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The Cochrane Database of Systematic... Aug 2015Drugs with combined alpha and beta blocking activity are commonly prescribed to treat hypertension. However, the blood pressure (BP) lowering efficacy of this class of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Drugs with combined alpha and beta blocking activity are commonly prescribed to treat hypertension. However, the blood pressure (BP) lowering efficacy of this class of beta blockers has not been systematically reviewed and quantified.
OBJECTIVES
To quantify the dose-related effects of various types of dual alpha and beta adrenergic receptor blockers (dual receptor blockers) on systolic and diastolic blood pressure versus placebo in patients with primary hypertension.
SEARCH METHODS
We searched the Cochrane Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and ClinicalTrials.gov for randomized controlled trials up to October 2014. The WHO International Clinical Trials Registry Platform (ICTRP) is searched for inclusion in the Group's Specialised Register.
SELECTION CRITERIA
Randomized double blind placebo controlled parallel or cross-over trials. Studies contained a beta blocker monotherapy arm with a fixed dose. Patients enrolled in the studies had primary hypertension at baseline. Duration of the studies was from three to 12 weeks. Drugs in this class of beta blockers are carvedilol, dilevalol and labetalol.
DATA COLLECTION AND ANALYSIS
Two review authors (GW and AL) confirmed the inclusion of studies and extracted the data independently. RevMan 5.3 was used to synthesize data.
MAIN RESULTS
We included eight studies examining the blood pressure lowering efficacy of carvedilol and labetalol in 1493 hypertensive patients. Five of the included studies were parallel design; three were cross-over design. The two largest included studies were unpublished carvedilol studies. The estimates of BP lowering effect (systolic BP/diastolic BP millimeters of mercury; SPB/DBP mm Hg) were -4 mm Hg (95% confidence intervals (CI) -6 to -2)/-3 mm Hg (95% CI -4 to -2) for carvedilol (>1000 subjects) and -10 mm Hg (95% CI -14 to -7)/-7 mm Hg (95% CI -9 to -5) for labetalol (110 subjects). The effect of labetalol is likely to be exaggerated due to high risk of bias. Carvedilol, within the recommended dose range, did not show a significant dose response effect for SBP or DBP. Carvedilol had little or no effect on pulse pressure (-1 mm Hg) and did not change BP variability. Overall, once and twice the starting dose of carvedilol and labetalol lowered BP by -6 mm Hg (95% CI -7 to -4) /-4 mm Hg (95% CI -4 to -3) (low quality evidence) and lowered heart rate by five beats per minute (95% CI -6 to -4) (low quality evidence). Five studies (N = 1412) reported withdrawal due to adverse effects; the risk ratio was 0.88 (95% CI 0.54 to 1.42) (moderate quality evidence).
AUTHORS' CONCLUSIONS
This review provides low quality evidence that in patients with mild to moderate hypertension, dual receptor blockers lowered trough BP by an average of -6/-4 mm Hg and reduced heart rate by five beats per minute. Due to the larger sample size from the two unpublished studies, carvedilol provided a better estimate of BP lowering effect than labetalol. The BP lowering estimate from combining carvedilol once and twice the starting doses is -4/-3 mm Hg. Doses higher than the recommended starting dose did not provide additional BP reduction. Higher doses of dual receptor blockers caused more bradycardia than lower doses. Based on indirect comparison with other classes of drugs, the blood pressure lowering effect of dual alpha- and beta-receptor blockers is less than non-selective, beta1 selective and partial agonist beta blockers, as well as thiazides and drugs inhibiting the renin angiotensin system. Dual blockers also had little or no effect on reducing pulse pressure, which is similar to the other beta-blocker classes, but less than the average reduction of pulse pressure seen with thiazides and drugs inhibiting the renin angiotensin system. Patients taking dual receptor blockers were not more likely to withdraw from the study compared to patients taking placebo.
Topics: Adrenergic alpha-1 Receptor Antagonists; Adrenergic beta-Antagonists; Antihypertensive Agents; Blood Pressure; Carbazoles; Carvedilol; Essential Hypertension; Heart Rate; Humans; Hypertension; Labetalol; Propanolamines; Randomized Controlled Trials as Topic; Withholding Treatment
PubMed: 26306578
DOI: 10.1002/14651858.CD007449.pub2 -
Journal of Dental Research Sep 2014The aim of this systematic review and meta-analysis was to investigate whether there are any effects of diabetes mellitus on implant failure rates, postoperative... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review and meta-analysis was to investigate whether there are any effects of diabetes mellitus on implant failure rates, postoperative infections, and marginal bone loss. An electronic search without time or language restrictions was undertaken in March 2014. The present review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria included clinical human studies. The search strategy resulted in 14 publications. The I (2) statistic was used to express the percentage of total variation across studies due to heterogeneity. The inverse variance method was used for the random effects model when heterogeneity was detected or for the fixed effects model when heterogeneity was not detected. The estimates of an intervention for dichotomous outcomes were expressed in risk ratio and in mean difference in millimeters for continuous outcomes, both with a 95% confidence interval. There was a statistically significant difference (p = .001; mean difference = 0.20, 95% confidence interval = 0.08, 0.31) between diabetic and non-diabetic patients concerning marginal bone loss, favoring non-diabetic patients. A meta-analysis was not possible for postoperative infections. The difference between the patients (diabetic vs. non-diabetic) did not significantly affect implant failure rates (p = .65), with a risk ratio of 1.07 (95% confidence interval = 0.80, 1.44). Studies are lacking that include both patient types, with larger sample sizes, and that report the outcome data separately for each group. The results of the present meta-analysis should be interpreted with caution because of the presence of uncontrolled confounding factors in the included studies.
Topics: Alveolar Bone Loss; Dental Implants; Dental Restoration Failure; Diabetes Complications; Humans; Surgical Wound Infection
PubMed: 24928096
DOI: 10.1177/0022034514538820 -
PloS One 2014To summarize relevant evidence investigating the associations between refractive error and age-related macular degeneration (AMD). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To summarize relevant evidence investigating the associations between refractive error and age-related macular degeneration (AMD).
DESIGN
Systematic review and meta-analysis.
METHODS
We searched Medline, Web of Science, and Cochrane databases as well as the reference lists of retrieved articles to identify studies that met the inclusion criteria. Extracted data were combined using a random-effects meta-analysis. Studies that were pertinent to our topic but did not meet the criteria for quantitative analysis were reported in a systematic review instead.
MAIN OUTCOME MEASURES
Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between refractive error (hyperopia, myopia, per-diopter increase in spherical equivalent [SE] toward hyperopia, per-millimeter increase in axial length [AL]) and AMD (early and late, prevalent and incident).
RESULTS
Fourteen studies comprising over 5800 patients were eligible. Significant associations were found between hyperopia, myopia, per-diopter increase in SE, per-millimeter increase in AL, and prevalent early AMD. The pooled ORs and 95% CIs were 1.13 (1.06-1.20), 0.75 (0.56-0.94), 1.10 (1.07-1.14), and 0.79 (0.73-0.85), respectively. The per-diopter increase in SE was also significantly associated with early AMD incidence (OR, 1.06; 95% CI, 1.02-1.10). However, no significant association was found between hyperopia or myopia and early AMD incidence. Furthermore, neither prevalent nor incident late AMD was associated with refractive error. Considerable heterogeneity was found among studies investigating the association between myopia and prevalent early AMD (P = 0.001, I2 = 72.2%). Geographic location might play a role; the heterogeneity became non-significant after stratifying these studies into Asian and non-Asian subgroups.
CONCLUSION
Refractive error is associated with early AMD but not with late AMD. More large-scale longitudinal studies are needed to further investigate such associations.
Topics: Aged; Aged, 80 and over; Female; Humans; Incidence; Macular Degeneration; Male; Middle Aged; Odds Ratio; Prevalence; Refractive Errors; Risk Factors; Time Factors
PubMed: 24603619
DOI: 10.1371/journal.pone.0090897 -
International Orthopaedics May 2014The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques... (Review)
Review
PURPOSE
The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques of radiographic assessment of upper limb lengthening after RSA and determine the ideal soft tissue tension that provides the best functional outcome without increasing the risk of complications.
METHODS
Inclusion criteria were articles in which the primary interest was the technique of measuring upper-extremity lengthening after complications related to lengthening and its role in postoperative function; those written in English, French or German; and those that provided evidence levels I-IV relevant to search terms.
RESULTS
Seven articles met our inclusion criteria. Postoperatively, changes in humeral length varied from minus five to five millimetres, and changes in upper-extremity length varied from 15 mm to 27 mm. The acromiohumeral distance averaged 23 mm. Humeral and arm shortening increased the risk of dislocation and led to poor anterior active elevation. The type of surgical approach did not play a role in postoperative function. Subclinical neurological lesions were frequent.
CONCLUSIONS
Studies in this systematic review indicate that deltoid tensioning by restoring humeral length and increasing the acromiohumeral distance is critical for adequate postoperative function and to prevent dislocation. Excessive arm lengthening should be avoided, with zero to two centimetres of lengthening being a reasonable goal to avoid postoperative neurological impairment.
Topics: Arthroplasty, Replacement; Biomechanical Phenomena; Bone Lengthening; Humans; Humerus; Shoulder Joint
PubMed: 24271331
DOI: 10.1007/s00264-013-2175-z -
The Cochrane Database of Systematic... Aug 2012Encapsulation of a filtering bleb following trabeculectomy may lead to elevation of intraocular pressure, prompting further medical or surgical intervention. It has been... (Review)
Review
BACKGROUND
Encapsulation of a filtering bleb following trabeculectomy may lead to elevation of intraocular pressure, prompting further medical or surgical intervention. It has been suggested that needling of an encapsulated bleb may be effective in re-establishing drainage and lowering intraocular pressure.
OBJECTIVES
The objective of this review was to assess the effects of needling encapsulated blebs on intraocular pressure.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 14 February 2012.
SELECTION CRITERIA
We included randomised and quasi-randomised in which bleb needling was compared with any form of antiglaucoma medication in people with encapsulated trabeculectomy blebs. The primary outcome was mean intraocular pressure measured in millimetres of mercury at day one, one week, one month and at last available follow-up.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.
MAIN RESULTS
One trial, which randomised 25 eyes to either needling or medical treatment, met the inclusion criteria. At one day post-treatment, mean intraocular pressure was lower in the needling group (16.28 mmHg, standard deviation 5.9) than the medical group (19.45 mmHg, standard deviation 3.75). The difference was not statistically significant. At all other follow-up points, mean intraocular pressure was consistently higher in the needling group than the medical group, although the differences were not statistically significant. However, only one needled bleb remained successful at the end of follow-up compared to 10 out of the 11 blebs managed conservatively. This difference was statistically highly significant.
AUTHORS' CONCLUSIONS
Evidence from one small trial suggests that needling of encapsulated trabeculectomy blebs is not better than medical treatment in reducing intraocular pressure.
Topics: Blister; Filtering Surgery; Glaucoma; Humans; Intraocular Pressure; Needles; Paracentesis; Randomized Controlled Trials as Topic; Trabeculectomy
PubMed: 22895936
DOI: 10.1002/14651858.CD003658.pub3 -
Hypertension (Dallas, Tex. : 1979) Feb 2012Lower birth weight because of fetal growth restriction is associated with higher blood pressure later in life, but the extent to which preterm birth (<37 completed... (Meta-Analysis)
Meta-Analysis Review
Lower birth weight because of fetal growth restriction is associated with higher blood pressure later in life, but the extent to which preterm birth (<37 completed weeks' gestation) or very low birth weight (<1500 g) predicts higher blood pressure is less clear. We performed a systematic review of 27 observational studies that compared the resting or ambulatory systolic blood pressure or diagnosis of hypertension among children, adolescents, and adults born preterm or very low birth weight with those born at term. We performed a meta-analysis with the subset of 10 studies that reported the resting systolic blood pressure difference in millimeters of mercury with 95% CIs or SEs. We assessed methodologic quality with a modified Newcastle-Ottawa Scale. The 10 studies were composed of 1342 preterm or very low birth weight and 1738 term participants from 8 countries. The mean gestational age at birth of the preterm participants was 30.2 weeks (range: 28.8-34.1 weeks), birth weight was 1280 g (range: 1098-1958 g), and age at systolic blood pressure measurement was 17.8 years (range: 6.3-22.4 years). Former preterm or very low birth weight infants had higher systolic blood pressure than term infants (pooled estimate: 2.5 mm Hg [95% CI: 1.7-3.3 mm Hg]). For the 5 highest quality studies, the systolic blood pressure difference was slightly greater, at 3.8 mm Hg (95% CI: 2.6-5.0 mm Hg). We conclude that infants who are born preterm or very low birth weight have modestly higher systolic blood pressure later in life and may be at increased risk for developing hypertension and its sequelae.
Topics: Adolescent; Adult; Blood Pressure; Child; Female; Humans; Hypertension; Infant, Low Birth Weight; Infant, Newborn; Predictive Value of Tests; Pregnancy; Premature Birth; Risk Factors; Systole; Young Adult
PubMed: 22158643
DOI: 10.1161/HYPERTENSIONAHA.111.181784 -
Experimental Neurology Apr 2012In the spinal cord, neuron and glial cells actively interact and contribute to neurofunction. Surprisingly, both cell types have similar receptors, transporters and ion... (Review)
Review
In the spinal cord, neuron and glial cells actively interact and contribute to neurofunction. Surprisingly, both cell types have similar receptors, transporters and ion channels and also produce similar neurotransmitters and cytokines. The neuroanatomical and neurochemical similarities work synergistically to maintain physiological homeostasis in the normal spinal cord. However, in trauma or disease states, spinal glia become activated, dorsal horn neurons become hyperexcitable contributing to sensitized neuronal-glial circuits. The maladaptive spinal circuits directly affect synaptic excitability, including activation of intracellular downstream cascades that result in enhanced evoked and spontaneous activity in dorsal horn neurons with the result that abnormal pain syndromes develop. Recent literature reported that spinal cord injury produces glial activation in the dorsal horn; however, the majority of glial activation studies after SCI have focused on transient and/or acute time points, from a few hours to 1 month, and peri-lesion sites, a few millimeters rostral and caudal to the lesion site. In addition, thoracic spinal cord injury produces activation of astrocytes and microglia that contributes to dorsal horn neuronal hyperexcitability and central neuropathic pain in above-level, at-level and below-level segments remote from the lesion in the spinal cord. The cellular and molecular events of glial activation are not simple events, rather they are the consequence of a combination of several neurochemical and neurophysiological changes following SCI. The ionic imbalances, neuroinflammation and alterations of cell cycle proteins after SCI are predominant components for neuroanatomical and neurochemical changes that result in glial activation. More importantly, SCI induced release of glutamate, proinflammatory cytokines, ATP, reactive oxygen species (ROS) and neurotrophic factors trigger activation of postsynaptic neuron and glial cells via their own receptors and channels that, in turn, contribute to neuronal-neuronal and neuronal-glial interaction as well as microglia-astrocytic interactions. However, a systematic review of temporal and spatial glial activation following SCI has not been done. In this review, we describe time and regional dependence of glial activation and describe activation mechanisms in various SCI models in rats. These data are placed in the broader context of glial activation mechanisms and chronic pain states. Our work in the context of work by others in SCI models demonstrates that dysfunctional glia, a condition called "gliopathy", is a key contributor in the underlying cellular mechanisms contributing to neuropathic pain.
Topics: Animals; Gliosis; Neuralgia; Neuroglia; Rats; Spinal Cord; Spinal Cord Injuries
PubMed: 22036747
DOI: 10.1016/j.expneurol.2011.10.010 -
The Journal of Manual & Manipulative... 2008The high frequency of static and dynamic palpation methods used during evaluation of SIJ problems in clinical practice demands an understanding of the factual quantity...
The high frequency of static and dynamic palpation methods used during evaluation of SIJ problems in clinical practice demands an understanding of the factual quantity of movement at the SIJ. The objective of this systematic literature review was to synthesize three-dimensional (3-D) motion of the sacroiliac joint (SIJ) during various functional static postures and movements and to determine the clinical utility of movement during examination. A computer-based search was performed by means of OVID, which included Medline (February 1966 to April 2007) and CINAHL (February 1982 to April 2007) using the key words Pelvis, Kinematics, Imaging, Three-dimensional, and Stereophotogrammetric. Articles included in-vivo or in-vitro studies that investigated human SIJs with 3-D analysis. Three-dimensional analyses conducted using mathematical modeling, computerized modeling, and/or skin markers were not included because of concerns of transferability and validity. Studies that failed to report standard error of measurement (SEM) or defined tabulated values for translations or rotations using the Cartesian coordinate system were not considered for this study. Studies included for review were analyzed by the SBC biomechanical checklist to measure the quality of procedural design. Seven manuscripts were eligible for inclusion in this study. Rotation ranged between -1.1 to 2.2 degrees along the X-axis, -0.8 to 4.0 degrees along the Y-axis, and -0.5 to 8.0 degrees along the Z-axis. Translation ranged between -0.3 to 8.0 millimeters (mm) along the X-axis, -0.2 to 7.0 mm along the Y-axis, -0.3 to 6.0 mm along the Z-axis. Motion of the SIJ is limited to minute amounts of rotation and of translation suggesting that clinical methods utilizing palpation for diagnosing SIJ pathology may have limited clinical utility.
PubMed: 19119382
DOI: 10.1179/106698108790818639 -
Clinical Journal of the American... Jan 2009Renal pelvis dilatation (RPD) occurs in 1% of fetuses. Severe RPD (>15 mm) is frequently associated with urinary tract pathology. For the majority with mild (5 to 9 mm)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Renal pelvis dilatation (RPD) occurs in 1% of fetuses. Severe RPD (>15 mm) is frequently associated with urinary tract pathology. For the majority with mild (5 to 9 mm) to moderate (10 to 15 mm) RPD, however, there is uncertainty about the risk of abnormalities and how much postnatal investigation is required.
STUDY DESIGN
Systematic review of cohort studies of fetuses with RPD < or = 15 mm and metaregression to estimate risks of postnatal RPD, obstruction, and VUR.
RESULTS
Of 506 potentially relevant papers, 18 met the inclusion criteria. Risk of postnatal RPD increased with fetal RP size and earlier gestation. Odds ratios for postnatal RPD doubled per millimeter increase in fetal RP size: At 20 wk gestation, for example, 18% of fetuses with mean RP of 6 mm were estimated to have persistent postnatal RPD, compared with 95% of fetuses with 12 mm RPD, but risks were decreased by 16% to 18% per week of presentation gestation. Estimated risks of obstruction and VUR were substantially lower, particularly in the mild group such as the 6 mm example above: obstruction 2%, VUR 4%.
CONCLUSIONS
Our novel risk estimates are useful for antenatal counseling at presentation. The low frequency of obstruction/VUR in mild RPD raises questions over the most appropriate investigation of these cases but further data are required before establishing definitive postnatal management pathways. We suggest the need for a large prospective multicenter study to collect individual patient parameters/results and search for additional prognostic indicators.
Topics: Counseling; Dilatation, Pathologic; Female; Gestational Age; Humans; Kidney Diseases; Kidney Pelvis; Odds Ratio; Pregnancy; Risk Assessment; Risk Factors; Severity of Illness Index; Ultrasonography, Prenatal; Ureteral Obstruction; Vesico-Ureteral Reflux
PubMed: 18987299
DOI: 10.2215/CJN.00810208 -
The Cochrane Database of Systematic... Oct 2007Taurine is the most abundant free amino acid in breast milk. Evidence exists that taurine has important roles in intestinal fat absorption, hepatic function, and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Taurine is the most abundant free amino acid in breast milk. Evidence exists that taurine has important roles in intestinal fat absorption, hepatic function, and auditory and visual development in preterm or low birth weight infants. Observational data suggest that relative taurine deficiency during the neonatal period is associated with adverse long-term neurodevelopmental outcomes in preterm infants. Current standard practice is to supplement formula milk and parenteral nutrition solutions with taurine.
OBJECTIVES
To assess the effect of providing supplemental taurine for enterally or parenterally fed preterm or low birth weight infants on growth and development.
SEARCH STRATEGY
The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), MEDLINE (1966 - June 2007), EMBASE (1980 - June 2007), conference proceedings, and previous reviews.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials that compared taurine supplementation versus no supplementation in preterm or low birth weight newborn infants.
DATA COLLECTION AND ANALYSIS
Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two review authors, and synthesis of data using relative risk, risk difference and weighted mean difference.
MAIN RESULTS
Nine small trials were identified. In total, 189 infants participated. Most participants were greater than 30 weeks gestational age at birth and were clinically stable. In eight of the studies, taurine was given enterally with formula milk. Only one small trial assessed parenteral taurine supplementation. Taurine supplementation increased intestinal fat absorption [weighted mean difference 4.0 (95% confidence interval 1.4, 6.6) percent of intake]. However, meta-analyses did not reveal any statistically significant effects on growth parameters assessed during the neonatal period or until three to four months chronological age [rate of weight gain: weighted mean difference -0.25 (95% confidence interval -1.16, 0.66) grams/kilogram/day; change in length: weighted mean difference 0.37 (95% confidence interval -0.23, 0.98) millimetres/week; change in head circumference: weighted mean difference 0.15 (95% confidence interval -0.19, 0.50) millimeters/week]. There are very limited data on the effect on neonatal mortality or morbidities, and no data on long-term growth or neurological outcomes.
AUTHORS' CONCLUSIONS
Despite that lack of evidence of benefit from randomised controlled trials, it is likely that taurine will continue to be added to formula milks and parenteral nutrition solutions used for feeding preterm and low birth weight infants given the putative association of taurine deficiency with various adverse outcomes. Further randomised controlled trials of taurine supplementation versus no supplementation in preterm or low birth weight infants are unlikely to be viewed as a research priority, but there may be issues related to dose or duration of supplementation in specific subgroups of infants that merit further research.
Topics: Enteral Nutrition; Humans; Infant Formula; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Randomized Controlled Trials as Topic; Taurine
PubMed: 17943882
DOI: 10.1002/14651858.CD006072.pub2