5.3 and QUADAS. Key metrics like sensitivity, specificity, and likelihood ratios were analyzed using STATA 15.1. The types of echocardiography assessed included transthoracic and focused cardiac ultrasound.
RESULTS
Eighteen articles were included, indicating echocardiography's high sensitivity (0.92) and specificity (0.96) in diagnosing AHF. The combined positive likelihood ratio of 23.2 suggests that patients with AHF are over 23 times more likely to have a positive echocardiography result than those without AHF, greatly influencing clinical decision-making toward confirming the diagnosis. The AUC of the SROC curve was 0.98, indicating excellent overall accuracy.
CONCLUSION
Echocardiography is highly accurate in diagnosing AHF, underscored by its critical role in early treatment decisions and potential integration into standard care protocols, thereby preventing adverse outcomes and improving patient management.
PubMed: 38940797
DOI: No ID Found