Separate Meta-analyses Research Articles

Aberrant p53 Immunostaining in Barrett's Esophagus Predicts Neoplastic Progression: Systematic Review and Meta-Analyses.

Risk stratification of patients with Barrett's esophagus (BE) presently relies on the histopathologic grade of dysplasia found in esophageal biopsies, which is limited by sampling error and inter-pathologist variability. p53 immunostaining of BE biopsies has shown promise as an adjunct tool but is not recommended by American gastroenterology societies, who cite insufficient evidence of its prognostic value. We have conducted a systematic review and meta-analyses to clarify this value. We searched for studies that: (1) used immunohistochemistry to assess p53 expression in esophageal biopsies of BE patients and (2) reported subsequent neoplastic progression. We performed separate meta-analyses of case-control studies and cohort studies. We identified 14 relevant reports describing 8 case-control studies comprising 1435 patients and 7 cohort studies comprising 582 patients. In the case-control study meta-analysis of the risk of neoplasia with aberrant p53 expression, the fixed- and random-effect estimates of average effect size with aberrant p53 expression were OR 3.84, p < .001 (95% CI 2.79-5.27) and OR 5.95, p < .001 (95% CI 2.68-13.22), respectively. In the cohort study meta-analysis, the fixed- and random-effect estimates of average effect size were RR = 17.31, p < .001 (95% CI 9.35-32.08) and RR = 14.25, p < .001 (95% CI 6.76-30.02), respectively. Separate meta-analyses of case-control and cohort studies of BE patients who had baseline biopsies with p53 immunostaining revealed consistent, strong, and significant associations between aberrant p53 immunostaining and progression to high-grade dysplasia or esophageal adenocarcinoma. These findings support the use of p53 immunostaining as an adjunct to routine clinical diagnosis for dysplasia in BE patients.

Recurrent patellar dislocations: trochleoplasty improves the results of medial patellofemoral ligament surgery only in severe trochlear dysplasia.

Medial patellofemoral ligament (MPFL) surgery combined with trochleoplasty (TP), is often performed to restore the normal patellofemoral biomechanics avoiding recurrent lateral patellar dislocation (LPD) in patients with trochlear dysplasia (TD). However, it is still unclear whether combining TP and MPFL surgery would be more beneficial than performing MPFL surgery on its own. This meta-analysis quantitatively synthesizes and compares published data on the outcomes of recurrent LPD treatment using MPFL surgery without or with TP in patients affected by TD. A systematic literature search about the treatment of recurrent LPD in the presence of TD was conducted. The primary outcome was redislocation rate, analyzed for different types of TD. Kujala, and IKDC scores, as well as complication rate, were also analyzed through a separate meta-analysis. No statistically significant difference was found in the overall redislocation rate of MPFL surgery without and with TP. There was, however, a statistically significant difference (p < 0.001) in redislocation rate after MPFL surgery without TP between patients with type A or B TD (2.7%) and in patients with type C or D TD (18.6%). In the analysis for every single type of TD, the following results were obtained: redislocation rate of 1.8% in type A, 3.2% in type B, 11.9% in type C, and 7.4% in type D. A statistically significant difference in the complication rate, favouring MPFL surgery without TP, was documented. Both surgical approaches provided a significant improvement with no difference in Kujala and IKDC scores. These results were confirmed when data were analyzed including only patients with type B, C, or D TD, or without additional bone remodelling procedures. Isolated MPFL is as effective as combined TP and MPFL surgery in preventing redislocation and improving clinical and functional outcomes in patients with recurrent LPD and knees affected by moderate TD. However, in case of severe TD, the redislocation rate is lower when TP is performed in combination with MPFL surgery, although with comparable clinical outcomes and a higher risk of post-operative range of motion (ROM) limitation. Systematic review and meta-analysis, Level IV.

Meta-analyses of Current Strategies to Treat Uncomplicated Diverticulitis.

Uncomplicated colonic diverticulitis is common. There is no consensus regarding the most appropriate management. Some authors have reported the efficacy and safety of observational management, and others have argued for a more aggressive approach with oral or intravenous antibiotic treatment. The purpose of this study was to perform an updated meta-analysis of the different management strategies for uncomplicated diverticulitis with 2 separate meta-analyses. MEDLINE, Embase, and Cochrane databases were used. All randomized clinical trials, prospective, and retrospective comparative studies were included. Observational and antibiotics treatment or oral and intravenous antibiotics treatment were included. Successful management (emergency management, recurrence, elective management) was measured. After review of 293 identified records, 11 studies fit inclusion criteria: 7 studies compared observational management and antibiotics treatment (2321 patients), and 4 studies compared oral and intravenous antibiotics treatment (355 patients). There was no significant difference between observational management and antibiotics treatment in terms of emergency surgery (0.7% vs 1.4%; p = 0.1) and recurrence (11% vs 12%; p = 0.3). In this part, considering only randomized trials, elective surgery during the follow-up occurred more frequently in the observational group than the antibiotic group (2.5% vs 0.9%; p = 0.04). The second meta-analysis showed that failure and recurrence rates were similar between oral and intravenous antibiotics treatment (6% vs 7% (p = 0.6) and 8% vs 9% (p = 0.8)). Inclusion of nonrandomized studies, identification of high risks of bias (selection, performance, and detection bias), and presence of heterogeneity between the studies limited this work. Observational management was not statistically different from antibiotic treatment for the primary outcome of needing to undergo surgery. However, in patients being treated by antibiotics, our studies demonstrated that oral administration was similar to intravenous administration and provided lower costs. Although it may be difficult for physicians to do, there is mounting evidence that not treating uncomplicated colonic diverticulitis with antibiotics is a viable treatment alternative.

Management of penetrating intraperitoneal colon injuries: A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma.

The management of penetrating colon injuries in civilians has evolved over the last four decades. The objectives of this meta-analysis are to evaluate the current treatment regimens available for penetrating colon injuries and assess the role of anastomosis in damage control surgery to develop a practice management guideline for surgeons. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines section of EAST conducted a systematic review using MEDLINE and EMBASE articles from 1980 through 2017. We developed three relevant problem, intervention, comparison, and outcome (PICO) questions regarding penetrating colon injuries. Outcomes of interest included mortality and infectious abdominal complications. Thirty-seven studies were identified for analysis, of which 16 met criteria for quantitative meta-analysis and included 705 patients considered low-risk in six prospective randomized studies. Seven hundred thirty-eight patients in 10 studies undergoing damage control laparotomy and repair or resection and anastomosis (R&A) were included in a separate meta-analysis. Meta-analysis of high-risk patients undergoing repair or R&A was not feasible due to inadequate data. In adult civilian patients sustaining penetrating colon injury without signs of shock, significant hemorrhage, severe contamination, or delay to surgical intervention we recommend that colon repair or R&A be performed rather than routine colostomy. In adult high-risk civilian trauma patients sustaining penetrating colon injury, we conditionally recommend that colon repair or R&A be performed rather than routine colostomy. In adult civilian trauma patients sustaining penetrating colon injury who had damage control laparotomy, we conditionally recommend that routine colostomy not be performed; instead, definitive repair or delayed R&A or anastomosis at initial operation should be performed rather than routine colostomy. Systematic review/meta-analysis, level III.

Faecal calprotectin to detect inflammatory bowel disease: a systematic review and exploratory meta-analysis of test accuracy

ObjectiveTest accuracy of faecal calprotectin (FC) testing in primary care is inconclusive. We aimed to assess the test accuracy of FC testing in primary care and compare it to secondary...

Sex Differences in Human Olfaction: A Meta-Analysis.

Although the view that women's olfactory abilities outperform men's is taken for granted, some studies involving large samples suggested that male and female olfactory abilities are actually similar. To address this discrepancy, we conducted a meta-analysis of existing studies on olfaction, targeting possible sex differences. The analyzed sample comprised n = 8 848 (5 065 women and 3 783 men) for olfactory threshold (as measured with the Sniffin Sticks Test; SST), n = 8 067 (4 496 women and 3 571 men) for discrimination (SST), n = 13 670 (7 501 women and 6 169 men) for identification (SST), and a total sample of n = 7 154 (3 866 women and 3 288 men) for works using University of Pennsylvania Smell Identification Test (UPSIT). We conducted separate meta-analyses for each aspect of olfaction: identification, discrimination and threshold. The results of our meta-analysis indicate that women generally outperform men in olfactory abilities. What is more, they do so in every aspect of olfaction analyzed in the current study. However, the effect sizes were weak and ranged between g = 0.08 and g = 0.30. We discuss our findings in the context of factors that potentially shape sex differences in olfaction. Nevertheless, although our findings seem to confirm the “common knowledge” on female olfactory superiority, it needs to be emphasized that the effect sizes we observed were notably small.

Blood Pressure Lowering and Sodium-Glucose Co-transporter 2 Inhibitors (SGLT2is): More Than Osmotic Diuresis.

This is an update of data regarding changes in blood pressure using sodium-glucose co-transporter 2 inhibitors (SGLT2i) for the treatment of diabetes. The mechanism of blood pressure lowering by SGLT2i was thought to be due to their osmotic diuretic effects. New data, however, has emerged from meta-analyses and studies of people with impaired kidney function demonstrating similar or greater magnitudes of blood pressure reduction in the absence of significant glycosuria. Potential additional mechanisms are proposed and reviewed. Two separate meta-analyses in over 10,000 participants combined demonstrate an average of 4/2 mmHg reduction in blood pressure by SGLT2i. This includes consistency between measurements of in-office and ambulatory blood pressure monitoring. This reduction extends to decreases in nocturnal blood pressure of 2.6 mmHg systolic pressure. These reductions in blood pressure by SGLT2i are also present when added to ongoing treatment with ACE inhibitors or ARBs. In one study, dapagliflozin, when added to a regimen of a renin-angiotensin-aldosterone system (RAAS) antagonist and a diuretic, further lowered in-office systolic pressure by 2.4 mmHg. In contrast, when prescribed to those on a RAAS antagonist plus a calcium channel blocker or RAAS antagonist plus a beta blocker, systolic pressure decreased 5.4 mmHg. Lastly, post hoc analyses of major cardiovascular outcome trials across the spectrum of estimated glomerular filtration rates from 30 to 80 ml/min/1.73 m2 demonstrated similar magnitudes of BP reduction in spite of far less reduction in glucosuria among those with advanced kidney disease. Moreover, recent data implicate the potential for increased ketones associated with SGLT2i contributing to blood pressure lowering in advanced-stage kidney disease. SGLT2i are well established to lower blood pressure. Their mechanism appears to be multifactorial and has a hemodynamic as well as metabolic component contributing to this reduction.

Dopaminergic Neurotransmission in Patients With Parkinson's Disease and Impulse Control Disorders: A Systematic Review and Meta-Analysis of PET and SPECT Studies.

Background: Around 30% Parkinson's disease (PD) patients develop impulse control disorders (ICDs) to D2/3 dopamine agonists and, to a lesser extent, levodopa. We aim to investigate striatal dopaminergic function in PD patients with and without ICD.Methods: PubMed, Science Direct, EBSCO, and ISI Web of Science databases were searched (from inception to March 7, 2018) to identify PET or SPECT studies reporting striatal dopaminergic function in PD patients with ICD (ICD+) compared to those without ICD (ICD–). Studies which included drug naïve patients, explored non-pharmacological procedures (e.g., deep brain stimulation), and those using brain blood perfusion or non-dopaminergic markers were excluded. Standardized mean difference (SDM) was used and random-effect models were applied. Separate meta-analyses were performed for dopamine transporter level, dopamine release, and dopamine receptors availability in the putamen, caudate, dorsal, and ventral striatum.Results: A total of 238 studies were title and abstract screened, of which 19 full-texts were assessed. Nine studies (ICD+: N = 117; ICD–: N = 175 patients) were included in the analysis. ICD+ showed a significant reduction of dopamine transporter binding in the putamen (SDM = −0.46; 95% CI: −0.80, −0.11; Z = 2.61; p = 0.009), caudate (SDM = −0.38; 95% CI: −0.73, −0.04; Z = 2.18; p = 0.03) and dorsal striatum (SDM = −0.45; 95% CI: −0.77, −0.13; Z = 2.76; p = 0.006), and increased dopamine release to reward-related stimuli/gambling tasks in the ventral striatum (SDM = −1.04; 95% CI: −1.73, −0.35; Z = 2.95; p = 0.003). Dopamine receptors availability did not differ between groups. Heterogeneity was low for dopamine transporter in the dorsal striatum (I2 = 0%), putamen (I2 = 0%) and caudate (I2 = 0%), and pre-synaptic dopamine release in the dorsal (I2 = 0%) and ventral striatum (I2 = 0%); heterogeneity was high for dopamine transporter levels in the ventral striatum (I2 = 80%), and for dopamine receptors availability in the ventral (I2 = 89%) and dorsal (I2 = 86%) striatum, putamen (I2 = 93%), and caudate (I2 = 71%).Conclusions: ICD+ patients show lower dopaminergic transporter levels in the dorsal striatum and increased dopamine release in the ventral striatum when engaged in reward-related stimuli/gambling tasks. This dopaminergic imbalance might represent a biological substrate for ICD in PD. Adequately powered longitudinal studies with drug naïve patients are needed to understand whether these changes may represent biomarkers of premorbid vulnerability to ICD.

Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.

Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids. We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors. We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake. Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet. LCn3 doses ranged from 0.5g/d LCn3 to > 5 g/d (16 RCTs gave at least 3g/d LCn3).Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted.Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs) and ALA may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence with greater effects in trials at low summary risk of bias), and probably reduces risk of arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear.Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression.There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, except LCn3 reduced triglycerides by ˜15% in a dose-dependant way (high-quality evidence). This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event and arrhythmia risk.

Low Hemoglobin Increases Risk for Stroke, Kidney Disease, Elevated Estimated Pulmonary Artery Systolic Pressure, and Premature Death in Sickle Cell Disease: A Systematic Literature Review and Meta-Analysis

Introduction: Sickle cell disease (SCD) is characterized by deoxygenation-induced polymerization of hemoglobin in red blood cells (RBCs), leading to altered RBC rheology, vaso-occlusion, and hemolytic anemia. The chronic hemolytic anemia, experienced in varying degrees by patients with SCD, reduces oxygen-carrying capacity and leads to multiple clinical manifestations, including fatigue and multiorgan damage.Methods: Systematic literature searches of Excerpta Medica (EMBASE) and MEDLINE (via PubMed) databases were conducted (January 1, 1998, to August 29, 2017) to identify studies reporting on the association of hemoglobin with clinical outcomes in patients with SCD. Abstracts from the previous 2 years of 5 scientific conferences that present studies related to SCD were also evaluated. Citations identified from the databases and grey literature searches were reviewed in a 2-step process by a single reviewer: first-pass title/abstract evaluation followed by full-text assessment. Three quality assessment (QA) scales were utilized to evaluate all included studies.For quantitative analyses, study findings were separated into categories of outcomes related to hemoglobin. For each category, study findings were aggregated to perform separate meta-analyses assessing the overall magnitude of the association. The summary measure was weighted by study size. Given the variation in hemoglobin levels, we stratified our findings by levels of hemoglobin to examine heterogeneity. Pooled results were analyzed using random effects models to control for within- and between-study variability.To derive risk ratios associated with hemoglobin change, ratios of means from select studies that reported hazard and odds ratios in meta-analyses by change in hemoglobin between groups for outcomes related to hemoglobin were combined. When studies reported separate values for hemoglobin outcomes in bivariate and multivariate analyses, these were combined within the study, forming a single value prior to the meta-analysis overall for studies in an outcome category. Analyses were performed using STATA 15.2.Results: A total of 1434 records were initially screened, and 139 studies were identified for inclusion. Results reported are on four key clinical outcomes where the literature was most robust.Ten studies representing 3397 patients and reporting on hemoglobin- and stroke-related outcomes demonstrated an association between lower hemoglobin levels and a history of stroke, silent cerebral infarct, or increased transcranial Doppler (TCD)-measured cerebral artery velocity; statistical significance was reached in 7 studies. Lower hemoglobin levels were significantly associated with the presence of microalbuminuria among 1579 pediatric patients with SCD in 7 of 8 studies. Twelve studies representing 1465 patients reported an association between lower hemoglobin and elevated estimated pulmonary artery systolic pressure (PASP), defined as elevated tricuspid regurgitant jet velocity (TRV ≥2.5 m/s). Six studies accounting for 3196 patients reported on hemoglobin and mortality among SCD patients and showed hemoglobin was lower across all but one study for deceased vs. living patients.Meta-analyses conducted to determine aggregate differences across groups among each of these 4 clinical outcomes demonstrated that hemoglobin was statistically significantly lower by approximately 0.4 to 1 g/dL among those experiencing a negative clinical outcome (Table).In our risk reduction meta-analysis, the risk for negative clinical outcomes decreased at all modeled levels of hemoglobin increase, most notably with improvements in hemoglobin of 1 g/dL or greater (Figure).Conclusions: In conclusion, comprehensive evaluation of peer-reviewed literature published over the past 20 years demonstrates a significant relationship between chronic anemia and worse clinical outcomes in individuals with SCD. Meta-analyses further demonstrate that even relatively modest differences in hemoglobin are important and support hemoglobin increase by ≥1 g/dL as a relevant therapeutic target. These results suggest that interventions that reduce hemolytic anemia may confer clinical benefit in this patient population. [Display omitted] DisclosuresAtaga:Novartis: Consultancy, Honoraria; Bioverativ: Honoraria, Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Modus Therapeutics: Honoraria; Pfizer: Research Funding. Allen:Global Blood Therapeutics: Consultancy. Colby:Xcenda, LLC: Employment. Gittings:Xcenda, LLC: Employment. Agodoa:Global Blood Therapeutics: Employment, Other: Stakeholder.

Prophylactic antibiotics for adults with chronic obstructive pulmonary disease: a network meta-analysis

Prophylactic antibiotics for adults with chronic obstructive pulmonary disease: a network meta-analysis

Effects of music therapy on anxiety and physiologic parameters in angiography: a systematic review and meta-analysis

BackgroundGiven the anxiety patients experience during angiography, evidence supporting the efficacy of music therapy during these angiographic procedures is potentially of clinical value.ObjectiveTo analyze the existing literature forthe use of...

Topical tranexamic acid in spinal surgery: A systematic review and meta-analysis

Tranexamic acid (TXA) is a commonly used antifibrinolytic agent for perioperative blood conservation in several surgical specialties. Although historically administered intravenously, such systemic administration may be accompanied by severe side effects. Thus, the topical usage of TXA has been established in several fields but remains poorly evaluated in spine surgery. In this study, the authors aimed to review the medical literature on topical TXA usage in spine surgery to evaluate its safety and efficacy. We reviewed manuscripts and clinical trials exploring topical TXA usage in spine surgery published by April 1st, 2018. Postoperative blood loss volumes and hospitalization lengths of stay were evaluated with separate meta-analyses. We identified five articles and one unpublished clinical trial that were placebo-controlled and comprised 218 patients receiving topical TXA in spine surgery. Patients receiving topical TXA demonstrated significantly lower postoperative blood loss as compared to the placebo group (Standardized Mean Difference [SMD] 2.21, 95% CI 0.79–3.62, p < 0.001) and had a lower hospitalization duration (MD 0.99, 95% CI 0.49–1.49, p < 0.001). Overall, topical TXA favorably reduced postoperative blood loss and hospitalization duration in patients undergoing spinal surgery. However, further randomized controlled trials will be needed to definitively establish the optimal therapeutic doses needed for hemorrhage management, and the pharmacodynamics of tTXA in spinal surgery.

A systematic review of the agreement between chronological age and skeletal age based on the Greulich and Pyle atlas

This systematic review examines the agreement between assessed skeletal age by the Greulich and Pyle atlas (GP skeletal age) and chronological age. We searched electronic databases until January 2017 for studies reporting GP skeletal age and confirmed chronological age in healthy individuals aged 10-25 years. Results are presented as forest plots and meta-analyses (random-effects models). In separate meta-analyses for each age group and sex (14-18 years for girls, 14-19 years for boys), the pooled mean differences between GP skeletal age and chronological age varied from -0.52 years to 0.47 years. In individual studies, age group and sex-specific mean differences between GP skeletal age and chronological age rarely exceeded 1 year, but between-study heterogeneities were large in most age groups. Few studies examined mean chronological age and distribution for each GP skeletal age. One study of good methodological quality indicates that 95% prediction intervals for chronological age from given GP skeletal ages are typically around 4 years. There is still good correlation between GP skeletal age and mean chronological age in modern populations. However, the individual variation of development within a population and heterogeneities between studies are substantial. • The GP atlas still corresponds well with mean chronological age in modern populations. • The substantial variation within a population must be considered. • The heterogeneity between studies is relatively large and of unknown origin.

Structural and functional brain alterations in obstructive sleep apnea: a multimodal meta-analysis

ObjectivesObstructive sleep apnea (OSA) is a disease with high prevalence, which reportedly influences our eyes, brain, cardiovascular system and endocrine metabolism system. Much of these symptoms are thought to be associated with damage to the brain. However, the basic neural pathophysiologic mechanism underlying these deficits is unclear. In this study, we investigate the specific and common neurostructural/functional abnormalities in OSA patients comparing with healthy people by conducting separate and multimodal meta-analysis of structural and functional magnetic resonance imaging studies. MethodWe search data from the original studies, extract height, coordinates of the peaks of the reported volumetric abnormalities, and recreate a map of the effect sizes of the differences between patients and controls. We use the anisotropic effect-size version of Signed Differential Mapping (AES-SDM) to clarify the robust regions in our brain when suffering from OSA. ResultWe find shared changes in the orbital frontal cortex (OFC), which showed both decreased gray matter volume (GMV) and functional response in OSA patients; as well as GMV of the bilateral anterior cingulate/paracingulate gyri (ACC/ApCC) and hippocampus/parahippocompalgyrus (Hippo/PHG), the orbital frontal cortex (OFC) and Left cerebellum VI decrease. The dorsolateral prefrontal cortex (DLPFC) exhibited hypoactivation relative to controls, whereas the insula showed hyperactivation. ConclusionWe demonstrated the significant alterations of brain structural and functional response in OSA patients. These changes give us a description about underlying neural alterations in OSA patients and may explain the psychic disorders, memory deficits, cardiovascular abnormalities and endocrine metabolism system problems, suggesting the early diagnose and treatment.

Meta-analysis of patient survival and rate of alcohol relapse in liver-transplanted patients for acute alcoholic hepatitis.

This review investigated survival and alcoholic relapse following liver transplantation (LT) in patients with severe acute alcoholic hepatitis (AH) without 6months of alcohol abstinence. All studies comparing acute AH patients undergoing LT with a control group were included. CENTRAL, MEDLINE, and Web of Science databases were searched. Survival benefits or odds ratios (OR) and 95% confidence intervals (CI) were assessed by meta-analyses using a random effects model. The study was registered in PROSPERO (CRD42017057971). According to the search results, two separate meta-analyses were performed: meta-analysis A compared early LT with medical therapy alone in patients with severe AH that were not responding to medical therapy and meta-analysis B compared LT outcome in patients with AH and chronic alcoholic cirrhosis (AC). The search yielded 2232 articles. Eight studies were included in the two meta-analyses-two studies in meta-analysis A and six studies in meta-analysis B. The two studies (n = 70) included in meta-analysis A revealed that 1-year patient survival was significantly higher in the LT group compared with the medical therapy-alone group (survival benefit, 15.88; 95% CI, 3.98-63.35; p < 0.0001). The six studies in meta-analysis B (including 1091 patients) showed that 1-year (survival benefit, 1.65; 95% CI, 0.95-2.89; p = 0.08), 3-year (survival benefit, 1.31; 95% CI, 0.79-2.18; p = 0.30), and 5-year survival (survival benefit, 1.54; 95% CI, 0.92-2.56; p = 0.10) were not significantly different between AH and AC groups. There was no significant difference in the rate of alcohol relapse between the groups (OR, 1.26; 95% CI, 0.53-2.96; p = 0.60). Early LT is a life-saving treatment for AH patients that do not respond to medical therapy. The chance of alcohol relapse after LT is not increased in selected patients.

Meta-analysis of the association between serum and gingival crevicular fluid matrix metalloproteinase-9 and periodontitis

BackgroundThe authors of this meta-analysis evaluated whether there is a difference in the levels of serum and gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-9 between patients with periodontitis and periodontally healthy control participants. Types of Studies ReviewedThe authors searched PubMed, Embase, the Cochrane Library, and the China Biology Medicine disk databases for eligible studies in which the investigators reported the relationships between MMP-9 levels in serum and GCF and periodontitis. The authors pooled the standardized mean differences (SMDs) and 95% confidence intervals (CIs) from each study to evaluate the difference in the serum and GCF MMP-9 levels between patients with periodontitis and periodontally healthy control participants. ResultsResults of a meta-analysis of 6 case-control studies including a total of 923 healthy control participants and 557 patients with periodontitis indicated that serum MMP-9 levels were significantly higher in patients with periodontitis than in periodontally healthy control participants (SMD, 1.60; 95% CI, 0.17 to 3.03; P < .05). Results of a separate meta-analysis of 6 case-control studies including a total of 153 healthy control participants and 189 patients with periodontitis indicated that GCF MMP-9 levels were significantly higher in patients with periodontitis than in periodontally healthy control participants (SMD, 1.96; 95% CI, 0.76 to 3.16; P < .01). Conclusions and Practical ImplicationsThe results of the meta-analysis revealed statistically significant differences in the MMP-9 levels in serum and GCF between patients with periodontitis and periodontally healthy control participants. These results cannot be used to confirm causality because the included studies were all case-control studies in which the investigators reported associations. Moreover, readers should view the results with caution because of the considerable heterogeneity among the studies included in the meta-analysis.

The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis

BackgroundMirror therapy is less commonly used to target the lower extremity after stroke to improve outcomes but is simple to perform. This review and meta-analysis aimed to evaluate the efficacy of lower extremity mirror therapy in improving balance, gait, and motor function for individuals with stroke. MethodsPubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and PsychINFO were searched from inception to May 2018 for randomized controlled trials (RCTs) comparing lower extremity mirror therapy to a control intervention for people with stroke. Pooled effects were determined by separate meta-analyses of gait speed, mobility, balance, and motor recovery. ResultsSeventeen RCTs involving 633 participants were included. Thirteen studies reported a significant between-group difference favoring mirror therapy in at least one lower extremity outcome. In a meta-analysis of 6 trials that reported change in gait speed, a large beneficial effect was observed following mirror therapy training (standardized mean differences [SMD] = 1.04 [95% confidence interval [CI] = .43, 1.66], I2 = 73%, and P < .001). Lower extremity mirror therapy also had a positive effect on mobility (5 studies, SMD = .46 [95% CI = .01, .90], I2 = 43%, and P = .05) and motor recovery (7 studies, SMD = .47 [95% CI = .21, .74], I2 = 0%, and P < .001). A significant pooled effect was not found for balance capacity. ConclusionsMirror therapy for the lower extremity has a large effect for gait speed improvement. This review also found a small positive effect of mirror therapy for mobility and lower extremity motor recovery after stroke.

Transcranial Direct-Current Stimulation on Motor Function in Pediatric Cerebral Palsy: A Systematic Review.

To determine effects of transcranial direct-current stimulation (tDCS) on motor function for children with cerebral palsy. Six electronic databases were searched using terms related to tDCS, combined with functional deficits/associated clinical measures. Results were filtered, including randomized controlled trials in English and children with cerebral palsy. Data were extracted using standardized procedures, and the PEDro scale was used to assess quality and meta-analyses conducted. From 135 articles, 9 studies with moderate quality met inclusion criteria. Six were included in 7 separate meta-analyses supporting a benefit of tDCS for static balance, only at follow-up. Benefits of tDCS on dynamic balance, step length, and mobility were not established. The findings from meta-analyses suggest that tDCS may provide improvements in static balance at follow-up in children with cerebral palsy and positive effects on gait velocity; however, there was heterogeneity. Further research is needed before this therapy can be endorsed.

Linking big five personality traits to sexuality and sexual health: A meta-analytic review.

This meta-analytic review addresses whether the major dimensions of trait personality relate to components of human sexuality. A comprehensive literature search identified 137 studies that met inclusion criteria (761 effect sizes; total n = 420,595). Pooled mean effects were computed using inverse-variance weighted random effects meta-analysis. Mean effect sizes from 100 separate meta-analyses provided evidence that personality relates to theoretically predicted components of sexuality and sexual health. Neuroticism was positively related to sexual dissatisfaction (r+ = .18), negative emotions (r+ = .42), and symptoms of sexual dysfunction (r+ = .16). Extraversion was positively related to sexual activity (r+ = .17) and risky sexual behavior (r+ = .18), and negatively related to symptoms of sexual dysfunction (r+ = -.17). Openness was positively related to homosexual orientation (r+ = .16) and liberal attitudes toward sex (r+ = .19). Agreeableness and conscientiousness were negatively related to sexually aggressive behavior (r+ = -.20; r+ = -.14) and sexual infidelity (r+ = -.18; r+ = -.17). Less robust evidence indicated that extraversion related negatively, and neuroticism positively, to child sexual abuse, and that openness related negatively to homophobic attitudes. Random effects metaregression identified age, gender, and study quality as important moderators of pooled mean effects. These findings might be of interest to health care professionals developing health care services that aim to promote sexually healthy societies. (PsycINFO Database Record