-
The Cochrane Database of Systematic... May 2013Many survivors of stroke complain about attentional impairments, such as diminished concentration and mental slowness. However, the effectiveness of cognitive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many survivors of stroke complain about attentional impairments, such as diminished concentration and mental slowness. However, the effectiveness of cognitive rehabilitation for improving these impairments is uncertain.
OBJECTIVES
To determine whether (1) people receiving attentional treatment show better outcomes in their attentional functions than those given no treatment or treatment as usual, and (2) people receiving attentional treatment techniques have a better functional recovery, in terms of independence in activities of daily living, mood and quality of life, than those given no treatment or treatment as usual.
SEARCH METHODS
We searched the Cochrane Stroke Group Trials Register (October 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library October 2012), MEDLINE (1948 to October 2012), EMBASE (1947 to October 2012), CINAHL (1981 to October 2012), PsycINFO (1806 to October 2012), PsycBITE and REHABDATA (searched October 2012) and ongoing trials registers. We screened reference lists and tracked citations using Scopus.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of cognitive rehabilitation for impairments of attention for people with stroke. The primary outcome was measures of global attentional functions, and secondary outcomes were measures of attention domains, functional abilities, mood and quality of life.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials, extracted data and assessed trial quality.
MAIN RESULTS
We included six RCTs with 223 participants. All six RCTs compared cognitive rehabilitation with a usual care control. Meta-analyses demonstrated no statistically significant effect of cognitive rehabilitation for persisting effects on global measures of attention (two studies, 99 participants; standardised mean difference (SMD) 0.16, 95% confidence interval (CI) -0.23 to 0.56; P value = 0.41), standardised attention assessments (two studies, 99 participants; P value ≥ 0.08) or functional outcomes (two studies, 99 participants; P value ≥ 0.15). In contrast, a statistically significant effect was found in favour of cognitive rehabilitation when compared with control for immediate effects on measures of divided attention (four studies, 165 participants; SMD 0.67, 95% CI 0.35 to 0.98; P value < 0.0001) but no significant effects on global attention (two studies, 53 participants; P value = 0.06), other attentional domains (six studies, 223 participants; P value ≥ 0.16) or functional outcomes (three studies, 109 participants; P value ≥ 0.21).Thus there was limited evidence that cognitive rehabilitation may improve some aspects of attention in the short term, but there was insufficient evidence to support or refute the persisting effects of cognitive rehabilitation on attention, or on functional outcomes in either the short or long term.
AUTHORS' CONCLUSIONS
The effectiveness of cognitive rehabilitation remains unconfirmed. The results suggest there may be a short-term effect on attentional abilities, but future studies need to assess the persisting effects and measure attentional skills in daily life. Trials also need to have higher methodological quality and better reporting.
Topics: Attention; Cognition Disorders; Cognitive Behavioral Therapy; Humans; Randomized Controlled Trials as Topic; Stroke; Stroke Rehabilitation
PubMed: 23728639
DOI: 10.1002/14651858.CD002842.pub2 -
Cancers Jun 2023Neutrophils are an important part of the tumor microenvironment, which stimulates inflammatory processes through phagocytosis, degranulation, release of small DNA... (Review)
Review
BACKGROUND
Neutrophils are an important part of the tumor microenvironment, which stimulates inflammatory processes through phagocytosis, degranulation, release of small DNA fragments (cell-free DNA), and presentation of antigens. Since neutrophils accumulate in peripheral blood in patients with advanced-stage cancer, a high neutrophil-to-lymphocyte ratio can be a biomarker of a poor prognosis in patients with glioblastoma. The present study aimed to explore the prognostic value of the preoperative levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and cell-free DNA (cfDNA) to better predict prognostic implications in the survival rate of glioblastoma patients.
METHODS
The meta-analysis was carried out according to the recommendations and standards established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases of PubMed, EBSCO, and Medline were systematically searched to select all the relevant studies published up to December 2022.
RESULTS
Poorer prognoses were recorded in patients with a high NLR or PLR when compared with the patients with a low NLR or PLR (HR 1.51, 95% CI 1.24-1.83, < 0.0001 and HR 1.34, 95% CI 1.10-1.63, < 0.01, respectively). Similarly, a worse prognosis was reported for patients with a higher cfDNA (HR 2.35, 95% CI 1.27-4.36, < 0.01). The SII and SIRI values were not related to glioblastoma survival ( = 0.0533 and = 0.482, respectively).
CONCLUSIONS
Thus, NLR, PLR, and cfDNA, unlike SII and SIRI, appeared to be useful and convenient peripheral inflammatory markers to assess the prognosis in glioblastoma.
PubMed: 37444448
DOI: 10.3390/cancers15133339 -
Heliyon May 2022The albumin-to-globulin ratio (AGR) has been used to predict severity and mortality in infectious diseases. The aim of this study is to evaluate the prognostic value of... (Review)
Review
BACKGROUND AND AIMS
The albumin-to-globulin ratio (AGR) has been used to predict severity and mortality in infectious diseases. The aim of this study is to evaluate the prognostic value of the AGR in COVID-19 patients.
METHODS
A systematic review and meta-analysis were conducted. We included observational studies assessing the association between the AGR values upon hospital admission and severity or all-cause mortality in COVID-19 patients. In the meta-analyses we used random effect models. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The effect measures were expressed as mean difference (MD) and their 95% confidence intervals (CI). We performed Egger's test and funnel plots to assess the publication bias.
RESULTS
The included studies had a total of 11356 patients corresponding to 31 cohort studies. Severe COVID-19 patients had lower AGR values than non-severe COVID-19 patients (mean difference (MD), -0.27; 95% IC, -0.32 to -0.22; p < 0.001; I = 88%). Non-survivor patients with COVID-19 had lower AGR values than survivor patients (MD, -0.29; 95% IC, -0.35 to -0.24; p < 0.001; I = 79%). In the sensitivity analysis, we only included studies with low risk of bias, which decreased the heterogeneity for both outcomes (severity, I = 20%; mortality, I = 5%).
CONCLUSIONS
Low AGR values upon hospital admission were found in COVID-19 patients with a worse prognosis.
PubMed: 35601226
DOI: 10.1016/j.heliyon.2022.e09457 -
Frontiers in Endocrinology 2023Preimplantation genetic testing for aneuploidy (PGT-A) is an emerging technology that aims to identify euploid embryos for transfer, reducing the risk of embryonic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Preimplantation genetic testing for aneuploidy (PGT-A) is an emerging technology that aims to identify euploid embryos for transfer, reducing the risk of embryonic chromosomal abnormalities. However, the clinical benefits of PGT-A in recurrent pregnancy failure (RPF) patients, particularly in young RPF patients, remains uncertain.
OBJECTIVE AND RATIONALE
This meta-analysis aimed to determine whether RPF patients undergoing PGT-A had better clinical outcomes compared to those not undergoing PGT-A, thus assessing the value of PGT-A in clinical practice.
SEARCH METHODS
We systematically searched PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database for Chinese Technical Periodicals (VIP) from 2002 to 2022. Thirteen published studies involving 930 RPF patients screened using PGT-A and over 1,434 RPF patients screened without PGT-A were included in this meta-analysis. Clinical outcomes were evaluated based on embryo transfers after PGT-A (n=1,015) and without PGT-A (n=1,799).
CLINICAL OUTCOMES
The PGT-A group demonstrated superior clinical outcomes compared to the fertilization (IVF)/intracytoplasmic sperm injection (ICSI) group. The PGT-A group had a significantly higher implantation rate (IR) (RR=2.01, 95% CI: [1.73; 2.34]), clinical pregnancy rate (CPR) (RR=1.53, 95% CI: [1.36; 1.71]), ongoing pregnancy rate (OPR) (RR=1.76, 95% CI: [1.35; 2.29]), live birth rate (LBR) (RR=1.75, 95% CI: [1.51; 2.03]), and significantly lower clinical miscarriage rate (CMR) (RR=0.74, 95% CI: [0.54; 0.99]). Subgroup analysis based on patient age (under 35 years and 35 years or older) showed that both PGT-A subgroups had significantly better CPR (P<0.01) and LBR (P<0.05) values compared to the IVF/ICSI groups.
SUMMARY
This meta-analysis demonstrates that PGT-A in RPF patients, is associated with improved clinical outcomes, including higher IR, CPR, OPR, and LBR values, and lower CMR compared to the IVF/ICSI group. These findings support the positive clinical application of PGT-A in RPF patients.
SYSTEMATIC REVIEW REGISTRATION
http://INPLASY.com, identifier INPLASY 202320118.
Topics: Pregnancy; Female; Humans; Male; Adult; Preimplantation Diagnosis; Semen; Genetic Testing; Fertilization in Vitro; Abortion, Spontaneous; Aneuploidy
PubMed: 37850092
DOI: 10.3389/fendo.2023.1178294 -
Frontiers in Endocrinology 2023To determine the effect of acupuncture in treating poor ovarian response (POR). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the effect of acupuncture in treating poor ovarian response (POR).
METHODS
We searched MEDLINE (via PubMed), EMBASE, Allied and Complementary Medicine Database, CNKI, CBM, VIP database, Wanfang Database, and relevant registration databases from inception to January 30, 2023. In this review, both Chinese and English peer-reviewed literature were included. Only randomized controlled trials (RCTs) using acupuncture as an intervention for POR patients undergoing fertilization were considered.
RESULTS
Seven clinical randomized controlled trials (RCTs) were eventually included for comparison (516 women). The quality of included studies was generally low or very low. For the meta-analysis, seven studies showed that compared with controlled ovarian hyperstimulation (COH) therapy, acupuncture combined with COH therapy could significantly increase the implantation rate (RR=2.13, 95%CI [1.08, 4.21], =0.03), the number of oocytes retrieved (MD=1.02, 95%CI [0.72, 1.32], <0.00001), the thickness of endometrium (MD=0.54, 95%CI [0.13, 0.96], =0.01), and the antral follicle count (MD=1.52, 95%CI [1.08, 1.95], <0.00001), reduce follicle-stimulating hormone (FSH) levels (MD=-1.52, 95%CI [-2.41, -0.62], =0.0009) and improve estradiol (E) levels (MD=1667.80, 95%CI [1578.29, 1757.31], <0.00001). Besides, there were significant differences in the duration of Gn (MD=0.47, 95%CI [-0.00, 0.94], =0.05) between the two groups. However, no statistical variation was observed in improving clinical pregnancy rate (CPR), fertilization rate, high-quality embryo rate, luteinizing hormone (LH) value, anti-mullerian hormone (AMH) value, or reducing the dose of gonadotropin (Gn) values between the acupuncture plus COH therapy group and the COH therapy group.
CONCLUSION
Acupuncture combined with COH therapy is doubtful in improving the pregnancy outcome of POR patients. Secondly, acupuncture can also improve the sex hormone level of POR women, and improve ovarian function. Furthermore, more RCTs of acupuncture in POR are needed to be incorporated into future meta-analyses.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42020169560.
Topics: Female; Humans; Pregnancy; Pregnancy Outcome; Fertilization in Vitro; Ovarian Hyperstimulation Syndrome; Gonadotropins; Acupuncture Therapy
PubMed: 36992800
DOI: 10.3389/fendo.2023.1028853 -
Journal of Patient-reported Outcomes Mar 2022The aim of this systematic review was to describe the prognostic value of patient-reported outcome measures (PROMs) in adult heart-transplant (HT) patients. (Review)
Review
BACKGROUND
The aim of this systematic review was to describe the prognostic value of patient-reported outcome measures (PROMs) in adult heart-transplant (HT) patients.
METHODS
A systematic search was performed on Ovid Medline, CINAHL Plus, Web of Science, and PubMed. The study protocol was registered on the PROSPERO database (CRD42021225398), and the last search was performed on January 7, 2021. We included studies of adult HT patients where generic and disease-specific PROMs were used as prognostic indicators for survival, readmissions, HT complications, and the onset of new comorbidities. We excluded studies that used clinician-reported and patient-experience outcomes. The Quality in Prognosis Studies tool (QUIPS) was used to measure the risk of bias of the included studies.
RESULTS
We included five observational studies between 1987 and 2015, whose populations' mean age ranged from 43 to 56 years and presented a higher proportion of males than females. The Kansas City Cardiomyopathy Questionnaire demonstrated a negative correlation with readmissions (coefficient = - 1.177, p = 0.031), and the EQ-5D showed a negative correlation with the onset of neuromuscular disease after HT (coefficient = - 0.158, p < 0.001). The Millon Behavioral Health Inventory and the Nottingham Health Profile demonstrated a statistically significant association as survival predictors (p = 0.002 and p < 0.05, respectively). A moderate overall risk of bias was reported in three studies, one study resulted in a low risk of bias, and a proportion of more than 75% of males in each of the studies. High heterogeneity between the studies impeded establishing a link between PROMs and prognostic value.
CONCLUSION
There is low evidence supporting PROMs usage as prognostic tools in adult HT patients. Comparing outcomes of PROMS to routine prognostic in wider and systematic settings is warranted. Systematic use of PROMs in clinical settings is warranted.
PubMed: 35294633
DOI: 10.1186/s41687-022-00431-4 -
World Journal of Surgical Oncology May 2021The inflammatory biomarker "C-reactive protein to albumin ratio (CAR)" has been reported to significantly correlate to a variety of human cancers. However, there are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUNDS
The inflammatory biomarker "C-reactive protein to albumin ratio (CAR)" has been reported to significantly correlate to a variety of human cancers. However, there are conflicting results regarding the prognostic value of CAR in colorectal cancer. Previous studies mainly assessed patients in Eastern countries, so their findings may not be applicable to the Western population. Therefore, this updated meta-analysis aimed to investigate the prognostic value of pre-treatment CAR and outcomes of patients with colorectal cancer.
METHODS
We conducted a systematic search for eligible literature until October 31, 2020, using PubMed and Embase databases. Studies assessing pre-treatment CAR and outcomes of colorectal cancer were included. Outcome measures included overall survival, disease-free survival, progression-free survival, and clinicopathological features. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were used as effective values.
RESULTS
A total of 15 studies involving 6329 patients were included in this study. The pooled results indicated that a high pre-treatment CAR was associated with poor overall survival (HR 2.028, 95% CI 1.808-2.275, p < 0.001) and poor disease-free survival/progression-free survival (HR 1.768, 95% CI 1.321-2.365, p < 0.001). Subgroup analysis revealed a constant prognostic value of the pre-treatment CAR despite different study regions, sample size, cancer stage, treatment methods, or the cut-off value used. We also noted a correlation between high pre-treatment CAR and old age, male sex, colon cancer, advanced stage (III/IV), large tumor size, poor differentiation, elevated carcinoembryonic antigen levels, neutrophil-to-lymphocyte ratio, and the modified Glasgow prognostic score.
CONCLUSIONS
High pre-treatment CAR was associated with poor overall survival, disease-free survival, and progression-free survival in colorectal cancer. It can serve as a prognostic marker for colorectal cancer in clinical practice.
Topics: C-Reactive Protein; Colonic Neoplasms; Colorectal Neoplasms; Humans; Male; Prognosis; Serum Albumin
PubMed: 33933070
DOI: 10.1186/s12957-021-02253-y -
International Journal of Clinical... Nov 2021Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19.
OBJECTIVE
To evaluate the prognostic value of the NLR in patients diagnosed with COVID-19.
METHODS
We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (ie, at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (ORs) and their 95% confidence intervals (CIs). Small study effects were assessed with the Egger's test.
RESULTS
We analysed 61 studies (n = 15 522 patients), 58 cohorts, and 3 case-control studies. An increase of one unit of NLR was associated with higher odds of severity (OR 6.22; 95%CI 4.93 to 7.84; P < .001) and higher odds of all-cause mortality (OR 12.6; 95%CI 6.88 to 23.06; P < .001). In our sensitivity analysis, we found that 41 studies with low risk of bias and moderate heterogeneity (I = 53% and 58%) maintained strong association between NLR values and both outcomes (severity: OR 5.36; 95% CI 4.45 to 6.45; P < .001; mortality: OR 10.42 95% CI 7.73 to 14.06; P = .005).
CONCLUSIONS
Higher values of NLR were associated with severity and all-cause mortality in hospitalised COVID-19 patients.
Topics: COVID-19; Humans; Lymphocytes; Neutrophils; Prognosis; SARS-CoV-2
PubMed: 34228867
DOI: 10.1111/ijcp.14596 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Non-union is a known and much-dreaded complication of paediatric lateral condyle fractures. This systematic review aims to pool together individual studies to find out... (Meta-Analysis)
Meta-Analysis Review
AIMS
Non-union is a known and much-dreaded complication of paediatric lateral condyle fractures. This systematic review aims to pool together individual studies to find out if the timing of fixation and method of fixation impacts surgical outcomes (postoperative union and elbow ROM) in paediatric lateral condyle non-union.
METHODS
A systematic review and individual patient data meta-analysis was conducted according to PRISMA guidelines. All surgical studies with original data on pediatric lateral humeral condyle non-union were included. Patients who did not undergo surgical fixation were excluded.
RESULTS
A total of 12 studies with 177 patients were included. In total, 159 patients (89.8%) achieved bony union postoperatively while 18 patients (10.2%) did not. Mixed-effects logistic regression showed that percutaneous fixation (p-value=0.020) was associated with lower rates of postoperative union compared to open fixation, whereas the age at surgery did not have a significant impact (p-value=0.401). For elbow ROM, mixed-effects linear regression showed that increased age at surgery (p-value=0.007) and reduction of the fracture fragment (vs. in situ fixation) (p-value=0.041) were associated with reduced postoperative ROM whereas female sex (p-value=0.009) and corrective osteotomy (p-value=0.045) were associated with increased postoperative ROM.
CONCLUSION
While the timing of surgical fixation did not significantly impact postoperative bony union, undergoing fixation at an older age was associated with reduced postoperative elbow ROM. In addition, percutaneous fixation may be associated with poorer postoperative union compared to open fixation while anatomical reduction may be associated with reduced postoperative elbow ROM compared to in situ fixation.
LEVEL OF EVIDENCE
IV.
Topics: Child; Elbow Joint; Female; Fracture Fixation, Internal; Humans; Humeral Fractures; Humerus; Range of Motion, Articular; Treatment Outcome
PubMed: 33857684
DOI: 10.1016/j.otsr.2021.102933 -
BMC Endocrine Disorders Apr 2019Previous studies have suggested that metabolic syndrome (MetS) and its component conditions are linked to the development of many benign or malignant diseases. Some... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies have suggested that metabolic syndrome (MetS) and its component conditions are linked to the development of many benign or malignant diseases. Some studies have described relationships among metabolic syndrome or diabetes and liver cancer, but not many articles described the relationships between MetS and cirrhosis, acute hepatic failure, end-stage liver disease, and even death. However, liver cancers, cirrhosis, acute hepatic failure, end-stage liver disease, and liver-related mortality-collectively described as liver-related events (LREs)-may have different relationships with MetS. We undertook this meta-analysis to examine the association between MetS and LREs, and to determine whether geographic region or hepatitis B virus (HBV) positivity might influence the association.
METHODS
Relevant studies were identified from PubMed, EMBASE, and the Cochrane database. Two reviewers independently searched records from January 1980 to December 2017. The search terms included 'metabolic syndrome', 'diabetes mellitus', 'insulin resistance syndrome', and 'metabolic abnormalities', combined with 'cirrhosis', 'hepatic fibrosis ', 'hepatocellular carcinoma', 'complication', 'LRE', 'HCC', 'liver-related events', and 'liver cancer'. No language restriction was applied to the search. We chose the studies reporting an association between MetS and LREs. We used Begg's and Egger's tests and visually examined a funnel plot to assess publication bias. All analyses were conducted in Stata 14.0 software.
RESULTS
There were 19 studies (18 cohort and 1 case-control) included in the analysis, with a total of 1,561,457 participants. The subjects' ages ranged from 18 to 84 years. The combined analysis showed an overall 86% increase risk of LREs in cases with MetS (RR: 1.86,95% CI: 1.56-2.23). The funnel plot was asymmetrical, and the Egger's test p values showed a publication bias in this meta analysis. However, through the trim and fill method, we obtained a new RR value for LREs with MetS of 1.49 (95% CI: 1.40-1.58, p = 0.000). There was no obvious difference with the two answers, so we concluded that the results were robust. For hepatitis B positive patients, the RR for MetS and LREs was 2.15 (95% CI:1.02-4.53, p = 0.038), but for the hepatitis B negative patients, the RR was 1.85 (95% CI:1.53-2.24, p = 0.000). And for non-Asians, the RR for MetS and LREs was 2.21 (95% CI: 1.66-2.69, p = 0.000), while for Asians, the RR was 1.73 (95% CI: 1.35-2.22, p = 0.000).
CONCLUSIONS
This meta-analysis showed that MetS is associated with a moderately increased risk of LREs prevalence. Patients with MetS together with hepatitis B are more likely to develop hepatic events. For non-Asians, MetS is more likely to increase the incidence of LREs.
Topics: Humans; Liver Diseases; Metabolic Syndrome; Prognosis; Risk Factors
PubMed: 31023282
DOI: 10.1186/s12902-019-0366-3