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Urologia Internationalis 2019The use of pericardium has been expanded into different surgical modalities; however, there are scarce data regarding the feasibility of the pericardium in... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The use of pericardium has been expanded into different surgical modalities; however, there are scarce data regarding the feasibility of the pericardium in reconstructive urologic surgeries. We systematically reviewed the literature on the effectiveness of the pericardial tissue for reconstructive urologic surgeries.
MATERIALS AND METHODS
PubMed and Scopus were searched online for evidence on the use of the pericardium in urologic surgeries. Through the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 38 of 4,071 studies were identified.
RESULTS
A total of 715 patients and 139 animals underwent reconstructive urologic surgeries using the pericardium. Bladder, urethral, and renal reconstructions were successful in 100% of the human cases. The rates of dissatisfaction, glans hypoesthesia, and penile shortening were comparable between the pericardial graft surgeries and the other operations during penile straightening, but there was a trend among the patients with pericardial grafts toward having a more penile curvature at follow-up (risk ratio [RR] 2.03, 95% CI 0.90-4.61, p = 0.09; I2 = 0%). Among the animal studies, there were 4 reports of penile reconstruction, 7 studies of bladder reconstruction, and 1 study of urethroplasty. Bladder reconstruction and urethroplasty were successful in 83 and 20% of the animals, respectively. The pooled result of the stimulated intracorporeal pressure 5 V significantly favored pericardial grafts during penile reconstruction (RR 2.61, 95% CI 1.26-3.97, p = 0.0002; I2 = 0%).
CONCLUSIONS
Our systematic review demonstrates the feasibility of the pericardium, regardless of its type, in urologic surgeries. It, however, seems that urethral substitution needs further investigation. Given the lower cost, easier handling, and less immunogenicity of the pericardium, further studies are required to examine its pros and cons.
Topics: Adult; Aged; Animals; Female; Graft Survival; Humans; Infant; Male; Middle Aged; Pericardium; Postoperative Complications; Plastic Surgery Procedures; Treatment Outcome; Urologic Surgical Procedures
PubMed: 30517943
DOI: 10.1159/000495513 -
The American Journal of Cardiology Feb 2019Many studies have explored the hypothesis that epicardial adipose tissue (EAT) accumulation adversely affects cardiac remodeling. We assessed, through a systematic... (Meta-Analysis)
Meta-Analysis
Many studies have explored the hypothesis that epicardial adipose tissue (EAT) accumulation adversely affects cardiac remodeling. We assessed, through a systematic review and meta-analysis, whether EAT is linked to left atrial (LA) and left ventricular (LV) structure and function, irrespective of global or abdominal visceral adiposity. We searched MEDLINE, Scopus, and Web of Science for studies evaluating the association of EAT volume quantified by computed tomography with cardiac morphology and function. We used DerSimonian and Laird random-effects models to summarize the adjusted-effect of 10 ml variation of EAT on LA size, LV mass, LV diastolic and systolic functions parameters, and presence of diastolic dysfunction. We quantified heterogeneity using I statistic. We included 19 studies. Quantitative analysis by cardiac parameters, including LA dimension (n = 2,719), LV mass (n = 2,519), diastolic function (n = 3,741), and systolic function (n = 2,037) showed that EAT was associated with LA dilation (pooled B-coefficient: 0.12 mm; 95% confidence interval [CI] 0.08 to 0.17; I: 97%), LV hypertrophy (pooled B-coefficient: 1.21 g; 95% CI 0.63 to 1.79; I: 77%), diastolic dysfunction (odds ratio: 1.35; 95% CI 1.16 to 1.57; I: 0%), higher E/E' ratio (pooled B-coefficient: 0.28 cm/s; 95% CI 0.08 to 0.49; I: 67%), lower E' velocity (pooled B-coefficient: -0.16 cm/s; 95% CI -0.22 to -0.09; I: 43%), and E/A ratio (pooled B-coefficient: -0.01; 95% CI -0.02 to -0.001; I: 70%), independently of body mass index. There was no association between EAT and LV systolic function. In conclusion, EAT volume measured by computed tomography was independently associated with LA dilation, LV hypertrophy, and diastolic dysfunction.
Topics: Adipose Tissue; Blood Flow Velocity; Diastole; Dilatation, Pathologic; Heart Atria; Humans; Hypertrophy, Left Ventricular; Pericardium; Tomography, X-Ray Computed
PubMed: 30477802
DOI: 10.1016/j.amjcard.2018.10.020 -
International Journal of Preventive... 2018Nausea and vomiting of pregnancy (NVP) is a common problem for pregnant women. Researchers have recently paid special attention to complementary medicine methods for the... (Review)
Review
Nausea and vomiting of pregnancy (NVP) is a common problem for pregnant women. Researchers have recently paid special attention to complementary medicine methods for the treatment of NVP. Regarding the high prevalence of NVP as well as maternal and fetal adverse effects of chemical drugs, the present study, focusing on clinical trials carried out in Iran, was conducted to assess safety and efficacy of different nonpharmacological methods in relieving NVP. This systematic review focused on randomized controlled trials (RCTs) and assessed complementary medicine on NVP for which databases including MedLib, Magiran, Iran Medex, SID, PubMed, Scopus, and Google Scholar search engines from 2000 to 2015 were searched. Those articles that gained score 3 or higher, according to Jadad criteria, were recruited for the study. In this study, 31 clinical trials assessing NVP were conducted on Iranian pregnant women. After removing ten articles, 21 articles with scores 3 and higher, according to Jedad criteria, were assessed. Out of 21 papers, 10 papers were about ginger, one was about cardamom, one was about lemon, two were about peppermint aromatherapy, six were about pericardium 6 (P6) acupressure, and one article about KID21 acupressure. Most studies have demonstrated a positive effect on reducing NVP; however, no adverse effect was reported. According to the results of this review, the majority of methods employed were effective in reducing the incidence of NVP, among which ginger and P6 acupressure can be recommended with more reliability.
PubMed: 30319738
DOI: 10.4103/ijpvm.IJPVM_430_16 -
Forensic Science International Nov 2018Being sudden cardiac death (SCD) and acute myocardial infarction (AMI) frequent occurrences in forensic medicine, extensive research has been published about the use of...
Being sudden cardiac death (SCD) and acute myocardial infarction (AMI) frequent occurrences in forensic medicine, extensive research has been published about the use of cardiac troponin T (cTnT) as a potential specific postmortem biochemical marker. However, cTnT has produced uncertain results, leading to the lack of a standardized application in routine postmortem examinations. The present systematic review focuses on the determination of whether cTnT may be considered as a suitable marker for the postmortem diagnosis of AMI and SCD, analysing the literature according to the following criteria: only human experiments, published from 1st January 2001 to 12th April 2018, available in English, on the following databases: (1). Medline/PubMed/MeSH search words: (("heart"[MeSH Terms] OR "cardiac"[All Fields]) AND ("troponin"[MeSH Terms] OR "troponins"[All Fields]) AND forensic[All Fields] AND "postmortem"[All Fields]); (2). Embase, Lilacs and Cochrane Library. 16 full-text articles were included. cTnT has been demonstrated to be elevated in a variety of pathological conditions, not strictly related to cardiac causes, but rather to the severity and extent of myocardial damage from various causes. cTnT levels have been consistently found higher in pericardial fluid than in the peripheral blood. Reviewed studies showed that the most suitable biological sample for cTnT evaluation seems to be pericardial fluid, since it may be less affected by haemolysis of blood. cTnT seems to be quite stable up to a PMI (postmortem interval) smaller than 48h; after this time, a mild time-dependent increase has been demonstrated. CPR seems to have no influence on cTnT values. The postmortem cut-offs differ from clinical ones, and at present no consensus has been reached concerning the postmortem ranges. Further research needs to be carried out in order to establish a common accepted cut-off value for forensic use.
Topics: Biomarkers; Cardiopulmonary Resuscitation; Death, Sudden, Cardiac; Forensic Medicine; Humans; Myocardial Infarction; Pericardial Fluid; Point-of-Care Systems; Postmortem Changes; Reproducibility of Results; Troponin T
PubMed: 30269044
DOI: 10.1016/j.forsciint.2018.09.002 -
Journal of Cardiovascular Medicine... Jun 2018: Pericardiocentesis is a valuable technique for the diagnosis and treatment of patients with pericardial effusion and cardiac tamponade, although it may be associated...
: Pericardiocentesis is a valuable technique for the diagnosis and treatment of patients with pericardial effusion and cardiac tamponade, although it may be associated with potentially serious complications. Through the years, many different imaging approaches have been described to reduce the complication rate of the procedure. This systematic review provides a focused overview of the different techniques developed in recent years to reduce the procedural complications and to increase the related success rate.
Topics: Biomedical Technology; Cardiac Tamponade; Echocardiography; Humans; Image Processing, Computer-Assisted; Pericardial Effusion; Pericardiocentesis; Pericardium; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 29553993
DOI: 10.2459/JCM.0000000000000649 -
European Heart Journal. Cardiovascular... May 2018To conduct a systematic review and meta-analysis on the crude and adjusted associations between epicardial adipose tissue (EAT) volume determined by computed tomography... (Meta-Analysis)
Meta-Analysis
To conduct a systematic review and meta-analysis on the crude and adjusted associations between epicardial adipose tissue (EAT) volume determined by computed tomography (CT) and coronary artery disease (CAD). MEDLINE, Scopus, and Web of Science databases were screened for all observational studies assessing the association between EAT volume and CAD. We calculated pooled odds ratio (OR) or hazard ratio (HR) and 95% confidence intervals (CI) for the association per 10 cm3 variation of EAT by five different definitions of CAD: obstructive or significant coronary stenosis (luminal narrowing ≥50% and ≥70%, respectively), presence of coronary artery calcification (CAC), myocardial ischaemia, and major adverse cardiovascular events (MACE) using DerSimonian and Laird random-effects models. Seventy studies were identified comprising 41 534 subjects, mainly derived from community-based or hospital-based low-to-intermediate pretest probability of CAD populations. Participants with any outcome of CAD had a higher mean volume of EAT than those without. Accordingly, the analysis of crude associations showed that EAT volume was associated with obstructive stenosis, significant stenosis, any CAC, and MACE. Based on the analysis of adjusted associations, although attenuated, EAT volume remained associated with obstructive stenosis (OR 1.055, 95% CI 1.033-1.078; I2 = 63.5%), significant stenosis (OR 1.514, 95% CI 1.262-1.815; I2 = 51.8%), myocardial ischaemia (OR 1.062, 95% CI 1.006-1.122; I2 = 86.9%), and MACE (HR 1.040, 95% CI 1.024-1.056; I2 = 64.7%) but was only borderline significant with CAC (OR 1.007, 95% CI 1.000-1.011; I2 = 75.8%). In low-to-intermediate cardiovascular risk subjects, EAT volume was independently associated with coronary artery stenosis, myocardial ischaemia, and MACE.
Topics: Adipose Tissue; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Female; Humans; Male; Organ Size; Pericardium; Predictive Value of Tests; Prognosis; Risk Assessment
PubMed: 29236951
DOI: 10.1093/ehjci/jex314 -
International Journal of Cardiology Jan 2018Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. The complications of pericardial effusion can either be acute (e.g., cardiac... (Review)
Review
Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. The complications of pericardial effusion can either be acute (e.g., cardiac tamponade) or chronic (e.g., constrictive pericarditis). We have conducted a systematic review of the scientific literature to evaluate the efficacy and safety of intrapericardial fibrinolysis in preventing complications of pericardial effusion. We searched for both published and unpublished studies. 29 studies, with a total of 109 patients were included in this review; 17 case reports, 11 case series, and one randomised controlled trial (RCT). All included studies had a high risk of bias. The most common causes of pericardial effusion were Staphylococcus aureus (12 studies with 23 cases) and Mycobacterium tuberculosis (2 studies with 19 cases). The most common fibrinolytic agents used were streptokinase (15 studies) and urokinase (5 studies). Intrapericardial fibrinolysis prevented complications in 94 (86.2%) patients. Non-fatal procedure-related complications were reported 21 (19.2%) patients. No patient died following intrapericardial fibrinolysis. There is very low certainty of the efficiency and safety of intrapericardial fibrinolysis in preventing the complications of pericardial effusion. High quality RCTs are required to address this question.
Topics: Fibrinolysis; Fibrinolytic Agents; Humans; Pericardial Effusion; Pericarditis; Pericardium; Randomized Controlled Trials as Topic; Streptokinase; Treatment Outcome
PubMed: 29107356
DOI: 10.1016/j.ijcard.2017.10.049 -
The Cochrane Database of Systematic... Sep 2017Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery.
OBJECTIVES
To assess the effects of treatments for tuberculous pericarditis.
SEARCH METHODS
We searched the Cochrane Infectious Diseases Group Specialized Register (27 March 2017); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2); MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and LILACS (1982 to 27 March 2017). In addition we searched the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We searched ClinicalTrials.gov and contacted researchers in the field of tuberculous pericarditis. This is a new version of the original 2002 review.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) and quasi-RCTs.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search outputs, evaluated study eligibility, assessed risk of bias, and extracted data; and we resolved any discrepancies by discussion and consensus. One trial assessed the effects of both corticosteroid and Mycobacterium indicus pranii treatment in a two-by-two factorial design; we excluded data from the group that received both interventions. We conducted fixed-effect meta-analysis and assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
Seven trials met the inclusion criteria; all were from sub-Saharan Africa and included 1959 participants, with 1051/1959 (54%) HIV-positive. All trials evaluated corticosteroids and one each evaluated colchicine, M. indicus pranii immunotherapy, and open surgical drainage. Four trials (1841 participants) were at low risk of bias, and three trials (118 participants) were at high risk of bias.In people who are not infected with HIV, corticosteroids may reduce deaths from all causes (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4 trials, low certainty evidence) and the need for repeat pericardiocentesis (RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty evidence). Corticosteroids probably reduce deaths from pericarditis (RR 0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty evidence). However, we do not know whether or not corticosteroids have an effect on constriction or cancer among HIV-negative people (very low certainty evidence).In people living with HIV, only 19.9% (203/1959) were on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55, 0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is uncertain whether corticosteroids have an effect on all-cause death or cancer (very low certainty evidence); and may have little or no effect on repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2 trials, low certainty evidence).For colchicine among people living with HIV, we found one small trial (33 participants) which had insufficient data to make any conclusions about any effects on death or constrictive pericarditis.Irrespective of HIV status, due to very low certainty evidence from one trial, it is uncertain whether adding M. indicus pranii immunotherapy to antituberculous drugs has an effect on any outcome.Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1 trial, low certainty evidence) but may make little or no difference to other outcomes. We did not find an eligible trial that assessed the effects of open surgical drainage in people living with HIV.The review authors found no eligible trials that examined the length of antituberculous treatment needed nor the effects of other adjunctive treatments for tuberculous pericarditis.
AUTHORS' CONCLUSIONS
For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant.Further research may help evaluate percutaneous drainage of the pericardium under local anaesthesia, the timing of pericardiectomy in tuberculous constrictive pericarditis, and new antibiotic regimens.
Topics: Adrenal Cortex Hormones; Antitubercular Agents; Cause of Death; Colchicine; Drainage; HIV Seronegativity; HIV Seropositivity; Humans; Immunotherapy; Pericardiectomy; Pericarditis, Tuberculous; Pericardium; Randomized Controlled Trials as Topic
PubMed: 28902412
DOI: 10.1002/14651858.CD000526.pub2 -
Journal of the American Heart... Aug 2017Epicardial adipose tissue (EAT) is hypothesized to alter atherosclerotic plaque composition, with potential development of high-risk plaque (HRP). EAT can be measured by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Epicardial adipose tissue (EAT) is hypothesized to alter atherosclerotic plaque composition, with potential development of high-risk plaque (HRP). EAT can be measured by volumetric assessment (EAT-v) or linear thickness (EAT-t). We performed a systematic review and random-effects meta-analysis to assess the association of EAT with HRP and whether this association is dependent on the measurement method used.
METHODS AND RESULTS
Electronic databases were systematically searched up to October 2016. Studies reporting HRP by computed tomography or intracoronary imaging and studies measuring EAT-v or EAT-t were included. Odds ratios were extracted from multivariable models reporting the association of EAT with HRP and described as pooled estimates with 95% confidence intervals (CIs). Analysis was stratified by EAT measurement method. Nine studies (n=3772 patients) were included with 7 measuring EAT-v and 2 measuring EAT-t. Increasing EAT was significantly associated with the presence of HRP (odds ratio: 1.26 [95% CI, 1.11-1.43]; <0.001). Patients with HRP had higher EAT-v than those without (weighted mean difference: 28.3 mL [95% CI, 18.8-37.8 mL]; <0.001). EAT-v was associated with HRP (odds ratio: 1.19 [95% CI, 1.06-1.33]; <0.001); however, EAT-t was not (odds ratio: 3.09 [95% CI, 0.56-17]; =0.2). Estimates remained significant when adjusted for small-study effect bias (odds ratio: 1.13 [95% CI, 1.03-1.28]; =0.04).
CONCLUSIONS
Increasing EAT is associated with the presence of HRP, and patients with HRP have higher quantified EAT-v. The association of EAT-v with HRP is significant compared with EAT-t; however, a larger scale study is still required, and further evaluation is needed to assess whether EAT may be a potential therapeutic target for novel pharmaceutical agents.
CLINICAL TRIAL REGISTRATION
URL: https://www.crd.york.ac.uk/. Unique identifier: CRD42017055473.
Topics: Adipose Tissue; Adiposity; Adult; Aged; Aged, 80 and over; Coronary Artery Disease; Coronary Vessels; Female; Humans; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pericardium; Plaque, Atherosclerotic; Risk Assessment; Risk Factors; Rupture, Spontaneous; Young Adult
PubMed: 28838916
DOI: 10.1161/JAHA.117.006379 -
Prenatal Diagnosis Sep 2017The purpose of this systematic review is to provide a comprehensive overview on the clinical course, perinatal outcome, and effectiveness of prenatal management options... (Review)
Review
OBJECTIVES
The purpose of this systematic review is to provide a comprehensive overview on the clinical course, perinatal outcome, and effectiveness of prenatal management options for pericardial teratoma.
METHODS
A comprehensive search including Ovid MEDLINE, Ovid EMBASE, and Scopus was conducted from inception to September 2016. All studies that reported the prenatal course of pericardial teratoma in singleton or twin gestations were considered eligible. Standardized forms were used for data abstraction by two independent reviewers.
RESULTS
Out of 217 screened abstracts, 59 studies reporting 67 fetuses with pericardial teratoma were included. Twenty-three singleton fetuses and 3 fetuses in twin gestations underwent prenatal treatment, and 20 (76.9%) of them were hydropic at the time of intervention. Of those, 15/20 (75%) had a favorable outcome. In the non-intervention group (n = 41), 26 (63.4%) developed hydrops, and out of those, 8 (30.8%) had a favorable outcome.
CONCLUSION
Prenatal fluid drainage and other prenatal techniques have been utilized in the treatment of intrapericardial teratoma. While most fetuses tolerated pericardiocentesis, the neonatal benefit of this procedure is still uncertain, and outcomes of other interventions had variable success. Prenatal intervention for pericardial teratoma may be an option in specialized units but, given the maternal and fetal risks, needs careful consideration. © 2017 John Wiley & Sons, Ltd.
Topics: Diseases in Twins; Drainage; Female; Fetal Diseases; Fetal Heart; Heart Neoplasms; Humans; Hydrops Fetalis; MEDLINE; Male; Pericardium; Pregnancy; Pregnancy Outcome; Prenatal Diagnosis; Risk Factors; Teratoma
PubMed: 28695637
DOI: 10.1002/pd.5113