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Systematic Reviews Sep 2016There is a lack of high-quality meta-analyses and network meta-analyses of immunosuppressive drugs for lupus nephritis. Our objective was to assess the comparative... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
There is a lack of high-quality meta-analyses and network meta-analyses of immunosuppressive drugs for lupus nephritis. Our objective was to assess the comparative benefits and harms of immunosuppressive drugs and corticosteroids in lupus nephritis.
METHODS
We conducted a systematic review and network meta-analysis (NMA) of trials of immunosuppressive drugs and corticosteroids in patients with lupus nephritis. We calculated odds ratios (OR) and 95 % credible intervals (CrI).
RESULTS
Sixty-five studies that met inclusion and exclusion criteria; data were analyzed for renal remission/response (37 trials; 2697 patients), renal relapse/flare (13 studies; 1108 patients), amenorrhea/ovarian failure (eight trials; 839 patients) and cytopenia (16 trials; 2257 patients). Cyclophosphamide [CYC] low dose (LD) and CYC high-dose (HD) were less likely than mycophenolate mofetil [MMF] and azathioprine [AZA], CYC LD, CYC HD and plasmapharesis less likely than cyclosporine [CSA] to achieve renal remission/response. Tacrolimus [TAC] was more likely than CYC LD to achieve renal remission/response. MMF and CYC were associated with a lower odds of renal relapse/flare compared to PRED and MMF was associated with a lower rate of renal relapse/flare than AZA. CYC was more likely than MMF and PRED to be associated with amenorrhea/ovarian failure. Compared to MMF, CYC, AZA, CYC LD, and CYC HD were associated with a higher risk of cytopenia.
CONCLUSIONS
In this systematic review and NMA, we found important differences between immunosuppressives used for the treatment of lupus nephritis. Patients and physicians can use this information for detailed informed consent in a patient-centered approach. Study limitations of between-study clinical heterogeneity and small sample size with type II error must be considered when interpreting these findings.
PROSPERO
CRD42016032965.
Topics: Adrenal Cortex Hormones; Clinical Trials as Topic; Drug Therapy, Combination; Glucocorticoids; Humans; Immunosuppressive Agents; Lupus Nephritis; Network Meta-Analysis; Odds Ratio; Treatment Outcome
PubMed: 27619512
DOI: 10.1186/s13643-016-0328-z -
Frontiers in Aging Neuroscience 2023Mild cognitive impairment (MCI) is a multifactorial and complex central neurodegenerative disease. Acupuncture appears to be an effective method for cognitive function...
Mild cognitive impairment (MCI) is a multifactorial and complex central neurodegenerative disease. Acupuncture appears to be an effective method for cognitive function improvement in MCI patients. Neural plasticity remaining in the MCI brain implies that acupuncture-associated benefits may not be limited to the cognitive function. Instead, neurological alternations in the brain play a vital role in corresponding to the cognitive improvement. However, previous studies have mainly focused on the effects of cognitive function, leaving neurological findings relatively unclear. This systematic review summarized existing studies that used various brain imaging techniques to explore the neurological effect regarding acupuncture use for MCI treatment. Potential neuroimaging trials were searched, collected, and identified independently by two researchers. Four Chinese databases, four English databases, and additional sources were searched to identify studies reporting the use of acupuncture for MCI from the inception of databases until 1 June 2022. Methodological quality was appraised using the Cochrane risk-of-bias tool. In addition, general, methodological, and brain neuroimaging information was extracted and summarized to investigate the potential neural mechanisms by which acupuncture affects patients with MCI. In total, 22 studies involving 647 participants were included. The methodological quality of the included studies was moderate to high. The methods used included functional magnetic resonance imaging, diffusion tensor imaging, functional near-infrared spectroscopy, and magnetic resonance spectroscopy. Acupuncture-induced brain alterations observed in those patients with MCI tended to be observable in the cingulate cortex, prefrontal cortex, and hippocampus. The effect of acupuncture on MCI may play a role in regulating the default mode network, central executive network, and salience network. Based on these studies, researchers could extend the recent research focus from the cognitive domain to the neurological level. Future researches should develop additional relevant, well-designed, high-quality, and multimodal neuroimaging researches to detect the effects of acupuncture on the brains of MCI patients.
PubMed: 36875696
DOI: 10.3389/fnagi.2023.1007436 -
Brain Imaging and Behavior Oct 2022Motor training is a widely used therapy in many pain conditions. The brain's capacity to undergo functional and structural changes i.e., neuroplasticity is fundamental... (Review)
Review
Motor training is a widely used therapy in many pain conditions. The brain's capacity to undergo functional and structural changes i.e., neuroplasticity is fundamental to training-induced motor improvement and can be assessed by transcranial magnetic stimulation (TMS). The aim was to investigate the impact of pain on training-induced motor performance and neuroplasticity assessed by TMS. The review was carried out in accordance with the PRISMA-guidelines and a Prospero protocol (CRD42020168487). An electronic search in PubMed, Web of Science and Cochrane until December 13, 2019, identified studies focused on training-induced neuroplasticity in the presence of experimentally-induced pain, 'acute pain' or in a chronic pain condition, 'chronic pain'. Included studies were assessed by two authors for methodological quality using the TMS Quality checklist, and for risk of bias using the Newcastle-Ottawa Scale. The literature search identified 231 studies. After removal of 71 duplicates, 160 abstracts were screened, and 24 articles were reviewed in full text. Of these, 17 studies on acute pain (n = 7) or chronic pain (n = 10), including a total of 258 patients with different pain conditions and 248 healthy participants met the inclusion criteria. The most common types of motor training were different finger tasks (n = 6). Motor training was associated with motor cortex functional neuroplasticity and six of seven acute pain studies and five of ten chronic pain studies showed that, compared to controls, pain can impede such trainings-induced neuroplasticity. These findings may have implications for motor learning and performance and with putative impact on rehabilitative procedures such as physiotherapy.
Topics: Humans; Magnetic Resonance Imaging; Neuronal Plasticity; Transcranial Magnetic Stimulation; Motor Cortex; Chronic Pain; Chronic Disease
PubMed: 35301674
DOI: 10.1007/s11682-021-00621-6 -
Frontiers in Neuroscience 2022Neuroplasticity following deafness has been widely demonstrated in both humans and animals, but the anatomical substrate of these changes is not yet clear in human...
Neuroplasticity following deafness has been widely demonstrated in both humans and animals, but the anatomical substrate of these changes is not yet clear in human brain. However, it is of high importance since hearing loss is a growing problem due to aging population. Moreover, knowing these brain changes could help to understand some disappointing results with cochlear implant, and therefore could improve hearing rehabilitation. A systematic review and a coordinate-based meta-analysis were realized about the morphological brain changes highlighted by MRI in severe to profound hearing loss, congenital and acquired before or after language onset. 25 papers were included in our review, concerning more than 400 deaf subjects, most of them presenting prelingual deafness. The most consistent finding is a volumetric decrease in gray matter around bilateral auditory cortex. This change was confirmed by the coordinate-based meta-analysis which shows three converging clusters in this region. The visual areas of deaf children is also significantly impacted, with a decrease of the volume of both gray and white matters. Finally, deafness is responsible of a gray matter increase within the cerebellum, especially at the right side. These results are largely discussed and compared with those from deaf animal models and blind humans, which demonstrate for example a much more consistent gray matter decrease along their respective primary sensory pathway. In human deafness, a lot of other factors than deafness could interact on the brain plasticity. One of the most important is the use of sign language and its age of acquisition, which induce among others changes within the hand motor region and the visual cortex. But other confounding factors exist which have been too little considered in the current literature, such as the etiology of the hearing impairment, the speech-reading ability, the hearing aid use, the frequent associated vestibular dysfunction or neurocognitive impairment. Another important weakness highlighted by this review concern the lack of papers about postlingual deafness, whereas it represents most of the deaf population. Further studies are needed to better understand these issues, and finally try to improve deafness rehabilitation.
PubMed: 35418829
DOI: 10.3389/fnins.2022.850245 -
Cortex; a Journal Devoted To the Study... Oct 2022The recent focus on the bidirectional heart-brain interactions in psychoneurophysiological research has led to a variety of findings suggesting vagal activity is... (Meta-Analysis)
Meta-Analysis Review
The recent focus on the bidirectional heart-brain interactions in psychoneurophysiological research has led to a variety of findings suggesting vagal activity is associated with cognition and, possibly, specifically with executive functioning. This systematic review and meta-analysis aimed to provide a better understanding of the association between vagally-mediated heart rate variability (HRV) and executive functioning. We included 13 correlational studies. We found a small positive association between vagally-mediated HRV and executive functioning (r = .19, 95% CI .15 to .23, p < .0001) using a quantitative synthesis of existing studies with random-effect models. Conducting meta-regression analyses, we found that vagally-mediated HRV predicts cognitive inhibition and cognitive flexibility more than working memory. In addition to the specific executive function measured, this relationship is moderated by the HRV measurement used, and age. After proposing a theoretical interpretation of the results, we emphasized the need for further research in light of the methodological issues identified in the included studies, and we outline several aspects to consider in future studies.
Topics: Brain; Executive Function; Heart Rate; Humans; Vagus Nerve
PubMed: 36030561
DOI: 10.1016/j.cortex.2022.07.008 -
BMJ Open Jan 2016To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported... (Review)
Review
OBJECTIVES
To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations.
DESIGN
Systematic review.
METHODS
Four databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case-control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included.
OUTCOME MEASURES
The outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study.
RESULTS
Of 11,792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity.
CONCLUSIONS
Whether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses.
Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Anticonvulsants; Cardiovascular Agents; Humans; Isotretinoin; Leukotriene Antagonists; Observational Studies as Topic; Prescription Drugs; Risk; Risk Factors; Suicide; Suicide, Attempted; Varenicline
PubMed: 26769782
DOI: 10.1136/bmjopen-2015-009074 -
Frontiers in Systems Neuroscience 2021It is only in recent decades that subjective experience - or consciousness - has become a legitimate object of scientific inquiry. As such, it represents perhaps the...
It is only in recent decades that subjective experience - or consciousness - has become a legitimate object of scientific inquiry. As such, it represents perhaps the greatest challenge facing neuroscience today. Subsumed within this challenge is the study of subjective experience in non-human animals: a particularly difficult endeavor that becomes even more so, as one crosses the great evolutionary divide between vertebrate and invertebrate phyla. Here, we explore the possibility of consciousness in one group of invertebrates: cephalopod molluscs. We believe such a review is timely, particularly considering cephalopods' impressive learning and memory abilities, rich behavioral repertoire, and the relative complexity of their nervous systems and sensory capabilities. Indeed, in some cephalopods, these abilities are so sophisticated that they are comparable to those of some higher vertebrates. Following the criteria and framework outlined for the identification of hallmarks of consciousness in non-mammalian species, here we propose that cephalopods - particularly the octopus - provide a unique test case among invertebrates for examining the properties and conditions that, at the very least, afford a basal faculty of consciousness. These include, among others: (i) discriminatory and anticipatory behaviors indicating a strong link between perception and memory recall; (ii) the presence of neural substrates representing functional analogs of thalamus and cortex; (iii) the neurophysiological dynamics resembling the functional signatures of conscious states in mammals. We highlight the current lack of evidence as well as potentially informative areas that warrant further investigation to support the view expressed here. Finally, we identify future research directions for the study of consciousness in these tantalizing animals.
PubMed: 35495582
DOI: 10.3389/fnsys.2021.787139 -
Cognitive, Affective & Behavioral... Aug 2019What it means to be well and to achieve well-being is fundamental to the human condition. Scholars of many disciplines have attempted to define well-being and to... (Review)
Review
What it means to be well and to achieve well-being is fundamental to the human condition. Scholars of many disciplines have attempted to define well-being and to investigate the behavioral and neural correlates of well-being. Despite many decades of inquiry into well-being, much remains unknown. The study of well-being has evolved over time, shifting in focus and methodology. Many recent investigations into well-being have taken a neuroscientific approach to try to bolster understanding of this complex construct. A growing body of literature has directly examined the association between well-being and the brain. The current review synthesizes the extant literature regarding the neural correlates of trait-like well-being (i.e., the propensity to live according to one's true nature). Although reported associations between well-being and the brain varied, some notable patterns were evidenced in the literature. In particular, the strongest and most consistent association emerged between well-being and the anterior cingulate cortex. In addition, patterns of association between well-being and the orbitofrontal cortex, posterior cingulate cortex, superior temporal gyrus, and thalamus emerged. These regions largely comprise the salience and default mode networks, suggesting a possible relationship between well-being and brain networks involved in the integration of relevant and significant stimuli. Various methodological concerns are addressed and recommendations for future research are discussed.
Topics: Gyrus Cinguli; Humans; Nerve Net; Personal Satisfaction; Prefrontal Cortex; Temporal Lobe; Thalamus
PubMed: 31062291
DOI: 10.3758/s13415-019-00720-4 -
Frontiers in Psychiatry 2022Cortisol is the main HPA axis hormone secreted by the adrenal cortex, and influences metabolism, cognition, and behavior. Recently, a plethora of studies have tried to...
Cortisol is the main HPA axis hormone secreted by the adrenal cortex, and influences metabolism, cognition, and behavior. Recently, a plethora of studies have tried to confirm the correlation between peripheral cortisol and autism spectrum disorder (ASD). However, the results were controversial. We assessed the effects of peripheral cortisol on ASD in this study. The included studies were identified according to the inclusion and exclusion criteria. The pooled Hedges' g and its 95% confidence interval were selected to evaluate the association between peripheral cortisol and ASD. Subgroup analyses, sensitivity analyses, meta-regression, and publication bias tests were also undertaken based on the obtained information. There were a total of twelve studies with 375 ASD patients and 335 controls included in our meta-analysis. Obvious heterogeneity across studies was found in the overall analysis. Peripheral cortisol levels were significantly elevated in ASD patients compared with controls in the absence of obvious heterogeneity. A single study did not influence the overall comparison results. Meta-regression analyses revealed that age and gender of the included subjects, sample size, and publication year did not moderate effects on the present results. These findings may provide us some targeted strategies to the diagnosis and treatment of ASD.
PubMed: 35911217
DOI: 10.3389/fpsyt.2022.928188 -
Alimentary Pharmacology & Therapeutics Aug 2015Cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) has an important role in T-cell regulation, proliferation and tolerance. Anti-CTLA-4 agents, such as ipilimumab and... (Review)
Review
BACKGROUND
Cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) has an important role in T-cell regulation, proliferation and tolerance. Anti-CTLA-4 agents, such as ipilimumab and tremelimumab, have been shown to prolong overall survival in patients with metastatic melanoma, and their use is being investigated in the treatment of other malignancies. Their novel immunostimulatory mechanism, however, predisposes patients to immune-related adverse effects, of which gastrointestinal effects such as diarrhoea and colitis are the most common.
AIMS
To discuss the existing literature and summarise the epidemiology, pathogenesis and clinical features of anti-CTLA-4-associated colitis, and to present a management algorithm for it.
METHODS
We searched PubMed for studies published through October 2014 using the terms 'anti-CTLA,' 'ipilimumab,' 'tremelimumab,' 'colitis,' 'gastrointestinal,' 'immune-related adverse effect,' 'immunotherapy,' 'melanoma,' and 'diarrhoea.'
RESULTS
Watery diarrhoea is commonly associated with anti-CTLA-4 therapy (27-54%), and symptoms occur within a few days to weeks of therapy. Diffuse acute and chronic colitis are the most common findings on endoscopy (8-22%). Concomitant infectious causes of diarrhoea must be evaluated. Most cases may be successfully managed with discontinuation of anti-CTLA-4 and conservative therapy. Those with persistent grade 2 and grade 3/4 diarrhoea should undergo endoscopic evaluation and require corticosteroid therapy. Corticosteroid-resistant cases may respond to anti-tumour necrosis factor-alpha therapy such as infliximab. Surgery is reserved for patients with bowel perforation or failure of medical therapy.
CONCLUSION
Given the increasing use of anti-CTLA-4 therapy, clinicians must be aware of related adverse events and their management.
Topics: Adrenal Cortex Hormones; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; CTLA-4 Antigen; Colitis; Diarrhea; Humans; Immunotherapy; Infliximab; Ipilimumab; Melanoma; Skin Neoplasms; Tumor Necrosis Factor-alpha
PubMed: 26079306
DOI: 10.1111/apt.13281