Trip Database Research Articles

O mindful eating modifica o comportamento alimentar em indivíduos com excesso de peso?

As estratégias tradicionais no controle ao excesso de peso, como a utilização de dietas restritivas e incentivo à prática de exercícios, à longo prazo, parecem não ser eficientes tendo em vista que muitas vezes não promovem mudanças de comportamento alimentar. Sendo assim, estratégias comportamentais, como o Mindful eating que é a habilidade de comer com atenção plena, sem julgamento ou crítica, auxiliando o indivíduo a ter uma melhor relação com a comida através da sintonia entre mente, corpo e alimentação, parece ser uma alternativa eficaz para consolidação de uma alimentação mais consciente. O objetivo deste estudo foi realizar uma revisão integrativa da literatura sobre os principais protocolos de Mindful eating utilizados em pesquisas com indivíduos com excesso de peso para mudança de comportamento alimentar. A pesquisa realizou-se nos principais bancos de dados: PubMed, ScienceDirect, TripDatabase e Scielo. Foram selecionados 8 artigos por preencherem os critérios de inclusão para a produção da revisão. Foi realizada a análise de diferentes protocolos de mindful eating, os quais demonstraram como principais benefícios, variando entre os estudos, a redução/manutenção do peso corporal; melhora no comportamento alimentar e diminuição nos episódios do transtorno de compulsão alimentar (TCA), aumento da atenção plena e da alimentação consciente. Dentre os protocolos avaliados, o MB-EAT foi o mais utilizado nas pesquisas com estes objetivos. Destaca-se a importância de mais pesquisas que utilizem esta estratégia e seus diferentes protocolos, ressaltando a análise dos efeitos que eles proporcionam no comportamento alimentar.

Electroconvulsive Therapy in Multiple Sclerosis: A Review of Current Evidence.

To review the published literature over the last 5 years on the use of electroconvulsive therapy (ECT) in multiple sclerosis (MS), focusing on efficacy, safety, and tolerability. MS commonly has neuropsychiatric comorbidity. ECT is used in MS for severe and life-threatening forms of mental illness when other treatment options have failed or when a rapid response is required. English-language literature published in the last 5 years (January 2015-June 2, 2020) was searched using the terms: ECT, electroconvulsive therapy, shock therapy, electroshock therapy, electroconvulsive therapies, multiple sclerosis, chronic progressive multiple sclerosis, acute relapsing multiple sclerosis, and multiple sclerosis, relapsing and remitting. KnowledgeShare, a National Health Service library application providing updates on evidence-based practice, was used along with EMBASE, PsycInfo, MEDLINE, PubMed, the TRIP database (which offers a complete and updated list of evidence-based online resources), HDAS (Healthcare Databases Advanced Search), CRDWeb (Centre for Reviews and Dissemination), and the Cochrane Library. Reference lists of articles identified in the search were also reviewed. Our initial search revealed 30 articles of potential relevance. However, after individually evaluating these articles, only 6 case studies and 1 review article detailing the use of ECT in MS were included. The studies were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review. The efficacy and safety in using ECT for MS is derived only from case series and case reports. There were no controlled trials or systematic reviews, and the evidence collated was of low quality. The consensus is that ECT is an effective treatment for specific mental disorders in MS including catatonia. We have used ECT successfully in our clinic for patients with MS. However, there are concerns about the potential effects of ECT on neurologic and cognitive function. There are also possible risks with using anesthetic agents and particularly neuromuscular blockers.

Abstract P158: Outcomes of Patients With a Transient Ischemic Attack Based on Inpatient Versus Urgent Outpatient Evaluations a Systematic Review and Meta-Analysis

Importance: Management of transient ischemic attack (TIA)and the concept of urgent TIA clinic have gained significant attention over the past years. Objective: To calculate the odds of subsequent ischemic stroke within 2, 7, 30, and 90 days and death within 90 days among the TIA patients who received acute care in a TIA clinic versus those admitted to a hospital. Data Sources: We performed a systematic review and meta-analysis of all the published TIA outcome studies. Included studies were obtained by searching Medline, Web of Science, Scopus, All EBM reviews series, International Clinical Trial Registry Platform (ICTRP), Trip database, and CINAHL, last updated in March 2020, irrespective of the study design, document type, or language. Study Selection: We accepted both the classic time-based definition of TIA and the new tissue-based definition and studies with a combined record of TIA and minor ischemic stroke patients. We excluded studies with a diagnosis of index TIA event after ischemic stroke occurrence, low suspicious for TIA, TIA acute care in settings other than an outpatient clinic or hospital, multicentric studies, or duplicate reports of the same database. Data Extraction and Synthesis: The study was conducted and reported according to PRISMA, MOOSE, and EQUATOR guidelines. Critical appraisal and methodological quality were conducted by ROBINS-E tool. Data were pooled under random-effects models. Results: Systematic review yielded to 19,547 reports, of which titles and abstracts of 9,113 reports were screened. The overall subsequent ischemic stroke odds ratios were estimated by meta-analyses as follows: 4 studies within 2 days with 1,829 patients (OR: 0.93, 95% CI: -0.52-2.38), 5 studies within 7 days with 1,801 patients (OR: 0.68, 95% CI: -0.73-2.08), 4 studies within 30 days with 1,768 patients (OR:1.01, 95% CI: -0.72 - 2.73), and 6 studies within 90 days with 2,319 population (OR: 0.94, 95% CI: 0.22-1.66). The 90-day risk of death by analyzing 3 studies, 1162 patients, was calculated as OR:1.29, 95% CI: 0.76-3.34. Conclusion and Relevance: Hospital management of TIA patients in the acute phase may not be associated with a lower risk of stroke and death compared with urgent outpatient management.

The Impact of Maxillary Expansion on Adults' Nasal Breathing: A Systematic Review and Meta-Analysis.

Nasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction leads to the closure of the internal and external nasal valves. Moreover, it is well established in the literature that maxillary expansion, both in adults and children, increases upper airway volume. However, it is yet unclear whether maxillary expansion may improve nasal function.Review Methods: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked by two authors from the Rhinology Study Group of the Young Otolaryngologists section of the International Federation of Otorhinolaryngological Societies. Two authors extracted the data. The main outcome was expressed as the value (in variable units) prior to treatment (T0), after expansion procedures (T1), after the retention period (T2), and after a follow-up period (T3). A total of 10 studies (257 patients) met the inclusion criteria. The data pooled in the meta-analysis reveals a statistically significant reduction of 0.27 Pa/cm3/s (CI 95% 0.15, 0.39) in nasal resistance after palatal expansion As far as subjective changes are concerned, the pooled data for the change in the NOSE score shows a statistically significant mean reduction after maxillary expansion of 40.08 points (CI 95% 36.28, 43.89). The initial available evidence is too limited to suggest maxillary expansion as a primary treatment option to target nasal breathing. However the data is encouraging with regards to the effect of maxillary expansion on nasal function. Further higher quality studies are needed in order to define clearer patient selection criteria, distinguish optimal techniques, and demonstrate long-term efficacy in long term follow up studies.

Photodynamic Therapy as a New Treatment for Chronic Rhinosinusitis - A Systematic Review.

This review examines the latest evidence for photodynamic therapy (PDT) in treating chronic rhinosinusitis. MedLine, EMBASE and TRIP Database searches were conducted using the terms: "photodynamic" or "phototherapy" or "photo" and "sinusitis" or "rhinosinusitis," date range January 2000 to May 2020. A total of 192 records were initially identified, after duplicates and exclusions, 9 full papers and 3 abstracts were included. All study types including in-vitro, animal and human studies were evaluated. Whilst there is in-vitro evidence for the efficacy of PDT's bactericidal effect on drug resistant bacteria and biofilm viability, there are few clinical studies. PDT is a promising area of research, but larger, focused studies looking at the safety, delivery, efficacy, and patient selection are required before it can be considered a viable treatment for CRS.

Fresh and cumulative live birth rates in mild versus conventional stimulation for IVF cycles in poor ovarian responders: a systematic review and meta-analysis.

Are cumulative and live birth rates (LBRs) comparable in poor ovarian response women treated with different protocols of mild stimulation IVF (i.e. oral compounds, lower doses or shorter treatments) versus conventional IVF? Mild ovarian stimulation (MOS) results in comparable outcomes to those of conventional stimulation in poor ovarian response patients with low ovarian reserve. Several randomized trials and meta-analyses have been published evaluating the role of mild (MOS) versus conventional ovarian stimulation in poor ovarian response patients. Most report a potentially higher safety profile, patient satisfaction and lower costs, suggesting that the higher cycle cancellation rate and fewer oocytes retrieved following MOS does not affect the final reproductive outcome. Additionally, over the last few years, new publications have added data regarding MOS, and shown the possible benefit of a higher oocyte yield which may also improve prognosis in patients with poor ovarian response. We conducted a systematic search of relevant randomized controlled trials (RCTs). We searched electronic databases, including MEDLINE, EMBASE, LILACS-BIREME, CINAHL, The Cochrane Library, CENTRAL (Cochrane Register), Web of Science, Scopus, Trip Database and Open Grey, to identify all relevant studies published up to March 2020. We examined trial registries for ongoing trials. No publication-year or language restrictions were adopted. We explored the reference list of all included studies, reviews and abstracts of major scientific meetings. The primary outcomes were cumulative and fresh LBR (CLBR and FLBR) per woman randomized. We included subfertile women undergoing IVF/ICSI characterized as poor responders and compared primary and secondary outcomes between the different protocols of mild stimulation IVF (i.e. oral compounds, lower doses or shorter treatments) and conventional IVF. We used the PICO (Patients, Intervention, Comparison and Outcomes) model to select our study population. Overall, 15 RCTs were included in the meta-analysis. CLBR and FLBR were comparable between mild versus conventional stimulation (RR 1.15; 95% CI: 0.73 - 1.81; I2 = 0%, n = 424, moderate certainty and RR 1.01; 95% CI: 0.97 - 1.04; I 2 = 0%, n = 1001, low certainty, respectively). No difference was observed either when utilizing oral compounds (i.e. letrozole and clomiphene) or lower doses. Similarly, ongoing pregnancy rate (OPR) and clinical pregnancy rate (CPR) were equivalent when comparing the two groups (RR 1.01; 95% CI: 0.98 - 1.05; I 2 = 0%, n = 1480, low certainty, and RR 1.00; 95% CI: 0.97 - 1.03; I2 = 0%, n = 2355, low certainty, respectively). A significantly lower oocyte yield (mean differences (MD) -0.80; 95% CI: -1.28, -0.32; I2 = 83%, n = 2516, very low certainty) and higher rate of cycle cancellation (RR 1.48; 95% CI: 1.08 - 2.02; I2 = 62%, n = 2588, low certainty) was observed in the MOS group. The overall quality of the included studies was low to moderate. Even though strict inclusion criteria were used, the selected studies were heterogeneous in population characteristics and treatment protocols. We found no differences in CLBR between MOS and COS (95% CI: 0.73 - 1.81.). MOS could be considered as a treatment option in low prognosis poor responder patients, given that it results in similar fresh and CLBRs compared with COS. A milder approach is associated with a lower number of oocytes retrieved and a higher cancellation rate, although treatment cost is significantly reduced. Future research should focus on which type of ovarian stimulation may be of benefit in better prognosis women. There were no sources of financial support. N.P.P. received research grants, honoraria for lectures from: Merck Serono, MSD, Ferring Pharmaceuticals, Besins International, Roche Diagnostics, IBSA, Theramex and Gedeon Richter. P.D. received unrestricted grants and honoraria from Merck Serono, MSD and Ferring Pharmaceuticals. I.G.F. received unrestricted grants and honoraria from Merck Serono, MSD, Ferring Pharmaceuticals, Gedeon-Richter and IBSA. P.M.B. reported no conflict of interest. CRD42020167260.

The effects of foods on LDL cholesterol levels: A systematic review of the accumulated evidence from systematic reviews and meta-analyses of randomized controlled trials

AimsTo systematically evaluate the evidence regarding the effects of foods on LDL cholesterol levels and to compare the findings with current guidelines. Data synthesisFrom inception through June 2019, we searched PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials for guidelines, systematic reviews, and RCTs (for coffee intake only) of at least 13 days duration. Additionally, we searched Trip database for guidelines from 2009 through Oct 2019. Language was restricted to English. The strength of evidence was evaluated using The Grading of Recommendations Assessment, Development, and Evaluation (GRADE). A total of 37 guidelines, 108 systematic reviews, and 20 RCTs were included. With high evidence, foods high in unsaturated and low in saturated and trans fatty acids (e.g. rapeseed/canola oil), with added plant sterols/stanols, and high in soluble fiber (e.g. oats, barley, and psyllium) caused at least moderate (i.e. 0.20–0.40 mmol/L) reductions in LDL cholesterol. Unfiltered coffee caused a moderate to large increase. Soy protein, tomatoes, flaxseeds, and almonds caused small reductions. With moderate evidence, avocados and turmeric caused moderate to large reductions. Pulses, hazelnuts, walnuts, high-fiber/wholegrain foods, and green tea caused small to moderate reductions, whereas sugar caused a small increase. Other identified foods were either neutral or had low or very low evidence regarding their effects. ConclusionsSeveral foods distinctly modify LDL cholesterol levels. The results may aid future guidelines and dietary advice for hypercholesterolemia.

Recommendations for SARS-CoV-2/COVID-19 testing: a scoping review of current guidance

BackgroundTesting used in screening, diagnosis and follow-up of COVID-19 has been a subject of debate. Several organisations have developed formal advice about testing for COVID-19 to assist in the control...

A Meta-Analysis of the Prognostic Value of Abnormally Expressed lncRNAs and Correlation with Clinicopathological Characteristics in Glioma

Objectives: Abnormal expression of lncRNAs are involved in the occurrence and development of glioma. Thus, we conducted a meta-analysis to clarify the prognostic value of lncRNAs in glioma integrally. Methods: Pubmed, Web of Science, Embase, Cochrane Library, Clinical Trial.gov and Trip database were searched. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated in the analysis of prognostic indicators. Odds ratio (OR) and 95%CI were applied to estimate the association between lncRNAs and clinicopathological features. Results: The expression level of lncRNA was significantly correlated with the OS rate of glioma patients (HR=1.29, 95%CI: 1.03-1.61, p=0.03). The low expression of CASC2 (HR=0.42, 95%CI: 0.27-0.66, p=0.0001) showed a poor prognosis of glioma patients. MALAT1 (HR=1.42, 95%CI: 0.38-5.29, p=0.60), HOTAIR (HR=1.70, 95%CI: 0.69-4.21, p=0.25) and TUSC7 (HR=1.81, 95%CI: 0.87-3.75, p=0.11) have no statistical significance for the prognosis of glioma patients. The high expression of lncRNA was related to WHO staging (OR=0.31, 95%CI: 0.19-0.50, p<0.00001), EGFR expression (OR=3.14, 95%CI: 1.70-5.77, p=0.0002) and IDH1 status (OR=0.33, 95% CI: 0.12-0.93, p=0.04), while unrelated to age (OR=1.05, 95%CI: 0.78-1.42, p=0.75), gender (OR=1.01, 95%CI: 0.85-1.20, p=0.92), tumor size (OR=0.67, 95%CI: 0.35-1.27, p=0.22), PTEN (OR=0.26, 95%CI: 0.06-1.10, p=0.07), KPS score (OR=1.06, 95%CI: 0.44-2.59, p=0.90), MGMT promoter methylation (OR=2.05, 95%CI: 0.94-4.50, p=0.07) and the recurrence (OR=0.87, 95%CI: 0.42-1.82, p=0.72). Conclusion: Abnormal expression of lncRNAs were related to survival of glioma patients and may serve as potential prognostic indicators in glioma. The higher expression level of lncRNAs, the worse prognosis of glioma. The expression of lncRNA CASC2 is correlated with the prognosis of glioma patients. The higher the expression level of CASC2, the better prognosis. LncRNAs are related to WHO staging, EGFR expression and IDH1 mutation, while unrelated to age, gender, tumor size, PTEN, KPS score, MGMT gene promoter methylation or tumor recurrence. Keywords: LncRNAs, clinicopathological features, glioma, prognosis

Application of Health Behavioral Models in Smoking Cessation - A Systematic Review.

Smoking is a significant risk factor for morbidity and mortality. Health education by health promotion is such a gauge to control tobacco epidemic at both national and multinational levels. The objectives of the study were to systematically review the literature to identify models for health behavior change and evaluate evidence for their effectiveness in smoking cessation. A systematic review of the literature identified four peer-reviewed studies describing two smoking cessation behavioral interventional models (transtheoretical model [TTM] and health belief model [HBM]) between 2008 and 2018. Electronic databases MEDLINE (PubMed) and Google Scholar and Trip database were carried out. There were two randomized controlled trials and two nonrandomized controlled interventional studies. There was a high degree of homogeneity of design, definition of smoking and smoking abstinence, and implementation, followed by comparison of studies. All included studies have evaluated outcome by stage of changes (component of TTM model) and therefore show the reduction of smoking rate. All studies did not have blinding of study participants, leading to a higher risk of bias in the outcome. There was a statistically significant difference between TTM-based interventional group and control group in smoking cessation rate. While comparing HBM- and TTM-based behavioral counseling, there was no statistically significant difference in smoking cessation rate. Both HBM- and TTM-based trainings were found to have positive effects on both smoking cessation and progression between the stages.

Prevalence of dental caries among Indian tribal population – A systematic review

The aim of this systematic review was to assess the burden of dental caries among various tribal populations in India. Relevant studies were included from the period of January 2000 to March 2020. A detailed search strategy was developed for MEDLINE through the use of MeSH terms and was revised for Google Scholar, EBSCO, Cochrane, and TRIP databases. The search generated a total of 1444 articles of which only 14 articles were included in this review. Among the 76 Indian tribes present only, 11 were reported in the review. On the whole, our systematic review showed that there are a high level of heterogeneity and a moderate level of bias in all the studies included. Adequate representation of the tribal population through zone-wise assessment of a particular tribe is recommended in establishing the validity of the results.

Most effective local anesthetic technique for mandibular posterior teeth with irreversible pulpitis: A systematic review and meta-analysis

Introduction: Achieving profound pulpal anesthesia is considered as a keystone in endodontic practice as it benefits both the patient and the dentist for smooth delivery of care. A tooth that has irreversible pulpitis causes severe pain and poses an additional challenge. The aim of the present systematic review is to compare the standard inferior alveolar nerve block with other local anesthesia techniques for effectively anesthetizing the mandibular posterior teeth that present with irreversible pulpitis. Materials and Methods: A systematic review protocol was registered at Prospero. The following databases were searched: PubMed, CINAHL, Cochrane, EBSCO Oral and Dentistry Database, and Trip Database using strict inclusion and exclusion criteria. All randomized control trials on the topic published in the English language only were included. Results: The first search yielded 1213 articles, and after going through extensive screening and eligibility process, only 8 articles were finally selected for the review. There were six articaine infiltration technique groups; two were based on intraosseous technique and one each on Gow-Gates and Vazirani–Akinosi methods. The standard inferior alveolar nerve block was compared with other mandibular anesthesia techniques pooled together. A meta-analysis was carried out to compare inferior alveolar nerve block with the articaine infiltration. The difference among two sets of techniques was found to be nonsignificant (P = 0.07). However, the overall results of the meta-analysis favor articaine infiltration. The study is first of its kind comparing multiple anesthetic techniques in mandibular posterior teeth with irreversible pulpitis. Studies with the highest level of evidence, i.e., randomized controlled trials, were included only. No conclusive inference regarding Gow-Gates block and Vazirani–Akinosi techniques could be drawn on account of limited data. Conclusions: Infiltration and intraosseous appeared to be viable alternative to standard inferior alveolar nerve block in the posterior teeth with irreversible pulpitis.

Enhancing security by two-way decryption of message passing of EMR in public cloud

Encryption is one of the most critical and mandatory technique to provide security in outsourced data. Message passing is the most unsecure place of transfer of crucial information and these messages passing are made end-to-end encryption to avoid a centralised security agent to access the data. Existing methods of encryption only provide end-to-end encryption which is not feasible for certain situations like implementing authentication. When the end-to-end encryption is made, the messages are always not known to the central authentication agent like CBI, in this paper, we provide a two-side decryption algorithm that can be decrypted by two entities (one receiver and the other is the central authentication agent) thus improving the message passing security by allowing the centralised authentication agent to read the transferring words. We implemented this two-way decryption in trip database dataset, and the experiment results prove that our proposed algorithm improves the security of message passing of electronic medical records in public cloud while comparing with existing encryption algorithms. Thus we made with quantitative research based on the previous techniques compared based on the various types of key generation occurs in the algorithms.

Efficacy of Electronic Cigarettes for Smoking Cessation: A Systematic Review and Meta-Analysis.

to synthesize evidence about the efficacy of electronic cigarettes versus Nicotine Replacement Therapy and placebo to quit smoking. We searched for clinical trials with no publication date restriction until December 2019. The search included CENTRAL, MEDLINE, PsycINFO, Science Direct, Center for reviews and dissemination and HTA database and Trip database, clinical trials registries, gray literature and examined the references of relevant articles. Two review authors independently checked the titles and abstracts then the full text of initial hits. Main outcomes were sustained continuous abstinence rate, 7-day point prevalence abstinence rate, sustained reduction of 50% or greater in baseline cigarette consumption and adverse effects. Two review authors independently extracted data and assessed risk of bias using the Cochrane RoB 2 tool. We conducted a random-effects model through the Mantel-Haenszel method. We retrieved 12 trials involving 9863 participants. CO- validated 1-month continuous abstinence rate improved by 33% in the e-cigarettes group (range 6-66%, moderate evidence). We are uncertain if e-cigarettess influence continuous abstinence rate at 3-, 6- and 12 months as well as sustained reduction of 50% or greater in baseline cigarette consumption at different follow-up periods. One study of 884 participants displayed improved 12-month 7-day point abstinence by 46% (range 17%-82%). E-cigarettes may increase or do not affect the proportion of serious adverse effect at 6 and 12 months follow up. Very low certainty evidence supported e-cigarettess to help quit smoking in the short term. There is not enough evidence to determine if e-cigarettess are a safe and efficacious means of smoking cessation in the long term (12+ months).

The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines.

Postpartum anemia can negatively affect maternal health and interfere with early parenting. Thus, it is important to have clear, evidence-informed recommendations on its diagnosis and treatment. To compare global recommendations regarding the appropriate management of postpartum anemia and to highlight similarities and differences. Systematic searches were conducted in the databases PubMed, CINAHL, LILACS, TRIP database, and Scopus, and in the websites of health institutions and scientific societies. Search terms were related to anemia and the postpartum period. Two hundred and eighty papers were identified; the full texts of 30 sets of guidelines were reviewed, with seven being included in the final analysis. Recommendations were extracted through an evaluation of the evidence on the definition, screening, and diagnosis of anemia. The quality of the guidelines was assessed using the AGREE II instrument. Two sets of guidelines have been elaborated by international organizations, and the rest were produced by professional associations within high-resource countries. The discrepancies found in the guidelines are important and affect the definition of anemia, the criteria for screening asymptomatic women, or the criteria guiding treatment. The quality of the guidelines commonly scored between 4 and 6 on a scale of 0 to 7. Recommendations with poor-quality evidence predominated over recommendations with high-quality evidence. This review highlights the need to reach a consensus on the definition of postpartum anemia, to agree on what constitutes a problem for maternal health, and to provide recommendations that reach greater consensus on its diagnosis and treatment.

Ultrasonography relative to Cormack-Lehane in predicting difficult laryngoscopy: a systematic review of diagnostic test accuracy.

The objective of this review is to determine the diagnostic test accuracy of point-of-care ultrasound anterior soft tissue quantification techniques for predicting difficult laryngoscopy in relation to Cormack-Lehane scores. Difficult airway management is a critical challenge for anesthesia providers, and a non-invasive test to confidently predict difficult airway is lacking. When difficult airway is not anticipated, the provider's management of the event deteriorates, resulting in significant morbidity or mortality. This systematic review of the diagnostic efficacy of newer ultrasound techniques has potential to advance difficult airway prediction and patient safety. This review will consider adults 18 years and older presenting for elective surgery, who undergo a preoperative point-of-care ultrasound anterior soft tissue airway examination that is referenced to an intraoperative Cormack-Lehane airway examination, obtained using direct laryngoscopy under general anesthesia. Data sources will include Ovid MEDLINE, Trip Database, Embase, CINAHL Complete, Clinicaltrials.gov, Google Scholar, MedNar, Grey Literature Report, and ProQuest Dissertations and Theses. Only studies published in English after the advent of the Cormack-Lehane reference test (1984) will be included. Studies will be critically appraised using a checklist for studies of diagnostic test accuracy. Details about the index tests, populations, study methods, and outcomes of significance to the review will be extracted. Where possible, sensitivity and specificity will be pooled in statistical bivariate meta-analysis. Diagnostic thresholds will be displayed on a paired forest plot or summary receiver operator characteristic curve, depending on the degree of variability. PROSPERO CRD42020205974.

PP255 Epigenetic Profile Predicts Response To Immunotherapy In Patients With Non-Small-Cell Lung Cancer: An Early Assessment

IntroductionEpigenetics is an innovative discipline that aims to provide biomarkers to aid in early diagnosis, patient risk classification, or outcome prediction. The identification of therapeutic targets is of particular interest in cancer therapy for selecting groups of patients who may benefit most from an intervention. Understanding the relationships between the immune system and tumor cells has led to new immunotherapy-based therapies that provide a promising alternative to conventional cancer therapies. The aim of this study was to conduct an early assessment of a novel epigenetic signature (EPIMMUNE) that could predict response to programmed cell death protein 1 (PD-1) inhibitor immunotherapy in patients with non-small cell lung cancer (NSCLC).MethodsWe identified the novel epigenetic signature EPIMMUNE through the Early Awareness and Alert System, “SINTESIS-new technologies” of the Agencia de Evaluación de Tecnologías Sanitarias in Spain (AETS-ISCIII). A literature search of PubMed, Embase, the Web of Science, the Trip database, the International Clinical Trials Registry Platform, ClinicalTrials.gov, The Cochrane Library, and the Centre for Reviews and Dissemination databases was conducted. Clinical studies on EPIMMUNE published in English or Spanish up to August 2019 were reviewed.ResultsOnly one retrospective study was found. Identification of EPIMMUNE was accomplished through interrogation of the DNA methylation status of CpG sites in 142 samples from adult patients with NSCLC who were treated with PD-1 inhibitors. EPIMMUNE was defined by 301 CpG sites whose methylation status was significantly associated with clinical response (progression-free and overall survival). No studies assessing the long-term clinical utility, impact on therapeutic decision making, or economic implications of EPIMMUNE were found.ConclusionsThe EPIMMUNE signature could provide an accurate and valid biomarker for identifying patients with NSCLC who may benefit from treatment with PD-1 inhibitors. However, the technology is under development, and there is only a single study on detecting the EPIMMUNE epigenetic profile and identifying the DNA methylation profiles associated with increased survival after PD-1 inhibitor therapy. More diagnostic accuracy studies and prospective, long-term trials are needed to evaluate the clinical impact this technology may have on therapeutic decision making. Given the limited evidence available, further research is needed before the technology can be disseminated.

PP262 PapSEEK: Liquid Biopsy For Endometrial And Ovarian Cancer Screening

IntroductionEndometrial and ovarian cancer are the first and second leading causes of death from gynecological cancer in Spain. Survival is generally determined by stage at diagnosis, but there is no test currently used for early detection of both tumor types. PapSEEK is a test developed to diagnose endometrial and ovarian cancer by detecting aneuploidies and somatic mutations commonly associated with both tumor types through DNA next-generation sequencing (NGS) of liquid from Papanicolaou test (Pap smear) samples. The objective of this work was to assess the effectiveness and safety of PapSEEK.MethodsPapSEEK was identified by the Early Awareness and Alert System, “SINTESIS-new technologies”, of the Agencia de Evaluación de Tecnologías Sanitarias in Spain (AETS-ISCIII). An early assessment of the technology was conducted through a literature search of the following databases: PubMed, Embase, the Web of Science, the Trip database, the International Clinical Trials Registry Platform, ClinicalTrials.gov, and The Cochrane Library. Clinical studies on the effectiveness and safety of PapSEEK published up to February 2019 were reviewed.ResultsThe evidence comprised proof of concept and diagnostic accuracy studies, which showed good preliminary results regarding the accuracy of the test for diagnosing endometrial cancer (sensitivity ranged from 0.81 to 0.93), but not for ovarian cancer (sensitivity ranged from 0.33 to 0.45). The specificity for both tumor types ranged from 0.99 to 1.00. Since PapSEEK uses a sampling method that is routinely used in clinical practice (the Pap smear), no evidence was found in the literature on the safety of the test.ConclusionsPapSEEK is a novel technology developed to diagnose endometrial and ovarian cancer by means of DNA-NGS of Pap smear samples. The identified studies showed good preliminary results regarding the ability of the test to diagnose endometrial cancer, but not ovarian cancer. PapSEEK may be useful as a screening tool for endometrial cancer. However, further research on PapSEEK is needed to prospectively evaluate its diagnostic accuracy, compare it with current tests used in the early diagnosis of both cancer types, evaluate its effect on patient survival and disease progression, and measure its economic impact.

Effectiveness of intravenous magnesium sulfate to attenuate hemodynamic changes in laparoscopic surgery: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to determine the effectiveness of intravenous magnesium sulfate when used to attenuate hemodynamic fluctuations associated with the creation of pneumoperitoneum in adults undergoing laparoscopic surgery. Laparoscopic surgery has gained popularity as a result of improved patient outcomes postoperatively, but pneumoperitoneum alters the patient's physiology and hemodynamic profile during the intraoperative period. Magnesium sulfate is a nonopioid agent known for its ability to blunt the physiologic sympathetic response associated with exposure to noxious stimuli. Magnesium sulfate may be efficacious in promoting anesthetic management that optimizes a patient's cardiopulmonary function while minimzing opioid use. Studies with participants at least 18 years old undergoing any elective laparoscopic surgery using pneumoperitoneum with CO2 insufflation were included. Studies were excluded if patients were being treated for pheochromocytoma. Studies eligible for inclusion employed any intravenous dosing strategy of magnesium sulfate, administered at any point in the perioperative period for the purpose of blunting the sympathetic response to creation of a pneumoperitoneum. The comparator utilized was normal saline. A systematic search of MEDLINE, CINAHL, Cochrane Library, Google Scholar, Trip Database, MedNar, Grey Literature Report, ClinicalTrials.gov, and ProQuest Dissertations and Theses was conducted to identify both published and unpublished studies. The search was limited to studies written in the English language and performed on human subjects. Studies were selected for review based on inclusion criteria and were appraised by two reviewers using the appropriate JBI standardized appraisal tool. Data extraction was performed for all outcome variables. Data were pooled using the JBI System for the Unified Management, Assessment and Review of Information. Mean differences (95% confidence interval) were calculated for all continuous variables. Meta-analysis using a fixed effects model was performed at various time points for heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure. Standard GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) evidence assessment was also reported. A total of six randomized controlled trials were included in the review. Meta-analysis of data for biophysical parameters (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) at five minutes, 10 to 15 minutes, 30 minutes after pneumoperitoneum, and at the end of surgery showed a consistent reduction in the magnesium groups compared to placebo. Support for all outcome variables was determined to be high using the GRADE criteria. The administration of magnesium sulfate consistently demonstrated improved hemodynamic measurements during laparoscopic surgery. All doses administered in the included studies proved beneficial compared to placebo. Magnesium sulfate should be considered as an adjunct agent in laparoscopic surgery to blunt the sympathetic nervous system response to surgical stimulation. The quality of the included studies was high, but small sample sizes and selection of healthy participants may limit the generalizability of the results. The use of magnesium sulfate may have improved effects on patients with significant health comorbidities, but the limitations of the included studies related to sample demographics make the evidence inconclusive. PROSPERO (CRD42019139991).

The analysis of the evidence base of the clinical efficiency and safety of acyclovir for topical application

Herpes viruses are a family of DNA viruses, among them herpes simplex virus is the most common (HSV). An important task of modern medicine is effective and safe pharmacotherapy of viral diseases caused by HSV.Aim. To analyze the range of drugs for the topical application in the pharmacotherapy of HSV at the pharmaceutical market of Ukraine, as well as search the evidence base of acyclovir, the leader of the pharmaceutical market.Materials and methods. The analysis of the range of antiherpetic drugs for the topical application was performed according to the analytical system of the study of the pharmaceutical market of Ukraine “Pharmstandard” by the company “Morion”. To analyze the clinical efficiency and safety of the antiherpetic drug “Acyclovir”, the following well-known evidence-based databases were used: Cochrane Library, Trip Database, PubMed, Nice.Results. Antiherpetic drugs for the topical application at the pharmaceutical market of Ukraine for 2016-2018 were quantitatively represented from 17 to 20 TN based on 7 INNs, mainly by foreign manufacturers. Drugs of acyclovir were the most accessible and widely presented at the market. The search for the evidence base of acyclovir for the topical application made it possible to find 7 systematic reviews devoted to the treatment of herpes diseases in the evidence-based medicine databases. Numerous studies have shown that the topical treatment with the acyclovir HSV cream on the lips and in genital herpes is less effective than its systemic application. And the use of acyclovir ointments in the treatment of herpetic keratitis is not inferior in effectiveness to the reference drugs. Conclusions. The analysis of systematic reviews and meta-analyses has shown that the topical treatment with the acyclovir HSV cream is less effective than its systemic application. The effectiveness of the use of acyclovir ointments in the treatment of herpetic keratitis has also been proven.