Pooled Effect Estimates Research Articles

Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort

BackgroundWe analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS.MethodsWe analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years).ResultsFor both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8–16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18–21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9–10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5–8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7–8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9–13%, p ≤ 0.03).ConclusionExcept for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.

Does Walking Reduce Postpartum Depressive Symptoms? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Rising demands for traditional postpartum depression (PPD) treatment options (e.g., psychiatry), especially in the context of the COVID-19 pandemic, are increasingly difficult to meet. More accessible treatment options (e.g., walking) are needed. Our objective is to determine the impact of walking on PPD severity. Methods: A structured search of seven electronic databases for randomized controlled trials published between 2000 and July 29, 2021 was completed. Studies were included if walking was the sole or primary aerobic exercise modality. A random-effects meta-analysis was conducted for studies reporting PPD symptoms measured using a clinically validated tool. A simple count of positive/null effect studies was undertaken as part of a narrative summary. Results: Five studies involving 242 participants were included (mean age = ∼28.9 years; 100% with mild-to-moderate depression). Interventions were 12 (n = 4) and 24 (n = 1) weeks long. Each assessed PPD severity using the Edinburgh Postnatal Depression Scale (EPDS), and was included in the meta-analysis. The pooled effect estimate suggests that relative to controls walking yielded clinically significant decreases in mean EPDS scores from baseline to intervention end (pooled mean difference = -4.01; 95% CI: -7.18 to -0.84, I2 = 86%). The narrative summary provides preliminary evidence that walking-only, supervised, and group-based interventions, including 90-120+ minutes per week of moderate-intensity walking, may produce greater EPDS reductions. Conclusions: While limited by a relatively small number of included studies, pooled effect estimates suggest that walking may help mothers manage PPD. This is the first-time walking as treatment for PPD, an exercise modality that uniquely addresses many barriers faced by mothers, has been summarized in a systematic way. Trial registration: PROSPERO (CRD42020197521) on August 16th, 2020.

The Efficacy and Safety of Tranexamic Acid in the Management of Perioperative Bleeding After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis of Comparative Studies.

Introduction: We performed a systematic review and meta-analysis of the current literature to assess the efficacy and safety of tranexamic acid (TXA) in the management of postoperative bleeding after percutaneous nephrolithotomy (PCNL). Methods: A systematic literature review was performed in March 2021. Two reviewers independently screened, identified, and evaluated comparative studies assessing the effectiveness of TXA in preventing bleeding after PCNL when compared with placebo or no intervention. The incidence of transfusion, complete stone clearance, and complications were extracted among TXA and control groups to generate the risk ratio (RR) and corresponding 95% confidence interval (CI). Blood loss, hemoglobin (Hb) drop, length of hospital stays, and operative (OR) time were analyzed using standard mean difference (SMD) with corresponding 95% CI. Effect estimates were pooled using the inverse-variance approach with a random-effect model. Results: A total of 11 studies (8 randomized controlled trial, 1 prospective cohort, and 2 retrospective cohort studies; total 1842 patients) of low-to-moderate-quality were included in the meta-analysis. Overall pooled effect estimates demonstrated a decreased transfusion rate (RR 0.36; 95% CI 0.25 to 0.51), blood loss (SMD -0.74; 95% CI -1.14 to -0.34), and Hb drop (SMD -0.95; 95% CI -1.51 to -0.39) among patients in the TXA group when compared with those in the control. The number needed to treat was 11 to prevent one transfusion. Patients who received TXA also had improved stone clearance (RR 1.08; 95% CI 1.02 to 1.14), lower minor (RR 0.72; 95% CI 0.58 to 0.89) and major (RR 0.38; 95% CI 0.21 to 0.69) complications, shorter hospital stays (SMD -0.52; 95% CI -1.01 to -0.04) and decreased OR time (SMD -0.89; 95% CI -1.46 to -0.31). Conclusions: TXA can effectively reduce postoperative bleeding after PCNL. Future studies should identify a subset of patients who may benefit from preoperative TXA administration for PCNL.

Standard- vs. low-dose rivaroxaban in patients with atrial fibrillation: a systematic review and meta-analysis.

Low-dose rivaroxaban is often given to patients with atrial fibrillation (AF) around the world, but the rationale for its use remains unclear. We aimed to compare the efficacy and safety of standard- or low-dose rivaroxaban in patients with AF through systematic review of literature with meta-analysis. We searched PubMed, Web of Science, EMBASE, Clinical Trials.gov, the Cochrane Library, and Bayer trial website from inception of each database until June 2020. Randomized controlled trials (RCTs) and cohort studies were included in the meta-analysis. A random-effects model was employed to calculate the pooled effect estimates. Two RCTs and 17 cohort studies were included in the qualitative analysis. Indirect comparison of RCTs showed no significant difference between the two rivaroxaban dosages in risk of efficacy or safety outcomes (p > 0.05). Indirect comparison of cohort studies showed a lower risk of MACE among Caucasians in standard-dose group (HR 0.779; 95% CI 0.687-0.884; p < 0.001). Bleeding outcomes did not differ significantly between the two dosage regimens in Asian or Caucasian populations, except that the standard dose was associated with higher risk of major bleeding among elderly Caucasian patients (HR 1.329; 95% CI 1.141-1.547; p < 0.001). The quality of evidence was rated ranging from very low to low for all the efficacy and safety outcomes. In Caucasians with AF, standard-dose rivaroxaban may prevent MACE significantly better than low-dose treatment. Further studies in Asians are needed to verify the advantages of the standard dose.

Outcomes of sutureless aortic valve replacement versus conventional aortic valve replacement and transcatheter aortic valve replacement, updated systematic review, and meta-analysis.

Sutureless aortic valve replacement (SuAVR) is an alternative to surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study compares the effectiveness of SuAVR to SAVR and TAVR. We searched MEDLINE and EMBASE from inception to July 2021 for studies evaluating SuAVR, SAVR, and TAVR in adults with aortic stenosis. We performed screening, full-text assessment, data collection, and risk of bias evaluation independently and in duplicate. We evaluated risk of bias using by Cochrane and CLARITY's tools, and certainty in evidence using the GRADE framework. Data were pooled using a random-effects model. We identified one randomized and 78 observational studies (n = 60,689; SuAVR vs. SAVR = 39,171, vs. TAVR = 21,518). All studies were at high or unclear risk of bias, with very-low certainty in effect estimates. Compared to TAVR, SuAVR demonstrates no significant difference in mortality at 30-days (odds ratio [OR]: 0.52, 95% confidence interval [CI: 0.85, 1.16], I2 = 0%), but decreased odds at 2-years (OR: 0.39, 95% CI [0.17, 0.88], I2 = 0%). SuAVR also reduced odds of mild paravalvular regurgitation (OR: 0.11, 95% CI [0.06, 0.21], I2 = 50%). Compared to SAVR, SuAVR was associated with a similar mortality at 30-days (OR: 0.99, 95% CI [0.85, 1.16], I2 = 0%) and 2-years (OR:0.99, 95% CI [0.43-2.30], I2 = 7%). SuAVR significantly increased odds of permanent pacemaker implantation (OR: 2.5, 95% CI [2.25, 2.77], I2 = 0%). Pooled effect estimates were consistent with results from the randomized trial comparing SuAVR and SAVR. Based on very-low quality evidence, SuAVR is associated with similar short- and midterm outcomes compared to TAVR and SAVR. Comparative randomized data with long-term follow-up are required to clarify the role of SuAVR.

Differences in the Clinical Manifestations and Mortality of Systemic Lupus Erythematosus Onset in Children and Adults: A Systematic Review and Meta-Analysis

Introduction: The aim of this study was to assess the differences between childhood-onset and adult-onset systemic lupus erythematosus (cSLE and aSLE) for clinical manifestations and mortality using a meta-analytic approach. Methods: The PubMed, EMBASE, and the Cochrane library were searched for eligible studies published between January 1982 and March 2021. The odds ratio (OR) with 95% confidence interval was used to calculate the pooled effect estimates using the random-effects model. Results: Thirty-four studies involving 21,946 SLE patients were included. cSLE was associated with an increased risk of malar rash (OR: 1.64; p < 0.001), ulcers/mucocutaneous involvement (OR: 1.22; p = 0.039), general neurological involvement (OR: 1.52; p < 0.001), seizures (OR: 1.92; p < 0.001), general renal involvement (OR: 2.08; p < 0.001), proteinuria (OR: 1.35; p = 0.015), urinary cellular casts (OR: 1.67; p = 0.047), fever (OR: 2.31; p < 0.001), anemia (OR: 1.91; p < 0.001), thrombocytopenia (OR: 1.41; p < 0.001), leucopenia (OR: 1.57; p = 0.017), lymphadenopathy (OR: 2.40; p < 0.001), and cutaneous vasculitis (OR: 1.72; p = 0.001) as compared with aSLE. Moreover, cSLE versus aSLE was associated with a reduced risk of articular manifestations (OR: 0.63; p = 0.001), pulmonary involvement (OR: 0.54; p = 0.001), and pleuritis (OR: 0.61; p < 0.001). There were no significant differences between cSLE and aSLE for mortality risk (OR: 1.20; p = 0.203). Conclusion: We found that certain clinical manifestations of SLE are different in cSLE and aSLE. Moreover, the mortality risk of cSLE and aSLE was not significantly different.

Medical cannabis and cannabinoids for impaired sleep: a systematic review and meta-analysis of randomized clinical trials.

We conducted a systematic review to explore the effectiveness of medical cannabis for impaired sleep. We searched MEDLINE, EMBASE, CENTRAL, and PsychINFO to January 2021 for randomized trials of medical cannabis or cannabinoids for impaired sleep vs. any non-cannabis control. When possible, we pooled effect estimates for all patient-important sleep-related outcomes and used the GRADE approach to appraise the certainty of evidence. Thirty-nine trials (5100 patients) were eligible for review, of which 38 evaluated oral cannabinoids and 1 administered inhaled cannabis. The median follow-up was 35 days, and most trials (33 of 39) enrolled patients living with chronic cancer or noncancer chronic pain. Among patients with chronic pain, moderate certainty evidence found that medical cannabis probably results in a small improvement in sleep quality versus placebo (modeled risk difference [RD] for achieving the minimally important difference [MID], 8% [95% CI, 3 to 12]). Moderate to high certainty evidence shows that medical cannabis vs. placebo results in a small improvement in sleep disturbance for chronic non-cancer pain (modeled RD for achieving the MID, 19% [95% CI, 11 to 28]) and a very small improvement in sleep disturbance for chronic cancer pain (weighted mean difference of -0.19 cm [95%CI, -0.36 to -0.03 cm]; interaction p = .03). Moderate to high certainty evidence shows medical cannabis, versus placebo, results in a substantial increase in the risk of dizziness (RD 29% [95%CI, 16 to 50], for trials with ≥3 months follow-up), and a small increase in the risk of somnolence, dry mouth, fatigue, and nausea (RDs ranged from 6% to 10%). Medical cannabis and cannabinoids may improve impaired sleep among people living with chronic pain, but the magnitude of benefit is likely small.

The management of moderate acute malnutrition in children aged 6-59 months in low- and middle-income countries: a systematic review and meta-analysis.

Malnutrition is a leading cause of morbidity and mortality in children aged <5 y, especially in low- and middle-income countries (LMICs). Unlike severe acute malnutrition, moderate acute malnutrition (MAM) affects greater numbers globally, and guidelines lack a robust evidence base. This systematic review and meta-analysis assessed the evidence for lipid-based nutrient supplements (LNSs), fortified blended flours (FBFs) and nutrition counselling, in the treatment of MAM. Four databases were systematically searched for studies conducted in LMICs that compared the effectiveness of food-based products with any comparator group in promoting recovery from MAM in children aged 6-59 mo. Where appropriate, pooled estimates of effect were estimated using random-effects meta-analyses. A total of 13 trials were identified for inclusion. All used active controls. There was evidence of increased probability of recovery (gaining normal weight-for-height and/or mid-upper arm circumference) among children treated with LNSs compared with children treated with FBFs (risk ratio 1.05, 95% CI 1.01 to 1.09, p=0·009). Based on a relatively small number of studies mainly from Africa, LNSs are superior to FBFs in improving anthropometric recovery from MAM. Current evidence for the use of food supplements in MAM treatment is based on comparisons with active controls. Future studies should assess a wider range of comparator groups, such as nutrition education/counselling alone, and outcomes, including body composition, morbidity and development.

The impact of comorbid allergic airway disease on the severity and mortality of COVID-19: a systematic review and meta-analysis.

PurposeTo analyze the impact of AAD on the severity and mortality of COVID-19 patients and compare clinical outcomes between patients with and without AAD.MethodsIn the systematic review and meta-analysis, we searched PubMed, Embase, Web of Science for studies reporting allergic rhinitis, asthma prevalence in COVID-19 patients and compared clinical outcomes, and excluded duplicate publications, reviews, comments, single or few cases reports (< 100 cases). We determined the pooled effect estimates using random effect model.ResultsThirty-four studies (345,091) were finally included for the meta-analysis. On the basis of 32 studies (337,821) involving with the severity of COVID-19, we did not find significant association between AAD and the severity of COVID-19 (p = 0.35, OR 1.10, 95% CI 0.90–1.35). Subgroup analysis indicated there was no the variability in the prevalence of AAD among COVID-19 patients in different study designs, disease categories, countries, the definition of severity, and population size of AAD. Based on 21 studies (306,331) involving with the mortality of COVID-19, AAD was significantly associated with the decreased mortality of COVID-19 (p < 0.05, OR 0.83, 95% CI 0.70–0.99). The subgroup analysis showed AAD was not associated with the mortality of COVID-19 in different countries or regions. Based on the population size of AAD, we found AAD within 100 cases was not associated with the mortality of COVID-19 (p = 0.63, OR 1.15, 95% CI 0.65–2.03). Moreover, study design was possible heterogeneity source as the heterogeneity I2 was reduced to 0 in prospective studies.ConclusionThe preexisting AAD was not inclined to deteriorate the course of COVID-19. The prevalence of AAD was not associated with the severity of COVD-19 patients and inclined to be significantly associated with the decreased mortality risk of COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-021-07072-1.

Patient satisfaction with deep versus light/moderate sedation for non-surgical procedures: A systematic review and meta-analysis.

Background:Deep sedation relieves a patient's anxiety and stress during the procedure by inducing patient unconsciousness. However, it remains unclear whether deep sedation actually improves patient satisfaction with the procedure. Therefore, we performed a systematic review and meta-analysis to compare the satisfaction of patients undergoing deep sedation with that of those undergoing light/moderate sedation during non-surgical procedures.Methods:A comprehensive literature search was performed using electronic databases (search until September 2020). The primary outcome was whether patient satisfaction was higher after deep sedation or light/moderate sedation. The secondary outcome was the relative safety of deep sedation compared with light/moderate sedation in terms of oxygen saturation, systolic blood pressure, and heart rate. The tertiary outcomes were the relative procedure and recovery times for deep versus light/moderate sedation.Data from each of the trials were combined, and calculations were made using DerSimonian and Laird random effects models. The pooled effect estimates for patient satisfaction were evaluated using relative risk (RR) with the 95% confidence interval (CI). The pooled effect estimates for continuous data are expressed as weighted mean difference with the 95% CI. We assessed heterogeneity with the Cochrane Q statistic and the I2 statistic. The risk of bias assessment and Grading of Recommendations Assessment, Development and Evaluation approach were used as the quality assessment method.Results:After removing unrelated studies and applying the exclusion criterion, 5 articles satisfied the inclusion criteria. Patient satisfaction was significantly higher in those who received deep sedation compared with light/moderate sedation (relative risk = 1.12; 95% CI, 1.04–1.20; P = .003; Cochrane Q = 25.0; I2 = 76%).There was no significant difference in oxygen saturation, systolic blood pressure, heart rate, and procedure times according to whether the procedures were performed under deep or light/moderate sedation. However, the recovery time was significantly prolonged in patients under deep sedation.Conclusions:Our meta-analysis suggests that deep sedation resulted in improved patient satisfaction compared with light/moderate sedation. Deep sedation is recommended for patients undergoing procedures because it improves patient satisfaction. However, respiration and circulation should be carefully monitored both intra-operatively and postoperatively.

A generalized BLUE approach for combining location and scale information in a meta-analysis

In systematic reviews and meta-analyses, one is interested in combining information from a variety of sources in order to obtain unbiased and efficient pooled estimates of the mean treatment effect compared to a control group along with the corresponding standard errors and confidence intervals, particularly when the source data is unavailable. However, in many studies the mean and standard deviation are not reported in lieu of other descriptive measures such as the median and quartiles. In this note we provide a theoretically optimal best linear unbiased estimator (BLUE) strategy for combining different types of summary information in order to pool results and estimate the overall treatment effect and the corresponding confidence intervals. Our approach is less biased and much more flexible than past attempts at solving this problem and can accommodate combining a variety of summary information across studies. We show that confidence intervals based on our methods have the appropriate coverage probabilities. Our proposed methods are theoretically justified and verified by simulation studies. The BLUE method is illustrated via a real data application.

Meta-analysis of randomized controlled trials and individual patient data comparing minimally invasive with open oesophagectomy for cancer.

Minimally invasive oesophagectomy (MIO) for oesophageal cancer may reduce surgical complications compared with open oesophagectomy. MIO is, however, technically challenging and may impair optimal oncological resection. The aim of the present study was to assess if MIO for cancer is beneficial. A systematic literature search in MEDLINE, Web of Science and CENTRAL was performed and randomized controlled trials (RCTs) comparing MIO with open oesophagectomy were included in a meta-analysis. Survival was analysed using individual patient data. Random-effects model was used for pooled estimates of perioperative effects. Among 3219 articles, six RCTs were identified including 822 patients. Three-year overall survival (56 (95 per cent c.i. 49 to 62) per cent for MIO versus 52 (95 per cent c.i. 44 to 60) per cent for open; P = 0.54) and disease-free survival (54 (95 per cent c.i. 47 to 61) per cent versus 50 (95 per cent c.i. 42 to 58) per cent; P = 0.38) were comparable. Overall complication rate was lower for MIO (odds ratio 0.33 (95 per cent c.i. 0.20 to 0.53); P < 0.010) mainly due to fewer pulmonary complications (OR 0.44 (95 per cent c.i. 0.27 to 0.72); P < 0.010), including pneumonia (OR 0.41 (95 per cent c.i. 0.22 to 0.77); P < 0.010). MIO for cancer is associated with a lower risk of postoperative complications compared with open resection. Overall and disease-free survival are comparable for the two techniques. Oesophagectomy for cancer is associated with a high risk of complications. A minimally invasive approach might be less traumatic, leading to fewer complications and may also improve oncological outcome. A meta-analysis of randomized controlled trials comparing minimally invasive to open oesophagectomy was performed. The analysis showed that the minimally invasive approach led to fewer postoperative complications, in particular, fewer pulmonary complications. Survival after surgery was comparable for the two techniques.

Physical activity interventions using behaviour change theories for women with breast cancer: a systematic review and meta-analysis.

Physical activity is a well-established strategy to alleviate breast cancer-related adverse outcomes. To optimise health benefits, behaviour change theories provide frameworks to support women in improving their physical activity. This review aimed to evaluate (i) the effects of behaviour change theory-based physical activity interventions for women with breast cancer and (ii) the application of these theories. Seven online databases were searched. Trials were included if randomised and controlled, involved physical activity interventions ≥ 12weeks duration, used a behaviour change theory, and participants were < 3years post-cancer treatment. Risk of bias and theory use were assessed. Data were synthesised narratively and meta-analysed. Forty articles describing 19 trials were included. Overall risk of bias was moderately high. Post-intervention pooled effect estimates were medium for self-reported (SMD = 0.57) and objectively measured physical activity (SMD = 0.52). Most trials cited the social cognitive theory (n = 10) and transtheoretical model (n = 9). Trials rarely applied theories in their entirety, expounded on behavioural mechanisms, or tailored interventions according to behavioural constructs. The most commonly used types of behavioural techniques were goals and planning (n = 18), shaping of knowledge (n = 18), feedback and monitoring (n = 17), and comparisons of outcomes (n = 17). The included trials were effective for increasing physical activity in women with breast cancer. Theories were applied using a wide range of approaches and levels of rigour, although shared the use of common behavioural techniques. Future research may benefit breast cancer survivors by more comprehensively applying behaviour change theories, emphasising individual patient needs and goals.

The bidirectional longitudinal association between depressive symptoms and HbA1c : A systematic review and meta-analysis.

AimTo investigate whether there is a bidirectional longitudinal association of depression with HbA1c.MethodsWe conducted a systematic literature search in PubMed, PsycINFO, CINAHL and EMBASE for observational, longitudinal studies published from January 2000 to September 2020, assessing the association between depression and HbA1c in adults. We assessed study quality with the Newcastle‐Ottawa‐Scale. Pooled effect estimates were reported as partial correlation coefficients (rp) or odds ratios (OR).ResultsWe retrieved 1642 studies; 26 studies were included in the systematic review and eleven in the meta‐analysis. Most studies (16/26) focused on type 2 diabetes. Study quality was rated as good (n = 19), fair (n = 2) and poor (n = 5). Of the meta‐analysed studies, six investigated the longitudinal association between self‐reported depressive symptoms and HbA1c and five the reverse longitudinal association, with a combined sample size of n = 48,793 and a mean follow‐up of 2 years. Higher levels of baseline depressive symptoms were associated with subsequent higher levels of HbA1c (partial r = 0.07; [95% CI 0.03, 0.12]; I238%). Higher baseline HbA1c values were also associated with 18% increased risk of (probable) depression (OR = 1.18; [95% CI 1.12,1.25]; I20.0%).ConclusionsOur findings support a bidirectional longitudinal association between depressive symptoms and HbA1c. However, the observed effect sizes were small and future research in large‐scale longitudinal studies is needed to confirm this association. Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self‐management behaviours. Our results may have clinical implications, as depressive symptoms and HbA1c levels could be targeted concurrently in the prevention and treatment of diabetes and depression.RegistrationPROSPERO ID CRD42019147551.

MP37-19 PERITONEAL DIALYSIS CATHETER INSERTION WITH OR WITHOUT OMENTECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery I (MP37)1 Sep 2021MP37-19 PERITONEAL DIALYSIS CATHETER INSERTION WITH OR WITHOUT OMENTECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS Jin Kyu (Justin) Kim, Marisol Lolas, Daniel Keefe, Mandy Rickard, Priyank Yadav, Armando Lorenzo, and Michael Chua Jin Kyu (Justin) KimJin Kyu (Justin) Kim More articles by this author , Marisol LolasMarisol Lolas More articles by this author , Daniel KeefeDaniel Keefe More articles by this author , Mandy RickardMandy Rickard More articles by this author , Priyank YadavPriyank Yadav More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , and Michael ChuaMichael Chua More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002046.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peritoneal dialysis (PD) is an option for renal replacement in patients with end-stage renal disease. Once placed in the peritoneal cavity, there is a chance of malfunction, often attributed to omental wrapping. Currently, there is mixed evidence regarding the role of omentectomy in improving PD outcomes and survival. This investigation aims to perform a systematic review and meta-analysis of literature on this topic to understand whether omentectomy during PD catheter insertion confers advantages. METHODS: A systematic review was performed in accordance with the Cochrane Collaboration. The review protocol was registered on the PROSPERO database (CRD42020218950). The systematic literature search was performed in February 2021 across Medline, EMBASE, Scopus, and Cochrane Library. All records with patients who underwent PD catheter insertion with and without omentectomy were included. The identified records were screened, followed by full-text review and data-extraction. Study quality was assessed using RoBINS-I and RoB2. The effect estimates were extracted as risk ratios (RRs) and corresponding 95% confidence intervals (CI) were pooled using inverse variance method with random effect model. Reporting of the study was in compliance with PRISMA guidelines. RESULTS: A total of 510 records were identified. 331 records were screened following duplicate removal and 37 records were identified for full-text review. 15 studies were ultimately included in the meta-analysis (2 prospective, 13 retrospective). When employing omentectomy, there was decreased likelihood of failure leading to removal of PD catheter (RR 0.47 [95% CI 0.38, 0.58]) and PD catheter obstruction (RR 0.23 [95% CI 0.14, 0.39]). Whether omentectomy was employed or not, there was no difference in malposition or migration of PD catheter (RR 0.87 [95% CI 0.23, 3.29]) or peritonitis (RR 0.74 [95% CI 0.40, 1.35]). CONCLUSIONS: Pooled effect estimates from our meta-analysis suggests that omentectomy confers benefits of decreased obstruction and failure requiring removal. The majority of the studies were retrospective in design and with higher risk of bias; hence, well-designed prospective studies are needed to validate these findings. Source of Funding: None. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e653-e654 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin Kyu (Justin) Kim More articles by this author Marisol Lolas More articles by this author Daniel Keefe More articles by this author Mandy Rickard More articles by this author Priyank Yadav More articles by this author Armando Lorenzo More articles by this author Michael Chua More articles by this author Expand All Advertisement Loading ...

Mortality risk attributable to wildfire-related PM2·5 pollution: a global time series study in 749 locations

Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world. For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM2·5 were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM2·5 exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM2·5 exposure was calculated. 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m3 increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM2·5 exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM2·5 exposure during the study period. Short-term exposure to wildfire-related PM2·5 was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires. Australian Research Council, Australian National Health & Medical Research Council.

455Association of interpregnancy interval and preterm births: what does a sibling-matched study indicate?

Abstract Background Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from between-women (unmatched) studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women (sibling-matched) can address this issue. Methods We conducted an international longitudinal study of births from Australia, Finland, Norway, and United States (California) covering over three decades (1980-2017). We included 5,523,914 births to 3,849,737 women, and within each country, we first investigated the associations between IPI and preterm birth (PTB), spontaneous PTB using logistic regression (unmatched analyses). Second, we used conditional logistic regression comparing IPIs in the same women (sibling-matched analyses), with 2,908,907 births to 1,234,730 women having at least two IPIs. Random effects meta-analysis was used to calculate pooled effect estimates. Results Compared to an IPI of 18-23 months, there was insufficient evidence of association between IPI &amp;lt;6 months and overall PTB (adjusted odds ratio (aOR)=1.08, 95%CI 0.99-1.18) but increased odds of spontaneous PTB (aOR=1.38, 95%CI 1.21-1.57). We observed elevated odds of both birth outcomes associated with IPI ≥60 months. In comparison, between-women analyses showed elevated odds of adverse birth outcomes for &amp;lt;12 month and &amp;gt;24 month IPIs. Conclusions We found consistently elevated odds of PTB following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of overall PTB. Key message Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries.

Association Of -308G/A, -238G/A TNF-α Polymorphisms with Multiple Myeloma Risk and Survival: A Systematic Review and Meta-Analysis

IntroductionTumor necrosis factor alpha (TNF-α) is a cytokine with a key role in proinflammation and multiple diseases, including cancer. The gene encoding TNF-α is located within a highly polymorphic region on chromosome 6p21.3; two polymorphisms -308G/A (rs1800629) and -238G/A (rs361525) have been associated with occurrence of human diseases. There is a debate in recent meta-analyses that reached discrepant conclusions regarding the potential role of TNF-α polymorphisms in multiple myeloma (MM) risk. The aim of this systematic review and meta-analysis is to investigate the association between the aforementioned two polymorphisms with the risk and survival of MM. Materials and methodsEligible articles were identified through an extensive search in PubMed database (end of search: June 18, 2020). The pooled effect estimates were calculated following the random-effects models by Der Simonian and Laird. Separate analyses were conducted by ethnicity. Between-study heterogeneity was quantified, and the deviation of genotype frequencies in controls from the Hardy-Weinberg equilibrium was evaluated. ResultsEighteen studies (2934 cases, 4291 controls) have been included in the quantitative synthesis examining risk and 5 studies for survival (557 cases). No association was found between -308G/A and -238G/A TNF-α polymorphisms and MM susceptibility in all genetic models for both Caucasian and East Asian populations. There was no association between -308G/A and -238G/A TNF-α polymorphisms and survival (overall or progression-free) of MM. ConclusionThis systematic review and meta-analysis did not reveal a significant effect of -308G/A and -238G/A TNF-α polymorphisms upon risk or survival of MM.

Body Composition According to Spinal Cord Injury Level: A Systematic Review and Meta-Analysis.

The level of injury is linked with biochemical alterations and limitations in physical activity among individuals with spinal cord injury (SCI), which are crucial determinants of body composition. We searched five electronic databases from inception until 22 July 2021. The pooled effect estimates were computed using random-effects models, and heterogeneity was calculated using I2 statistics and the chi-squared test. Study quality was assessed using the Newcastle–Ottawa Scale. We pooled 40 studies comprising 4872 individuals with SCI (3991 males, 825 females, and 56 sex-unknown) in addition to chronic SCI (median injury duration 12.3 y, IQR 8.03–14.8). Individuals with tetraplegia had a higher fat percentage (weighted mean difference (WMD) 1.9%, 95% CI 0.6, 3.1) and lower lean mass (WMD −3.0 kg, 95% CI −5.9, −0.2) compared to those with paraplegia. Those with tetraplegia also had higher indicators of central adiposity (WMD, visceral adipose tissue area 0.24 dm2 95% CI 0.05, 0.43 and volume 1.05 L 95% CI 0.14, 1.95), whereas body mass index was lower in individuals with tetraplegia than paraplegia (WMD −0.9 kg/mg2, 95% CI −1.4, −0.5). Sex, age, and injury characteristics were observed to be sources of heterogeneity. Thus, individuals with tetraplegia have higher fat composition compared to paraplegia. Anthropometric measures, such as body mass index, may be inaccurate in describing adiposity in SCI individuals.

Causal analyses of existing databases: no power calculations required

Observational databases are often used to study causal questions. Before being granted access to data or funding, researchers may need to prove that “the statistical power of their analysis will be high.” Analyses expected to have low power, and hence result in imprecise estimates, will not be approved. This restrictive attitude towards observational analyses is misguided.A key misunderstanding is the belief that the goal of a causal analysis is to “detect” an effect. Causal effects are not binary signals that are either detected or undetected; causal effects are numerical quantities that need to be estimated. Because the goal is to quantify the effect as unbiasedly and precisely as possible, the solution to observational analyses with imprecise effect estimates is not avoiding observational analyses with imprecise estimates, but rather encouraging the conduct of many observational analyses. It is preferable to have multiple studies with imprecise estimates than having no study at all. After several studies become available, we will meta-analyze them and provide a more precise pooled effect estimate. Therefore, the justification to withhold an observational analysis of preexisting data cannot be that our estimates will be imprecise. Ethical arguments for power calculations before conducting a randomized trial which place individuals at risk are not transferable to observational analyses of existing databases.If a causal question is important, analyze your data, publish your estimates, encourage others to do the same, and then meta-analyze. The alternative is an unanswered question.