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Journal of Clinical Medicine May 2019Breast density, a measure of dense fibroglandular tissue relative to non-dense fatty tissue, is confirmed as an independent risk factor of breast cancer. Although there... (Review)
Review
Breast density, a measure of dense fibroglandular tissue relative to non-dense fatty tissue, is confirmed as an independent risk factor of breast cancer. Although there has been an increasing interest in the quantitative assessment of breast density, no research has investigated the optimal technical approach of breast MRI in this aspect. Therefore, we performed a systematic review and meta-analysis to analyze the current studies on quantitative assessment of breast density using MRI and to determine the most appropriate technical/operational protocol. Databases (PubMed, EMBASE, ScienceDirect, and Web of Science) were searched systematically for eligible studies. Single arm meta-analysis was conducted to determine quantitative values of MRI in breast density assessments. Combined means with their 95% confidence interval (CI) were calculated using a fixed-effect model. In addition, subgroup meta-analyses were performed with stratification by breast density segmentation/measurement method. Furthermore, alternative groupings based on statistical similarities were identified via a cluster analysis employing study means and standard deviations in a Nearest Neighbor/Single Linkage. A total of 38 studies matched the inclusion criteria for this systematic review. Twenty-one of these studies were judged to be eligible for meta-analysis. The results indicated, generally, high levels of heterogeneity between study means within groups and high levels of heterogeneity between study variances within groups. The studies in two main clusters identified by the cluster analysis were also subjected to meta-analyses. The review confirmed high levels of heterogeneity within the breast density studies, considered to be due mainly to the applications of MR breast-imaging protocols and the use of breast density segmentation/measurement methods. Further research should be performed to determine the most appropriate protocol and method for quantifying breast density using MRI.
PubMed: 31137728
DOI: 10.3390/jcm8050745 -
BMC Neurology Aug 2021Brain age is a biomarker that predicts chronological age using neuroimaging features. Deviations of this predicted age from chronological age is considered a sign of...
BACKGROUND
Brain age is a biomarker that predicts chronological age using neuroimaging features. Deviations of this predicted age from chronological age is considered a sign of age-related brain changes, or commonly referred to as brain ageing. The aim of this systematic review is to identify and synthesize the evidence for an association between lifestyle, health factors and diseases in adult populations, with brain ageing.
METHODS
This systematic review was undertaken in accordance with the PRISMA guidelines. A systematic search of Embase and Medline was conducted to identify relevant articles using search terms relating to the prediction of age from neuroimaging data or brain ageing. The tables of two recent review papers on brain ageing were also examined to identify additional articles. Studies were limited to adult humans (aged 18 years and above), from clinical or general populations. Exposures and study design of all types were also considered eligible.
RESULTS
A systematic search identified 52 studies, which examined brain ageing in clinical and community dwelling adults (mean age between 21 to 78 years, ~ 37% were female). Most research came from studies of individuals diagnosed with schizophrenia or Alzheimer's disease, or healthy populations that were assessed cognitively. From these studies, psychiatric and neurologic diseases were most commonly associated with accelerated brain ageing, though not all studies drew the same conclusions. Evidence for all other exposures is nascent, and relatively inconsistent. Heterogenous methodologies, or methods of outcome ascertainment, were partly accountable.
CONCLUSION
This systematic review summarised the current evidence for an association between genetic, lifestyle, health, or diseases and brain ageing. Overall there is good evidence to suggest schizophrenia and Alzheimer's disease are associated with accelerated brain ageing. Evidence for all other exposures was mixed or limited. This was mostly due to a lack of independent replication, and inconsistency across studies that were primarily cross sectional in nature. Future research efforts should focus on replicating current findings, using prospective datasets.
TRIAL REGISTRATION
A copy of the review protocol can be accessed through PROSPERO, registration number CRD42020142817 .
Topics: Adult; Aged; Aging; Brain; Cross-Sectional Studies; Female; Humans; Middle Aged; Neuroimaging; Prospective Studies; Young Adult
PubMed: 34384369
DOI: 10.1186/s12883-021-02331-4 -
The Cochrane Database of Systematic... Jan 2008Metacarpophalangeal (MCP) arthroplasty with implants, which is the replacement of painful knuckle joints with artificial knuckle joints, has been performed for people... (Review)
Review
BACKGROUND
Metacarpophalangeal (MCP) arthroplasty with implants, which is the replacement of painful knuckle joints with artificial knuckle joints, has been performed for people with rheumatoid arthritis (RA) since the 1960s. The surgery is done because RA can cause damage of the knuckle joints making them unable to straighten out (flexion deformity) and causing them to lean over toward the small finger (flexion or ulnar deviation deformity). For eight to 12 weeks following surgery, patients wear hand splints and perform exercises to maintain and increase motion in the healing hand. Post-operative therapy regimes share common aims of encouraging MCP flexion and extension without the recurrence of flexion or ulnar deviation deformity.
OBJECTIVES
To compare the effectiveness of post-operative therapy regimes for increasing hand function after MCP arthroplasty in adults with rheumatoid arthritis.
SEARCH STRATEGY
The Cochrane Musculoskeletal Group Register, MEDLINE (January 1950 to August 2006), EMBASE (January 1993 to August 2006), CINAHL (January 1982 to August 2006), Digital Dissertations (January 1960 to August 2006), DARE (The Cochrane Library 2006, Issue 3), Current Contents Connect (January 1998 to August 2006), and AMED (January 1985 to August 2006) were searched for randomised controlled trials and controlled clinical trials using rheumatoid arthritis and hand as the search terms. The bibliographies of all trials identified by this strategy were also searched and primary authors were contacted for unpublished data and also clarification regarding study protocols. We performed handsearches of all relevant society conference proceedings and reference lists of retrieved articles. No language limits were applied, although searches were only relevant after the 1950s when MCP arthroplasty began to be performed.
SELECTION CRITERIA
Randomised controlled trials and controlled clinical trials were accepted if they evaluated the efficacy of a post-operative therapy regime for MCP arthroplasty.
DATA COLLECTION AND ANALYSIS
No data analyses were performed as only one controlled clinical trial was found. The data from that study are described.
MAIN RESULTS
Our search only identified one controlled clinical trial involving 22 participants. The majority of the evidence for various splinting and exercise regimes consisted of case series and case studies. Results from the one (poor quality) trial suggest that the use of continuous passive motion is not effective in increasing motion or strength after MCP arthroplasty.
AUTHORS' CONCLUSIONS
Well-designed randomised controlled trials which compare the efficacy of different therapeutic splinting programmes following MCP arthroplasty are required. At this time, the results of one study (silver level evidence) suggest that continuous passive motion alone is not recommended for increasing motion or strength after MCP arthroplasty.
Topics: Arthritis, Rheumatoid; Arthroplasty, Replacement; Humans; Metacarpophalangeal Joint; Motion Therapy, Continuous Passive
PubMed: 18254021
DOI: 10.1002/14651858.CD003522.pub2 -
Anti-cancer Drugs Nov 2021The objective of the study was to evaluate and summarize the evidence from systematic reviews and meta-analyses regarding the efficacy and safety of Aidi injection...
The objective of the study was to evaluate and summarize the evidence from systematic reviews and meta-analyses regarding the efficacy and safety of Aidi injection combined with chemotherapy in the treatment of cancer patients. PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chong qing VIP databases, and Wanfang databases were searched for systematic reviews/meta-analyses on the topic of Aidi treating cancer patients published from inception to 20 December 2020. Google Scholar and OpenGrey were searched for grey literature and International Prospective Register of Systematic Reviews for ongoing reviews. Two investigators independently selected eligible studies, extracted data, and assessed the methodological quality of included systematic reviews/meta-analyses using the measurement tool to assess systematic reviews 2 (AMSTAR-2) tool, and the strength of evidence was assessed with the grade of recommendation, assessment, development, and evaluation (GRADE) system. Twenty-seven systematic reviews/meta-analyses were identified in the study. The methodological quality of all 27 systematic reviews/meta-analyses were critically low when evaluated by AMSTAR-2, and the evidence quality of all outcomes rated as either low or very low based on the GRADE system. The available evidence is currently insufficient to support or refute the use of Aidi in the treatment of cancer patients, thus high-quality trials with large sample sizes are needed to explore its efficacy and safety in cancer patients.
Topics: Antineoplastic Agents; Disease Progression; Drugs, Chinese Herbal; Humans; Karnofsky Performance Status; Meta-Analysis as Topic; Neoplasms; Systematic Reviews as Topic
PubMed: 34183496
DOI: 10.1097/CAD.0000000000001110 -
Health Research Policy and Systems Dec 2022Accurate, consistent assessment of outcomes and impacts is challenging in the health research partnerships domain. Increased focus on tool quality, including conceptual,... (Review)
Review
BACKGROUND
Accurate, consistent assessment of outcomes and impacts is challenging in the health research partnerships domain. Increased focus on tool quality, including conceptual, psychometric and pragmatic characteristics, could improve the quantification, measurement and reporting partnership outcomes and impacts. This cascading review was undertaken as part of a coordinated, multicentre effort to identify, synthesize and assess a vast body of health research partnership literature.
OBJECTIVE
To systematically assess the outcomes and impacts of health research partnerships, relevant terminology and the type/use of theories, models and frameworks (TMF) arising from studies using partnership assessment tools with known conceptual, psychometric and pragmatic characteristics.
METHODS
Four electronic databases were searched (MEDLINE, Embase, CINAHL Plus and PsycINFO) from inception to 2 June 2021. We retained studies containing partnership evaluation tools with (1) conceptual foundations (reference to TMF), (2) empirical, quantitative psychometric evidence (evidence of validity and reliability, at minimum) and (3) one or more pragmatic characteristics. Outcomes, impacts, terminology, definitions and TMF type/use were abstracted verbatim from eligible studies using a hybrid (independent abstraction-validation) approach and synthesized using summary statistics (quantitative), inductive thematic analysis and deductive categories (qualitative). Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD).
RESULTS
Application of inclusion criteria yielded 37 eligible studies. Study quality scores were high (mean 80%, standard deviation 0.11%) but revealed needed improvements (i.e. methodological, reporting, user involvement in research design). Only 14 (38%) studies reported 48 partnership outcomes and 55 impacts; most were positive effects (43, 90% and 47, 89%, respectively). Most outcomes were positive personal, functional, structural and contextual effects; most impacts were personal, functional and contextual in nature. Most terms described outcomes (39, 89%), and 30 of 44 outcomes/impacts terms were unique, but few were explicitly defined (9, 20%). Terms were complex and mixed on one or more dimensions (e.g. type, temporality, stage, perspective). Most studies made explicit use of study-related TMF (34, 92%). There were 138 unique TMF sources, and these informed tool construct type/choice and hypothesis testing in almost all cases (36, 97%).
CONCLUSION
This study synthesized partnership outcomes and impacts, deconstructed term complexities and evolved our understanding of TMF use in tool development, testing and refinement studies. Renewed attention to basic concepts is necessary to advance partnership measurement and research innovation in the field. Systematic review protocol registration: PROSPERO protocol registration: CRD42021137932 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=137932 .
Topics: Humans; Reproducibility of Results; Psychometrics
PubMed: 36517852
DOI: 10.1186/s12961-022-00938-8 -
International Journal of Surgery... 2020The complexities and risks inherent to the field of surgery and surgical interventions present unique challenges to the design and analysis of surgical randomized...
INTRODUCTION
The complexities and risks inherent to the field of surgery and surgical interventions present unique challenges to the design and analysis of surgical randomized controlled trials (RCT). Prior studies have investigated the practical and methodologic challenges posed by surgical RCTs. To date, however, a comprehensive analysis of the contemporary literature across multiple surgical subspecialties does not exist. In this descriptive analysis, we set out to characterize surgical RCTs over the past 10 years across six major surgical specialties.
METHODS AND ANALYSIS
A literature search by a medical librarian will be performed to identify all surgical randomized clinical trials published between January 2009 and December 2019 in the two journals with the highest impact factor for six surgical specialties as well as two large general medicine journals. Two reviewers will independently screen the citations retrieved from the literature search and extract data according to a previously described protocol via a pre-defined data collection form. Categorical variables will be reported as counts and percentages. Following assessment of normality, continuous variables will be reported as mean (standard deviation) or median (inter-quartile range). Based on normality of data, independent t-test or the Mann-Whitney U test will be used to compare continuous variables and chi-square and Fisher's exact tests to compare categorical variables. Comparisons across multiple sets will be performed using ANOVA or Kruskak-Wallis tests. Two-sided significance testing will be used and a p-value <0.05 will be considered significant without adjustment for multiple testing. All analyses will be performed using SPSS version 24 and R within RStudio. PROSPERO (ID number: 162797).
ETHICS AND DISSEMINATION
There are no ethical concerns directly pertinent to this systematic review. The retrieved data will be made available upon request. The study will be written in English and submitted for publication in a peer-reviewed journal.
PubMed: 32258836
DOI: 10.1016/j.isjp.2020.03.002 -
BMC Medicine May 2013Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic... (Review)
Review
BACKGROUND
Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care.
METHODS
We searched PubMed, CENTRAL, CINAHL, Web of Science, and PEDro to identify randomized controlled trials exploring the effect of NMES in critically ill patients, which had a well-defined NMES protocol, provided outcomes related to skeletal-muscle strength and/or mass, and for which full text was available. Two independent reviewers extracted data on muscle-related outcomes (strength and mass), and participant and intervention characteristics, and assessed the methodological quality of the studies. Owing to the lack of means and standard deviations (SDs) in some studies, as well as the lack of baseline measurements in two studies, it was impossible to conduct a full meta-analysis. When means and SDs were provided, the effect sizes of individual outcomes were calculated, and otherwise, a qualitative analysis was performed.
RESULTS
The search yielded 8 eligible studies involving 172 patients. The methodological quality of the studies was moderate to high. Five studies reported an increase in strength or better preservation of strength with NMES, with one study having a large effect size. Two studies found better preservation of muscle mass with NMES, with small to moderate effect sizes, while no significant benefits were found in two other studies.
CONCLUSIONS
NMES added to usual care proved to be more effective than usual care alone for preventing skeletal-muscle weakness in critically ill patients. However, there is inconclusive evidence for its benefit in prevention of muscle wasting.
Topics: Critical Illness; Electric Stimulation Therapy; Humans; Muscle Strength; Muscle Weakness; Neuromuscular Junction; Randomized Controlled Trials as Topic
PubMed: 23701811
DOI: 10.1186/1741-7015-11-137 -
PloS One 2021The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology, and outcomes of co-infection and superinfection are limited. The purpose of this study was to examine the occurrence of co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection.
PATIENTS AND METHODS
We searched literature databases for studies published from October 1, 2019, through February 8, 2021. We included studies that reported clinical features and outcomes of co-infection or superinfection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines, and we registered the protocol with PROSPERO as: CRD42020189763.
RESULTS
Of 6639 articles screened, 118 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 19% (95% confidence interval [CI]: 14%-25%, I2 = 98%) and that of superinfection was 24% (95% CI: 19%-30%). Pooled prevalence of pathogen type stratified by co- or superinfection were: viral co-infections, 10% (95% CI: 6%-14%); viral superinfections, 4% (95% CI: 0%-10%); bacterial co-infections, 8% (95% CI: 5%-11%); bacterial superinfections, 20% (95% CI: 13%-28%); fungal co-infections, 4% (95% CI: 2%-7%); and fungal superinfections, 8% (95% CI: 4%-13%). Patients with a co-infection or superinfection had higher odds of dying than those who only had SARS-CoV-2 infection (odds ratio = 3.31, 95% CI: 1.82-5.99). Compared to those with co-infections, patients with superinfections had a higher prevalence of mechanical ventilation (45% [95% CI: 33%-58%] vs. 10% [95% CI: 5%-16%]), but patients with co-infections had a greater average length of hospital stay than those with superinfections (mean = 29.0 days, standard deviation [SD] = 6.7 vs. mean = 16 days, SD = 6.2, respectively).
CONCLUSIONS
Our study showed that as many as 19% of patients with COVID-19 have co-infections and 24% have superinfections. The presence of either co-infection or superinfection was associated with poor outcomes, including increased mortality. Our findings support the need for diagnostic testing to identify and treat co-occurring respiratory infections among patients with SARS-CoV-2 infection.
Topics: Bacterial Infections; COVID-19; Coinfection; Hospitalization; Humans; Mycoses; Prevalence; SARS-CoV-2; Superinfection; Treatment Outcome; Virus Diseases
PubMed: 33956882
DOI: 10.1371/journal.pone.0251170 -
Clinical Orthopaedics and Related... Oct 2014Computer-assisted surgery (CAS) has been developed to enhance prosthetic alignment during primary TKAs. Imageless CAS improves coronal and sagittal alignment compared... (Review)
Review
BACKGROUND
Computer-assisted surgery (CAS) has been developed to enhance prosthetic alignment during primary TKAs. Imageless CAS improves coronal and sagittal alignment compared with conventional TKA. However, the effect of imageless CAS on rotational alignment remains unclear.
QUESTIONS/PURPOSES
We conducted a systematic and qualitative review of the current literature regarding the effectiveness of imageless CAS during TKA on (1) rotational alignment of the femoral and tibial components and tibiofemoral mismatch in terms of deviation from neutral rotation, and (2) the number of femoral and tibial rotational outliers.
METHODS
Data sources included PubMed, MEDLINE, and EMBASE. Study selection, data extraction, and methodologic quality assessment were conducted independently by two reviewers. Standardized mean difference with 95% CI was calculated for continuous variables (rotational alignment of the femoral or tibial component and tibiofemoral mismatch). To compare the number of outliers for femoral and tibial component rotation, the odds ratio and 95% CI were calculated. The literature search produced 657 potentially relevant studies, 17 of which met the inclusion criteria. One study was considered as having high methodologic quality, 15 studies had medium, and one study had low quality.
RESULTS
Conflicting evidence was found for all outcome measures except for tibiofemoral mismatch. Moderate evidence was found that imageless CAS had no influence on postoperative tibiofemoral mismatch. The measurement protocol for measuring tibial rotation varied among the studies and in only one of the studies was the sample size calculation based on one of the outcome measures used in our systematic review.
CONCLUSIONS
More studies of high methodologic quality and with a sample size calculation based on the outcome measures will be helpful to assess whether an imageless CAS TKA improves femoral and tibial rotational alignment and tibiofemoral mismatch or decreases the number of femoral and tibial rotational outliers. To statistically analyze the results of different studies, the same measurement protocol should be used among the studies.
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Chi-Square Distribution; Humans; Knee Joint; Knee Prosthesis; Odds Ratio; Prosthesis Design; Range of Motion, Articular; Recovery of Function; Risk Assessment; Risk Factors; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 24867451
DOI: 10.1007/s11999-014-3688-5 -
Frontiers in Immunology 2023The aim of this study was to systematically review the neuroimmunology literature to determine the average immune cell counts reported by flow cytometry in wild-type...
OBJECTIVE
The aim of this study was to systematically review the neuroimmunology literature to determine the average immune cell counts reported by flow cytometry in wild-type (WT) homogenized mouse brains.
BACKGROUND
Mouse models of gene dysfunction are widely used to study age-associated neurodegenerative disorders, including Alzheimer's disease and Parkinson's disease. The importance of the neuroimmune system in these multifactorial disorders has become increasingly evident, and methods to quantify resident and infiltrating immune cells in the brain, including flow cytometry, are necessary. However, there appears to be no consensus on the best approach to perform flow cytometry or quantify/report immune cell counts. The development of more standardized methods would accelerate neuroimmune discovery and validation by meta-analysis.
METHODS
There has not yet been a systematic review of 'neuroimmunology' by 'flow cytometry' via examination of the PROSPERO registry. A protocol for a systematic review was subsequently based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the Studies, Data, Methods, and Outcomes (SDMO) criteria. Literature searches were conducted in the Google Scholar and PubMed databases. From that search, 900 candidate studies were identified, and 437 studies were assessed for eligibility based on formal exclusion criteria.
RESULTS
Out of the 437 studies reviewed, 58 were eligible for inclusion and comparative analysis. Each study assessed immune cell subsets within homogenized mouse brains and used flow cytometry. Nonetheless, there was considerable variability in the methods, data analysis, reporting, and results. Descriptive statistics have been presented on the study designs and results, including medians with interquartile ranges (IQRs) and overall means with standard deviations (SD) for specific immune cell counts and their relative proportions, within and between studies. A total of 58 studies reported the most abundant immune cells within the brains were TMEM119 microglia, bulk CD4 T cells, and bulk CD8 T cells.
CONCLUSION
Experiments to conduct and report flow cytometry data, derived from WT homogenized mouse brains, would benefit from a more standardized approach. While within-study comparisons are valid, the variability in methods of counting of immune cell populations is too broad for meta-analysis. The inclusion of a minimal protocol with more detailed methods, controls, and standards could enable this nascent field to compare results across studies.
Topics: Animals; Mice; Brain; CD8-Positive T-Lymphocytes; Flow Cytometry; Research Design; Systematic Reviews as Topic
PubMed: 38022545
DOI: 10.3389/fimmu.2023.1281705