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Journal of Intensive Care Medicine Jun 2024Patients in the intensive care unit (ICU) often experience poor sleep quality. Pharmacologic sleep aids are frequently used as primary or adjunctive therapy to improve... (Review)
Review
Patients in the intensive care unit (ICU) often experience poor sleep quality. Pharmacologic sleep aids are frequently used as primary or adjunctive therapy to improve sleep, although their benefits in the ICU remain uncertain. This review aims to provide a comprehensive assessment of the objective and subjective effects of medications used for sleep in the ICU, as well as their adverse effects. PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from their inception until June 2023 for comparative studies assessing the effects of pharmacologic sleep aids on objective and subjective metrics of sleep. Thirty-four studies with 3498 participants were included. Medications evaluated were melatonin, ramelteon, suvorexant, propofol, and dexmedetomidine. The majority of studies were randomized controlled trials. Melatonin and dexmedetomidine were the best studied agents. Objective sleep metrics included polysomnography (PSG), electroencephalography (EEG), bispectral index, and actigraphy. Subjective outcome measures included patient questionnaires and nursing observations. Evidence for melatonin as a sleep aid in the ICU was mixed but largely not supportive for improving sleep. Evidence for ramelteon, suvorexant, and propofol was too limited to offer definitive recommendations. Both objective and subjective data supported dexmedetomidine as an effective sleep aid in the ICU, with PSG/EEG in 303 ICU patients demonstrating increased sleep duration and efficiency, decreased arousal index, decreased percentage of stage N1 sleep, and increased absolute and percentage of stage N2 sleep. Mild bradycardia and hypotension were reported as side effects of dexmedetomidine, whereas the other medications were reported to be safe. Several ongoing studies have not yet been published, mostly on melatonin and dexmedetomidine. While definitive conclusions cannot be made for most medications, dexmedetomidine improved sleep quantity and quality in the ICU. These benefits need to be balanced with possible hemodynamic side effects.
PubMed: 38881385
DOI: 10.1177/08850666241255345 -
BMC Neurology Jun 2024The application of cerebellar transcranial magnetic stimulation (TMS) in stroke patients has received increasing attention due to its neuromodulation mechanisms.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The application of cerebellar transcranial magnetic stimulation (TMS) in stroke patients has received increasing attention due to its neuromodulation mechanisms. However, studies on the effect and safety of cerebellar TMS to improve balance capacity and activity of daily living (ADL) for stroke patients are limited. This systematic review and meta-analysis aimed to investigate the effect and safety of cerebellar TMS on balance capacity and ADL in stroke patients.
METHOD
A systematic search of seven electronic databases (PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang and Chinese Scientific Journal) were conducted from their inception to October 20, 2023. The randomized controlled trials (RCTs) of cerebellar TMS on balance capacity and/or ADL in stroke patients were enrolled. The quality of included studies were assessed by Physiotherapy Evidence Database (PEDro) scale.
RESULTS
A total of 13 studies involving 542 participants were eligible. The pooled results from 8 studies with 357 participants showed that cerebellar TMS could significantly improve the post-intervention Berg balance scale (BBS) score (MD = 4.24, 95%CI = 2.19 to 6.29, P < 0.00001; heterogeneity, I = 74%, P = 0.0003). The pooled results from 4 studies with 173 participants showed that cerebellar TMS could significantly improve the post-intervention Time Up and Go (TUG) (MD=-1.51, 95%CI=-2.8 to -0.22, P = 0.02; heterogeneity, I = 0%, P = 0.41). The pooled results from 6 studies with 280 participants showed that cerebellar TMS could significantly improve the post-intervention ADL (MD = 7.75, 95%CI = 4.33 to 11.17, P < 0.00001; heterogeneity, I = 56%, P = 0.04). The subgroup analysis showed that cerebellar TMS could improve BBS post-intervention and ADL post-intervention for both subacute and chronic stage stroke patients. Cerebellar high frequency TMS could improve BBS post-intervention and ADL post-intervention. Cerebellar TMS could still improve BBS post-intervention and ADL post-intervention despite of different cerebellar TMS sessions (less and more than 10 TMS sessions), different total cerebellar TMS pulse per week (less and more than 4500 pulse/week), and different cerebellar TMS modes (repetitive TMS and Theta Burst Stimulation). None of the studies reported severe adverse events except mild side effects in three studies.
CONCLUSIONS
Cerebellar TMS is an effective and safe technique for improving balance capacity and ADL in stroke patients. Further larger-sample, higher-quality, and longer follow-up RCTs are needed to explore the more reliable evidence of cerebellar TMS in the balance capacity and ADL, and clarify potential mechanisms.
Topics: Humans; Transcranial Magnetic Stimulation; Activities of Daily Living; Postural Balance; Stroke Rehabilitation; Cerebellum; Stroke; Randomized Controlled Trials as Topic
PubMed: 38879485
DOI: 10.1186/s12883-024-03720-1 -
Global Spine Journal Jun 2024Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVE
Degenerative cervical myelopathy (DCM) is a common spinal cord disorder necessitating surgery. We aim to explore how effectively diffusion tensor imaging (DTI) can distinguish DCM from healthy individuals and assess the relationship between DTI metrics and symptom severity.
METHODS
We included studies with adult DCM patients who had not undergone decompressive surgery and implemented correlation analyses between DTI parameters and severity, or compared healthy controls and DCM patients.
RESULTS
57 studies were included in our meta-analysis. At the maximal compression (MC) level, fractional anisotropy (FA) exhibited lower values in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were notably higher in the DCM group. Moreover, our investigation into the diagnostic utility of DTI parameters disclosed high sensitivity, specificity, and area under the curve values for FA (.84, .80, .83 respectively) and ADC (.74, .84, .88 respectively). Additionally, we explored the correlation between DTI parameters and myelopathy severity, revealing a significant correlation of FA (.53, 95% CI:0.40 to .65) at MC level with JOA/mJOA scores.
CONCLUSION
Current guidelines for DCM suggest decompressive surgery for both mild and severe cases. However, they lack clear recommendations on which mild DCM patients might benefit from conservative treatment vs immediate surgery. ADC's role here could be pivotal, potentially differentiating between healthy individuals and DCM. While it may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM.
PubMed: 38877604
DOI: 10.1177/21925682241263792 -
Medicine Jun 2024Many randomized controlled trials have demonstrated that exercise benefits cognitive function in patients with mild cognitive impairment (MCI), but less attention has... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many randomized controlled trials have demonstrated that exercise benefits cognitive function in patients with mild cognitive impairment (MCI), but less attention has been paid to the development of exercise programs in this population.
OBJECTIVE
This study aimed to assess the effect of exercise intervention for elderly with MCI and provide the most effective exercise intervention plan.
METHODS
We searched 4 international databases (PubMed, EMBASE, Web of Science, Cochrane Library) and 4 Chinese databases (Chinese National Knowledge Infrastructure, VIP database and Wanfang database) for studies on exercises associated with MCI up to September 25, 2022. The resulting standardized mean differences (SMD) and 95% confidence intervals were statistically analyzed using Review Manager 5.3 software.
RESULTS
A total of 20 RCTs were comprised in this meta-analysis, including 1393 participants. The results of the meta-analysis revealed that exercise had positive effects on cognitive function in elderly with MCI and was statistically significant (SMD = 1.25, 95%CI: [0.88,1.62], P < .00001). Subgroup analysis showed that the most significant factor was the Peterson 2004 criteria, multi-exercise, 35 to 50 minutes/times, <3 times/3 to 5 times per week, >16 weeks and medium intensity.
CONCLUSION
Exercise intervention can significantly alleviate cognition in elderly with MCI. The best exercise program for exercise intervention for MCI is: multi-exercise, 35 to 50 minutes/times, 3 to 5 times/week, and exercise cycle for more than 16 weeks with medium intensity, has the best effect. Plus, more RCTs with larger sample sizes will be required in the future to demonstrate the link between exercise duration, intensity, and cognitive function.
Topics: Humans; Cognitive Dysfunction; Exercise Therapy; Aged; Randomized Controlled Trials as Topic; Cognition; Exercise; Female; Male
PubMed: 38875404
DOI: 10.1097/MD.0000000000038025 -
Neuroepidemiology Jun 2024This study aims to precisely determine the prevalence of Mild Cognitive Impairment (MCI) in China, acknowledging its significance as a preclinical stage of dementia and...
OBJECTIVE
This study aims to precisely determine the prevalence of Mild Cognitive Impairment (MCI) in China, acknowledging its significance as a preclinical stage of dementia and a potential "intervention window". The acceleration of the aging process in China underscores the urgency of this research.
METHODS
A comprehensive search was conducted across PubMed, Embase, Web of Science, CNKI, WFD, VIP, and CBM databases from their inception until March 1, 2023. The Agency for Healthcare Research and Quality (AHRQ) methodology checklist guided our quality assessment. A random-effects model meta-analysis was employed to synthesize the pooled prevalence data of MCI in China.
RESULTS
Our analysis encompassed 139 studies, incorporating data from 393,525 individuals aged 40 years and above. The studies were predominantly rated as moderate-to-high quality. The overall prevalence of MCI was determined to be 19.6% (95% CI: 17.7%-21.6%). Subgroup analyses indicated variations in prevalence: 20.8% (95% CI: 18.9%-22.7%) for P-MCI compared to 16.2% (95% CI: 11.7%-20.7%) for DSM criteria. Geographically, prevalence in Southern China (21.0%, 95% CI: 18.1%-23.9%) exceeded that in Northern China (17.6%, 95% CI: 15.9%-19.4%). Notably, prevalence in hospitals (61.7%, 95% CI: 27.8%-95.7%) was significantly higher than in nursing homes (16.1%, 95% CI: 14.3%-17.9%) and communities (25.3%, 95% CI: 17.4%-33.2%), especially after the COVID-19 outbreak.
CONCLUSION
The study confirms a 19.6% prevalence rate of MCI in China, influenced by factors such as sample sources, beginning year of survey, and regional differences. It highlights the need for targeted screening and resource allocation to subpopulations at risk, aiming to prevent the progression to dementia.
PubMed: 38870921
DOI: 10.1159/000539802 -
Oncology Research and Treatment Jun 2024Stomach cancer is one of the most common causes of cancer worldwide, especially in the population over 65 years, the survival rate is less in comparison with young...
INTRODUCTION
Stomach cancer is one of the most common causes of cancer worldwide, especially in the population over 65 years, the survival rate is less in comparison with young people, the evaluation of geriatric assessment would be key for assessing the prognosis of these patients.
METHODS
A search was performed in the OVID, EMBASE and PUBMED databases, and after applying inclusion and exclusion criteria, four (4) articles were analyzed.
RESULTS
In the included studies, the MGA battery was not implemented, but rather easily measurable scales as nutritional status, functional status, cognitive and behavioral disorders, comorbidities, and polypharmacy, some authors proposed through the assessment of overall survival is not explicit among the included studies, patients with gastric cancer and mild, moderate, severe, and total dependence had a higher mortality than independent patients (39% HR 1.39; 95% CI 1.09-1.7), 68% (95% CI: 1.46-1.93), 187% (HR 2.87 95% CI: 2.47-3.34), and 234% 95% CI: 2.81-3.97), respectively. The Zhou study showed an association between sarcopenia, assessed by imaging studies, and a longer hospital stay in days (16 [9] vs. 13 [6], p 0.004). The study by Pujara found that polypharmacy (OR 2.36 CI 1.08-5.17) and weight loss greater than 10% in the past 6 months were associated with greater postoperative morbidity at 90 days (OR 2.36 CI 1.08-5.17, (OR 11.21 IC 2.16-58.24).
CONCLUSION
Geriatric assessment dependency appear to be prognostic markers of survival in patients with gastric cancer, however, higher quality studies in this specific population are required to support the systematic use of this assessment for the choice of appropriate therapy according to the patient.
PubMed: 38870920
DOI: 10.1159/000539774 -
International Immunopharmacology Jun 2024To evaluate the efficacy and safety of Janus kinases inhibitors (JAKi) for adult-onset Still's disease (AOSD) patients. (Review)
Review
OBJECTIVE
To evaluate the efficacy and safety of Janus kinases inhibitors (JAKi) for adult-onset Still's disease (AOSD) patients.
METHODS
We searched the Embase, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and the China National Knowledge Infrastructure (CNKI) from inception up to 22 October 2023. The results were supplemented by a backward search of relevant publications. Two authors independently selected trials. The available studies were comprehensively reviewed and analysed.
RESULTS
A total of 9 studies with a total of 35 patients were included in the review. Of these patients, 17 (48.6%) patients were treated with tofacitinib, 14 (40%) with baricitinib, 4 (11.4%) with ruxolitinib and 1 (2.9%) with upadacitinib. After treatment with JAKi, 17 (48.6%) patients showed complete remission, 12 (34.3%) patients showed partial remission, and 7 (20%) patients showed loss of efficacy or relapse. The use of ruxolitinib showed a remission rate of 100% in AOSD patients with macrophage activation syndrome (MAS). The incidence of adverse events (AEs) reported were mild and rare overall. Most AEs were abnormal lipid parameters (9.7%), bacterial pneumonia (3.2%), organised pneumonia (3.2%), diarrhoea (3.2%), increased heart rate (3.2%), menometrorrhagia (3.2%) and leukopenia (3.2%). One patient died from bacterial pneumonia.
CONCLUSION
JAKi therapy may be an option for patients with AOSD, especially for refractory AOSD. For patients with AOSD complicated by MAS, ruxolitinib seems to be a better choice than other JAKi agents. Although our study shows that JAKi are well tolerated in AOSD patients, we still need to be on the lookout for fatal infections.
PubMed: 38870881
DOI: 10.1016/j.intimp.2024.112451 -
The Gerontologist Jun 2024Amyloid positron emission tomography (PET) scans can enhance the accuracy of dementia diagnoses. However, the perspectives and experiences of people with cognitive...
BACKGROUND AND OBJECTIVES
Amyloid positron emission tomography (PET) scans can enhance the accuracy of dementia diagnoses. However, the perspectives and experiences of people with cognitive impairment and their care partners undergoing an amyloid scan are less well understood. Therefore, this review aimed to identify and summarize qualitative studies exploring patient and care partner experiences of undergoing an amyloid scan.
RESEARCH DESIGN AND METHODS
We searched Embase, MEDLINE, and PsychInfo in March 2024. Articles were screened for inclusion by two reviewers and critically appraised using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Studies. Data from the included studies were synthesized using thematic synthesis.
RESULTS
We identified ten papers from six studies. We identified four themes: 1) motivations for undergoing an amyloid scan, 2) experiences of receiving the result, 3) emotional responses to the result, and 4) actions in light of the scan result. Participants reported undergoing the scan to determine the cause of cognitive impairment. They described the information gained from the scan as helpful but struggled to recall the correct terminology or implications of the scan. Emotional responses to the scan varied depending on the scan result. In light of the scan result, the most common action was making advanced plans; however; this was mainly discussed among participants with elevated amyloid.
DISCUSSIONS AND IMPLICATIONS
Amyloid scans can provide useful and actionable information. However, learning the scan result could be distressing. Future research is needed to balance the potential benefits and harms of amyloid scans.
PubMed: 38869891
DOI: 10.1093/geront/gnae075 -
Digestive Diseases and Sciences Jun 2024Rebleeding is a significant complication of endoscopic injection of cyanoacrylate in gastric varices in cirrhotic patients.
BACKGROUND
Rebleeding is a significant complication of endoscopic injection of cyanoacrylate in gastric varices in cirrhotic patients.
AIM
This systematic review and meta-analysis aimed to evaluate the efficiency of endoscopic cyanoacrylate injection and summarized the risk factors for rebleeding.
METHODS
Databases were searched for articles published between January 2012 and December 2022. Studies evaluating the efficiency of endoscopic injection of cyanoacrylate glue for gastric varices and the risk factors for rebleeding were included.
RESULTS
The final analysis included data from 24 studies. The hemostatic rates ranged from 65 to 100%. The pooled rate of gastric varices recurrence was 34% [95% CI 21-46, I = 61.4%], early rebleeding rate was 16% [95% CI 11-20, I = 37.4%], late rebleeding rate was 39% [95% CI 36-42, I = 90.9%], mild and moderate adverse events rate were 28% [95% CI 24-31, I = 91.6%], 3% [95% CI - 2 to 8, I = 15.3%], rebleeding-related mortality rate was 6% [95% CI 2-10, I = 0%], all-cause mortality rate was 17% [95% CI 12-22, I = 63.6%]. Independent risk factors for gastric variceal rebleeding included portal venous thrombosis, ascites, cyanoacrylate volume, fever/systemic inflammatory response syndrome, red Wale sign, previous history of variceal bleeding, active bleeding and paragastric veins. The use of proton pump inhibitors could be a protective factor.
CONCLUSIONS
Endoscopic cyanoacrylate glue injection is an effective and safe treatment for gastric varices. Cirrhotic patients with the above risk factors may benefit from treatment aimed at reducing portal hypertension, antibiotic prophylaxis, and anticoagulation if they meet the indications.
PubMed: 38864930
DOI: 10.1007/s10620-024-08482-x -
The Cochrane Database of Systematic... Jun 2024IgA nephropathy (IgAN) is the most common cause of primary glomerulonephritis. It is a heterogeneous disease with different presentations and high morbidity. Thirty per... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
IgA nephropathy (IgAN) is the most common cause of primary glomerulonephritis. It is a heterogeneous disease with different presentations and high morbidity. Thirty per cent of adults and 20% of children (followed into adulthood) will have a 50% decline in kidney function or develop kidney failure after 10 years.
OBJECTIVES
To determine the benefits and harms of immunosuppressive therapy for the treatment of IgAN in children.
SEARCH METHODS
We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 03 October 2023 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) investigating the treatment of IgAN in children with immunosuppressive therapies compared to placebo, no treatment, supportive care, standard therapy (Japanese protocol), other immunosuppressive therapies or non-immunosuppressive therapies.
DATA COLLECTION AND ANALYSIS
Two authors independently extracted data and assessed the risk of bias. Random effects meta-analyses were used to summarise estimates of treatment effects. Treatment effects were expressed as risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and the mean difference (MD) and 95% CI for continuous outcomes. The risk of bias was assessed using the Cochrane risk of bias tool for RCTs and the ROBIN-I tool for NRSIs. The certainty of the evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).
MAIN RESULTS
This review included 13 studies with 686 participants. Ten RCTs included 334 children and 191 adults, and three NRSIs included 151 participants, all children. Most participants had mild kidney disease. The risk of bias was unclear for most of the domains relating to allocation concealment, blinding of participants, personnel, and outcome assessment. In children with IgAN, it is uncertain if corticosteroid (steroid) therapy, compared to placebo reduces proteinuria (1 study, 64 children and young adults: RR 0.47, 95% CI 0.13 to 1.72; low certainty evidence) or the decline in estimated glomerular filtration rate (eGFR) (1 study, 64 children and young adults: RR 0.47, 95% CI 0.09 to 2.39; low certainty evidence). It is uncertain if steroids reduce proteinuria compared to supportive care (2 studies, 61 children: RR 0.04, 95% CI -0.83 to 0.72; low certainty evidence). Adverse events associated with steroid therapy were not assessed due to heterogeneity in steroid protocols, including dose and duration, and lack of systematic assessment for adverse events in the included studies. Azathioprine, mycophenolate mofetil, mizoribine, or cyclophosphamide alone or in combination with steroid therapy had uncertain effects on improving proteinuria or preventing eGFR decline in children with IgAN. Fish oil, vitamin E and tonsillectomy had uncertain effects on improving proteinuria or preventing eGFR decline. Effects of other immunosuppressive therapies, secondary outcomes and adverse events were not assessed due to insufficient data.
AUTHORS' CONCLUSIONS
There is a lack of high-quality evidence to guide the management of IgAN in children. There is no evidence to indicate that steroids, other immunosuppressive therapies, or tonsillectomy, when added to optimal supportive care, prevent a decline in eGFR or proteinuria in children with IgAN. Available studies were few, with small numbers, low-quality evidence, high or uncertain risk of bias, did not systematically assess harms associated with treatment, or report net benefits or harms. Severe cases and atypical presentations of IgAN were not included in the reviewed studies, and our findings cannot be generalised to these situations.
Topics: Adolescent; Child; Humans; Bias; Disease Progression; Glomerular Filtration Rate; Glomerulonephritis, IGA; Immunosuppressive Agents; Mycophenolic Acid; Placebos; Proteinuria; Randomized Controlled Trials as Topic; Young Adult
PubMed: 38864363
DOI: 10.1002/14651858.CD015060.pub2