Combined Risk Estimates Research Articles

Single- and two-pollutant Concentration-Response Functions for PM2.5 and NO2 for Quantifying Mortality Burden in Health Impact Assessments

ObjectiveHealth Impact Assessments (HIAs) for air pollutant mixtures are challenging because risk estimates are primarily derived from single-pollutant models. Combining risk estimates from multiple pollutants requires new approaches, as a simple addition of single pollutant risk estimates from correlated air pollutants may result in double counting. We investigated approaches applying concentration-response functions (CRFs) from single- and two-pollutant models in HIAs, focusing on long-term exposure to particulate matter with a diameter less than 2.5 micrometers (PM2.5) and nitrogen dioxide (NO2) and their associations with all-cause mortality. MethodsA systematic literature search of MEDLINE and EMBASE identified cohort studies employing single- and two-pollutant models of long-term exposure to PM2.5 and NO2 with all-cause mortality. Pooled CRFs were calculated through random-effects meta-analyses of risk estimates from single- and two-pollutant models. Coefficient differences were calculated by comparing single- and two-pollutant model estimates. Four approaches to estimating population-attributable fractions (PAFs) were compared: PM2.5 or NO2 single-pollutant models to represent the mixture, the sum of single-pollutant models, the sum of two-pollutant models and the sum of single-pollutant models from a larger body of evidence adjusted by coefficient difference. ResultsSeventeen papers reported both single and two-pollutant estimates. Pooled hazard ratios (HRs) for mortality from single- and two-pollutant models were 1.053 (95% confidence interval: 1.034-1.071) and 1.035 (1.014-1.057), respectively, for a 5 μg/m3 increase in PM2.5. HRs for a 10 μg/m3 increase in NO2 were 1.032 (1.014-1.049) and 1.024 (1.000-1.049) for single- and two-pollutant models, respectively. The average coefficient difference between single- and two-pollutant models was 0.017 for PM2.5 and 0.007 for NO2. Combined PAFs for the PM2.5-NO2 mixture using joint HRs from single- and two-pollutant model CRFs were 0.09 and 0.06, respectively. ConclusionUtilizing CRFs from two-pollutant models or applying the coefficient difference to a more extensive evidence base seems to mitigate the potential overestimation of mixture health impacts from adding single-pollutant CRFs.

Establishment and validation of a risk prediction model for sarcopenia in gastrointestinal cancer patients: A systematic review and meta-analysis-based approach

The study aimed to develop a model to predict the risk of sarcopenia in gastrointestinal cancer patients. The goal was to identify these patients early and classify them into different risk categories based on their likelihood of developing sarcopenia. This study evaluated risk factors for sarcopenia in patients with gastrointestinal cancers through a systematic review and meta-analysis. The natural logarithm of the combined risk estimate for each factor was used as a coefficient to assign scores within the model for risk prediction. Data from 270 patients with gastrointestinal cancers, collected between October 2023 and April 2024, was used to assess the predictive performance of the scoring model. The analysis included 17 studies that included 9405 patients with gastrointestinal cancers, out of which 4361 had sarcopenia. The model identified several significant predictors of sarcopenia, including age (OR=2.45), sex (OR=1.15), combined diabetes (OR=2.02), neutrophil-to-lymphocyte ratio (NLR) category (OR=1.61), TNM stage (OR=1.61), and weight change (OR=1.60). Model validation was performed using an external cohort through logistic regression, resulting in an area under the curve (AUC) of 0.773. This model attained a sensitivity of 0.714 and a specificity of 0.688 and ultimately selected 16.5 as the ideal critical risk score. Furthermore, an AUC of 0.770 was obtained from Bayesian model validation; the optimal critical risk score was determined to be 19.0, which corresponds to a sensitivity of 0.658 and a specificity of 0.847. The model of risk prediction developed through systematic review and meta-analysis demonstrates substantial for sarcopenia in patients with gastrointestinal cancers. Its clinical usability facilitates the screening of patients at high risk for sarcopenia.

Short-term exposure to sulfur dioxide and the occurrence of chronic obstructive pulmonary disease: An updated systematic review and meta-analysis based on risk of bias and certainty of evidence

Several studies have documented a relationship between short-term exposure to atmospheric sulfur dioxide (SO2) and chronic obstructive pulmonary disease (COPD). However, findings vary across different regions. This meta-analysis employed a random-effects model to calculate the combined risk estimate for each 10-μg/m3 increase in ambient SO2 concentration. Subgroup analysis aimed to identify sources of heterogeneity. To assess potential bias, studies were evaluated using a domain-based assessment tool developed by the World Health Organization. Sensitivity analyses, based on bias risk, explored how model assumptions influenced associations. An evidence certainty framework was used to evaluate overall evidence quality. The study protocol was registered with PROSPERO (CRD42023446823). We thoroughly reviewed 191 full-text articles, ultimately including 15 in the meta-analysis. The pooled relative risk for COPD was 1.26 (95 % CI 0.94–1.70) per 10-μg/m3 increase in ambient SO2. Eleven studies were deemed high risk due to inadequate handling of missing data. Overall evidence certainty was rated as medium. Given SO2's significant public health implications, continuous monitoring is crucial. Future research should include countries in Africa and Oceania to enhance global understanding of atmospheric SO2-related health issues.

Combined risk estimates of diabetes and coronary angiography-derived index of microcirculatory resistance in patients with non-ST elevation myocardial infarction

BackgroundDiabetes mellitus (DM) and coronary microvascular dysfunction (CMD) increase the risk of adverse cardiac events in patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study aimed to evaluate the combined risk estimates of DM and CMD, assessed by the angiography-derived index of microcirculatory resistance (angio-IMR), in patients with NSTEMI.MethodsA total of 2212 patients with NSTEMI who underwent successful percutaneous coronary intervention (PCI) were retrospectively enrolled from three centers. The primary outcome was a composite of cardiac death or readmission for heart failure at a 2-year follow-up.ResultsPost-PCI angio-IMR did not significantly differ between the DM group and the non-DM group (20.13 [17.91–22.70] vs. 20.19 [18.14–22.77], P = 0.530). DM patients exhibited a notably higher risk of cardiac death or readmission for heart failure at 2 years compared to non-DM patients (9.5% vs. 5.4%, P < 0.001). NSTEMI patients with both DM and CMD experienced the highest cumulative incidence of cardiac death or readmission for heart failure at 2 years (24.0%, P < 0.001). The combination of DM and CMD in NSTEMI patients were identified as the most powerful independent predictor for cardiac death or readmission for heart failure at 2 years (adjusted HR: 7.894, [95% CI, 4.251–14.659], p < 0.001).ConclusionsIn patients with NSTEMI, the combination of DM and CMD is an independent predictor of cardiac death or readmission for heart failure. Angio-IMR could be used as an additional evaluation tool for the management of NSTEMI patients with DM.Trial registrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT05696379.Graphical

Fall-risk assessment in elderly pilgrims attending large religious congregation: A cross-sectional cohort study

BackgroundFalls are an important geriatric syndrome with tremendous economic burden. The aim of this study was to find the prevalence of fall risk as assessed by digital sensor–based quantitative timed up and go (QTUG) device in elderly pilgrims attending Mahakumbh festival 2019. MethodsAn observational cross-sectional study done in elderly pilgrims attending the Kumbh Festival 2019. Combined fall risk and frailty assessment was estimated objectively using a digital sensor–based QTUG device. Details of age, body mass index (BMI), co-morbidities, and history of falls were also recorded. The association of fall and frailty assessment with gender, age, BMI, co-morbidities, and timed up and go (TUG) time was noted. ResultsIn total, 370 elderly (aged >60 years) individuals were assessed. The mean age was 65.51 ± 5.22 years. The mean BMI was 25.17 ± 4.56 kg/m2. Previous falls history was seen in 40.12%. The mean combined fall risk and combined frailty risk was 51.79 ± 18.11% and 50.12 ± 18.55%, respectively. The mean TUG time was 16.16 ± 7.46 seconds. Age, female gender, and TUG time had significantly increased combined fall-risk percentage and combined frailty estimate (p: <0.0006, <0.0001, and <0.0001, respectively) and combined frailty percentage (p < 0.0001). BMI and age also had a significant correlation with combined frailty risk (p = 0.0018). ConclusionMore than 50% of elderly Indians at Kumbh 2019 had a high combined fall risk and frailty estimate. The mean TUG time of elderly in our study was 16.16 seconds. There was a strong association between increased fall risk and female gender, age, and TUG time.

Association Between the Frequency of Tooth Brushing and the Risk of Cardiovascular Disease: A Systematic Review and Meta-analysis.

Several epidemiological studies suggested that frequency of tooth brushing may be associated with cardiovascular disease (CVD) risk, but the results remain inconclusive. Therefore, the aim of this study was to synthesize frequency of tooth brushing and CVD risk using meta-analysis. Science Direct, PubMed, CINAHL, and OVID were searched through October 15, 2022. The random-effects model was used to quantitatively assess the combined risk estimation. In addition, we performed the sensitivity analysis to evaluate the robustness of the study results by excluding the included studies one by one. A total of 9 cohort studies containing 10 reports with 803,019 individuals were included in the meta-analysis. Pooled results showed that compared with the lowest brushing frequency, the highest brushing frequency (relative risk = 0.85, 95% confidence interval: 0.80-0.90) significantly reduced the risk of cardiovascular disease. There was moderate heterogeneity among included studies (P = .002, I2 = 65.4%). The exclusion of any one study did not materially change the combined risk estimates. Our meta-analysis supported the hypothesis that higher frequency of tooth brushing can reduce the risk of CVD, which may have important implications for conducting research on the prevention strategies of CVD.

The risk of attention-deficit hyperactivity disorder among children with congenital heart disease: A systematic review and meta-analysis.

Although current treatments are effective in dealing with congenital heart disease (CHD), non-cardiac comorbidities such as attention-deficit hyperactivity disorder (ADHD) have received widespread attention. The purpose of this systematic review and meta-analysis is to assess the risk of ADHD associated with CHD. The literature search was carried out systematically through eight different databases by the end of September 2022. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. The heterogeneity of the studies was assessed by the Cochran Q test and the I2 statistic. Subgroup and sensitivity analyses were used to explore the potential sources of heterogeneity. Eleven studies were included in this study, which involved a total of 296 741 participants. Our study showed that the children with CHD were at a significantly increased risk of ADHD compared with the reference group (OR = 2.98, 95% CI: 2.18-4.08). The results were moderately heterogeneous. These factors including study design, geographic region and study quality were identified as the first three of the most relevant heterogeneity moderators by subgroup analyses. Sensitivity analysis yielded consistent results. There was no evidence of publication bias. The present study suggests that CHD children have a significantly higher risk of ADHD when compared with those without CHD. Early identification and intervention of ADHD is important to reduce its symptoms and adverse effects; therefore, clinicians should increase screening for ADHD in children with CHD and intervene promptly to reduce its effects whenever possible.

Viral hepatitis increases the risk of cholangiocarcinoma: a systematic review and meta-analysis.

Whether viral hepatitis increases the risk of cholangiocarcinoma (CCA) has been controversial. The reasons for the differences between previous research results may be related to the differences in sample size, region, living environment and course of disease. A meta-analysis is needed to clarify the correlation between them and select the key population for early screening of CCA. Meta-analysis was used to explore the relationship between viral hepatitis and the risk of CCA, so as to provide evidence for the prevention and treatment of CCA. We systematically searched EmBase, SinoMed, PubMed, Web of Science China National Knowledge Infrastructure, and Wanfang databases. The quality of the included literature was evaluated using the Newcastle Ottawa Scale. Before merging the effect quantities, the data was first subjected to heterogeneity testing. Heterogeneity testing was evaluated using I2 (the proportion of heterogeneity variation to overall variation). Subgroup analysis was used to identify sources of heterogeneity in this study. The effect odds ratio (OR) of various studies was extracted or calculated for consolidation. Beta's rank correlation, Egger's Law of Return and funnel plot were used to test publication bias. Conduct subgroup analysis based on the regions included in the literature. A total of 2,113 articles were retrieved, and a total of 38 articles were included in the meta-analysis. There are 29 case-control studies and 9 Cohort study, including 333,836 cases and 4,042,509 controls. The combined risk estimate of all studies showed a statistically significant increased risk of CCA, extrahepatitis and intrahepatitis incidence with hepatitis B virus (HBV) infection (OR =1.75, OR =1.49, and OR =2.46, respectively). The combined risk estimate of all studies showed a statistically significant increased risk of CCA, extrahepatitis and intrahepatitis incidence with hepatitis C virus (HCV) infection (OR =1.45, OR =2.00, and OR =2.81, respectively). The research points of HCV and CCA were asymmetric, indicating that there may be publication bias in the study of HCV and CCA. HBV and HCV infection could increase the risk of CCA. Therefore, in clinical practice, attention should be paid to CCA screening and early prevention of HBV and HCV infected patients.

Overweight and Obesity in Adult Birth by Cesarean Section: A Systematic Review With Meta-analysis.

Overweight/obesity is one of the most important health problems. Birth by cesarean section has been shown to influence long-term health outcomes including obesity. The aim of this systematic review-meta-analysis is to update acknowledgment of the increased risk of cesarean section on offspring's overweight/obesity. This study follows the PRISMA guidelines. A systematic literature search was conducted on Scopus, PubMed, and Web of Science; we have selected all the articles published until January 2, 2022. For inclusion, studies must have reported either (i) both birth by cesarean section and adult (≥18 years) offspring's body mass index; (ii) cohort or case-control study design; and (iii) a risk estimate. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by the Egger test and the Begg test. Meta-analysis was performed through a random-effects model. Twelve studies with a combined population of 180 065 subjects were included in the meta-analysis. The overall analysis (N = 19) yielded a combined risk estimate for overweight/obesity of 1.19 (95% CI, 1.08-1.30) and the test of heterogeneity resulted into Q = 57.44 ( I2 = 68.67%, P ≤ .001). The risk of offspring obesity is 1.23 (95% CI, 1.09-1.39) and the test of heterogeneity resulted into Q = 39.55 ( I2 = 69.66%, P ≤ .001). Children born by cesarean section have an increased risk of obesity in adulthood.

Low-level occupational exposure to BTEX and dyschromatopsia: a systematic review and meta-analysis

Objectives. The present study aimed to assess whether occupational exposure to low concentrations of benzene, toluene, ethylbenzene and xylene (BTEX) is associated with color vision impairment. Methods. We queried PubMed, Scopus, Embase, Web of Science and ProQuest as the main databases, as well as gray literature such as Google Scholar. A random-effects model was used to assess relative risk. A funnel plot was created to assess publication bias. Meta-regression analysis was applied to identify variables that explain the between-study variation in the reported risk estimate. Results. An overall standardized mean difference of 0.529 (95% confidence interval [0.269, 0.788]; p < 0.0001) was obtained in the random-effects model, which corresponded to a medium-size effect. Duration and the levels of exposure to benzene, toluene and xylene were the significant predictors of the magnitude of the combined risk estimate. Chronic exposure to low levels of BTEX was associated with dyschromatopsia determined by the color confusion index. Conclusions. The impairments can occur even at exposures lower than the occupational exposure limits of BTEX. However, there are several flaws in the determination of workers’ exposure, which did not allow to establish how low a level of these chemicals can cause color vision impairment.

Association between Glucocorticoids and Mortality in Patients with Severe Pneumonia: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials.

Objective To explore the associations between glucocorticoid use and the clinical outcome of patients with severe pneumonia. Methods Medical databases including PubMed, EMBASE, and ScienceDirect were searched for relevant literature. Two independent researchers extracted the primary endpoint from the included literature. The Cochrane Q test and I2 statistics were used to evaluate the interstudy heterogeneity. The combined risk estimates were calculated by random effect model, and the source of heterogeneity was evaluated by subgroup analysis. Funnel plot and Egger's test were used to assess publication bias. P < 0.05 denoted statistical significance. Results A total of 12 literature, including 8171 patients with 1083 deaths, were included in this study for meta-analysis. The use of glucocorticoids significantly increased the mortality (RR = 1.44, 95% CI: 1.13, 1.84, P < 0.001), the risk of requiring mechanical ventilation (RR = 1.62, 95% CI: 1.30, 2.02, P < 0.001), and the incidence of nosocomial infection (RR = 1.36, 95% CI: 1.01, 1.82, P = 0.04) in patients with severe pneumonia as compared with the control group. In addition, the use of glucocorticoids did not seem to be associated with length of treatment in the intensive care unit (mean difference = 1.47, 95% CI: -1.04, 3.96, P = 0.25) and the length of hospital stay (mean difference = 0.55, 95% CI: -3.90, 4.99, P = 0.81). Conclusion The use of glucocorticoids may increase the mortality, the incidence of hospital-acquired pneumonia, and the need for mechanical ventilation in patients with severe pneumonia.

Association of hormone replacement therapy with risk of gastric cancer: a systematic review and meta-analysis

Hormone replacement therapy (HRT) is widely used to relieve menopausal symptoms; however, it remains unclear whether the use of HRT was associated with gastric cancer. We conducted a systematic review and meta-analysis to synthesize available evidence. This study followed the PRISMA guideline to report meta-analysis. PubMed, Embase, and Cochrane library were searched from conception through 23 February 2022. Eligible studies reporting risk of gastric cancer after HRT were screened and accessed by two independent reviewers. Random-effects meta-analysis was used to calculate pooled risk estimate as relative risk (RR, 95% CI). Pre-established review protocol was registered in PROSPERO (CRD42021281260). Among the 1095 articles identified, we included 11 studies with 1,919,089 women in this meta-analysis. The combined risk estimate (RR, 0.72; 95% CI 0.64–0.81; I2 = 2%) indicated that the use of HRT was associated with a 28% reduction in risk of gastric cancer compared with those who had no HRT exposure. The narrow prediction interval (0.62–0.84) for gastric cancer risk suggested a low between-study variance. In subgroup analysis defined by HRT formulation, there were reduction in risks of gastric cancer after the use of estrogen-only therapy (Pooled RR, 0.63; 95% CI 0.51–0.77, I2 = 0%) and estrogen-progestin therapy (Pooled RR, 0.70; 95% CI 0.57–0.87; I2 = 0%), as compared with non-users. In this systematic review and meta-analysis, the use of HRT was associated with a reduced gastric cancer risk regardless of HRT formulation. Further investigations are warranted to confirm underlying mechanisms.

Benzene exposure increases the risk of non-Hodgkin's lymphoma: a systematic review and meta-analysis of observational studies.

BackgroundAlthough there is sufficient evidence that benzene exposure increases the risk of leukemia, whether benzene exposure increases the risk of non-Hodgkin’s lymphoma (NHL) remains controversial. The method of meta-analysis can reduce the uncertainty in evidence-based medicine (EBM) evidence decision-making caused by the bias between studies by systematically searching, evaluating, and combining all relevant literatures.MethodsPubMed, Embase, ScienceDirect and other databases were searched according to the population exposure comparison outcome principles: whether the general population exposed to benzene has a higher risk of developing NHL than the population without benzene exposure. Two independent researchers extracted the main endpoint indicators from the included literature, including the odds ratio (OR) or relative risk (RR) of benzene exposure to the risk of NHL. Risk of bias was assessed for each study using the Newcastle-Ottawa scale (NOS). Heterogeneity between studies was evaluated using the Cochrane Q test and I2 statistics, and combined risk estimates were calculated with the random-effects and fixed-effect models. Meanwhile, source of heterogeneity was evaluated by subgroup analysis. Publication bias was evaluated by funnel plot and Egger’s test, and the stability of results was evaluated by sensitivity analysis. All results with P<0.05 were considered statistically significant.ResultsA total of 14 articles were included in this study for meta-analysis, including 9 cohort studies and 5 case-control studies with NOS scores between 5 and 9. Four of the articles were at low risk of bias, and 10 were at moderate risk of bias. Of 492,719 people with benzene exposure, there were 1,994 cases of NHL. The OR of NHL in the benzene-exposed population compared with nonexposed population was 1.23 (P=0.03), with moderate heterogeneity (I2=63.47%). People with high exposure to benzene showed a higher risk of NHL (OR =1.81) and there was a low degree of heterogeneity (I2=27.56%). The risk of benzene exposure in China (OR =2.48) was higher than that in Europe (OR =1.19), the United Kingdom (OR =1.07), and the United States (OR =1.24).ConclusionsBenzene exposure was positively correlated with the incidence of NHL.

Meta-analysis on the association between the frequency of tooth brushing and hypertension risk.

It is unclear whether the frequency of tooth brushing affects the risk of hypertension; thus, we conducted the first meta‐analysis to focus on this topic. In this meta‐analysis, we systematically searched the PubMed, Scopus, and Web of Science databases from their inception to October 2021 to identify eligible studies, while reference lists from retrieved review paper were also reviewed. We then conducted a meta‐analysis of the highest compared with the lowest tooth brushing frequency, along with a dose‐response meta‐analysis, to explore this association. Subgroup and sensitivity analyses were conducted to identify the sources of heterogeneity. Publication bias was evaluated using Begg's and Egger's tests. We found eight relevant studies, three cohort and five cross‐sectional, involving a total of 274 124 patients. Compared to the highest tooth brushing frequency, the lowest increased the risk of hypertension by 84.0% (OR 1.84; 95% CI, 1.44–2.35). Furthermore, a nonlinear dose‐response relationship was observed (P < .05). The exclusion of any studies did not significantly alter the combined risk estimate, and no publication bias was detected. In conclusions, we report that epidemiological evidence supports the hypothesis that a lower frequency of tooth brushing is significantly associated with a higher risk of hypertension. Preventive interventions, such as adopting a good oral health routine, should be encouraged to maintain good general health.

Allium Vegetables Intake and Risk of Breast Cancer: A Meta-Analysis.

Background:Intake of allium vegetables may modify the risk of breast cancer. The aim of this study was to examine the association between allium vegetables intake and breast cancer risk via a meta-analysis.Methods:PubMed, Web of Knowledge, Scopus and Chinese National Knowledge Infrastructure (CNKI) were electronically searched up to June 2021 to identify relevant studies. We used random-effect models to calculate pooled risk estimates and their 95% confidence intervals (CIs) for risk of breast cancer with allium vegetables intake.Results:A total of 17 studies were included in this meta-analysis on the association of total allium vegetables, garlic and onion intake with breast cancer risk. The combined risk estimate of breast cancer for the highest vs lowest category of total allium vegetables, garlic and onion intake was 0.70 (95% CI: 0.49–0.91, P < 0.001), 0.77 (95% CI: 0.61–0.93, P = 0.016) and 0.75 (95% CI: 0.53–0.98, P < 0.001), respectively. A significant heterogeneity was found among studies for all three pooled analyses.Conclusion:High intake of allium vegetables may be protective against the development of breast cancer. Further well-designed prospective studies are needed to confirm the results.

Hypertensive Disorders in Pregnancy Are Associated With Congenital Heart Defects in Offspring: A Systematic Review and Meta-Analysis.

BackgroundAlthough research indicates an association between hypertensive disorders of pregnancy (HDP) and congenital heart defects (CHDs) in offspring, consistency is still lacking. Therefore, we aimed to synthesize the updated published epidemiologic evidence to estimate the association of maternal HDP with the risk of total CHDs and its phenotypes in offspring.MethodsA systematic search of Web of Science Database, PubMed, and Embase were searched from inception through April 30, 2021 based on a preprepared protocol, and the reference lists were also manually searched. The combined risk estimates were calculated using either the fixed-effect models or random-effect models. Possible heterogeneity moderators were detected by subgroup, sensitivity analyses, and Galbraith plot.ResultsTwenty-four studies involving 477,839 CHDs cases among 40,394,699 participants were included in our meta-analysis. Mothers who had HDP exposure were significantly associated with an increased risk of total CHDs compared with non-exposure. When maternal HDP exposure was further subdivided into pre-eclampsia (OR = 1.79, 95% CI: 1.50–2.13), gestational hypertension (OR = 1.16, 95% CI: 1.02–1.31), and chronic hypertension (OR = 1.68, 95% CI: 1.49–1.89), a significantly increased risk of total CHDs were still presented. Furthermore, a statistically significant increased association was found between maternal HDP exposure and most CHD phenotypes. Besides, relevant heterogeneity moderators have been identified by subgroup and sensitivity analyses.ConclusionOur study suggested that maternal HDP exposure may be associated with an increase in the risk of CHDs in offspring. These findings highlight the need for greater surveillance of pregnant women with HDP exposure to allow early prevention that may be good for reducing the risk of CHDs in offspring.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [CRD42021268093].

Toxic element contents and associated multi-medium health risk assessment in an area under continuous agricultural use.

Soils and contaminated plants are in the group of significant environmental pathways of human exposure to toxic elements (TEs). This study aimed to assess the soil-to-plant transfer of TEs (Pb, As, Cd, Hg), as well as the plausible health risks via different exposure pathways in the Armavir region of Armenia. The contents of TEs were determined in soil, fruit and vegetable samples using X-ray fluorescence and atomic absorption spectroscopy, respectively, and the soil-to-plant transfer of TEs and induced chronic non-carcinogenic risks were evaluated. The detected TE contents did not exceed the available national and international regulatory levels. Moreover, the evaluated soil-to-plant transfer of these TEs was negligible. The obtained results indicated the absence of a single-element non-carcinogenic risk via one single ingestion pathway. Meanwhile, in the case of multi-food and multi-soil ingestion, the combined non-carcinogenic risk estimates for Pb and As exceeded the precautionary level of 0.1 indicating a low health risk. Similarly, the multi-element hazard index (HI) showed a low level of non-carcinogenic risk through a multi-pathway ingestion. Thus, the outcomes highlighted that there was a need for precautionary measures to prevent plausible health issues for the adult population in Armavir.

The association of PRECISE-DAPT score with ischaemic outcomes in patients taking dual antiplatelet therapy following percutaneous coronary intervention: a meta-analysis

The PRECISE-DAPT (Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) score identifies patients at high risk of bleeding complications following percutaneous coronary intervention (PCI). International guidelines recommend the PRECISE-DAPT score to identify patients at high risk for bleeding, who may benefit from shortened dual antiplatelet therapy. The association of the PRECISE-DAPT score with ischaemic outcomes remains unclear. We performed a meta-analysis investigating the association between a high PRECISE-DAPT score and ischaemic outcomes. A comprehensive literature search was conducted on articles published between 11 March 2017 and 5 June 2021. Two reviewers independently screened articles for inclusion using pre-defined criteria. The outcome measures extracted included composite ischaemic events, major bleeding events, and all-cause mortality. A random effects model was applied to obtain combined risk estimates for outcomes. From 12 included studies, there were 39459 patients with PRECISE-DAPT <25 and 14761 patients with PRECISE-DAPT ≥25. PRECISE-DAPT score ≥25 was associated with increased risk of composite ischaemic events [odds ratio (OR) 2.16; 95% confidence interval (CI) 1.77-2.65], myocardial infarction (OR 2.06; 95% CI 1.38-3.08), and ischaemic stroke (OR 2.90; 95% CI 1.76-4.78). Patients with a PRECISE-DAPT score ≥25 had increased risk of major bleeding (OR 3.62; 95% CI 2.62-4.99). Patients with a PRECISE-DAPT score ≥25 had higher risk of all-cause mortality (OR 5.83; 95% CI 5.37-6.33). Patients with a PRECISE-DAPT score ≥25 are at increased risk for ischaemic events, bleeding, and all-cause mortality. Prospective evaluation of a PRECISE-DAPT guided approach to antiplatelet therapy is required to demonstrate benefit in this high-risk population.

Diabetes mellitus as a risk factor for chemotherapy-induced peripheral neuropathy: a meta-analysis

BackgroundTo identify the association between diabetes mellitus (DM) and the risk of chemotherapy-induced peripheral neuropathy (CIPN) through a systematic review and meta-analysis.MethodsAn electronic literature search was conducted in PubMed, Embase, Web of Science, the Wanfang database, the VIP Journals database (CQVIP), the China National Knowledge Infrastructure (CNKI) database, and the China Biology Medicine database (Sinomed) between January 2010 and January 2021. Articles were included if they investigated CIPN and DM. Stata 15.1 was used to analyze the data.ResultsWe examined 8923 cancer patients from 25 studies comprising 9 cohort studies and 16 case–control studies. Meta-analysis showed that there was a statistically significant positive correlation between DM and CIPN (odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.38–1.85, P < 0.001). Egger’s test (P = 0.824) showed no evidence of publication bias. The positive associations did not significant differ by study type, study quality, evaluation instrument, and type of antineoplastic drug. Omission of any single study had little effect on the combined risk estimate. Little evidence of heterogeneity was observed.ConclusionThis meta-analysis provides evidence of a significant positive association between DM and risk of CIPN. Furthermore, a more detailed evaluation is warranted for cancer patients with diabetes when they are treated with antineoplastic drugs that have the potential to cause peripheral neuropathy.

Adverse pregnancy outcomes among mothers with hypertensive disorders in pregnancy: A meta-analysis of cohort studies.

Presently, the results of studies assessing the association of hypertensive disorders in pregnancy (HDP) with adverse pregnancy outcomes (APOs) in offspring remain inconclusive, and a complete overview is missing. We performed a meta-analysis of cohort studies to review and summarize the association between HDP and risk of APOs in offspring. PubMed, Embase, Web of Science and Chinese databases were searched through May 2019 to identify eligible studies. Outcomes of interest were APOs including perinatal death, fetal death, stillbirth, neonatal death, congenital malformations, preterm birth (PTB), very preterm birth (VPTB), intrauterine growth restriction (IUGR), small for gestational age (SGA), low birth weight (LBW), and very low birth weight (VLBW). Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators. Total 152 cohort studies involving 1,426,742 mothers with HDP and 36,374,542 mothers without HDP were included for analysis. Overall, mothers with HDP compared with those without HDP had a significantly higher risk of perinatal death (OR=2.86), fetal death (OR=2.82), stillbirth (OR=1.93), neonatal death (OR=1.55), congenital malformations (OR=2.66), IUGR (OR=5.48), SGA (OR=3.39), LBW (OR=5.02), VLBW (OR=1.74), PTB (OR=4.20) and VPTB (OR=3.26) in offspring. Relevant heterogeneity moderators were identified by subgroup analyses. The sensitivity analysis yielded consistent results. No evidence of publication bias was observed. The present study indicates that HDP significantly increases risk of APOs. Further research is needed to explore efficient management methods to minimize the risk of APOs associated with HDP.