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Annals of Palliative Medicine Oct 2015The morbidity and mortality associated with metastatic disease to brain make this problem a formidable challenge faced by health care providers and caregivers. The aim... (Review)
Review
BACKGROUND
The morbidity and mortality associated with metastatic disease to brain make this problem a formidable challenge faced by health care providers and caregivers. The aim of this review is to summarize management for patients with brain metastases with a particular focus on symptom management.
METHODS
A systematic review of the literature was performed. Outcomes of interest included survival, brain control (local in field and whole brain). In particular, symptom control (quality of life, neurological function and neurocognition) was examined.
RESULTS
Steroids provide relief of symptoms due to intra-cerebral edema. The steroid of choice is dexamethasone. Anti-seizure medications should not be given as prophylaxis but instead be given for treatment of seizures. Depending on patient, tumour and treatment factors, management for brain metastases range from optimal supportive care including the use of steroids, whole brain radiotherapy (WBRT), radiosurgery, surgery alone or in combination. Surgery or radiosurgery improves survival for selected patients with single brain metastasis as compared to WBRT alone. Ongoing research topics include focal postoperative cavity radiation, focal fractionated regimens, molecular targeted therapies, chemoprevention of brain metastases and neurocognitive protection (such as neuro-protective drugs and radiation techniques such as hippocampal sparing).
CONCLUSIONS
The management of brain metastases has evolved over the decades. Other than survival and brain control (local in-field and whole brain), the outcomes of quality of life and neurocognition are becoming increasingly important.
Topics: Brain Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Melanoma; Meta-Analysis as Topic; Multicenter Studies as Topic; Palliative Care; Prognosis; Randomized Controlled Trials as Topic
PubMed: 26541403
DOI: 10.3978/j.issn.2224-5820.2015.09.01 -
Nutrients Apr 2020For millennia, naturopaths and physicians have used (reishi mushroom) for its diverse therapeutic properties, as recorded in the oldest Chinese herbal encyclopedia.... (Meta-Analysis)
Meta-Analysis Review
For millennia, naturopaths and physicians have used (reishi mushroom) for its diverse therapeutic properties, as recorded in the oldest Chinese herbal encyclopedia. Indeed, a radioprotective effect has been reported in the isolated components of its extracts. A systematic review and meta-analyses (PRISMA) was conducted in March 2020, searching databases including PubMed, Scopus, Embase, and Google Scholar, along with Clinical Trials. The inclusion criteria were ex vivo, in vitro, and in vivo studies, with full texts in English, conducted to determine the radioprotective benefits of , or reports in which ionizing radiation was used. From a total number of 1109 records identified, 15 full text articles were eligible, none of them were clinical trials. In vivo studies reveal the efficiency of aqueous extracts of polysaccharides and triterpenes in mice exposed to -rays. In plasmid, they can reduce radiation damage as an increment of the open circular form, as well as increase the DNA extension, as shown in vitro studies. Ex vivo studies conducted in human blood cells show the radioprotective effect of β-glucan of aqueous extract of , nevertheless, its implementation as radioprotector to humans is in need of further clinical research studies.
Topics: Animals; Drugs, Chinese Herbal; Fungal Polysaccharides; Humans; In Vitro Techniques; Mice; Phytotherapy; Radiation Injuries; Radiation-Protective Agents; Reishi; Triterpenes
PubMed: 32325828
DOI: 10.3390/nu12041143 -
The Lancet. Planetary Health Nov 2023High-level exposure to indoor air pollutants (IAPs) and their corresponding adverse health effects have become a public concern in China in the past 10 years. However,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
High-level exposure to indoor air pollutants (IAPs) and their corresponding adverse health effects have become a public concern in China in the past 10 years. However, neither national nor provincial level burden of disease attributable to multiple IAPs has been reported for China. This is the first study to estimate and rank the annual burden of disease and the financial costs attributable to targeted residential IAPs at the national and provincial level in China from 2000 to 2017.
METHODS
We first did a systematic review and meta-analysis of 117 articles from 37 231 articles identified in major databases, and obtained exposure-response relationships for the candidate IAPs. The exposure levels to these IAPs were then collected by another systematic review of 1864 articles selected from 52 351 articles. After the systematic review, ten IAPs with significant and robust exposure-response relationships and sufficient exposure data were finally targeted: PM, nitrogen dioxide, sulphur dioxide, ozone, carbon monoxide, radon, formaldehyde, benzene, toluene, and p-dichlorobenzene. The annual exposure levels in residences were then evaluated in all 31 provinces in mainland China continuously from 2000 to 2017, using the spatiotemporal Gaussian process regression model to analyse indoor originating IAPs, and the infiltration factor method to analyse outdoor originating IAPs. The disability-adjusted life-years (DALYs) attributable to the targeted IAPs were estimated at both national and provincial levels in China, using the population attributable fraction method. Financial costs were estimated by an adapted human capital approach.
FINDINGS
From 2000 to 2017, annual DALYs attributable to the ten IAPs in mainland China decreased from 4620 (95% CI 4070-5040) to 3700 (3210-4090) per 100 000. Nevertheless, in 2017, IAPs still ranked third among all risk factors, and their DALYs and financial costs accounted for 14·1% (95% CI 12·3-15·6) of total DALYs and 3·45% (3·01-3·82) of the gross domestic product. Specifically, the rank of ten targeted IAPs in order of their contribution to DALYs in 2017 was PM, carbon monoxide, radon, benzene, nitrogen dioxide, ozone, sulphur dioxide, formaldehyde, toluene, and p-dichlorobenzene. The DALYs attributable to IAPs were 9·50% higher than those attributable to outdoor air pollution in 2017. For the leading IAP, PM, the DALYs attributable to indoor origins are 18·3% higher than those of outdoor origins.
INTERPRETATION
DALYs attributed to IAPs in China have decreased by 20·0% over the past two decades. Even so, they are still much higher than those in the USA and European countries. This study can provide a basis for determining which IAPs to target in various indoor air quality standards and for estimating the health and economic benefits of various indoor air quality control approaches, which will help to reduce the adverse health effects of IAPs in China.
FUNDING
The National Key Research and Development Program of China and the National Natural Science Foundation of China.
Topics: Humans; Air Pollutants; Carbon Monoxide; Sulfur Dioxide; Benzene; Nitrogen Dioxide; Formaldehyde; Cost of Illness; Particulate Matter; Radon; Ozone; Toluene
PubMed: 37940210
DOI: 10.1016/S2542-5196(23)00215-2 -
Cureus Apr 2024One of the leading environmental hazards, ionizing radiation, is linked to several detrimental health consequences in the body. RADPAD (Worldwide Innovations &... (Review)
Review
Assessing the Efficacy of RADPAD Protection Drape in Reducing Radiation Exposure to Operators in the Cardiac Catheterization Laboratory: A Systematic Review and Meta-Analysis.
One of the leading environmental hazards, ionizing radiation, is linked to several detrimental health consequences in the body. RADPAD (Worldwide Innovations & Technologies, Inc., Kansas City, Kansas) is a sterile, lead-free, lightweight, disposable radiation protection shield. We conducted a systematic review and meta-analysis to determine the effectiveness of RADPAD protection drapes in the cardiac catheterization lab and how they can aid interventional cardiologists in becoming subjected to less scatter radiation. PubMed, Embase, and Google Scholar were searched for studies discussing the efficacy of RADPAD protection drapes in reducing radiation exposure to operators in the cardiac catheterization laboratory. A random-effects model was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) for endpoints: primary operator exposure dose, dose area product (DAP), relative exposure, and screening time. Our analysis included 892 patients from six studies. Compared to the No-RADPAD group, primary operator exposure dose (E) was significantly lower in the RADPAD group (OR: -0.9, 95% CI: -1.36 to -0.43, I= 80.5%, p = 0.0001). DAP was comparable between both groups (OR: 0.008, 95% CI: -0.12 to -0.14, I= 0%, p = 0.9066). There was no difference in the relative exposure (E/DAP) (OR: -0.47, 95% CI: -0.96 to 0.02, I= 0%, p = 0.90) and screening time (OR: 0.13, 95% CI: 0.08 to 0.35, I= 0%, p = 0.22) between the two groups. The interventional cardiology laboratory is exposed to significantly less scatter radiation during procedures owing to the RADPAD protective drape. Consequently, all catheterization laboratories could be advised to employ RADPAD protective drapes.
PubMed: 38807800
DOI: 10.7759/cureus.59215 -
PloS One 2015Radiation overexposure accidents are rare but can have severe long-term health consequences. Although underreporting can be an issue, some extensive literature reviews... (Review)
Review
BACKGROUND
Radiation overexposure accidents are rare but can have severe long-term health consequences. Although underreporting can be an issue, some extensive literature reviews of reported radiation overexposures have been performed and constitute a sound basis for conclusions on general trends. Building further on this work, we performed a systematic review that completes previous reviews and provides new information on characteristics and trends of reported radiation accidents.
METHODS
We searched publications and reports from MEDLINE, EMBASE, the International Atomic Energy Agency, the International Radiation Protection Association, the United Nations Scientific Committee on the Effects of Atomic Radiation, the United States Nuclear Regulatory Commission, and the Radiation Emergency Assistance Center/Training Site radiation accident registry over 1980-2013. We retrieved the reported overexposure cases, systematically extracted selected information, and performed a descriptive analysis.
RESULTS
297 out of 5189 publications and reports and 194 records from the REAC/TS registry met our eligibility criteria. From these, 634 reported radiation accidents were retrieved, involving 2390 overexposed people, of whom 190 died from their overexposure. The number of reported cases has decreased for all types of radiation use, but the medical one. 64% of retrieved overexposure cases occurred with the use of radiation therapy and fluoroscopy. Additionally, the types of reported accidents differed significantly across regions.
CONCLUSIONS
This review provides an updated and broader view of reported radiation overexposures. It suggests an overall decline in reported radiation overexposures over 1980-2013. The greatest share of reported overexposures occurred in the medical fields using radiation therapy and fluoroscopy; this larger number of reported overexposures accidents indicates the potential need for enhanced quality assurance programs. Our data also highlights variations in characteristics of reported accidents by region. The main limitation of this study is the likely underreporting of radiation overexposures. Ensuring a comprehensive monitoring and reporting of radiation overexposures is paramount to inform and tailor prevention interventions to local needs.
Topics: Fluoroscopy; History, 20th Century; History, 21st Century; Humans; Radiation Exposure; Radioactive Hazard Release; Radiotherapy
PubMed: 25789482
DOI: 10.1371/journal.pone.0118709 -
Nutrients Dec 2022The retinal vessel caliber (RVC) is an important biomarker of cardiovascular diseases, which can be semi-automatically measured by fundus photography. This review... (Meta-Analysis)
Meta-Analysis Review
The retinal vessel caliber (RVC) is an important biomarker of cardiovascular diseases, which can be semi-automatically measured by fundus photography. This review investigated the associations between the RVCs and the life styles of early life, such as physical activity (PA), sedentary behavior (SB), dietary and sleep, by summarizing the findings from studies on children and adolescents. Two databases (Medline and Embase) were searched from their inception to 30 June 2022. The selected studies were literatures on observational designs, fundus photographs, retinal vessels and lifestyles of children or adolescents. Correlation coefficients of unhealthy life styles and RVCs were transformed to Fisher's z-scores, and the random-effects model was applied to pool data. A total of 18 observational studies were selected; the lifestyles accessed include 9 studies for PA and SB, 8 studies for dietary and 1 study for sleep. The meta-analysis on the correlation coefficients of regression models found the high level of SB (qualified by screen time, ST) was associated the narrower central retinal arteriolar equivalent (CRAE) among children (r = -0.043, 95% confidence intervals [CI] -0.078 to -0.009). By comparing the first and fourth quartiles of PA, the meta-analysis showed that more indoor PA was associated with smaller venular calibers and more outdoor PA was associated with wider CRAE (r = 0.88, 95%CI -3.33 to 0). Unhealthy lifestyles might be harmful on the retinal microcirculation among children and adolescents but their health effect seems not to be as significant as those in adults.
Topics: Adult; Humans; Child; Adolescent; Retinal Vessels; Arterioles; Retina; Microcirculation; Life Style
PubMed: 36615807
DOI: 10.3390/nu15010150 -
Journal of Parkinson's Disease 2023Swallowing impairment, including altered physiology and aspiration, occur across the progression of Parkinson's disease (PD). The phase of respiration during which a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Swallowing impairment, including altered physiology and aspiration, occur across the progression of Parkinson's disease (PD). The phase of respiration during which a swallow is initiated has been linked to swallowing impairment and aspiration in cohorts with dysphagia following stroke and head and neck cancer treatment, but has been understudied in PD. If similar findings are shown in individuals with PD, the implications for swallowing assessment and treatment are significant.
OBJECTIVE
The aim of this systematic review and meta-analysis of literature was to examine respiratory-swallow coordination measures and potential implications on swallowing physiology in individuals with PD.
METHODS
An extensive search of 7 databases (PubMed, EMBASE, Central, Web of Science, ProQuest Dissertations & Theses, Scopus, and CINAHL) with predetermined search terms was conducted. Inclusion criteria were individuals with PD and the use of objective evaluations of respiratory-swallow coordination.
RESULTS
Of the 13,760 articles identified, 11 met the inclusion criteria. This review supports the presence of atypical respiratory swallow patterning, respiratory pause duration and lung volume at swallow initiation in individuals with PD. The meta-analysis estimated an occurrence of 60% of non-expiration-expiration and 40% of expiration-expiration respiratory phase patterns surrounding swallowing.
CONCLUSION
Although this systematic review supports the occurrence of atypical respiratory-swallow coordination in individuals with PD, the evidence is limited by the variability in the methods of data acquisition, analysis, and reporting. Future research examining the impact of respiratory swallow coordination on swallowing impairment and airway protection using consistent, comparable, and reproducible methods and metrics in individuals with PD is warranted.
Topics: Humans; Parkinson Disease; Deglutition; Deglutition Disorders; Respiration
PubMed: 37393516
DOI: 10.3233/JPD-230057 -
Current Oncology (Toronto, Ont.) Dec 2022Australia and New Zealand have the highest incidence of skin cancer. Sport is a fundamental part of Australasian culture, beginning in childhood, often with life-long... (Review)
Review
Australia and New Zealand have the highest incidence of skin cancer. Sport is a fundamental part of Australasian culture, beginning in childhood, often with life-long participation. Participating in outdoor sports can contribute significantly to the lifetime ultraviolet radiation (UVR) dose individuals receive and their risk of developing skin cancer. This systematic scoping review explores the use of sun-protection by outdoor sporting participants in Australasia and considers how sun-protection practices may be improved and better evaluated in the community. A search of electronic databases using the search strategy "sun protection" AND "sport" AND "Australia" yielded 17 studies published in English from January 1992 to August 2021. Study methods included using UV-dosimeters to measure individual UVR-exposure; remote estimates of clothing-adjusted UVR-exposure; direct observation of sun-protection practices; and self-reported sun-exposure and sun-protection. Despite 40 years of 'Slip, Slop, Slap' campaigns in Australia, the use of sun-protection in most outdoor sports is inadequate. The paucity of comparable data limited our analyses, demonstrating a need for standardized, objective evaluation tools. Such tools, if used across a range of sports, should inform the development of workable recommendations that sporting clubs could implement and adopt into policy, thus empowering them to better protect the health of their participants.
Topics: Humans; Australasia; Self Report; Skin Neoplasms; Sunscreening Agents; Ultraviolet Rays; Sports
PubMed: 36661682
DOI: 10.3390/curroncol30010033 -
Environment International Jan 2022This systematic review provides a comprehensive synthesis of recent epidemiological evidence that environmental noise negatively impacts human cognition. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review provides a comprehensive synthesis of recent epidemiological evidence that environmental noise negatively impacts human cognition.
METHODS
We update a prior review with recent publications (PROSPERO CRD42019151923). The strength of evidence for associations was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. We also conducted random-effects meta-analyses where suitable.
RESULTS
16 studies were identified and reviewed in tandem with 32 studies previously reviewed by Clark & Paunovic (2018). A meta-analysis from 3 studies found that reading comprehension scores in quiet classrooms were 0.80 (95% confidence interval: 0.40; 1.20) points higher than children in noisier classrooms. Meta-analysis of the impact of 1 dB (dB) increase in environmental noise on reading and language abilities gave a pooled beta coefficient of -0.11(95% confidence interval: -0.32; 0.10). A meta-analysis of Odds Ratios (OR) from 3 studies found higher odds of cognitive impairment in people aged 45 + with higher residential noise exposure (OR 1.40, 95% CI: 1.18;1.61). After qualitative synthesis of remaining studies, there was high quality evidence for an association between environmental noise and cognitive impairment in middle-to-older adults, moderate quality evidence for an association between aircraft noise and reading and language in children, and moderate quality evidence against an association between aircraft noise and executive functioning in children. Generally the literature was supportive for other cognitive outcomes, but with low or very low-quality evidence.
DISCUSSION
The evidence so far suggests that noise exposure is associated with cognition, but more good quality research using standardised methodology is required to corroborate these results and to allow for precise risk estimation by larger meta-analyses. There is also a need for more research with older teenagers and young-to-middle aged adults, on the synergistic effects of noise and air pollution, and in Africa, Central and South America, South Asia and Australasia.
Topics: Adolescent; Aged; Air Pollution; Aircraft; Child; Cognition; Cognitive Dysfunction; Humans; Middle Aged; Noise
PubMed: 34649047
DOI: 10.1016/j.envint.2021.106905 -
Journal of Vascular Surgery Sep 2015Endovascular aortic repair has become increasingly popular the last years for the treatment of abdominal aortic aneurysms (EVAR) and thoracic aortic aneurysms. EVAR is... (Review)
Review
BACKGROUND
Endovascular aortic repair has become increasingly popular the last years for the treatment of abdominal aortic aneurysms (EVAR) and thoracic aortic aneurysms. EVAR is less invasive compared with the classic open approach, related to a decreased immediate postoperative morbidity and mortality. Those beneficial characteristics of EVAR do not come without a cost, since EVAR requires that the patient will be exposed to a significant amount of radiation during preoperative planning, graft placement, and consecutive follow-up. This systematic review examines the periprocedural radiation exposure to patients and staff as well as ways to ameliorate it.
METHODS
A systematic literature search was conducted using the MEDLINE electronic database. All articles reporting radiation exposure to alive humans during EVAR were eligible for review. Only studies publishing numerical data regarding radiation exposure were included in the Results section. Other relevant articles were used for further discussion.
RESULTS
Twenty-four studies, both prospective and retrospective in nature, were included. These studies revealed that the radiation exposure depends on the specific type of procedure, with more complex procedures carrying greater radiation burden. Variations in the positioning and operating of the fluoroscopic unit may significantly alter radiation dose to both patients and staff. There was an apparent lack of education among vascular specialists and trainees in terms of radiation safety awareness. At follow-up, a significant number of patients needed additional procedures, and all required radiographic imaging, further increasing the radiation exposure to alarming levels.
CONCLUSIONS
Every effort should be made to decrease radiation exposure related to endovascular aortic procedures. Attempts must be directed towards maximizing the operator's awareness, welcoming new imaging technology emitting less radiation, and shifting to follow-up strategies that require minimal or no radiation.
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortography; Endovascular Procedures; Humans; Occupational Exposure; Radiation Dosage; Radiation Injuries; Radiation Monitoring; Radiation Protection; Radiography, Interventional; Risk Assessment; Risk Factors
PubMed: 26169014
DOI: 10.1016/j.jvs.2015.05.033