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Journal of Global Oncology Dec 2016There is considerable variation in prevalence rates of triple-negative breast cancer (TNBC) reported by various studies from India. We performed a systematic review and... (Review)
Review
PURPOSE
There is considerable variation in prevalence rates of triple-negative breast cancer (TNBC) reported by various studies from India. We performed a systematic review and literature-based meta-analysis of these studies.
METHODS
We searched databases of Medline, Scopus, EMBASE, and Web of Science for studies that reported on the prevalence of TNBC in India that were published between January 1, 1999, and December 31, 2015. We extracted relevant information from each study by using a standardized form. We pooled study-specific estimates by using random-effects meta-analysis to provide summary estimates. We explored sources of heterogeneity by using subgroup analyses and metaregression.
RESULTS
Data were obtained from 17 studies that involved 7,237 patients with breast cancer. Overall combined prevalence of TNBC was 31% (95% CI, 27% to 35%). There was substantial heterogeneity across the studies (I of 91% [95% CI, 88% to 94%]; < .001) that was not explained by available study level characteristics, including study location, definition of human epidermal growth factor receptor 2 or estrogen receptor, mean age of participants, proportion of patients with premenopausal cancer, grade 3 disease, or tumor size > 5 cm. Overall combined prevalence of hormone receptor-positive and human epidermal growth factor receptor 2-positive breast cancer was 48% (95% CI, 42% to 54%) and 27% (95% CI, 24% to 31%), respectively. There was no evidence of publication bias.
CONCLUSION
Prevalence of TNBC in India is considerably higher compared with that seen in Western populations. As many as as one in three women with breast cancer could have triple-negative disease. This finding has significant clinical relevance as it may contribute to poor outcomes in patients with breast cancer in India. Additional research is needed to understand the determinants of TNBC in India.
PubMed: 28717728
DOI: 10.1200/JGO.2016.005397 -
Endocrine Disrupting Chemicals and Risk of Testicular Cancer: A Systematic Review and Meta-analysis.The Journal of Clinical Endocrinology... Nov 2021The incidence of many hormone-dependent diseases, including testicular cancer, has sharply increased in all high-income countries during the 20th century. This is not... (Meta-Analysis)
Meta-Analysis
The incidence of many hormone-dependent diseases, including testicular cancer, has sharply increased in all high-income countries during the 20th century. This is not fully explained by established risk factors. Concurrent, increasing exposure to antiandrogenic environmental endocrine disrupting chemicals (EDCs) in fetal life may partially explain this trend. This systematic review assessed available evidence regarding the association between environmental EDC exposure and risk of testicular cancer (seminomas and nonseminomas). Following PRISMA guidelines, a search of English peer-reviewed literature published prior to December 14, 2020 in the databases PubMed and Embase® was performed. Among the 279 identified records, 19 were eligible for quality assessment and 10 for further meta-analysis. The completeness of reporting was high across papers, but over 50% were considered subject to potential risk of bias. Mean age at diagnosis was 31.9 years. None considered effects of EDC multipollutant mixtures. The meta-analyses showed that maternal exposure to combined EDCs was associated with a higher risk of testicular cancer in male offspring [summary risk ratios: 2.16, (95% CI:1.78-2.62), 1.93 (95% CI:1.49-2.48), and 2.78 (95% CI:2.27-3.41) for all, seminoma, and nonseminoma, respectively]. Similarly, high maternal exposures to grouped organochlorines and organohalogens were associated with higher risk of seminoma and nonseminoma in the offspring. Summary estimates related to postnatal adult male EDC exposures were inconsistent. Maternal, but not postnatal adult male, EDC exposures were consistently associated with a higher risk of testicular cancer, particularly risk of nonseminomas. However, the quality of studies was mixed, and considering the fields complexity, more prospective studies of prenatal EDC multipollutant mixture exposures and testicular cancer are needed.
Topics: Endocrine Disruptors; Environmental Exposure; Humans; Male; Prognosis; Risk Factors; Testicular Neoplasms
PubMed: 34270734
DOI: 10.1210/clinem/dgab523 -
The Cochrane Database of Systematic... Feb 2012Growth retardation is a common complication of chronic kidney disease (CKD) in children and is of concern to families. Recombinant human growth hormone (rhGH) treatment... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Growth retardation is a common complication of chronic kidney disease (CKD) in children and is of concern to families. Recombinant human growth hormone (rhGH) treatment has been used to help short children with CKD attain a height more in keeping with their age group. However there are concerns about the long-term benefits of rhGH in significantly improving adult height as well as concerns about potential adverse effects (deterioration in native kidney function, increased acute rejection in kidney transplant recipients, benign intracranial hypertension).
OBJECTIVES
To evaluate the benefits and harms of rhGH treatment in children with CKD.
SEARCH METHODS
Randomised controlled trials (RCTs) were identified from the Cochrane Renal Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 12, 2011), MEDLINE (from 1966), EMBASE (from 1980), article reference lists and through contact with local and international experts in the field.Date of last search: December 29, 2011
SELECTION CRITERIA
RCTs were included if they were carried out in children aged zero to 18 years, diagnosed with CKD, who were pre-dialysis, on dialysis or post-transplant; if they compared rhGH treatment with placebo/no treatment or two doses of rhGH treatments; and if they included height outcomes.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed studies for risk of bias and extracted data from eligible studies. Data was pooled using a random effects model with calculation of mean difference (MD) for continuous outcomes with 95% confidence intervals (CI).
MAIN RESULTS
Sixteen studies (enrolling 809 children) were identified. Risk of bias assessment indicated that study quality was poor or poorly reported with only four and five studies respectively reporting adequate allocation concealment or blinding of study participants and investigators. Treatment with rhGH (28 IU/m²/wk) compared with placebo or no specific therapy resulted in a significant increase in height standard deviation score (HSDS) at one year (8 studies, 391 children: MD 0.82, 95% CI 0.56 to 1.07), and a significant increase in height velocity at six months (2 studies, 27 children: MD 2.85 cm/6 mo, 95% CI 2.22 to 3.48) and one year (7 studies, 287 children: MD 3.88 cm/y, 95% CI 3.32 to 4.44). Height velocity, though reduced, remained significantly greater than untreated children during the second year of therapy (1 study, 82 children: MD 2.30 cm/y, 95% CI 1.39 to 3.21). Compared to the 14 IU/m²/wk group, there was a 1.18 cm/y increase in height velocity in the 28 IU/m²/wk group (3 studies, 150 children: 1.18 cm/y, 95% CI 0.52 to 1.84) . The frequency of reported side effects of rhGH was generally similar to that of the control group.
AUTHORS' CONCLUSIONS
One year of 28 IU/m²/wk rhGH in children with CKD resulted in a 3.88 cm increase in height velocity above that of untreated patients. Studies were too short to determine if continuing treatment resulted in an increase in final adult height.
Topics: Adolescent; Body Height; Child; Child, Preschool; Growth Disorders; Human Growth Hormone; Humans; Infant; Infant, Newborn; Kidney Failure, Chronic; Randomized Controlled Trials as Topic; Recombinant Proteins
PubMed: 22336787
DOI: 10.1002/14651858.CD003264.pub3 -
Frontiers in Endocrinology 2023To evaluate the clinical efficacy of acupuncture for the treatment of diminished ovarian reserve (DOR) based on the existing randomized controlled trials (RCTs). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the clinical efficacy of acupuncture for the treatment of diminished ovarian reserve (DOR) based on the existing randomized controlled trials (RCTs).
METHODS
Nine databases from their inception to December 6th, 2022, were comprehensively searched to retrieve RCTs related to the clinical efficacy of acupuncture for the treatment of DOR. The outcomes of interest were sex hormones level and antral follicle count (AFC). Risk of Bias (RoB) was adopted to assess the quality of the included trials.
RESULTS
A total of 13 RCTs involving 787 patients were included in this meta-analysis. The review of available evidence revealed acupuncture produced a significant efficacy in decreasing follicle-stimulating hormone (FSH) levels (SMD = -1.07, 95%CI [-1.79, -0.36], = 0.003), FSH/LH ratio (MD = -0.31, 95%CI [-0.54, -0.09], = 0.006) and increasing anti-Müllerian hormone (AMH) levels (SMD = 0.25, 95%CI [-0.00, 0.49], = 0.05), along with AFC (MD = 1.87, 95%CI [0.96, 2.79], < 0.0001) compared to controls. Compared with electro-acupuncture treatment, manual acupuncture was superior in reducing FSH levels, FSH/LH ratio, and increasing AMH levels and AFC ( < 0.05). A notable association was also seen when acupuncture was combined with traditional Chinese medicine therapy for improving FSH levels, FSH/LH ratio, and AFC ( < 0.05). Besides, a high dose of acupuncture (≥10 acupoints) was more conducive to ameliorating FSH levels, FSH/LH ratio, and AFC ( < 0.05) than a low dose of acupuncture (<10 acupoints). Substantial heterogeneity existed among studies.
CONCLUSION
Acupuncture may have significant clinical potential for patients with DOR in terms of improving sex hormones level and increasing AFC, although the evidence is drawn with high heterogeneity. This finding suggests that more rigorous trials conducted in diverse regions worldwide are necessary to identify the efficacy of acupuncture for patients diagnosed with DOR.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk, identifier CRD42023402336.
Topics: Humans; Female; Ovarian Reserve; Randomized Controlled Trials as Topic; Acupuncture Therapy; Treatment Outcome; Ovarian Diseases; Anti-Mullerian Hormone; Peptide Hormones; Transforming Growth Factor beta; Follicle Stimulating Hormone
PubMed: 37600702
DOI: 10.3389/fendo.2023.1136121 -
The Cochrane Database of Systematic... Jul 2020Burn injuries are an important health problem. They occur frequently in the head and neck region. The face is the area central to a person's identity that provides our...
BACKGROUND
Burn injuries are an important health problem. They occur frequently in the head and neck region. The face is the area central to a person's identity that provides our most expressive means of communication. Topical interventions are currently the cornerstone of treatment of burns to the face.
OBJECTIVES
To assess the effects of topical interventions on wound healing in people with facial burns of any depth.
SEARCH METHODS
In December 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA
Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, data extraction, risk of bias assessment and GRADE assessment of the certainty of the evidence.
MAIN RESULTS
In this first update, we included 12 RCTs, comprising 507 participants. Most trials included adults admitted to specialised burn centres after recent burn injuries. Topical agents included antimicrobial agents (silver sulphadiazine (SSD), Aquacel-Ag, cerium-sulphadiazine, gentamicin cream, mafenide acetate cream, bacitracin), non-antimicrobial agents (Moist Exposed Burn Ointment (MEBO), saline-soaked dressings, skin substitutes (including bioengineered skin substitute (TransCyte), allograft, and xenograft (porcine Xenoderm), and miscellaneous treatments (growth hormone therapy, recombinant human granulocyte-macrophage colony-stimulating factor hydrogel (rhGMCS)), enzymatic debridement, and cream with Helix Aspersa extract). Almost all the evidence included in this review was assessed as low or very low-certainty, often because of high risk of bias due to unclear randomisation procedures (i.e. sequence generation and allocation concealment); lack of blinding of participants, providers and sometimes outcome assessors; and imprecision resulting from few participants, low event rates or both, often in single studies. Topical antimicrobial agents versus topical non-antimicrobial agents There is moderate-certainty evidence that there is probably little or no difference between antimicrobial agents and non-antimicrobial agents (SSD and MEBO) in time to complete wound healing (hazard ratio (HR) 0.84 (95% confidence interval (CI) 0.78 to 1.85, 1 study, 39 participants). Topical antimicrobial agents may make little or no difference to the proportion of wounds completely healed compared with topical non-antimicrobial agents (comparison SSD and MEBO, risk ratio (RR) 0.94, 95% CI 0.68 to 1.29; 1 study, 39 participants; low-certainty evidence). We are uncertain whether there is a difference in wound infection (comparison topical antimicrobial agent (Aquacel-Ag) and MEBO; RR 0.38, 95% CI 0.12 to 1.21; 1 study, 40 participants; very low-certainty evidence). No trials reported change in wound surface area over time or partial wound healing. There is low-certainty evidence for the secondary outcomes scar quality and patient satisfaction. Two studies assessed pain but it was incompletely reported. Topical antimicrobial agents versus other topical antimicrobial agents It is uncertain whether topical antimicrobial agents make any difference in effects as the evidence is low to very low-certainty. For primary outcomes, there is low-certainty evidence for time to partial (i.e. greater than 90%) wound healing (comparison SSD versus cerium SSD: mean difference (MD) -7.10 days, 95% CI -16.43 to 2.23; 1 study, 142 participants). There is very low-certainty evidence regarding whether topical antimicrobial agents make a difference to wound infection (RR 0.73, 95% CI 0.46 to 1.17; 1 study, 15 participants). There is low to very low-certainty evidence for the proportion of facial burns requiring surgery, pain, scar quality, adverse effects and length of hospital stay. Skin substitutes versus topical antimicrobial agents There is low-certainty evidence that a skin substitute may slightly reduce time to partial (i.e. greater than 90%) wound healing, compared with a non-specified antibacterial agent (MD -6.00 days, 95% CI -8.69 to -3.31; 1 study, 34 participants). We are uncertain whether skin substitutes in general make any other difference in effects as the evidence is very low certainty. Outcomes included wound infection, pain, scar quality, adverse effects of treatment and length of hospital stay. Single studies showed contrasting low-certainty evidence. A bioengineered skin substitute may slightly reduce procedural pain (MD -4.00, 95% CI -5.05 to -2.95; 34 participants) and background pain (MD -2.00, 95% CI -3.05 to -0.95; 34 participants) compared with an unspecified antimicrobial agent. In contrast, a biological dressing (porcine Xenoderm) might slightly increase pain in superficial burns (MD 1.20, 95% CI 0.65 to 1.75; 15 participants (30 wounds)) as well as deep partial thickness burns (MD 3.00, 95% CI 2.34 to 3.66; 10 participants (20 wounds)), compared with antimicrobial agents (Physiotulle Ag (Coloplast)). Miscellaneous treatments versus miscellaneous treatments Single studies show low to very low-certainty effects of interventions. Low-certainty evidence shows that MEBO may slightly reduce time to complete wound healing compared with saline soaked dressing (MD -1.7 days, 95% CI -3.32 to -0.08; 40 participants). In addition, a cream containing Helix Aspersa may slightly increase the proportion of wounds completely healed at 14 days compared with MEBO (RR 4.77, 95% CI 1.87 to 12.15; 43 participants). We are uncertain whether any miscellaneous treatment in the included studies makes a difference in effects for the outcomes wound infection, scar quality, pain and patient satisfaction as the evidence is low to very low-certainty.
AUTHORS' CONCLUSIONS
There is mainly low to very low-certainty evidence on the effects of any topical intervention on wound healing in people with facial burns. The number of RCTs in burn care is growing, but the body of evidence is still hampered due to an insufficient number of studies that follow appropriate evidence-based standards of conducting and reporting RCTs.
Topics: Administration, Topical; Anti-Infective Agents; Bias; Burns; Carboxymethylcellulose Sodium; Facial Injuries; Humans; Randomized Controlled Trials as Topic; Skin, Artificial; Wound Healing
PubMed: 32725896
DOI: 10.1002/14651858.CD008058.pub3 -
Children (Basel, Switzerland) Feb 2023The growth of children and adolescents is both an important health indicator and a major public health issue. Many recent studies have investigated the effects of... (Review)
Review
The growth of children and adolescents is both an important health indicator and a major public health issue. Many recent studies have investigated the effects of taekwondo on growth factors, but no consensus has yet been reached. This meta-analysis aimed to determine the effects of taekwondo on the growth factors in children and adolescents (aged 8 to 16 years). Randomized controlled trials from PubMed, Web of Science, Cochrane Library, the Research Information Sharing Service, the Korea Citation Index, and the Korean-studies Information Service System were analyzed. The effect sizes (standardized mean differences, SMD) were calculated, the risk of bias and publication bias were assessed, and the effect size and subgroup analyses were pooled. We found that the taekwondo group had significantly higher levels of growth hormones (SMD 1.78, 95% confidence interval [CI] 0.98-2.58, and < 0.001) and insulin-like growth factors (SMD 1.76, 95% CI 0.60-2.92, and < 0.001) than the control group. For height, a medium effect size was observed (SMD 0.62, 95% CI -0.56-1.80, and = 0.300), but the between-group difference was not significant. Thus, taekwondo had significant positive effects on the secretion of growth hormones and insulin-like growth factors in Korean children and adolescents. A longitudinal follow-up is necessary to determine the effect on height. This suggests that taekwondo can be recommended as an appropriate physical exercise for maintaining normal growth in children and adolescents.
PubMed: 36832454
DOI: 10.3390/children10020326 -
Frontiers in Physiology 2023A training program can stimulate physiological, anatomical, and performance adaptations, but these improvements can be partially or entirely reversed due to the...
A training program can stimulate physiological, anatomical, and performance adaptations, but these improvements can be partially or entirely reversed due to the cessation of habitual physical activity resulting from illness, injury, or other influencing factors. To investigate the effects of detraining on cardiorespiratory, metabolic, hormonal, muscular adaptations, as well as short-term and long-term performance changes in endurance athletes. Eligible studies were sourced from databases and the library up until July 2023. Included studies considered endurance athletes as subjects and reported on detraining duration. Total cessation of training leads to a decrease in VOmax due to reductions in both blood and plasma volume. Cardiac changes include decreases in left ventricular mass, size, and thickness, along with an increase in heart rate and blood pressure, ultimately resulting in reduced cardiac output and impaired performance. Metabolically, there are declines in lactate threshold and muscle glycogen, increased body weight, altered respiratory exchange ratio, and changes in power parameters. In the short term, there is a decrease in insulin sensitivity, while glucagon, growth hormone, and cortisol levels remain unchanged. Skeletal muscle experiences reductions in arterial-venous oxygen difference and glucose transporter-4. Implementing a partial reduction in training may help mitigate drastic losses in physiological and performance parameters, a consideration when transitioning between training seasons. There is a dearth of data investigating the detraining effects of training reduction/cessation among endurance athletes. Delving deeper into this topic may be useful for professionals and researchers to identify the optimal strategies to minimize these effects.
PubMed: 38344385
DOI: 10.3389/fphys.2023.1334766 -
Journal of Personalized Medicine May 2023To investigate the influence of endogenous and exogenous neuroendocrine analogues on the range and motion of jaw movement, mandibular growth, and factors affecting... (Review)
Review
Neuroendocrine Influencers and Associated Factors That Shape Jaw Movement and Growth in Temporomandibular Joint Disorder Management: A Systematic Review of Clinical and Radiographic Evidence.
OBJECTIVE
To investigate the influence of endogenous and exogenous neuroendocrine analogues on the range and motion of jaw movement, mandibular growth, and factors affecting condylar guidance in patients with temporomandibular joint disorders using clinical assessment and radiographic imaging.
MATERIAL AND METHODS
Eligible articles were extracted from eleven databases in early 2023 and screened following PRISMA protocols. Certainty of evidence and potential biases were assessed using the GRADE approach.
RESULTS
Nineteen articles were screened, with four deemed to be of high quality, eight of moderate quality, and the remaining seven of low to very low quality. Corticosteroids improve maximal incisal opening but not TMJ disorder symptoms. Higher doses worsen jaw movement and cause osseous deformity. Growth hormone affects occlusal development, and delayed treatment affects arch width. Sex hormone correlation with TMJ disorder is complex, with some studies showing a correlation between menstrual cycle phases and pain/limited mobility.
CONCLUSIONS
The evaluation of neuroendocrine influencers in relation to jaw movement in patients with temporomandibular joint disorders involves the complex interplay of potentially confounding factors that each require careful consideration to ensure accurate diagnoses and evaluations.
PubMed: 37241010
DOI: 10.3390/jpm13050840 -
Journal of Cancer Research and Clinical... Jan 2024The numerous first-line treatment regimens for human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer (ABC) necessitate a comprehensive... (Meta-Analysis)
Meta-Analysis
PURPOSE
The numerous first-line treatment regimens for human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer (ABC) necessitate a comprehensive evaluation to inform clinical decision-making. We conducted a Bayesian network meta-analysis (NMA) to compare the efficacy and safety of different interventions.
METHODS
We systematically searched for relevant randomized controlled trials (RCTs) in Pubmed, Embase, Cochrane Library and online abstracts from inception to June 1, 2023. NMA was performed to calculate and analyze progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and adverse events of grade 3 or higher (≥ 3 AEs).
RESULTS
Out of the 10,313 manuscripts retrieved, we included 28 RCTs involving 11,680 patients. Regarding PFS and ORR, the combination of trastuzumab with tyrosine kinase inhibitors (TKIs) was more favorable than dual-targeted therapy. If only using trastuzumab, combination chemotherapy is superior to monochemotherapy in terms of PFS. It is important to note that the addition of anthracycline did not result in improved PFS. For patients with hormone receptor-positive HER2-positive diseases, dual-targeted combined with endocrine therapy showed better benefit in terms of PFS compared to dual-targeted alone, but it did not reach statistical significance. The comprehensive analysis of PFS and ≥ 3 AEs indicates that monochemotherapy combined with dual-targeted therapy still has the optimal balance between efficacy and safety.
CONCLUSION
Monochemotherapy (Docetaxel) plus dual-target (Trastuzumab and Pertuzumab) therapy remains the optimal choice among all first-line treatment options for ABC. The combination of trastuzumab with TKIs (Pyrotinib) demonstrated a significant improvement in PFS and ORR, but further data are warranted to confirm the survival benefit.
Topics: Humans; Female; Network Meta-Analysis; Randomized Controlled Trials as Topic; Breast Neoplasms; Trastuzumab; Receptor, ErbB-2; Docetaxel; Antineoplastic Combined Chemotherapy Protocols
PubMed: 38244085
DOI: 10.1007/s00432-023-05530-3 -
The Cochrane Database of Systematic... Sep 2014Recombinant human growth hormone (rhGH) increases protein synthesis, therefore it is used in burns with a total body surface area (TBSA) greater than 40%, where there is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recombinant human growth hormone (rhGH) increases protein synthesis, therefore it is used in burns with a total body surface area (TBSA) greater than 40%, where there is frequently an increase in protein breakdown and a decrease in protein synthesis. This change in protein metabolism correlates with poor wound healing of the burn and donor sites.
OBJECTIVES
To determine the effects of rhGH on the healing rate of burn wounds and donor sites in people with burns.
SEARCH METHODS
For this first update we searched the Cochrane Wounds Group Specialised Register (searched 04 September 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8); Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library 2014, Issue 3); Ovid MEDLINE (1950 to September Week 4 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations September 8, 2014); Ovid EMBASE (1980 to 2014 Week 35); and EBSCO CINAHL (1982 to 8 September 2014).
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing rhGH with any comparator intervention, e.g. oxandrolone or placebo, in adults or children with burns.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed trial quality and extracted data. The primary outcomes were the healing of the burn wound and donor sites and the occurrence of wound infections. The secondary outcomes were mortality rate, length of hospital stay, scar assessment, and adverse events: hyperglycaemia and septicaemia.
MAIN RESULTS
We included 13 RCTs (701 people). Six of the RCTs included only children aged 1 to 18 years and seven involved only adults (from 18 to 65 years of age). The mean TBSA of the included participants was greater than 49%. Twelve studies compared rhGH with placebo and one study compared rhGH with oxandrolone. Two trials found that compared with placebo, burn wounds in adults treated with rhGH healed more quickly (by 9.07 days; 95% confidence interval (CI) 4.39 to 13.76, I² = 0%). The donor site healing time was significantly shorter in rhGH-treated adults compared with placebo-treated participants (by 3.15 days; 95% CI 1.54 to 4.75, I² = 0%). Two studies in children with the outcome of donor site healing time could be pooled and the donor site healing time was shorter in the rhGH-treated children (by 1.70 days; 95% CI 0.87 to 2.53, I² = 0%). No studies reporting the outcome of wound infection were found. The incidence of hyperglycaemia was higher in adults during rhGH treatment compared with placebo (risk ratio (RR) 2.43; 95% CI 1.54 to 3.85), but not in children. Pooling the studies of adults and children yielded a significantly higher incidence of hyperglycaemia in the rhGH-treated participants (RR 2.65; 95% CI 1.68 to 4.16).
AUTHORS' CONCLUSIONS
There is some evidence that using rhGH in people with large burns (more than 40% of the total body surface area) could result in more rapid healing of the burn wound and donor sites in adults and children, and in reduced length of hospital stay, without increased mortality or scarring, but with an increased risk of hyperglycaemia. This evidence is based on studies with small sample sizes and risk of bias and requires confirmation in higher quality, adequately powered trials.
Topics: Adolescent; Adult; Aged; Anabolic Agents; Body Surface Area; Burns; Child; Child, Preschool; Human Growth Hormone; Humans; Infant; Middle Aged; Oxandrolone; Randomized Controlled Trials as Topic; Recombinant Proteins; Transplant Donor Site; Wound Healing; Young Adult
PubMed: 25222766
DOI: 10.1002/14651858.CD008990.pub3