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BMJ Open May 2024This systematic review with meta-analyses of randomised trials evaluated the preventive effects of vitamin A supplements versus placebo or no intervention on clinically... (Meta-Analysis)
Meta-Analysis
Effects of primary or secondary prevention with vitamin A supplementation on clinically important outcomes: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.
OBJECTIVES
This systematic review with meta-analyses of randomised trials evaluated the preventive effects of vitamin A supplements versus placebo or no intervention on clinically important outcomes, in people of any age.
METHODS
We searched different electronic databases and other resources for randomised clinical trials that had compared vitamin A supplements versus placebo or no intervention (last search 16 April 2024). We used Cochrane methodology. We used the random-effects model to calculate risk ratios (RRs), with 95% CIs. We analysed individually and cluster randomised trials separately. Our primary outcomes were mortality, adverse events and quality of life. We assessed risks of bias in the trials and used Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) to assess the certainty of the evidence.
RESULTS
We included 120 randomised trials (1 671 672 participants); 105 trials allocated individuals and 15 allocated clusters. 92 trials included children (78 individually; 14 cluster randomised) and 28 adults (27 individually; 1 cluster randomised). 14/105 individually randomised trials (13%) and none of the cluster randomised trials were at overall low risk of bias. Vitamin A did not reduce mortality in individually randomised trials (RR 0.99, 95% CI 0.93 to 1.05; I=32%; p=0.19; 105 trials; moderate certainty), and this effect was not affected by the risk of bias. In individually randomised trials, vitamin A had no effect on mortality in children (RR 0.96, 95% CI 0.88 to 1.04; I=24%; p=0.28; 78 trials, 178 094 participants) nor in adults (RR 1.04, 95% CI 0.97 to 1.13; I=24%; p=0.27; 27 trials, 61 880 participants). Vitamin A reduced mortality in the cluster randomised trials (0.84, 95% CI 0.76 to 0.93; I=66%; p=0.0008; 15 trials, 14 in children and 1 in adults; 364 343 participants; very low certainty). No trial reported serious adverse events or quality of life. Vitamin A slightly increased bulging fontanelle of neonates and infants. We are uncertain whether vitamin A influences blindness under the conditions examined.
CONCLUSIONS
Based on moderate certainty of evidence, vitamin A had no effect on mortality in the individually randomised trials. Very low certainty evidence obtained from cluster randomised trials suggested a beneficial effect of vitamin A on mortality. If preventive vitamin A programmes are to be continued, supporting evidence should come from randomised trials allocating individuals and assessing patient-meaningful outcomes.
PROSPERO REGISTRATION NUMBER
CRD42018104347.
Topics: Humans; Vitamin A; Randomized Controlled Trials as Topic; Dietary Supplements; Primary Prevention; Secondary Prevention; Quality of Life; Vitamins
PubMed: 38816049
DOI: 10.1136/bmjopen-2023-078053 -
BMJ Open May 2024Fluorine-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) CT imaging has been used in many inflammatory and infectious conditions to differentiate areas of...
Can FDG-PET/CT imaging be used to predict decline in quality of life in interstitial lung disease? A prospective study of the relationship between FDG uptake and quality of life in a UK outpatient setting.
BACKGROUND
Fluorine-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) CT imaging has been used in many inflammatory and infectious conditions to differentiate areas of increased metabolic activity. FDG uptake differs between areas of normal lung parenchyma and interstitial lung disease (ILD).
OBJECTIVES
In this study, we investigated whether FDG-PET/CT parameters were associated with a change in the quality of life (QoL) in patients with ILD over 4 years of follow-up.
METHODS
Patients underwent PET-CT imaging at diagnosis and were followed up with annual QoL assessment using the St George's Respiratory Questionnaire (SGRQ) until death or 4 years of follow-up. Maximum standard uptake value (SUVmax) and Tissue-to-Background Ratio (TBR) were assessed against SGRQ overall and subscale scores.
RESULTS
193 patients (94 patients in the idiopathic pulmonary fibrosis (IPF) subgroup and 99 patients in the non-IPF subgroup) underwent baseline FDG-PET/CT imaging and QoL assessment. Weak-to-moderate correlation was observed between baseline SUVmax and SGRQ scores in both ILD subgroups. No relationship was observed between baseline SUVmax or TBR and change in SGRQ scores over 4 years of follow-up. In the IPF subgroup, surviving patients reported a decline in QoL at 4 years post diagnosis whereas an improvement in QoL was seen in surviving patients with non-IPF ILD.
CONCLUSIONS
Weak-to-moderate positive correlation between baseline SUVmax and SGRQ scores was observed in both ILD subgroups (IPF:r=0.187, p=0.047, non-IPF: r=0.320, p=0.001). However, baseline SUVmax and TBR were not associated with change in QoL in patients with IPF and non-IPF ILD over 4 years of follow-up. At 4 years post diagnosis, surviving patients with IPF reported declining QoL whereas improvement was seen in patients with ILD who did not have IPF.
Topics: Humans; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Quality of Life; Male; Female; Lung Diseases, Interstitial; Prospective Studies; Aged; Middle Aged; United Kingdom; Radiopharmaceuticals; Surveys and Questionnaires; Idiopathic Pulmonary Fibrosis
PubMed: 38816048
DOI: 10.1136/bmjopen-2023-081103 -
EBioMedicine May 2024Dengue epidemics impose considerable strain on healthcare resources. Real-time continuous and non-invasive monitoring of patients admitted to the hospital could lead to...
BACKGROUND
Dengue epidemics impose considerable strain on healthcare resources. Real-time continuous and non-invasive monitoring of patients admitted to the hospital could lead to improved care and outcomes. We evaluated the performance of a commercially available wearable (SmartCare) utilising photoplethysmography (PPG) to stratify clinical risk for a cohort of hospitalised patients with dengue in Vietnam.
METHODS
We performed a prospective observational study for adult and paediatric patients with a clinical diagnosis of dengue at the Hospital for Tropical Disease, Ho Chi Minh City, Vietnam. Patients underwent PPG monitoring early during admission alongside standard clinical care. PPG waveforms were analysed using machine learning models. Adult patients were classified between 3 severity classes: i) uncomplicated (ward-based), ii) moderate-severe (emergency department-based), and iii) severe (ICU-based). Data from paediatric patients were split into 2 classes: i) severe (during ICU stay) and ii) follow-up (14-21 days after the illness onset). Model performances were evaluated using standard classification metrics and 5-fold stratified cross-validation.
FINDINGS
We included PPG and clinical data from 132 adults and 15 paediatric patients with a median age of 28 (IQR, 21-35) and 12 (IQR, 9-13) years respectively. 1781 h of PPG data were available for analysis. The best performing convolutional neural network models (CNN) achieved a precision of 0.785 and recall of 0.771 in classifying adult patients according to severity class and a precision of 0.891 and recall of 0.891 in classifying between disease and post-disease state in paediatric patients.
INTERPRETATION
We demonstrate that the use of a low-cost wearable provided clinically actionable data to differentiate between patients with dengue of varying severity. Continuous monitoring and connectivity to early warning systems could significantly benefit clinical care in dengue, particularly within an endemic setting. Work is currently underway to implement these models for dynamic risk predictions and assist in individualised patient care.
FUNDING
EPSRC Centre for Doctoral Training in High-Performance Embedded and Distributed Systems (HiPEDS) (Grant: EP/L016796/1) and the Wellcome Trust (Grants: 215010/Z/18/Z and 215688/Z/19/Z).
PubMed: 38815363
DOI: 10.1016/j.ebiom.2024.105164 -
PloS One 2024Population aging has become a social issue of concern to the whole world, and as the world's most populous country, how to cope with population aging will be a hot issue...
Population aging has become a social issue of concern to the whole world, and as the world's most populous country, how to cope with population aging will be a hot issue that all sectors of Chinese society must think about. This paper uses provincial panel data from 30 provinces in China from 2000 to 2021 to study the relationship between population aging and economic development based on the perspective of health expenditure. The DIFF-GMM model, the fixed effect model (FE), and fixed effect instrumental variable model (FE-IV) are used to test this study. The following two conclusions are drawn from the empirical study: (1) population aging has a significant inhibitory effect on economic development, while health expenditures have a significant promotional effect on economic development; and (2) increased health expenditures help to alleviate the negative impact of population aging on economic development. However, the deepening of population aging will likewise inhibit the positive effect of health expenditure on economic growth. Based on the conclusions of the study, it is recommended that the government and society should continue to increase spending in the field of health protection, encourage and guide residents to carry out self-care, and moderately increase personal health expenditure, to promote economic development with healthy bodies and realize the goal of "Healthy China".
Topics: China; Humans; Economic Development; Health Expenditures; Aging; Population Dynamics
PubMed: 38814970
DOI: 10.1371/journal.pone.0303197 -
PloS One 2024Clinicians commonly use manual therapy to treat low back pain by palpating the spine to identify the spinous processes. This study aims to evaluate the ability of... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Clinicians commonly use manual therapy to treat low back pain by palpating the spine to identify the spinous processes. This study aims to evaluate the ability of experienced clinicians to consistently locate the spinous processes from S1 to T12 through palpation. The results will be compared to topographical data representing the lumbar lordosis at baseline and four follow-up time points.
MATERIALS AND METHODS
In a prior prospective randomized trial, experienced clinicians used palpation to locate the lumbar spinous processes (S1-T12) and then digitized these locations in three-dimensional space. The same digitizing equipment was then used to continuously collect three-dimensional position data of a wheel that rolled along the back's surface through a trajectory that connected the previously digitized locations of the spinous processes. This process was repeated at 4 days, 1, 4, and 12 weeks. The resulting lordosis trajectories were plotted and aligned using the most anterior point in the lordosis to compare the locations of the spinous processes identified in different trials. This way, spinous palpation points could be compared to surface topography over time. Intra- and interrater reliability and agreement were estimated using intraclass correlations of agreement and Bland-Altman limits of agreement.
RESULTS
Five clinicians palpated a total of 119 participants. The results showed a large degree of variation in precision estimates, with a mean total value of 13 mm (95%CI = 11;15). This precision error was consistent across all time points. The smallest precision error was found at L5, followed by S1 File, after which the error increased superiorly. Intra- and interrater reliability was poor to moderate.
CONCLUSIONS
Comparison of palpation results to a topographic standard representing the lumbar lordosis is a new approach for evaluating palpation. Our results confirm the results of prior studies that find palpation of lumbar spinous processes imprecise, even for experienced clinicians.
Topics: Humans; Palpation; Lumbar Vertebrae; Female; Male; Lordosis; Adult; Low Back Pain; Prospective Studies; Middle Aged
PubMed: 38814967
DOI: 10.1371/journal.pone.0304571 -
PloS One 2024In order to reveal the impact of pilot free trade zones policy on green development, we use multi-period difference-in-difference estimation and fixed effect model to...
In order to reveal the impact of pilot free trade zones policy on green development, we use multi-period difference-in-difference estimation and fixed effect model to explore the impact and impact mechanism of the establishment of free trade zones on the green transformation of enterprises from the micro perspective, based on the panel data of China's A-share listed companies from 2009-2021, The results show that pilot free trade zones policy significantly improves the green transformation of enterprises in the zones. Pilot free trade zones policy affects the corporate green transformation through industrial agglomeration and financial constraints. The green transformation of state-owned enterprises, non-heavy polluting enterprises and high-tech enterprises are significantly impacted by pilot free trade zones policy. Urban innovation and green subsidies play a positive moderating role in the impact of free trade zones on enterprises' green transformation. The research conclusions provide a valuable policy basis for how to promote the green transformation of enterprises under the free trade zones policy.
Topics: China; Commerce; Conservation of Natural Resources; Industry; Pilot Projects; Humans
PubMed: 38814953
DOI: 10.1371/journal.pone.0301393 -
PloS One 2024Untargeted metabolomics investigations have characterized metabolic disturbances associated with various diseases in domestic cats. However, the pre-analytic stability...
Untargeted metabolomics investigations have characterized metabolic disturbances associated with various diseases in domestic cats. However, the pre-analytic stability of serum metabolites in the species is unknown. Our objective was to compare serum metabolomes from healthy cats stored at -20°C for up to 12 months to samples stored at -80°C. Serum samples from 8 adult, healthy cats were stored at -20°C for 6 months, -20°C for 12 months, or -80°C for 12 months. Untargeted liquid chromatography-mass spectrometry was used to generate serum metabolite profiles containing relative abundances of 733 serum metabolites that were compared among storage conditions. Unsupervised analysis with principal component analysis and hierarchical clustering of Euclidian distances revealed separation of samples from individual cats regardless of storage condition. Linear mixed-effects models identified 75 metabolites that differed significantly among storage conditions. Intraclass correlation analysis (ICC) classified most serum metabolites as having excellent (ICC ≥ 0.9; 33%) or moderate (ICC 0.75-0.89; 33%) stability, whereas 13% had poor stability (ICC < 0.5). Biochemicals that varied significantly among storage conditions and classified with poor stability included glutathione metabolites, amino acids, gamma-glutamyl amino acids, and polyunsaturated fatty acids. The benzoate; glycine, serine and threonine; tryptophan; chemical (xenobiotics); acetylated peptide, and primary bile acid sub pathways were enriched among highly stable metabolites, whereas the monohydroxy fatty acid, polyunsaturated fatty, and monoacylglycerol sub-pathways were enriched among unstable metabolites. Our findings suggest that serum metabolome profiles are representative of the cat of origin, regardless of storage condition. However, changes in specific serum metabolites, especially glutathione, gamma-glutamyl amino acid, and fatty acid metabolites were consistent with increased sample oxidation during storage at -20°C compared with -80°C. By investigating the pre-analytic stability of serum metabolites, this investigation provides valuable insights that could aid other investigators in planning and interpreting studies of serum metabolomes in cats.
Topics: Animals; Cats; Metabolomics; Metabolome; Male; Female; Chromatography, Liquid; Mass Spectrometry; Amino Acids
PubMed: 38814947
DOI: 10.1371/journal.pone.0303500 -
Blood Transfusion = Trasfusione Del... May 2024There is some evidence showing rebound of COVID-19 infections in patients treated with nirmatrelvir-ritonavir between 2 and 8 days following cessation of the antiviral... (Review)
Review
BACKGROUND
There is some evidence showing rebound of COVID-19 infections in patients treated with nirmatrelvir-ritonavir between 2 and 8 days following cessation of the antiviral treatment. COVID-19 rebound is not unique to patients treated with nirmatrelvir-ritonavir, but is also observed in molnupiravir recipients, in patients who did not receive any antiviral treatment and in patients who received convalescent plasma (CP).
MATERIALS AND METHODS
This was a systematic review with meta-analysis of clinical trials evaluating rates of virologic and clinical rebound in COVID-19 patients receiving antiviral agents, CP or no treatment. Both randomized clinical trials and controlled cohort studies were considered. The methodological quality of trials was assessed using ROB-2 and ROBIN-1 checklists, and the GRADE approach.
RESULTS
Data were available from 16 trials. The occurrence of virologic rebound was more commonly observed among nirmatrelvir recipients than among untreated patients (relative risk [RR]=2.12; 95% confidence interval [CI]: 1.38-3.28; p=0.0007). No differences were observed in the occurrence of virologic rebound between nirmatrelvir-ritonavir and molnupiravir recipients (RR=1.01; 95% CI: 0.71-1.43). Similar rates of virologic rebounds were observed in molnupiravir recipients and untreated patients (RR=1.14; 95% CI: 0.81-1.6). One study in the pre-omicron period compared rates of virologic rebound between patients receiving standard of care with or without CP: no differences were observed between groups (RR=1.04; 95% CI: 0.55-1.99). Rates of clinical rebound were reported in seven trials, five evaluating nirmatrelvir-ritonavir and untreated patients, and two evaluating nirmatrelvir-ritonavir and molnupiravir recipients. No statistically significant differences between groups were observed. For all these comparisons, the certainty of the available evidence was graded as low or moderate.
DISCUSSION
Virologic rebound of COVID-19 infections appears to be mild and self-limited, and was observed more commonly in nirmatrelvir-ritonavir recipients than in untreated patients, but was also observed in patients treated with molnupiravir or CP.
PubMed: 38814880
DOI: 10.2450/BloodTransfus.764 -
BJS Open May 2024Postoperative pancreatic fistulas remain a driver of major complications after partial pancreatectomy. It is unclear whether coverage of the anastomosis or pancreatic... (Meta-Analysis)
Meta-Analysis
Effect of artificial or autologous coverage of the pancreatic remnant or anastomosis on postoperative pancreatic fistulas after partial pancreatectomy: meta-analysis of randomized clinical trials.
BACKGROUND
Postoperative pancreatic fistulas remain a driver of major complications after partial pancreatectomy. It is unclear whether coverage of the anastomosis or pancreatic remnant can reduce the incidence of postoperative pancreatic fistulas. The aim of this study was to evaluate the effect of autologous or artificial coverage of the pancreatic remnant or anastomosis on outcomes after partial pancreatectomy.
METHODS
A systematic literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) up to March 2024. All RCTs analysing a coverage method in patients undergoing partial pancreatoduodenectomy or distal pancreatectomy were included. The primary outcome was postoperative pancreatic fistula development. Subgroup analyses for pancreatoduodenectomy or distal pancreatectomy and artificial or autologous coverage were conducted.
RESULTS
A total of 18 RCTs with 2326 patients were included. In the overall analysis, coverage decreased the incidence of postoperative pancreatic fistulas by 29% (OR 0.71, 95% c.i. 0.54 to 0.93, P < 0.01). This decrease was also seen in the 12 RCTs covering the remnant after distal pancreatectomy (OR 0.69, 95% c.i. 0.51 to 0.94, P < 0.02) and the 4 RCTs applying autologous coverage after pancreatoduodenectomy and distal pancreatectomy (OR 0.53, 95% c.i. 0.29 to 0.96, P < 0.04). Other subgroup analyses (artificial coverage or pancreatoduodenectomy) showed no statistically significant differences. The secondary endpoints of mortality, reoperations, and re-interventions were each affected positively by the use of coverage techniques. The certainty of evidence was very low to moderate.
CONCLUSION
The implementation of coverage, whether artificial or autologous, is beneficial after partial pancreatectomy, especially in patients undergoing distal pancreatectomy with autologous coverage.
Topics: Humans; Pancreatic Fistula; Pancreatectomy; Randomized Controlled Trials as Topic; Postoperative Complications; Anastomosis, Surgical; Pancreaticoduodenectomy; Pancreas
PubMed: 38814751
DOI: 10.1093/bjsopen/zrae059 -
Translational Vision Science &... May 2024We aimed to determine the causal effects of physical activities with different frequencies, durations, and intensities on the risk of senile cataracts using Mendelian...
PURPOSE
We aimed to determine the causal effects of physical activities with different frequencies, durations, and intensities on the risk of senile cataracts using Mendelian randomization (MR).
METHODS
A bidirectional two-sample MR approach was used to determine the association between physical activity and senile cataract risk. Our primary analysis used the inverse variance weighted method, and secondary analyses included MR-Egger regression, MR-PRESSO, and Cochran's Q statistic to evaluate heterogeneity and pleiotropy. Causal estimates were presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).
RESULTS
Genetically predicted moderate physical activity ≥ 10 min/wk (OR = 0.765, 95% CI = 0.627-0.936, P = 8.73E-03), vigorous physical activity ≥ 10 min/wk (OR = 0.691, 95% CI = 0.521-0.917, P = 1.04E-02), moderate-to-vigorous physical activity levels (OR = 0.552, 95% CI = 0.369-0.823, P = 3.75E-03), and overall acceleration average (OR = 0.952, 95% CI = 0.926-0.978, P = 3.80E-04) were associated with a decreased risk of senile cataract while walking ≥ 10 min/wk (OR = 0.972, 95% CI = 0.741-1.275, P = 8.36E-01) had no significant correlation. The reverse MR analysis showed no reversal causality from senile cataract to physical activity except for walking ≥ 10 min/wk (OR = 0.951, 95% CI = 0.923-0.979, P = 7.30E-04).
CONCLUSIONS
Our findings suggest that moderate to vigorous physical activity with higher frequency and longer duration will causally reduce the risk of senile cataracts, and there is no reverse causal relationship.
TRANSLATIONAL RELEVANCE
These findings underscore the potential of incorporating physical activity into preventive health strategies for senile cataracts.
Topics: Humans; Cataract; Mendelian Randomization Analysis; Exercise; Risk Factors; Aged; Polymorphism, Single Nucleotide; Odds Ratio; Time Factors
PubMed: 38814746
DOI: 10.1167/tvst.13.5.26