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Annals of Clinical Biochemistry Jan 2023Faecal Immunochemical tests (FITs) in the assessment of patients presenting with symptoms have generally used a single sample. Little evidence pertains to the use of... (Review)
Review
BACKGROUND
Faecal Immunochemical tests (FITs) in the assessment of patients presenting with symptoms have generally used a single sample. Little evidence pertains to the use of replicate, where a number of tests are done prior to decision-making or repeat FIT, where additional FIT are performed following clinical decision-making. Overwhelmingly, research has focussed on FIT to help identify colorectal cancer (CRC). The aim of this review is to assess the available literature concerning replicate and repeat FIT in symptomatic patients to help generate consensus and guide future research.
METHODS
The terms 'faecal immunochemical test' or 'FIT' were combined with 'multiple' or 'repeat'. EMBASE, Medline and PubMed database and other searches were conducted. All papers published in English were included with no exclusion date limits until November 2021.
RESULTS
Of the 161 initial papers screened, seven were included for review. Qualitative and quantitative FIT outcomes were assessed in the studies. The primary aims of most related to whether replicate FIT increased diagnostic yield of CRC, with colonoscopy used as the reference standard. One publication assessed the impact of a new COVID-adapted pathway on CRC detection. No consensus on replicate FIT was apparent. Some concluded that FITs may help minimise missed CRC diagnoses: others showed no increase in diagnostic yield of CRC.
CONCLUSIONS
Current evidence on replicate and repeat FIT is both minimal and conflicting. FIT is a superb clinical tool, but significant gaps surrounding application remain. Further studies relating to replicate and repeat FIT are required.
Topics: Humans; Sensitivity and Specificity; Colorectal Neoplasms; Early Detection of Cancer; COVID-19; Colonoscopy; Occult Blood; Feces; Hemoglobins
PubMed: 35394384
DOI: 10.1177/00045632221096036 -
Molecular Psychiatry Jul 2022Telomere length may serve as a biomarker of cellular aging. The literature assessing telomere length in schizophrenia contains conflicting results. (Meta-Analysis)
Meta-Analysis
CONTEXT
Telomere length may serve as a biomarker of cellular aging. The literature assessing telomere length in schizophrenia contains conflicting results.
OBJECTIVE
To assess differences in leukocyte telomere length (LTL) in peripheral blood in patients with schizophrenia and related disorders and healthy controls and to explore the effect of potential confounding variables.
DATA SOURCES
A search of Ovid MEDLINE, and Proquest databases was conducted to identify appropriate studies published from database inception through December 2020. The review protocol was registered with PROSPERO-ID: CRD42021233280.
STUDY SELECTION
The initial literature search yielded 192 studies. After study selection in 3 phases, we included 29 samples from 22 studies in the meta-analysis database.
DATA EXTRACTION
We used random effects and meta-regression models to derive Cohen d values with pooled 95% confidence intervals (CI) as estimates of effect size (ES) and to test effects of potential moderators.
RESULTS
The overall meta-analysis included 4145 patients with schizophrenia and related disorders and 4184 healthy controls and showed that LTL was significantly shorter in patients, with a small to medium effect size (ES, -0.388; 95% CI, -0.492 to -0.283; p < 0.001). Subgroup meta-analyses did not find a significant effect of age or illness duration on differences in LTL in patients with psychosis relative to controls. Meta-regression analyses showed that none of the putative moderators had a significant effect on effect size estimates.
CONCLUSIONS
This meta-analysis find further support for the hypothesis of accelerated cellular aging in schizophrenia and related disorders and highlights the need for large longitudinal studies with repeated LTL measurements over time and appropriate assessments of associated factors.
Topics: Case-Control Studies; Humans; Leukocytes; Psychotic Disorders; Schizophrenia; Telomere; Telomere Shortening
PubMed: 35393557
DOI: 10.1038/s41380-022-01541-7 -
Psychology and Aging Feb 2022A number of developmental theories have been proposed that make differential predictions about the links between age and temporal discounting, or the devaluation of... (Meta-Analysis)
Meta-Analysis
A number of developmental theories have been proposed that make differential predictions about the links between age and temporal discounting, or the devaluation of future rewards. Most empirical studies examining adult age differences in temporal discounting have relied on economic intertemporal choice tasks, which pit choosing a smaller, sooner monetary reward against choosing a larger, later one. Although initial studies using these tasks suggested older adults discount less than younger adults, follow-up studies provided heterogeneous, and thus inconclusive, results. Using an open science approach, we test the replicability of adult age differences in temporal discounting by conducting a preregistered systematic literature search and meta-analysis of adult age differences in intertemporal choice tasks. Across 37 cross-sectional studies (Total N = 104,737), a planned meta-analysis found no sizeable relation between age and temporal discounting, r = -0.068, 95% CI [-0.170, 0.035]. We also found little evidence of publication bias or p-hacking. Exploratory analyses of moderators found no effect of research design (e.g., extreme-group vs. continuous age), incentives (hypothetical vs. real rewards), duration of delay (e.g., days, weeks, months, or years), or quantification of discounting behavior (e.g., proportion of immediate choices vs. parameters from computational modeling). Additional analyses of 12 participant-level data sets found little support for a nonlinear relation between age and temporal discounting across adulthood. Overall, the results suggest that younger, middle-aged, and older adults show similar preferences for smaller, sooner over larger, later rewards. We provide recommendations for future empirical work on temporal discounting across the adult life span. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Adult; Aged; Aging; Choice Behavior; Cross-Sectional Studies; Delay Discounting; Humans; Middle Aged; Motivation; Reward
PubMed: 35113618
DOI: 10.1037/pag0000634 -
Schizophrenia Research Feb 2022Early intervention for psychosis services have been established worldwide and consist of specialist services for those with the At-Risk Mental State (ARMS) and a first... (Meta-Analysis)
Meta-Analysis Review
Outcomes for first-episode psychosis after entry via an at-risk mental state clinic compared to direct entry to a first episode of psychosis service: A systematic review and meta-analysis.
OBJECTIVE
Early intervention for psychosis services have been established worldwide and consist of specialist services for those with the At-Risk Mental State (ARMS) and a first episode of psychosis (FEP). This systematic review identified the literature on the outcomes of people who initially presented via an ARMS clinic and later transitioned to a psychotic disorder (UHR-T), compared to those who presented directly to an EI service with a FEP (FEP-D). The outcomes examined were (i) symptomatic (ii) functional, (iii) morbidity and mortality (including physical health) and (iv) service-usage.
METHOD
A systematic search strategy was employed using three databases: MEDLINE, PsycInfo, and EMBASE. Studies published in English and that compared any of the above outcomes in a cohort of people with a first episode of psychosis who initially presented via an ARMS clinic to those who presented directly to a FEP service were included. Meta-analysis was performed for any outcome data from at least two studies.
RESULTS
A total of 988 unique articles were identified and of these, three studies fulfilled the inclusion criteria and these included a total of 78 UHR-T and 253 FEP-D individuals. In the one study examining remission rates, there was no difference observed after one year in the UHR-T and FEP-D groups. In the one study that examined neurocognition, no differences were observed in any of the neurocognitive domains between groups after one year. Two studies examined psychiatric admission rates within one year and one of these found that UHR-T individuals were less likely to have any psychiatric admission (46% vs 68%) and admissions were less likely to be involuntary (30% vs 74%), while the other study found no difference in admission rates. In the meta-analysis, UHR-T individuals had lower odds for any psychiatric hospital admission within one year compared to FEP-D individuals (OR = 0.54, 95% C.I. 0.32 - 0.94, p = .03). No studies examined functional outcomes or mortality and morbidity between the groups.
CONCLUSION
The limited research indicates similar or superior outcomes for people with a FEP who present initially via an ARMS clinic. The reduced psychiatric admission rate is an important potential benefit of ARMS clinics that requires replication.
Topics: Ambulatory Care Facilities; Cohort Studies; Hospitalization; Humans; Psychotic Disorders
PubMed: 35032907
DOI: 10.1016/j.schres.2021.12.019 -
Neurosurgical Focus Jan 2022The utility of robotic instrumentation is expanding in neurosurgery. Despite this, successful examples of robotic implementation for endoscopic endonasal or skull base...
OBJECTIVE
The utility of robotic instrumentation is expanding in neurosurgery. Despite this, successful examples of robotic implementation for endoscopic endonasal or skull base neurosurgery remain limited. Therefore, the authors performed a systematic review of the literature to identify all articles that used robotic systems to access the sella or anterior, middle, or posterior cranial fossae.
METHODS
A systematic review of MEDLINE and PubMed in accordance with PRISMA guidelines performed for articles published between January 1, 1990, and August 1, 2021, was conducted to identify all robotic systems (autonomous, semiautonomous, or surgeon-controlled) used for skull base neurosurgical procedures. Cadaveric and human clinical studies were included. Studies with exclusively otorhinolaryngological applications or using robotic microscopes were excluded.
RESULTS
A total of 561 studies were identified from the initial search, of which 22 were included following full-text review. Transoral robotic surgery (TORS) using the da Vinci Surgical System was the most widely reported system (4 studies) utilized for skull base and pituitary fossa procedures; additionally, it has been reported for resection of sellar masses in 4 patients. Seven cadaveric studies used the da Vinci Surgical System to access the skull base using alternative, non-TORS approaches (e.g., transnasal, transmaxillary, and supraorbital). Five cadaveric studies investigated alternative systems to access the skull base. Six studies investigated the use of robotic endoscope holders. Advantages to robotic applications in skull base neurosurgery included improved lighting and 3D visualization, replication of more traditional gesture-based movements, and the ability for dexterous movements ordinarily constrained by small operative corridors. Limitations included the size and angulation capacity of the robot, lack of drilling components preventing fully robotic procedures, and cost. Robotic endoscope holders may have been particularly advantageous when the use of a surgical assistant or second surgeon was limited.
CONCLUSIONS
Robotic skull base neurosurgery has been growing in popularity and feasibility, but significant limitations remain. While robotic systems seem to have allowed for greater maneuverability and 3D visualization, their size and lack of neurosurgery-specific tools have continued to prevent widespread adoption into current practice. The next generation of robotic technologies should prioritize overcoming these limitations.
Topics: Humans; Neurosurgery; Neurosurgical Procedures; Robotic Surgical Procedures; Robotics; Skull Base
PubMed: 34973668
DOI: 10.3171/2021.10.FOCUS21505 -
Current Topics in Behavioral... 2022Drug addiction is a complex brain disorder that is characterized by craving, withdrawal, and relapse, which can be perpetuated by social stress. Stemming from an acute...
BACKGROUND
Drug addiction is a complex brain disorder that is characterized by craving, withdrawal, and relapse, which can be perpetuated by social stress. Stemming from an acute life event, chronic stress, or trauma in a social context, social stress has a major role in the initiation and trajectory of substance use. Preclinical literature shows that early life stress exposure and social isolation facilitate and enhance drug self-administration. Epidemiological evidence links childhood adversity to increased risk for drug use and demonstrates that cumulative stress experiences are predictive of substance use severity in a dose-dependent manner. Stress and drug use induce overlapping brain alterations leading to downregulation or deficits in brain reward circuitry, thereby resulting in greater sensitization to the rewarding properties of drugs. Though stress in the context of addiction has been studied at the neural level, a gap in our understanding of the neural underpinnings of social stress in humans remains.
METHODS
We conducted a systematic review of in vivo structural and functional neuroimaging studies to evaluate the neural processes associated with social stress in individuals with substance use disorder. Results were considered in relation to participants' history of social stress and with regard to the effects of social stress induced during the neuroimaging paradigm.
RESULTS
An exhaustive search yielded 21 studies that matched inclusion criteria. Social stress induces broad structural and functional neural effects in individuals with substance use disorder throughout their lifespan and across drug classes. A few patterns emerged across studies: (1) many of the brain regions altered in individuals who were exposed to chronic social stress and during acute stress induction have been implicated in addiction networks (including the prefrontal cortex, insula, hippocampus, and amygdala); (2) individuals with childhood maltreatment and substance use history had decreased gray matter or activation in regions of executive functioning (including the medial prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex), the hippocampal complex, and the supplementary motor area; and (3) during stress-induction paradigms, activation in the anterior cingulate cortex, caudate, and amygdala was most commonly observed.
CONCLUSIONS/IMPLICATIONS
A distinct overlap is shown between social stress-related circuitry and addiction circuitry, particularly in brain regions implicated in drug-seeking, craving, and relapse. Given the few studies that have thoroughly investigated social stress, the evidence accumulated to date needs to be replicated and extended, particularly using research designs and methods that disentangle the effects of substance use from social stress. Future clinical studies can leverage this information to evaluate the impact of exposure to trauma or adverse life events within substance use research. Expanding knowledge in this emerging field could help clarify neural mechanisms underlying addiction risk and progression to guide causal-experimental inquiry and novel prevention and treatment strategies.
Topics: Behavior, Addictive; Brain; Humans; Magnetic Resonance Imaging; Recurrence; Stress, Psychological; Substance-Related Disorders
PubMed: 34971448
DOI: 10.1007/7854_2021_272 -
European Journal of Cancer Care May 2022This study aimed to summarise research findings on dysphagia prehabilitation initiated before chemoradiation therapy (C)RT in head and neck cancer (HNC) including its... (Review)
Review
INTRODUCTION
This study aimed to summarise research findings on dysphagia prehabilitation initiated before chemoradiation therapy (C)RT in head and neck cancer (HNC) including its impact on three swallow-related outcomes at distinct time points.
METHODS
A comprehensive search was completed in PubMed, Embase, Web of Science and CINAHL. Inclusion criteria were studies of adults with HNC with an exercise-based prehabilitation programme beginning before (C)RT. Methodological quality was rated using the Downs and Black checklist. The Template for Intervention Descriptions and Replication (TIDieR) checklist was used to evaluate how well studies were reported.
RESULTS
Eight studies (three randomised control trials) involving 295 adults with HNC were included. The largest participant group (63%) were Stage III/IV head and neck squamous cell carcinoma (HNSCC). Prehabilitation was completed independently at home (100%) and typically began 2 weeks before CRT (75%). Studies evaluated the impact of dysphagia prehabilitation across functional (n = 6), quality of life (n = 5) and physiological (n = 4) domains. Prehabilitation significantly altered physiological (25%), functional (66%) and quality of life (50%) outcomes. Fifty per cent of studies included long-term (>1 year) outcomes. Quality of included studies ranged from poor (25%) to good (38%). Six (75%) studies reported sufficient details of exercise programmes.
CONCLUSION
Limited evidence supports exercise-based dysphagia prehabilitation before (C)RT to improve swallow-related outcomes, and long-term benefits remain unclear. Further high-quality research using core outcome sets is required.
Topics: Adult; Deglutition; Deglutition Disorders; Head and Neck Neoplasms; Humans; Preoperative Exercise; Quality of Life
PubMed: 34964185
DOI: 10.1111/ecc.13549 -
Cardiovascular Diabetology Dec 2021Atrial fibrillation (AF) is a common arrhythmia classified as paroxysmal and non-paroxysmal. Non-paroxysmal AF is associated with an increased risk of complications.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Atrial fibrillation (AF) is a common arrhythmia classified as paroxysmal and non-paroxysmal. Non-paroxysmal AF is associated with an increased risk of complications. Diabetes contributes to AF initiation, yet its role in AF maintenance is unclear. We conducted a systematic review and meta-analysis to summarize the evidence regarding the association of diabetes with AF types.
METHODS
We searched 5 databases for observational studies investigating the association of diabetes with the likelihood of an AF type (vs another type) in humans. Study quality was evaluated using the Newcastle-Ottawa Scale. Studies classifying AF types as paroxysmal (reference) and non-paroxysmal were pooled in a meta-analysis using random effects models.
RESULTS
Of 1997 articles we identified, 20 were included in our systematic review. The population sample size ranged from 64 to 9816 participants with mean age ranging from 40 to 75 years and percentage of women from 24.8 to 100%. The quality of studies varied from poor (60%) to fair (5%) to good (35%). In the systematic review, 8 studies among patients with AF investigated the cross-sectional association of diabetes with non-paroxysmal AF (vs paroxysmal) of which 6 showed a positive association and 2 showed no association. Fourteen studies investigated the longitudinal association of diabetes with "more sustained" AF types (vs "less sustained") of which 2 showed a positive association and 12 showed no association. In the meta-analysis of cross-sectional studies, patients with AF and diabetes were 1.31-times more likely to have non-paroxysmal AF than those without diabetes [8 studies; pooled OR (95% CI), 1.31 (1.13-1.51), I = 82.6%]. The meta-analysis of longitudinal studies showed that for patients with paroxysmal AF, diabetes is associated with 1.32-times increased likelihood of progression to non-paroxysmal AF [five studies; pooled OR (95% CI), 1.32 (1.07-1.62); I = 0%].
CONCLUSIONS
Our findings suggest that diabetes is associated with an increased likelihood of non-paroxysmal AF rather than paroxysmal AF. However, further high quality studies are needed to replicate these findings, adjust for potential confounders, elucidate mechanisms linking diabetes to non-paroxysmal AF, and assess the impact of antidiabetic medications on AF types. These strategies could eventually help decrease the risk of non-paroxysmal AF among patients with diabetes.
Topics: Adult; Aged; Atrial Fibrillation; Diabetes Mellitus; Female; Heart Disease Risk Factors; Humans; Male; Middle Aged; Observational Studies as Topic; Prognosis; Risk Assessment; Time Factors
PubMed: 34876114
DOI: 10.1186/s12933-021-01423-2 -
Current Medical Research and Opinion Feb 2022With constantly emerging new information regarding the epidemiology, pathogenesis, diagnosis and management of Coronavirus Disease 2019 (COVID-19), reviewing literature... (Meta-Analysis)
Meta-Analysis
With constantly emerging new information regarding the epidemiology, pathogenesis, diagnosis and management of Coronavirus Disease 2019 (COVID-19), reviewing literature related to it has become increasingly complicated and resource-intensive. In the setting of this global pandemic, clinical decisions are being guided by the results of multiple pertinent studies; however, it has been observed that these studies are often heterogenous in design and population characteristics and results of initial trials may not be replicated in subsequent studies. The resulting clinical conundrum can be resolved by high-quality systematic review and meta-analysis with a robust and reliable methodology, encapsulating and critically appraising all the available literature relevant to the clinical scenario under scrutiny. It can condense the large volume of scientific information available and can also identify the cause of differences in the degree of effect under consideration across different studies. It can identify optimal diagnostic algorithms, assess efficacy of treatment strategies, and analyze inherent factors influencing the efficacy of treatment for COVID-19. The current review aims to provide a basic guide to plan and conduct a high-quality systematic review and meta-analysis pertaining to COVID-19, describing the main steps and addressing the pitfalls commonly encountered at each step. Knowledge of the basic steps would also allow the reader to critically appraise published systematic review and meta-analysis and the quality of evidence provided therein.
Topics: COVID-19; Humans; Pandemics; SARS-CoV-2
PubMed: 34870545
DOI: 10.1080/03007995.2021.2015160 -
Archives of Oral Biology Feb 2022To investigate by means of a literature review, what non-coding RNAs engage in non-syndromic cleft lip with or without cleft palate (NSCL/P) and how they lead to the... (Review)
Review
OBJECTIVE
To investigate by means of a literature review, what non-coding RNAs engage in non-syndromic cleft lip with or without cleft palate (NSCL/P) and how they lead to the occurrence of this malformation.
DESIGN
A literature search of online databases (Medline via PubMed, Web of Science, Scopus, and Embase) was performed using appropriate keywords (e.g. non-coding RNA, miRNA, lncRNA, NSCL/P, non-syndromic cleft lip only, and non-syndromic orofacial cleft). The risk of bias in the included studies was then assessed, and a comprehensive review of reported non-coding RNAs associated with NSCL/P was performed.
RESULTS
The initial search retrieved 133 studies reporting non-coding RNAs associated with NSCL/P; after excluding 18 replicates and 77 ineligible studies, 35 remained. Of these, 16 studies fulfilled all the criteria and were included in the systematic review. These studies established the roles of non-coding RNAs in the development of craniofacial structures. The differential expression of these non-coding RNAs could lead to orofacial clefts, indicating their significance in NSCL/P and their profound research value.
CONCLUSION
There is evidence that non-coding RNAs are involved in the formation of NSCL/P. Specifically, they play significant roles in the regulation of genes and signalling pathways related to NSCL/P.
Topics: Cleft Lip; Cleft Palate; Genetic Predisposition to Disease; Genotype; Humans; Polymorphism, Single Nucleotide; RNA, Untranslated
PubMed: 34864430
DOI: 10.1016/j.archoralbio.2021.105319