Arcsine Square Research Articles

Sexually transmitted diseases and HIV co-infection among adult male patients in the 2022 monkeypox outbreak: a systematic review and meta-analysis.

This meta-analysis estimates sexually transmitted disease (STI) and HIV rates in male monkeypox patients during the 2022 outbreak. The study examines contextual factors that increase monkeypox risk. A systematic review of PubMed/Medline, Scopus, and Google Scholar was conducted to find observational studies on monkeypox patients' demographics and medical characteristics from the 2022 outbreak. This review's meta-analysis followed the System for the Unified Management, Assessment, and Review of Information - Joanna Briggs Institute (SUMARI JBI) guidelines. All HIV and STI prevalence data for male monkeypox patients was exported into the SUMARI JBI. For point prevalence of HIV and STIs, we used the Freeman-Tukey-type arcsine square root transformation to stabilize raw proportion variances. A fixed-effects model weighted and pooled all estimates by inverse variance. We then used a random model to account for sampling variation and reported fixed-effect model effect size heterogeneity across studies. Study heterogeneity was measured using the I2 test statistic and P-values. I2 test results were interpreted as low (25%), moderate (50%), and high (75%). Six Spanish and English studies qualified. These studies included 541 male monkeypox patients, 214 of whom had HIV and 255 with other STIs. HIV prevalence was estimated at 40% (95% CI = 0.31%, 0.50%; ᵡ2=15) and STIs at 43% (95% CI = 25%, 61%; ᵡ2=118). Overall, analyses showed moderate to high heterogeneity. Four in ten male monkeypox patients in 2022 had HIV or other STIs. To prevent HIV and other STIs, public health measures should target male and female monkeypox patients.

Clinical features of Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome and efficacy of the current therapy.

Cytomegalovirus retinitis (CMVR) is the most common and sight-threatening opportunistic retinal infection in patients with acquired immunodeficiency syndrome (AIDS) and several controversies remain to be settled. We aimed to summarize the current evidence and clarify the clinical features and prognosis of CMVR in AIDS patients. The databases PubMed, EMBASE, and Ovid from inception to April 2022 were searched to identify the relevant studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval (CI) were calculated using the Freeman-Tukey variant of arcsine square transformation. We finally included 236 studies comprising 20,214 patients. CMVR in AIDS was male-dominated (88%, 95%CI 86%-89%), with 57% (95%CI 55%-60%) aged <41 years and 44% (95%CI 41%-47%) being bilaterally involved. CMVR was preponderant in AIDS patients with the following characteristics: white and non-Hispanic, homosexual, HIV RNA load ≥ 400 copies/mL, and CD4+ T-cells <50 cells/μL. The positivity of CMV-DNA in blood, aqueous humor, and vitreous humor was 66% (95%CI 52%-79%), 87% (95%CI 76%-96%), and 95% (95%CI 85%-100%), respectively. The most common symptoms were blurred vision (55%, 95%CI 46%-65%), followed by asymptomatic, visual field defect, and floaters. CMVR was first diagnosed and regarded as the clue to AIDS diagnosis in 9% (95%CI 6%-13%) of CMVR patients. Approximately 85% (95%CI 76%-93%) of the CMVR patients have received cART. CMVR remission was observed in 72%-92% of patients depending on the specific category of anti-CMV therapy. The general incidence of CMVR-related RD in the entire course was 24% (95%CI 18%-29%), of which most patients received PPV with SO or gas tamponade and the rate of anatomic success was 89% (95%CI 85%-93%). CMVR is a common opportunistic infection with diverse clinical features in AIDS patients, preponderant in those who are male, homosexual, or with CD4+ T-cells <50 cells/μL. Current therapies for CMVR and CMVR-related RD were shown to be effective. Early detection and routine ophthalmic screening should be promoted in AIDS patients. PROSPERO, identifier CRD42022363105.

Estimation of median survival time and its 95% confidence interval using SAS PROC LIFETEST

ABSTRACT Estimation of median survival and its 95% confidence interval depends on the choice of the survival function, standard error, and a method for constructing the confidence interval. This paper outlines several available possibilities in SAS® (version 9.4) PROC LIFETEST and compares them on theoretical grounds and using simulated data, with criteria: ability to estimate the 95% CI, coverage probability, interval width, and appropriateness for practical use. Data are generated with varying hazard patterns, N, % censoring, and censoring patterns (early, uniform, late, last visit). LIFETEST was run using the Kaplan–Meier and Nelson–Aalen estimators and the transformations available (linear, log, logit, complementary log–log, and arcsine square root). Using the Kaplan–Meier estimator with the logarithmic transformation as well as with the logit leads to a high frequency of LIFETEST not being able to estimate the 95% CI. The combination of Kaplan–Meier with the linear transformation is associated with poor coverage achieved. For small samples, late/last visit censoring has a negative effect on being able to estimate the 95% CI. Heavy early censoring can lead to low coverage of the 95% CI of median survival for sample sizes up to and including N = 40. The two combinations that are optimal for being able to estimate the 95% CI and having adequate coverage are the Kaplan–Meier estimator with complementary log–log transformation, and the Nelson–Aalen estimator with linear transformation. The former fares best on the third criterion (smaller width) and is also the SAS® default and validates the choice of default.

Meta-Analysis and Meta-Regression to Assess Four-Factor Prothrombin Complex Concentrate's Ability to Achieve Hemostatic Effectiveness in Patients with Oral Factor Xa Inhibitor-Associated Intracranial Hemorrhage

Background: Four-factor prothrombin complex concentrates (4FPCCs), both non-activated and activated products, are commonly used off-label to manage oral factor Xa (FXa) inhibitor-associated severe or life-threatening bleeds including intracranial hemorrhage (ICH). Available evidence supporting 4FPCC use in the management of oral FXa inhibitor-associated ICH patients come from small-to-modest sized studies or case series. These studies or case series often differed in key inclusion and exclusion criteria employed and definition of hemostatic effectiveness utilized. We performed a systematic review and meta-analysis including multivariable meta-regression to assess the proportion of oral FXa inhibitor-associated ICH patients achieving hemostatic effectiveness with 4FPCC and the effect of key methodological decisions on this estimate. Methods: We searched PubMed and Embase from the earliest date possible through May 31, 2022. Studies or case series were included if: 4FPCC was administered for the management of oral FXa inhibitor-associated bleeding; reported solely on ICH patients (or a subgroup of); evaluated ≥10 patients; was performed within the United States; and provided data on the proportion of patients achieving hemostatic effectiveness. Meeting abstracts were not included. We performed a random-effects meta-analysis to calculate the pooled arcsine square root transformation weighted proportion of patients achieving hemostatic effectiveness with 95% confidence intervals (CIs). Multivariable meta-regression was used to determine the impact of studies’ inclusion or exclusion of severe ICH; requirement that the oral FXa inhibitor was taken within 24-hours and/or drug concentration or FXa levels were drawn; handling of patients with missing repeat imaging; and use (or non-use) of an accepted definition of hemostatic effectiveness on our pooled estimate. Results: We identified 36 studies or case series reporting on 38 unique study arms and including 1,732 oral FXa inhibitor-associated ICH patients managed with 4FPCC. Nearly 16% of study arms excluded patients with severe ICH (i.e., those with a hematoma volume >60 mL and/or Glasgow Coma Scale score <7) and fewer than 8% required the last oral intake of FXa inhibitor be within 24 hours or drug or FXa levels be drawn prior to 4FPCC administration. More than half (55.3%) of study arms excluded patients due to missing repeat imaging and 21.1% of arms failed to use an accepted definition to assess hemostatic effectiveness. The weighted pooled proportion of ICH patients achieving hemostatic effectiveness was 79.7% (95% CI 76.5, 82.8) (Figure). Upon multivariable meta-regression, study arms that excluded severe ICH patients reported a significant 8.5% increase in in the proportion achieving hemostatic effectiveness compared to those who retained these patients (p<0.001). Moreover, study arms that did not require oral FXa inhibitor intake within 24 hour or drug concentration/FXa levels reported a 12.5% (95% CI 4.0, 21.0, p=0.004) higher incidence of achieving hemostatic effectiveness. Exclusion of patients with missing repeat imaging and the use of an accepted definition of hemostatic effectiveness were not shown in this meta-regression analysis to significantly impact hemostatic effectiveness estimates. Conclusions: Studies’ and case series’ exclusion of patients with severe ICH and lack of implementation of inclusion criteria to increase the likelihood of therapeutic anticoagulation being present at time of treatment may result in the overestimation of 4FPCC's hemostatic effectiveness in oral FXa inhibitor-associated ICH. Readers of these (and future) studies should consider these methodological decisions when using them in clinical decision-making. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

S268 Rectal Retroflexion for Screening Colonoscopy: A Systematic Review and Meta-Analysis

Introduction: The primary goal of screening colonoscopy is to detect and resect premalignant colon lesions. However, the miss rate of these lesions remains significant in quality adjusted colonoscopies. A previous meta-analysis showed that right-sided retroflexion significantly increases the detection of adenomas in the right colon. However, evidence regarding the value of rectal retroflexion remains unclear. In this meta-analysis, we attempt to determine the effect of rectal retroflexion on the polyp detection rate compared to straight view examination and to determine the overall success rate of this maneuver. Methods: A systematic review of all the major databases was performed (MEDLINE, Embase, CINHAL, Google Scholar). Abstracts of all major gastrointestinal scientific meetings were also searched. Two reviewers extracted the data from selected studies. Data on patient demographics, study design, country of publication, polyp histology, detection rate of polyps with retroflexion were extracted. Pooled proportions were calculated using the arcsine square root transformed portion. Pooled estimates were obtained using a random effects model. Heterogeneity and publication bias were assessed. Results: Six studies were included in this analysis (N=5482). Studies were reported from the USA, United Kingdom and Mexico. All the studies were prospective studies. The mean age of the patients ranged from 53-60 years with 48.8% females. Retroflexion lead to higher polyp detection rates in the rectum (pooled event rate 1.2%; 95% CI: 0.6%-2.3%, p< 0.0001). A subgroup analysis for the detection rate of tubular adenoma or tubulovillous adenoma revealed a statistically significant higher detection in the retroflexion group compared to the forward view (pooled event rate 0.4%, 95% CI: 0.1%-0.9%, p=0.009). The overall rate of success of rectal retroflexion was 97.3%. Only 2 studies reported the rate of adverse events of this technique. The adverse events reported were pain and erosions with minor bleeding. Conclusion: Rectal retroflexion significantly increased the detection of adenomatous polyps compared to forward view with a high maneuver success rate. Further studies with a randomized design and with reporting of adverse events are needed to guide recommendations regarding the efficacy of rectal retroflexion for screening colonoscopy.

SP6.1.3 A Decision-Analysis Study of Endoscopic, Surgical and Pharmacological Treatment Options for Chronic Gastro Oesophageal Reflux Disease

Abstract Aims To compare emerging endo-luminal interventions for the treatment of chronic gastro-esophageal reflux disease (GORD) to pharmacological and surgical interventions. Methods An advanced decision-tree model was constructed and populated with data from 19 randomised controlled trials to compare competing treatment pathways that included: Laparoscopic Fundoplication, Stretta, Transoesophageal Incisionless Fundoplication (TIF) and medical management with proton pump inhibitor (PPI). Model transition probabilities were calculated using weighted pooled estimates of proportions calculated using Freeman-Tukey arcsine square root transformation under random effects model to account for heterogeneity. Model uncertainties for all included components were tested with one-way deterministic sensitivity analysis. Monte Carlo Probabilistic Sensitivity Analysis (PSA) was set to 10000 iterations with model probabilities sampled from the entirety of the data distribution of each variable. Results Base-case analysis at 12months follow-up showed that Laparoscopic Fundoplication had the highest probability of treatment success followed by TIF, Stretta and PPI respectively. Conclusion Endo-luminal interventions, although not shown to be superior to surgery, may have an emerging role in the management of GORD, but data on long-term follow-up and cost-effectiveness is lacking.

SP6.1.2 Endoscopic versus Laparoscopic Surgical Management of Achalasia: A Decision Analysis

Abstract Aims To compare achalasia treatment outcomes at one and two years post intervention. Methods A decision-tree model was populated with data from 36 randomised controlled trials to compare: pneumatic dilation, botulinum toxin injection, Heller myotomy (+/- Dor or Toupet), Dor and peroral endoscopic myotomy (POEM). Freeman-Tukey arcsine square root transformation under random effects model, to account for heterogeneity, was used to calculate weighted pooled model transition probabilities. Utility was 1, 0.5 and 0 for treatment success without significant complication, success with significant complications and treatment failure respectively. Deterministic sensitivity analysis and Monte Carlo Probabilistic Sensitivity Analysis (PSA) set to 10000 iterations tested model uncertainty. Results Laparoscopic Heller myotomy had marginally superior utility over POEM but only if the risk of significant complications remained less than 7.2% and 7.9% at one and two years respectively. Conclusion Superior treatment selection depends on individual risk of complications. Future research should therefore focus on personalised risk stratification and cost-effectiveness implications.

The Effects of Partially Slatted Floor Designs on Some Early Behavioral Traits in Broiler Chicks

This study was carried out to determine the effects of different levels of slatted floor applications on some early behavioral characteristics of broiler chickens. In this study, male-female mixed 600 fast-growing broiler chicks (Ross308) were used. The experiment consisted of five treatment groups with 120 chicks each (7 chicks/m2): fully littered, fully slatted, ½ littered+½ slatted, 1/3 littered+2/3 slatted, 2/3 littered+1/3 slatted. In the study, the feeding, drinking, resting, aggregation, other behaviors, and slatted floor preferences of the chicks were evaluated three times a day (at 9.00, 13.00, and 17.00 h) at 2, 5, 9 and 11 days of age. Each behavioral trait was expressed as a percentage of the total number of chicks showing the relevant behavior at the pen level. Different floor designs significantly affected the chicks' feeding, resting, aggregation behavior, and preference for being on the slatted floor (P &lt; 0.05). Feeding behavior was higher in chicks reared on the fully slatted floor than in the others (P &lt; 0.001). The percentage of chicks showing resting behavior was highest in the 2/3 littered+1/3 slatted floor application (P = 0.001). The 64.42% of the chicks reared in 2/3 slatted, 47.53% of those reared in ½ slatted, and 36.38% of those raised in 1/3 slatted preferred the use of the slatted floor. The percentage of chicks showing feeding behavior was highest at 5 (16.12%) and 2 d-old (15.73%) (P = 0.001). Resting behavior was highest at 2 (78.72%), 5 (76.89%), and 9 (72.82%) days of age (P &lt; 0.001). In conclusion, this study revealed that different floor designs affect some behavioral characteristics in the early chick period. Since it is known that early rearing conditions affect later performance in broilers, slatted floor systems with higher feeding behavior can be an effective tool for better performance in broiler production.

Whole-Genome Sequencing Reveals Age-Specific Changes in the Human Blood Microbiota.

Based on several reports that indicate the presence of blood microbiota in patients with diseases, we became interested in identifying the presence of bacteria in the blood of healthy individuals. Using 37 samples from 5 families, we extracted sequences that were not mapped to the human reference genome and mapped them to the bacterial reference genome for characterization. Proteobacteria account for more than 95% of the blood microbiota. The results of clustering by means of principal component analysis showed similar patterns for each age group. We observed that the class Gammaproteobacteria was significantly higher in the elderly group (over 60 years old), whereas the arcsine square root-transformed relative abundance of the classes Alphaproteobacteria, Deltaproteobacteria, and Clostridia was significantly lower (p < 0.05). In addition, the diversity among the groups showed a significant difference (p < 0.05) in the elderly group. This result provides meaningful evidence of a consistent phenomenon that chronic diseases associated with aging are accompanied by metabolic endotoxemia and chronic inflammation.

Differential mortality with COVID-19 and invasive mechanical ventilation between high-income and low-and middle-income countries: a systematic review, meta-analysis, and meta-regression.

The COVID-19 pandemic has markedly affected the health care of patients in low- and middle-income countries (LMICs), but no systematic study to corroborate this effect has been undertaken. In addition, the survival outcomes of patients with COVID-19 who received invasive mechanical ventilation (IMV) have not been well established. We pooled evidence from all available studies and did a systematic review and meta-analysis to assess and compare mortality outcomes between LMICs and high-income countries (HICs). We searched MEDLINE and the University of Michigan Library according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from December 1, 2019, to July 15, 2021, for case-control studies, cohort studies, and brief reports that discussed mortality ratios and survival outcomes among patients with SARS-CoV-2 who received IMV. We excluded studies and case reports without comparison groups, narrative reviews, and preprints. A random-effects estimate of the arcsine square root transformation (PAS) of each outcome was generated with the DerSimonian-Laird method. Seven eligible studies, consisting of 243,835 patients with COVID-19, were included. We identified a significantly higher mortality rate (i.e., a larger PAS) among the patients receiving IMV in LMICs (PAS, 0.754; 95% CI, 0.569-0.900; P<.001) compared to patients in HICs (PAS, 0.588; 95% CI, 0.263-0.876; P<.001). Considerable heterogeneity was present within the individual subgroups possibly because of the extent of the included studies, which had data from specific countries and states but not from individual hospitals or health care centers. Moreover, the sample population in each study was diverse. Meta-regression showed that a higher mortality rate among patients with COVID-19 who received IMV in both HICs (P<.001) and LMICs (P=.04) was associated with chronic pulmonary disease. Our study suggests that chronic pulmonary diseases and poor demographics lead to a worse prognosis among patients with COVID-19 who received IMV. Moreover, the survival outcome is worse in LMICs, where health care systems are usually understaffed and poorly financed.

INCIDENCE AND SEVERITY OF SISAL BOLE ROT DISEASE IN SMALL SCALE AND ESTATE FARMERS FIELDS IN MUHEZA DISTRICT

Sisal yields the world’s natural strong fiber used to produce several industrial products and boosts economy of many countries. However, sisal production is under threat due to bole rot disease responsible for great loss in production areas. The aim of the study was to determine the incidence (DI) and severity (DS) of bole rot disease in farmer’s sisal fields of Muheza district. The assessment was done during dry and wet seasons in three wards, one estate and three small scale farmers per ward obtained through systematic random sampling. Monthly weather data (temperature, relative humidity, rainfall) were from Tanzania Meteorological Agency. Data were transformed using arcsine square root and analysis of variance (ANOVA), means comparison for disease parameters were performed using GenStat® version 16 Software. Means were compared by Duncan Multiple Range Test at 5% probability. ANOVA was used to check the effect of altitude and season on disease parameters. Regression (R2) between climatic factors and disease parameters was established and Student’s t-test was used to compare mean for (DI), (DS), and disease intensity index (DII) for both seasons. The results revealed that, bole rot disease was present in all surveyed wards with different intensity. DI, DS and DII were significantly different (P &lt; 0.05) amongst the surveyed wards in both seasons. For both seasons, Kigombe ward recorded the highest DI, DS and DII while Tanganyika ward recorded the least. Plans are needed to improve farmers’ access to improved disease-free planting materials and on the use of integrated disease management practices.

Natural Resistance of Native and Commercial Maize to Fall Armyworm, Spodoptera frugiperda, and Corn Earworm, Helicoverpa zea1, and Their Relationship with Ear Rot

Maize (Zea mays L.) is the most representative crop of Mexico, mainly because of its social, cultural, and economic importance. The objective of this research was to identify genotypes with natural resistance to damage by fall armyworm, Spodoptera frugiperda (J.E. Smith), and corn earworm, Helicoverpa zea (Boddie), and their relationship with ear rot caused by Fusarium spp. Link (Nectriaceae). Samples were collected from September to November 2019 from hybrids and native maize in nine plots in Puebla and Morelos states. Ear rot pathogens and Lepidoptera found in plots were morphologically identified; ear rot incidence, severity, and damage caused by the pests were evaluated. Data of ear rot, leaf damage, and ear damage were adjusted by arcsine square root and analysis of variance (ANOVA), and means were compared by a Tukey multiple range test (p = 0.05). Fusarium spp. was found with 15.04 to 32.01% severity; damage by fall armyworm and corn earworm ranged from 23.63 to 46.96%, with galleries as long as 4.77 cm. The amount of ear rot was proportional to damage by Lepidoptera, demonstrating relationship between injury by these insects and ear rot severity caused by Fusarium spp. in hybrids and native cultivars in different areas, cultural practices, and production systems. Genotypes more resistant to damage by pests were Black Native from San Miguel, Teotlalco, Puebla; Pioneer 30F35 from Contla, Puebla; Pioneer P4028W from Tetelilla, Morelos; and Pioneer P4028W from Tepalcingo, Morelos.

BJS.03Markov Decision Analysis of Treatment Pathways for Resectable Malignancy of the Oesophagus or Gastrooesophageal Junction

Abstract Aims To perform decision-analysis of treatment options for resectable malignancy of the oesophagus or gastroesophageal junction including: surgery alone, neoadjuvant chemoradiotherapy, neoadjuvant chemotherapy and surgery followed by adjuvant therapy based on current highest-level evidence. Methods A Markov decision analysis model in an advanced decision-tree format was constructedand populated with data from existing randomised controlled trials. Markov model transition probabilities were based on weighted pooled estimates of proportions from included studies, calculated using Freeman-Tukey arcsine square root transformation under random effects model to account for heterogeneity.Each Markov cycle equated with one month and Markov states within the model included: alive without disease, alive with disease and dead. Extensive deterministic and Monte Carlo probabilistic sensitivity analysis was performed to test all parameters contained within the model. Results 23 randomised controlled trials were included. Intention-to-treat analysis of the treatment pathways showed that neoadjuvant chemoradiotherapy was the superior pathway with an overall survival time of 50.52 months (42.26 QALMs). Monte Carlo sensitivity analysis run over 10000 iterations showed that neoadjuvant chemoradiotherapy was selected as the superior treatment pathway at a frequency of 93.21% followed by surgery followed by adjuvant therapy with a frequency of 6.79%. Subgroup analysis of only squamous cell carcinomas demonstrated that neoadjuvant chemoradiotherapy was the superior pathway with an overall survival time of 62.67 months (55.22 QALMs). Conclusions Based on current best available evidence this decision analysis supports neoadjuvant chemoradiotherapy as the treatment strategy of choice for resectable malignancy of the oesophagus or gastroesophageal junction.

A note on confidence intervals for the restricted mean survival time based on transformations in small sample size.

Restricted mean survival time (RMST) is one measure now used to summarize time-to-event type data, but it has been pointed out that the distribution of differences in RMST deviates markedly from a normal distribution for controlled clinical trials with small sample sizes. Therefore, we conducted a numerical simulation of the RMST in which the one-sample survival time follows a Weibull distribution, comparing eight different confidence intervals combining two types of variance with four types of variable transformations, including no transformation. The evaluation items were the coverage probability and the above and below error probabilities for the true value. The variance types were based on Greenwood's formula and its Kaplan-Meier correction. The arcsine square root transformation, logit transformation, and complementary log-log transformation were used as the variable transformations. When the sample size was small and the event rate was low, the confidence interval of the untransformed RMST tended to have a small coverage probability and to be overestimated. Variance by Kaplan-Meier correction improved the coverage. The problems of coverage and overestimation were also improved by variable transformations, and in particular, applying the logit transformation and the complementary log-log transformation both resulted in substantial improvements. Our study suggested that it is preferable to construct the confidence intervals of RMST using the logit transformation for variances based on Greenwood's formula in small sample size trials. The SAS code to replicate the analyses is available at https://github.com/HiroyaHashimoto/SAS-Programs.

문치가자미, Pleuronectes yokohamae와 도다리, Pleuronichthys cornutus의 계측형질 비교

A closely associated set of characteristics was analyzed to discriminate between the morphologically similar marbled sole, Pleuronectes yokohamae and fine-spotted flounder, Pleuronichthys cornutus. With the arc sin square root transformation, 19 measurements relative to the standard length and another 18 measurements relative to the head length of each species of Pleuronectidae were compared statistically. One classical and 2 truss dimensions of each 19 morphometric trait for the marbled sole showed higher values than those of fine-spotted flounder respectively (p < 0.05). Two classical and 5 truss dimensions of each 19 morphometric trait for the fine-spotted flounder showed higher values than those of marbled sole respectively (p < 0.05). In the head part dimension of the two species, the pectoral fin length and the pelvic fin length of marbled sole were longer than those of fine-spotted flounder, while the eye diameter and the distance between the pectoral fins of fine-spotted flounder were longer than those of marbled sole. According to the above results of this study, we can reach a conclusion that the two species of Pleuronectidae can be adequately distinguished with the external shape of their body. We hope that these results of this study could serve as a taxonomical parameter in identifying Pleuronectidae family.

Clinical characteristics of retinal arterial macroaneurysms and prognosis of different interventions.

To estimate the clinical characteristics of retinal arterial macroaneurysms (RAM) and evaluate the prognosis of different interventions. This study is a meta-analysis. The databases PubMed, EMBASE, and Ovid from inception to January 2021 were searched to identify the relevant studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval were calculated by means of Freeman-Tukey variant of arcsine square transformation. Sixty-nine studies involving 1332 patients were finally included. The pooling results indicated that 91% (95% CI [88 ~ 94%]) of the RAM patients were over sixty, 73% (95% CI [68 ~ 77%]) were female, and 73% (95% CI [66 ~ 79%]) have hypertension. By observation, the RAM closure rate was 64% (95% CI [39 ~ 86%]), the visual acuity (VA) improved in 55% (95% CI [40 ~ 71%]) of the patients, and the VA of 64% (95% CI [54 ~ 74%]) hemorrhagic versus 27% (95% CI [15 ~ 41%]) exudative patients improved significantly. By laser, the closure rate was 96% (95% CI [87 ~ 100%]), the VA improved in 73% (95% CI [65 ~ 80%]) of the patients, and the VA of 66% (95% CI [47 ~ 84%]) hemorrhagic versus 35% (95% CI [23 ~ 47%]) exudative patients improved significantly. By anti-VEGF, the closure rate was 98% (95% CI [93 ~ 100%]), the VA improved in 90% (95% CI [74 ~ 100%]) of the patients, and the VA of 58% (95% CI [18 ~ 94%]) hemorrhagic versus 67% (95% CI [31 ~ 96%]) exudative patients improved significantly. RAM are most commonly seen in the elderly with a marked female predominance and a strong association with hypertension. Patients receiving laser or anti-VEGF treatments get higher closure rate and better visual prognosis than those with observation alone. Hemorrhagic RAM have a better visual prognosis by observation or laser treatment, while exudative RAM have a better visual prognosis by anti-VEGF treatment.

The efficacy and safety of ocriplasmin for patients with vitreous macular traction.

To estimate the efficacy and safety of ocriplasmin for patients with vitreous macular traction (VMT). The PubMed, EMBASE and Ovid were searched up to May 2020 to identify related studies. Statistical analysis was conducted by R software version 3.6.3. Results in proportion with 95% confidence interval (CI) were calculated by means of Freeman-Tukey variant of arcsine square transformation. The pooling results indicated the overall complete release rate was 50% (95% CI [45%-54%]). For VMT patients younger than 65 years old, with smaller adhesion size of VMT (<1500 μm), phakic eyes, with macular hole (MH) and subretinal fluid (SRF), while without epiretinal membrane (ERM), ocriplasmin could achieve much higher complete release rates than those under opposite conditions. The general nonsurgical closure rate of MH was 34% (95% CI [30%-37%]), and it was positively correlated with the MH size. The visual improvement rate was 45% (95% CI [32%-59%]), and it was higher for patients with VMT resolution (59%, 95% CI [41%-75%]). The secondary pars plana vitrectomy (PPV) rate for patients without MH closure or VMT resolution was about 31% (95% CI [23%-39%]). The incidence of MH progression was 10% (95% CI [4%-18%]), and other severe adverse events such as endophthalmitis, retinal detachment and retinal tear were relatively rare. Ocriplasmin is an effective, reliable and relatively safe intervention for the treatment of VMT. The most suitable candidates were patients younger than 65 years old, with smaller adhesion size (<1500 μm), phakic eyes, with MH and SRF, while without ERM.

Urban sprawl into Natura 2000 network over Europe.

Urban growth is a major threat to biodiversity conservation at the global scale. Its impacts are expected to be especially detrimental when it sprawls into the landscape and reaches sites of high conservation value due to the species and ecosystems they host, such as protected areas. I analyzed the degree of urbanization (i.e., urban cover and growth rate) from 2006 to 2015 in protected sites in the Natura 2000 network, which, according to the Habitats and Birds Directives, harbor species and habitats of high conservation concern in Europe. I used data on the degree of land imperviousness from COPERNICUS to calculate and compare urban covers and growth rates inside and outside Natura 2000. I also analyzed the relationships of urban cover and growth rates with a set of characteristics of Natura sites. Urban cover inside Natura 2000 was 10 times lower than outside (0.4% vs. 4%) throughout the European Union. However, the rates of urban growth were slightly higher inside than outside Natura 2000 (4.8% vs. 3.9%), which indicates an incipient urban sprawl inside the network. In general, Natura sites affected most by urbanization were those surrounded by densely populated areas (i.e., urban clusters) that had a low number of species or habitats of conservation concern, albeit some member states had high urban cover or growth rate or both in protected sites with a large number of species or habitats of high conservation value. Small Natura sites had more urban cover than large sites, but urban growth rates were highest in large Natura sites. Natura 2000 is protected against urbanization to some extent, but there is room for improvement. Member states must enact stricter legal protection and control law enforcement to halt urban sprawl into protected areas under the greatest pressure from urban sprawl (i.e., close to urban clusters). Such actions are particularly needed in Natura sites with high urban cover and growth rates and areas where urbanization is affecting small Natura sites of high conservation value, which are especially vulnerable and concentrated in the Mediterranean region.

The polyp regression rate and treatment prognosis of different interventions for polypoidal choroidal vasculopathy: a systematic review and meta-analysis.

To estimate the polyp regression rate and treatment prognosis of different interventions for polypoidal choroidal vasculopathy (PCV) and clarify its baseline characteristics. The PubMed, EMBASE, and Ovid were searched up to January 2020 to identify related studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval (CI) were calculated by means of the Freeman-Tukey variant of arcsine square transformation. Chi-squared test and I2 statistics were used to evaluate the statistical heterogeneity. Sensitivity analysis and subgroup analyses were performed to identify the source of heterogeneity. This meta-analysis included 104 studies with 5816 patients. The pooling results indicated the general rate of complete polyp regression at post-treatment 12months was 64% (95% CI [57~71%]), 89% (95% CI [81~95%]) for photodynamic therapy (PDT) monotherapy, 78% (95% CI [68~86%]) for PDT plus anti-vascular endothelial growth factor (anti-VEGF), and 42% (95% CI [35~49%]) for anti-VEGF monotherapy; PDT plus anti-VEGF showed the best efficacy in visual improvement and achieved the highest rate of dry macula (91%, 95% CI [78~99%]), while anti-VEGF monotherapy achieved the lowest polyp recurrence rate (14%, 95% CI [8~20%]); PDT monotherapy showed the best efficacy in pigment epithelial detachment regression (66%, 95% CI [58~83%]). Additionally, the baseline characteristics of PCV were also well described. PDT plus anti-VEGF is still valuable for the management of PCV; it could achieve not only satisfactory anatomical outcomes like dry macula rate and polyp regression rate but also ideal visual prognosis like BCVA improvement.

Impacts of snow on seed germination are independent of seed traits and plant ecological characteristics in a temperate desert of Central Asia

Seed germination profoundly impacts plant community composition within the plant life cycle. Snow is an important source of water for seed germination in the temperate deserts of Central Asia. Understanding how seed germination responds to variations in snow cover in relation to seed traits and plant ecological characteristics can help predict plant community sustainability and stability in Central Asia under a scenario climate change. This study investigated the seed germination of 35 plant species common to the Gurbantunggut Desert in Central Asia under the three snow treatments: (1) snow addition; (2) ambient snow; and (3) snow removal. Two-way analysis of variance (ANOVA) tests were performed to assess interactions among the impacts of snow treatments, seed traits and plant ecological characteristics on seed germination. Phylogenetic generalized least-squares (PGLS) model was used to test the relationships between seed traits and seed germination. The results demonstrated that snow variations had no significant impacts on seed germination overall. Seed germination under the snow addition treatment was similar with that under the ambient snow treatment, irrespective of seed traits and plant ecological characteristics. Snow removal only had negative impacts on seed germination for certain groups of seed traits and plant ecological characteristics. Seed mass positively affected seed germination, showing a linear increase of arcsin square root-transformed seed germination with log-transformed seed mass. Seed shape also profoundly impacted seed germination, with a higher germination percentage for elongated and flat seeds. Seed germination differed under different plant life forms, with semi-shrub species showing a significantly higher germination percentage. Most importantly, although snow treatments, seed traits and plant ecological characteristics had no interactive effects on seed germination overall, some negative impacts from the snow removal treatment were detected when seeds were categorized on the basis of seed mass and shape. This result suggests that variations of snow cover may change plant community composition in this temperate desert due to their impacts on seed germination.