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The World Journal of Men's Health Apr 2024Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could...
Effects of Varicocele Repair on Sperm DNA Fragmentation and Seminal Malondialdehyde Levels in Infertile Men with Clinical Varicocele: A Systematic Review and Meta-Analysis.
PURPOSE
Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA).
MATERIALS AND METHODS
A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD).
RESULTS
Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I²=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I²=93.7%).
CONCLUSIONS
Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.
PubMed: 38164034
DOI: 10.5534/wjmh.230235 -
Scientific Reports May 2023There are currently two main treatment strategies mainly for high-risk patients: percutaneous transluminal angioplasty and stenting (PTAS) and aggressive medical... (Meta-Analysis)
Meta-Analysis
Percutaneous transluminal angioplasty and stenting vs aggressive medical management on stroke or intracranial atherosclerotic stenosis: a systematic review and meta-analysis.
There are currently two main treatment strategies mainly for high-risk patients: percutaneous transluminal angioplasty and stenting (PTAS) and aggressive medical management (AMM). However, the choice between PTAS or AMM remains controversial for patients with stroke or intracranial atherosclerotic stenosis (ICAS). The investigators searched the PubMed, Web of Science, Embase, Scopus, and Cochrane library databases. Randomized controlled trial (RCT) comparing PTAS and AMM for patients with stroke or ICAS were selected. RevMan 5.3 was used to analyze the results and assess risk of bias. The primary endpoints are stroke and death within 30 days after enrollment, or ischemic stroke in the territory of the qualifying artery beyond 30 days, and entire follow-up endpoints. The secondary outcomes were the disabling or fatal stroke, and incidence of death within 3 years. Four studies, 989 patients were included in this article. The AMM group was superior in the entire follow-up endpoint (OR 0.56; 95% CI 0.40, 0.79). The AMM also better in primary endpoint within 30 days (OR 0.32; 95% CI 0.17, 0.61). There was no significant difference beyond 30 days (OR 1.08; 95% CI 0.63, 1.86). The remaining outcomes, such as stroke and death, were not significantly different (P > 0.05). This meta-analysis shows AMM is significantly more effective than PTAS in subjects with ICAS due to the high rate of periprocedural stroke (OR 0.32; 95% CI 0.17, 0.61) and stroke during the entire follow-up (OR 0.56; 95% CI 0.40, 0.79) associated with PTAS. Furthermore, PTAS offers no additional benefits over AMM beyond 30 days (OR 1.08; 95% CI 0.63, 1.86).
Topics: Humans; Constriction, Pathologic; Stroke; Angioplasty; Ischemic Stroke; Intracranial Arteriosclerosis
PubMed: 37161029
DOI: 10.1038/s41598-023-34663-1 -
JAMA Network Open Mar 2023High-dose docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid, may affect the risk of bronchopulmonary dysplasia (BPD). However, high-level summative... (Meta-Analysis)
Meta-Analysis
Association Between Enteral Supplementation With High-Dose Docosahexaenoic Acid and Risk of Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review and Meta-analysis.
IMPORTANCE
High-dose docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid, may affect the risk of bronchopulmonary dysplasia (BPD). However, high-level summative evidence supporting such clinical association in very preterm infants is lacking.
OBJECTIVE
To examine the association between enteral supplementation with high-dose DHA during the neonatal period and the risk of BPD in preterm infants born at less than 29 weeks' gestation.
DATA SOURCES
PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, medRxiv, and ClinicalTrials.gov were searched from inception to August 1, 2022, for eligible articles with no language restrictions.
STUDY SELECTION
Randomized clinical trials (RCTs) were eligible for inclusion (1) if their interventions involved direct administration of a minimum DHA supplementation of 40 mg/kg/d or breast milk or formula feeding of at least 0.4% of total fatty acids, and (2) if they reported data on either BPD, death, BPD severity, or a combined outcome of BPD and death.
DATA EXTRACTION AND SYNTHESIS
Two investigators completed independent review of titles and abstracts, full text screening, data extraction, and quality assessment using the Cochrane Risk of Bias 2.0. Risk ratios (RRs) with 95% CIs were pooled using random-effect meta-analyses.
MAIN OUTCOMES AND MEASURES
Primary outcome was BPD using trial-specific definitions, which was further stratified for RCTs that used a more stringent BPD definition based on systematic pulse oximetry assessment at 36 weeks' postmenstrual age. Other outcomes were BPD, death, BPD severity, or combined BPD and death.
RESULTS
Among the 2760 studies screened, 4 RCTs were included, which involved 2304 infants (1223 boys [53.1%]; mean [SD] gestational age, 26.5 [1.6] weeks). Enteral supplementation with high-dose DHA was associated with neither BPD (4 studies [n = 2186 infants]; RR, 1.07 [95% CI, 0.86-1.34]; P = .53; I2 = 72%) nor BPD or death (4 studies [n = 2299 infants]; RR, 1.04 [95% CI, 0.91-1.18]; P = .59; I2 = 61%). However, an inverse association with BPD was found in RCTs that used a more stringent BPD definition (2 studies [n = 1686 infants]; RR, 1.20 [95% CI, 1.01-1.42]; P = .04; I2 = 48%). Additionally, DHA was inversely associated with moderate-to-severe BPD (3 studies [n = 1892 infants]; RR, 1.16 [95% CI, 1.04-1.29]; P = .008; I2 = 0%).
CONCLUSIONS AND RELEVANCE
Results of this study showed that enteral supplementation with high-dose DHA in the neonatal period was not associated overall with BPD, but an inverse association was found in the included RCTs that used a more stringent BPD definition. These findings suggest that high-dose DHA supplementation should not be recommended to prevent BPD in very preterm infants.
Topics: Infant, Newborn; Infant; Male; Female; Humans; Adult; Docosahexaenoic Acids; Bronchopulmonary Dysplasia; Infant, Premature; Gestational Age; Infant, Premature, Diseases; Fetal Growth Retardation; Dietary Supplements
PubMed: 36943265
DOI: 10.1001/jamanetworkopen.2023.3934 -
Journal of Asthma and Allergy 2023Asthma is the common chronic inflammatory disease affecting children. It is usually associated with airway hyper-responsiveness. Globally, the prevalence of asthma among... (Review)
Review
BACKGROUND
Asthma is the common chronic inflammatory disease affecting children. It is usually associated with airway hyper-responsiveness. Globally, the prevalence of asthma among pediatrics population varies from 10% to 30%. Its symptoms range from chronic cough to life-threatening bronchospasm. At emergency department, all patients with acute severe asthma should initially receive oxygen, nebulized β2-agonists, nebulized anticholinergic agent, and corticosteroids. Though bronchodilators act within minutes, corticosteroids may require hours. Magnesium sulphate (MgSO) was first considered for treating asthma about 60 years ago. Several case reports were published on its usefulness in decreasing admission and endotracheal intubation. So far, evidence is conflicting to fully employ MgSO for asthma management in children under five.
OBJECTIVE
This systematic review was aimed to evaluate the effectiveness and safety of MgSO in the treatment of severe acute asthmatic attacks in children.
METHODS
A systematic and comprehensive search of literature was performed to identify controlled clinical trials conducted on IV and nebulized MgSO in pediatric patients with acute asthma.
RESULTS
Data generated from three randomized clinical trials were included in the final analysis. In this analysis, intravenous MgSO did not improve respiratory function (RR=1.09, 95%CI: 0.81-1.45) and not safer than conventional treatment (RR=0.38, 95%CI: 0.08-1.67). Similarly, use of nebulized MgSO showed no significant effect on respiratory function (RR=1.05, 95%CI: 0.68-1.64) and more tolerable (RR=0.31, 95%CI: 0.14-0.68).
CONCLUSION
Intravenous MgSO may not be superior to conventional treatment in moderate to severe acute asthma among children and neither have significant adverse effects. Similarly, nebulized MgSO showed no significant effect on respiratory function in moderate to severe acute asthma in children under five but it seems a safer alternative.
PubMed: 36895494
DOI: 10.2147/JAA.S390389 -
The American Journal of Psychiatry Jan 2023The aim of this study was to catalog and evaluate response biomarkers correlated with autism spectrum disorder (ASD) symptoms to improve clinical trials. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study was to catalog and evaluate response biomarkers correlated with autism spectrum disorder (ASD) symptoms to improve clinical trials.
METHODS
A systematic review of MEDLINE, Embase, and Scopus was conducted in April 2020. Seven criteria were applied to focus on original research that includes quantifiable response biomarkers measured alongside ASD symptoms. Interventional studies or human studies that assessed the correlation between biomarkers and ASD-related behavioral measures were included.
RESULTS
A total of 5,799 independent records yielded 280 articles for review that reported on 940 biomarkers, 755 of which were unique to a single publication. Molecular biomarkers were the most frequently assayed, including cytokines, growth factors, measures of oxidative stress, neurotransmitters, and hormones, followed by neurophysiology (e.g., EEG and eye tracking), neuroimaging (e.g., functional MRI), and other physiological measures. Studies were highly heterogeneous, including in phenotypes, demographic characteristics, tissues assayed, and methods for biomarker detection. With a median total sample size of 64, almost all of the reviewed studies were only powered to identify biomarkers with large effect sizes. Reporting of individual-level values and summary statistics was inconsistent, hampering mega- and meta-analysis. Biomarkers assayed in multiple studies yielded mostly inconsistent results, revealing a "replication crisis."
CONCLUSIONS
There is currently no response biomarker with sufficient evidence to inform ASD clinical trials. This review highlights methodological imperatives for ASD biomarker research necessary to make definitive progress: consistent experimental design, correction for multiple comparisons, formal replication, sharing of sample-level data, and preregistration of study designs. Systematic "big data" analyses of multiple potential biomarkers could accelerate discovery.
Topics: Humans; Autism Spectrum Disorder; Biomarkers; Phenotype; Magnetic Resonance Imaging; Research Design
PubMed: 36475375
DOI: 10.1176/appi.ajp.21100992 -
The World Journal of Men's Health Apr 2023Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains...
PURPOSE
Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls.
MATERIALS AND METHODS
A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies).
RESULTS
A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I²=97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I²=97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I²=98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I²=97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I²=98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI -0.242 to 0.868; I²=89.7%).
CONCLUSIONS
This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies' practice recommendations favoring VR to improve conventional semen parameters in infertile men.
PubMed: 36326166
DOI: 10.5534/wjmh.220142 -
Journal of Clinical Medicine Jul 2022Coated urethral catheters were introduced in clinical practice to reduce the risk of catheter-acquired urinary tract infection (CAUTI). We aimed to systematically review... (Review)
Review
Catheter-Associated Urinary Infections and Consequences of Using Coated versus Non-Coated Urethral Catheters-Outcomes of a Systematic Review and Meta-Analysis of Randomized Trials.
Coated urethral catheters were introduced in clinical practice to reduce the risk of catheter-acquired urinary tract infection (CAUTI). We aimed to systematically review the incidence of CAUTI and adverse effects in randomized clinical trials of patients requiring indwelling bladder catheterization by comparing coated vs. non-coated catheters. This review was performed according to the 2020 PRISMA framework. The incidence of CAUTI and catheter-related adverse events was evaluated using the Cochran−Mantel−Haenszel method with a random-effects model and reported as the risk ratio (RR), 95% CI, and p-values. Significance was set at p < 0.05 and a 95% CI. Twelve studies including 36,783 patients were included for meta-analysis. There was no significant difference in the CAUTI rate between coated and non-coated catheters (RR 0.87 95% CI 0.75−1.00, p = 0.06). Subgroup analysis demonstrated that the risk of CAUTI was significantly lower in the coated group compared with the non-coated group among patients requiring long-term catheterization (>14 days) (RR 0.82 95% CI 0.68−0.99, p = 0.04). There was no difference between the two groups in the incidence of the need for catheter exchange or the incidence of lower urinary tract symptoms after catheter removal. The benefit of coated catheters in reducing CAUTI risk among patients requiring long-term catheterization should be balanced against the increased direct costs to health care systems when compared to non-coated catheters.
PubMed: 35956080
DOI: 10.3390/jcm11154463 -
Sao Paulo Medical Journal = Revista... 2022Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR...
BACKGROUND
Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures.
OBJECTIVE
To compare AR with other learning methods in interventional radiology.
DESIGN AND SETTING
Systematic review of comparative studies on teaching techniques.
METHODS
We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model.
RESULTS
Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR.
CONCLUSION
AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model.
SYSTEMATIC REVIEW REGISTRATION NUMBER
DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.
Topics: Augmented Reality; Clinical Competence; Humans; Learning; Radiology, Interventional; Randomized Controlled Trials as Topic
PubMed: 35946678
DOI: 10.1590/1516-3180.2021.0606.R2.27122021 -
Urolithiasis Oct 2022We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy... (Meta-Analysis)
Meta-Analysis Review
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
Topics: Humans; Kidney Calculi; Length of Stay; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Postoperative Complications; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Fistula
PubMed: 35674819
DOI: 10.1007/s00240-022-01337-y -
Journal of Traditional Chinese Medicine... Aug 2019To evaluate the effect and safety of Chinese herbal medicines on Helicobacter pylori (HP)-associated gastroduodenal ulcers. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effect and safety of Chinese herbal medicines on Helicobacter pylori (HP)-associated gastroduodenal ulcers.
METHODS
All randomized controlled trials (RCTs) listed in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure Database, WanFang, China Science and Technology Journal Database and SinoMed databases that were published in English or Chinese were searched, and the retrieval time range was from database inception to December 31, 2018. A comprehensive Meta-analysis of all publications was performed with RevMan 5.3 software, and the quality of the evidence reported in the results of Meta-analysis was analyzed with GRADE profiler software (version 3.6.1). Dichotomous data were analyzed by calculating odds ratios and 95% confidence intervals (CIs). Outcome measures included the HP clearance rate and percentage of adverse effects.
RESULTS
Eight trials with 919 participants were included in this Meta-analysis. Compared with the effects of single drug therapy on HP-associated gastroduodenal ulcers, according to the statistical analysis, odds ratios for the HP clearance rate and percentage of adverse effects of Chinese herbal medicines administered as complementary medicines combined with drugs were 3.10 [95% CI (2.21, 4.36), P < 0.01] and 0.28 [95% CI (0.15, 0.52), P < 0.01], respectively, and the differences were statistically significant. According to the GRADE analysis, the quality of evidence for the HP clearance rate and percentage of adverse effects were both very low.
CONCLUSION
Compared with using the drug therapy only, the combination of Chinese herbal medicines with the drug therapy more effectively eliminates HP and alleviates adverse reactions. However, the available studies were of low quality, and therefore more well-designed studies are required to further confirm the findings.
Topics: Adult; Drugs, Chinese Herbal; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Peptic Ulcer; Randomized Controlled Trials as Topic; Treatment Outcome; Young Adult
PubMed: 32186092
DOI: No ID Found