Oxygen therapy for acute myocardial infarction: A systematic review and meta-analysis

BackgroundPotential benefits or risks of oxygen inhalation for patients with acute myocardial infarction are not fully understood.ObjectiveWe performed this study to systematically assess the effectiveness and safety of oxygen therapy for patients with acute myocardial infarction.DesignA systematic review and meta-analysis.Data sourcesWe searched randomized controlled trials systematically in PubMed, EMBASE, Web of Science and Cochrane Library up to June 2016.Review methodsRandomized controlled trials that estimated the effectiveness and safety of oxygen therapy for patients with acute myocardial infarction were identified by two independent reviewers. The primary outcomes were short-term mortality and recurrent rate of myocardial infarction, and the secondary outcomes were arrhythmia incidence and pain incidence. Relative risks (RRs) and 95% confidence intervals (CIs) were used to measure the pooled data.ResultsA total of five randomized controlled trials were in accordance with inclusion criteria and were included in this meta-analysis. Compared with no oxygen group, the oxygen group did not significantly reduce short-term death (RR: 1.08, 95%CI: 0.31–3.74), and there was moderate heterogeneity (I² = 50.8%, P < 0.107) among studies. We found a significant increase in the rate of recurrent myocardial infarction (RR: 6.73, 95%CI: 1.80–25.17, I² = 0.0%, P = 0.598) in the oxygen group. The oxygen group did not have a significant reduction in arrhythmia (RR: 1.12, 95%CI: 0.91–1.36; I² = 46.2%, P < 0.156) or pain (RR: 0.97, 95%CI: 0.91–1.04; I² = 7.2%, P = 0.340).ConclusionsOxygen inhalation did not benefit patients with acute myocardial infarction with normal oxygen saturation. It may increase the rate of recurrent myocardial infarction. High quality trials with larger sample sizes are required.     

Wenxin Keli for Ventricular premature complexes with Heart failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

ObjectiveTo evaluate the efficacy and safety of Wenxin Keli (WXKL) alone or combined with Western medicine in treating ventricular premature complexes (VPCs) with heart failure (HF).MethodsWe searched five databases to identify relevant randomized controlled trials (RCTs) published before May 2016. Two review authors independently searched and screened the literature, extracted the data as well as assessed the methodological quality of the included studies by using criteria from the Cochrane Handbook, and analyzed via using Review Manager 5.3 software.ResultsEight studies of WXKL were included. The results of the Meta-analysis showed that WXKL was more significant on the frequency of VPCs (MD = −427.08, 95% CI: −526.73 ∼ −327.43, P < 0.01), left ventricular ejection fraction (LVEF) (MD = −4.12, 95% CI: 2.97 ∼ 5.27, P < 0.01), the total effect of VPCs (RR = 0.48, 95% CI: 0.34 ∼ 0.69, P < 0.01) and 6-min walking test (MD = 28.05, 95% CI: 19.56 ∼ 36.54, P < 0.01). The treatment group presented a significant reduction at left ventricular end-diastolic diameter (LVED) (MD = −3.94, 95% CI: −6.57 ∼ −1.31, P < 0.01) when treatment time was 12 weeks, however, there was no statistical difference at 8 weeks. In addition, the included trials generally showed low methodological quality.ConclusionsWenxin Keli may be effective and safe for treating VPCs and HF. However, further RCTs of larger scale, multi-center/country, longer follow-up periods, and higher quality are still required to verify the efficacy of Wenxin Keli in ventricular premature beat with heart failure.     

Effect of age of red cells for transfusion on patient outcomes: a systematic review and meta-analysis

Longer storage duration of red blood cell (RBC) units prior to transfusion has been associated with worse outcomes in observational studies. We performed a systematic review, including recently published randomized trials, to determine if storage age of RBCs is associated with mortality, morbidity or adverse events in patients. Searches were performed up to 21^st July 2017 in Medline (OvidSP), 20 July in EMBASE (OvidSP) and June 2017 in Cochrane Library. Eligible studies were randomized controlled trials comparing transfusion of fresher or freshest available with older or standard issue RBCs. Human volunteer and autologous RBC transfusion studies were excluded. Data were extracted from published reports independently by 2 authors and strength of evidence assessed according to GRADE criteria. The primary outcome was latest-reported mortality. Sixteen trials randomizing 31,359 patients were identified. Transfusion with fresher compared with older RBC was not associated with risk of death (relative risk [RR] 1.04, 95% CI 0.98-1.09; P = .20, I² = 0%, high quality evidence), but was associated with higher risk of transfusion reactions (RR 1.35, 95% CI 1.04-1.76; P = .02; I² = 0%; high quality evidence) and infection (RR 1.08, 95% CI 1.00-1.17; P = .05; I² = 0%, moderate evidence). Trial sequential analysis showed required information size has now been reached to exclude a 10% relative risk increase or decrease in mortality. Transfusion of fresher RBCs is not associated with decreased risk of death but is associated with higher rates of transfusion reactions and possibly infection. The current evidence does not support a change from current usual transfusion practice.     

Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis

ObjectiveTo systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke.MethodsThis meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies.ResultsThree studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD] = −1.89, 95% confidence interval [CI] −2.44 to −1.34; I² 79%, P < 0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD = 3.50, 95% CI −3.45 to 10.45; I² 54.7%, P = 0.32), shoulder flexion (MD = −1.20, 95% CI −8.95 to 6.55; I² 0%, P = 0.76) or wrist extension (MD = −0.32, 95% CI −6.98 to 5.75; I² 38.5%, P = 0.92). No data were available concerning the mobility of other joints.ConclusionThis meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed.Clinical Trial RegistrationPROSPERO (CRD42017078784).     

Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis

ObjectivePreventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings.MethodsA literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model.ResultsOf the 1,056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95%CI: 0.19-0.45, P < 0.01). We found no significant difference between results of studies conducted in intensive care settings (RR = 0.25, 95%CI: 0.15-0.43, P < 0.01) and non-intensive care settings (RR = 0.38, 95%CI: 0.17-0.83, P = 0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95%CI: 0.20-0.48, P < 0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95%CI: 0.01-0.73, P = 0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27).ConclusionThe present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.     

The effect of Chinese herbal medicine on hemorrhagic shock: A systematic review and meta-analysis

BackgroundChinese herbal medicine (CHM) has been widely used in the treatment of hemorrhagic shock (HS) in China. Many controlled trials have been undertaken to investigate its efficacy.ObjectiveTo evaluate the effectiveness and safety of CHM for Hemorrhagic Shock patients.MethodsWe screening the Web of ScienceDirect database, PubMed, the Cochrane Library, EMBASE, China Biomedical Database web (CBM), China National Knowledge Infrastructure (CNKI) and WanFang database (WF), from inception to January 2015. All the randomized controlled trials (RCTs) that compared CHM plus conventional therapy with conventional therapy alone for HS patients were included. Meta-analysis on included studies was performed using fixed-effects model with RevMan 5.2. Risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was used as effect measure. STATA 12.0 was used for publication bias.ResultsFifteen RCTs involving 1076 participants were included in the meta-analysis. CHM combined with conventional therapy was tested to be more effective in reduce mortality (RR = 0.24, 95%CI:0.13–0.46, P < 0.0001), reduce the incidence of MODS (RR = 0.47, 95%CI: 0.34–0.66,P < 0.00001), symptomatic improvement: increase blood pressure (BP) (MD = 8.83, 95%CI:6.82–10.84,P < 0.00001), regulate heart rate (MD = −7.6,95%CI:−9.17 to −6.02,P < 0.00001), increase urine volume (MD = 7.26, 95%CI:5.00–9.53, P < 0.00001), compared with conventional therapy alone. No serious adverse events were reported.ConclusionsCHM combined with conventional therapy seems to be more effective on HS patients. However, the analysis results should be interpreted with caution due to the low methodological quality of the included trials. Future, the rigorously designed, high methodological quality, multicenter and large-scale trials are needed to confirm these conclusions.     

Safety of the reuse of needles for subcutaneous insulin injection: A systematic review and meta-analysis

ObjectiveMany people with diabetes often reuse disposable needles for subcutaneous insulin injection. We aimed to identify, critically appraise and summarize the available evidence about the safety of this practice.DesignSystematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Data sourcesMEDLINE (via PubMed), CINALH (via EBSCO), SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials and Open Grey were searched from their inception to December 2015, with no language restrictions.Review methodsEpidemiologic and experimental studies assessing adverse effects of reusing needles in people of any age or sex, with or without diabetes, were included. Two reviewers independently assessed the methodological quality of included studies using a multi-design tool.ResultsIn total, 25 studies were included. All studies had a high risk of bias and data from only nine studies could be pooled. Five studies showed no association between infection at site of injection and reuse of needles (risk difference = −0.00; 95% confidence interval = −0.12–0.11; P = 0.99); heterogeneity between these studies was substantial (I² = 66%; P = 0.02). Five cross-sectional studies showed an association between lipohypertrophy and needle reuse (risk difference = 0.16, 95% confidence interval = 0.05–0.28, P = 0.006); there was strong evidence of heterogeneity between these studies (I² = 87%; P < 0.001). Pooled data of two studies with no evidence of heterogeneity between them showed more perceived pain among reusers (risk difference = 0.24; 95% confidence interval = 0.06–0.43; P = 0.006). Reusing a pen needle or disposable syringe-needle was not associated with worse glycaemic control.ConclusionsThere is currently no clear scientific evidence to suggest for or against the reuse of needles for subcutaneous insulin injection. This practice is very common among people with diabetes; consequently, further research is necessary to establish its safety.     

Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: A systematic review and meta-analysis

BackgroundKnowledge of the optimal protocol and safety of particularly high-intensity exercise applied to individuals with stroke is lacking.ObjectiveThis systematic review and meta-analysis aimed to investigate the effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors.MethodsWe performed a systematic electronic search for articles in MedLine via PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and SPORTSDiscus up to April 1, 2019. Peak oxygen consumption (VO₂peak), 6-min walk test (6MWT), fastest 10-m walk test (10MWT), and adverse events were assessed. The standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) were used to compute the effect size, and subgroup analysis was conducted to test the consistency of results as well as sensitivity analysis to assess the robustness of the results. The quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsWe included 17 studies (PEDro score ≥ 4) in the meta-analysis. Post-intervention, high-intensity exercise had a significant effect on peak oxygen uptake (VO₂peak; SMD = 0.56, P < 0.01, I² = 8%; WMD = 2.53 mL/kg/min; high quality of evidence) and 6MWT (SMD = 0.26, P < 0.01, I² = 40%; WMD = 17.08 m; moderate quality of evidence) but not fastest 10MWT (SMD = 0.33, P = 0.27, I² = 77%; WMD = 0.05 m/s; low quality of evidence). Subgroup analysis showed better effects of higher-intensity treadmill training (≥ 70% heart rate reserve/VO₂peak) for a longer duration (≥ 12 weeks) on VO₂peak and 6MWT in sub-acute or chronic stroke survivors. The high-intensity exercise and control groups did not differ in adverse events including falls [odds ratio (OR) 1.40, P = 0.35, I² = 11%; low quality of evidence], pain (OR 3.34, P = 0.09, I² = 0%; moderate quality of evidence), or skin injuries (OR 1.08, P = 0.90, I² = 0%; low quality of evidence).ConclusionsOur meta-analysis suggests that high-intensity exercise is beneficial for cardiorespiratory fitness in stroke survivors and might be safe as a novel intervention in cardiopulmonary rehabilitation after stroke.     

Cannabinoids for spasticity due to multiple sclerosis or paraplegia: A systematic review and meta-analysis of randomized clinical trials

ObjectivesSpasticity remains highly prevalent in patients with spinal cord injury and multiple sclerosis. To summarize the effects of cannabinoids compared with usual care, placebo for spasticity due to multiple sclerosis (MS) or paraplegia.MethodsSearches of MEDLINE, EMBASE, CENTRAL and LILACS to March 2017 were performed to identify randomized controlled trials. The primary outcomes were spasticity and spasm frequency. The criteria were any patient with MS and spasticity affecting upper or lower limbs or both, and that had a confirmed diagnosis of MS based on validated criteria, or however defined by the authors of the included studies.Results16 trials including 2597 patients were eligible. Moderate-certainty evidence suggested a non-statistically significant decrease in spasticity (standardized mean difference (SMD) 0.36 [confidential interval (CI) 95% −0.17 to 0.88; p = 0.18; I2 = 88%]), and spasm frequency (SMD 0.04 [CI 95% −0.15 to 0.22]). There was an increase in adverse events such as dizziness (risk ratio (RR) 3.45 [CI 95% 2.71–4.4; p = 0.20; I2 = 23%]), somnolence (RR 2.9 [CI 95% 1.98–4.23; p = 0.77; I2 = 0%]), and nausea (RR 2.25 [CI 95% 1.62–3.13; p = 0.83; I2 = 0%]).ConclusionsThere is moderate certainty evidence regarding the impact of cannabinoids in spasticity (average 0.36 more spasticity; 0.17 fewer to 0.88 more) due to multiple sclerosis or paraplegia, and in adverse events such as dizziness (419 more dizziness/1000 over 19 weeks), somnolence (127 more somnolence/1000 over 19 weeks), and nausea (125 more somnolence/1000 over 19 weeks).     

Upper torso pain and musculoskeletal structure and function in women with and without large breasts: A cross sectional study

BackgroundWomen with large breasts frequently experience upper torso pain secondary to their breast size. Evidence is lacking on the underlying causes of this pain. This study investigated whether upper torso pain and musculoskeletal structure and function differed between women with large breasts and women with small breasts.MethodsA linear regression, adjusting for body mass, compared the upper torso pain, thoracic flexion torque due to breast mass, thoracic kyphosis, shoulder active range-of-motion, and scapular retraction muscle strength of 27 women with large breasts (bilateral breast volume > 1200 ml, age 45.9 y SD 9.9 y, BMI 29.0 kg/m² SD 3.8 kg/m²) and 26 women with small breasts (bilateral breast volume < 800 ml, age 43.8 y SD10.9 y, BMI 23.3 kg/m² SD 2.9 kg/m²).FindingsWomen with large breasts reported a higher upper torso pain score (46.6, 95%CI 33.3–58.0 versus 24.1, 95%CI 12.5–37.8), accompanied by a larger flexion torque (5.9 Nm, 95%CI 4.5–5.8 Nm versus 0.9 Nm, 95%CI 0.8–2.4 Nm), greater thoracic kyphosis (34°, 95%CI 31–38° versus 27°, 95% CI 24–31°), decreased shoulder elevation range-of-motion (160°, 95%CI 158–163° versus 169°, 95%CI 166–172°), and decreased scapular retraction endurance-strength (511.4 s, 95%CI 362.2–691.3 s versus 875.8 s, 95%CI 691.5–1028.4 s) compared to the women with small breasts.InterpretationDifferences in the upper torso posture, range-of-motion, and muscle strength of women with large breasts provides insight into underlying causes of their musculoskeletal pain. This information can be used to develop evidence-based assessment and treatment strategies to relieve and prevent symptom progression.     

A systematic review and meta-analysis of the herbal formula Buzhong Yiqi Tang for stable chronic obstructive pulmonary disease

ObjectiveTo systematically evaluate the efficacy and safety of Buzhong Yiqi Tang (BZYQT) for stable chronic obstructive pulmonary disease (COPD).MethodsThree electronic English databases (PubMed, EMBASE and CENTRAL) and four Chinese databases (CBM, CNKI, CQVIP and WFMO) were searched from their inceptions until 30th June 2016. Participants were diagnosed with COPD according to the Chinese Medical Association’s COPD diagnosis and treatment guidelines or Global Initiative for Chronic Obstructive Lung Disease (GOLD), and were in stable stage. Randomized controlled trials (RCTs) of oral BZYQT, alone or combined with conventional treatment, compared with conventional treatment alone or plus placebo were included in the review. Clinical improvement and the six-minute walking test (6MWT) were the primary outcome measures. The secondary outcome measures were defined as forced expiratory volume in one second (FEV1), forced vital capacity (FVC), respiratory muscle strength index with maximum inspiratory pressure (MIP), COPD Assessment Test (CAT), and frequency of acute exacerbations. To assess risk of bias the Cochrane, Risk of Bias tool was used, and statistical analysis was performed using RevMan 5.3.0 software.ResultsSixteen studies (1400 participants) were included. The results of meta-analysis indicated patients receiving BZYQT alone or BZYQT in combination with conventional treatment showed a significant increase in clinical improvement (RR 1.25, 95% CI 1.18 to 1.33, I² = 0%), enhanced exercise capacity 6MWT (MD 51.22 m, 95% CI 45.56 to 56.89, I² = 44%), improved lung function FVC (L) (MD 0.26 liters, 95% CI 0.18 to 0.33, I² = 37%), reduced respiratory muscle fatigue MIP (MD 0.46 liters, 95% CI 0.11 to 0.80, I² = 0%), and improved quality of life CAT (MD −2.56 points, 95% CI −3.40 to −1.72, I² = 0%) when compared with conventional treatment alone, or plus placebo. BZYQT also showed small but significant improvements in FEV1% and decreased acute exacerbations of COPD. Four studies reported that no adverse events occurred, other studies did not mention adverse events. The finding should be considered with caution because the included studies had methodological shortfalls.ConclusionsBZYQT improves clinically important outcomes for patients with stable COPD, such as improved clinical symptoms, exercise capacity, lung function and quality of life. Moreover, it has an excellent safety profile. However further evaluation is needed to validate these preliminary findings in high quality RCTs.     

Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational,multicenter, cross-sectional study

ObjectivesTo investigate if burnout in the Intensive Care Unit (ICU) is influenced by aspects of personality, religiosity and job satisfaction.Research methodologyCross-sectional study, designed to assess burnout in the ICU and to investigate possible determinants. Three different questionnaires were used: the Malach Burnout Inventory, the Eysenck Personality Questionnaire and the Spiritual/Religious Attitudes Questionnaire. Predicting factors for high burnout were identified by multivariate logistic regression analysis.Setting/ParticipantsThis national study was addressed to physicians and nurses working full-time in 18 Greek ICU departments from June to December 2015.ResultsThe participation rate was 67.9% (n = 149) and 65% (n = 320) for ICU physicians and nurses, respectively). High job satisfaction was recorded in both doctors (80.8%) and nurses (63.4%). Burnout was observed in 32.8% of the study participants, higher in nurses compared to doctors (p < 0.001). Multivariate analysis revealed that neuroticism was a positive and extraversion a negative predictor of exhaustion (OR 5.1, 95%CI 2.7–9.7, p < 0.001 and OR 0.49, 95%CI 0.28–0.87, p = 0.014, respectively). Moreover, three other factors were identified: Job satisfaction (OR 0.26, 95%CI 0.14–0.48, p < 0.001), satisfaction with current End-of-Life care (OR 0.41, 95%CI 0.23–0.76, p = 0.005) and isolation feelings after decisions to forego life sustaining treatments (OR 3.48, 95%CI 1.25–9.65, p = 0.017).ConclusionsPersonality traits, job satisfaction and the way End-of-Life care is practiced influence burnout in the ICU.     

Protective isolation precautions for the prevention of nosocomial colonisation and infection in burn patients: A systematic review and meta-analysis

ObjectivesTo assess the impact of protective isolation precautions on nosocomial colonisation and infection rates in burn patients.Research methodologyA systematic review and meta-analysis were performed of studies identified through Pubmed and Web of Science. Only articles in English were considered. The Downs and Black tool was used to evaluate their methodological quality. Random-effects meta-analysis obtained pooled risk ratios (RRs) and 95% confidence intervals (CIs) of nosocomial colonisation and infection rates.ResultsFive eligible before-after studies were identified, encompassing a total of 3033 patients (1192 in the experimental group; 1841 in the control group). Varying protective isolation precautions were investigated, resulting in high clinical heterogeneity. Quality assessment revealed overall poor methodological quality. Protective isolation significantly reduces combined colonisation and infection rates compared to baseline care (RR 0.52, 95% CI 0.40–0.69; P < 0.0001). Subgroup analyses indicated significant reductions in both nosocomial colonisation (RR 0.65, 95% CI 0.51–0.83; P = 0.02) and infection rates (RR 0.53, 95% CI 0.49–0.58; P < 0.0001).ConclusionsProtective isolation precautions appear to decrease the risk of colonization and infection in burn patients. Because of the absence of higher quality study designs, clinical heterogeneity and the small number of studies involved, these results must be interpreted cautiously.     

Tanreqing injection for acute bronchitis disease: A systematic review and meta-analysis of randomized controlled trials

BackgroundAcute bronchitis (AB) is one of the common diseases. Tanreqing injection (TRQ) was widely used to treat patients with acute bronchitis, and many randomized controlled trials have been conducted to investigate its efficacy.ObjectiveThe purpose of this systematic review is to evaluate the efficacy and safety of TRQ for AB.MethodsEight English and Chinese electronic databases, up to October 2014, were searched to identify randomized controlled trials on TRQ for AB. Two reviewers independently extracted data and assessed the quality of each trial by using Cochrane handbook. Meta-analysis was carried out by using Review Manager software.ResultA total of 49 trials with 5131 participants were collected. Data of three main outcomes were pooled and analyzed as following: (1) effective rates: TRQ versus antibiotics (RR 1.12; 95% CI 1.05, 1.18; P = 0.0002); TRQ plus antiviral drugs versus antiviral drugs (RR: 5.12; 95% CI 3.03, 8.66; P < 0.00001); TRQ plus antibiotics versus antibiotics (RR 3.46; 95% CI 2.59, 4.62; P < 0.00001); TRQ versus antibiotics plus antiviral drugs (RR 2.03; 95% CI 1.10, 3.74; P = 0.02); TRQ plus conventional therapy versus conventional therapy alone (RR 1.21; 95% CI 1.15, 1.27; P < 0.00001). (2) Time for fever resolution: TRQ plus antiviral drugs versus antiviral drugs (MD: −1.08; 95% CI −1.59, −0.57; P < 0.00001); TRQ plus antibiotics versus antibiotics (MD −1.33; 95% CI −1.81, −0.86; P < 0.00001); TRQ versus antibiotics plus antiviral drugs (MD −0.88; 95% CI −1.25, −0.51; P < 0.00001); TRQ plus conventional therapy versus conventional therapy alone (MD −1.06; 95% CI −1.13, −0.98; P < 0.00001). (3) Resolution of cough: TRQ plus antiviral drugs versus antiviral drugs (MD: −2.09; 95% CI −3.11, −1.43; P < 0.00001); TRQ plus antibiotics versus antibiotics (MD: −2.65; 95% CI −2.88, −2.42; P < 0.00001); TRQ plus conventional therapy versus conventional therapy alone (MD −1.84; 95% CI −2.85, −0.83; P = 0.0003). Four trials described the adverse drug reactions of TRQ, while no severe adverse drug reactions reported.ConclusionsAs a therapy for AB, TRQ has potentially beneficial effect in improving effective rates, reducing the time to resolution of fever, cough, crackles and absorption of shadows on X-ray. However, due to the limitations of methodological quality of the included trials, it is difficult to make a conclusive recommendation about TRQ treating patients with AB. Further rigorous clinical trials are warranted to evaluate the efficacy and safety of TRQ.     

Depth of anaesthesia monitoring during procedural sedation and analgesia: A systematic review and meta-analysis

ObjectivesProcessed electroencephalogram-based depth of anaesthesia monitoring devices provide an additional method to monitor level of consciousness during procedural sedation and analgesia. The objective of this systematic review was to determine whether using a depth of anaesthesia monitoring device improves the safety and efficacy of sedation.DesignSystematic review and meta-analysis.Data sourcesElectronic databases (CENTRAL; Medline; CINAHL) were searched up to May 2015.Review methodsRandomised controlled trials that compared use of a depth of anaesthesia monitoring device to a control group who received standard monitoring during procedural sedation and analgesia were included. Study selection, data extraction and risk of bias assessment (Cochrane risk of bias tool) were performed by two reviewers. Safety outcomes were hypoxaemia, hypotension and adverse events. Efficacy outcomes were amount of sedation used, duration of sedation recovery and rate of incomplete procedures.ResultsA total of 16 trials (2138 participants) were included. Evidence ratings were downgraded to either low or moderate quality due to study limitations and imprecision. Meta-analysis of 8 trials (766 participants) found no difference in hypoxaemia (RR 0.87; 95% CI = 0.67–1.12). No statistically significant difference in hypotension was observed in meta-analysis of 8 trials (RR 0.96; 95% CI = 0.54–1.7; 942 participants). Mean dose of propofol was 51 mg lower for participants randomised to depth of anaesthesia monitoring (95% CI = −88.7 to −13.3 mg) in meta-analysis of results from four trials conducted with 434 participants who underwent interventional endoscopy procedures with propofol infusions to maintain sedation. The difference in recovery time between depth of anaesthesia and standard monitoring groups was not clinically significant (standardised mean difference −0.41; 95% CI = −0.8 to −0.02; I² = 86%; 8 trials; 809 participants).ConclusionsDepth of anaesthesia monitoring did impact sedation titration during interventional procedures with propofol infusions. For this reason, it seems reasonable for anaesthetists to utilise a depth of anaesthesia monitoring device for select populations of patients if it is decided that limiting the amount of sedation would be beneficial for the individual patient. However, there is no need to invest in purchasing extra equipment or training staff who are not familiar with this technology (e.g. nurses who do not routinely use a depth of anaesthesia monitoring device during general anaesthesia) because there is no high quality evidence suggestive of clear clinical benefits for patient safety or sedation efficacy.     

An evidence map of yoga for low back pain

ObjectiveYoga is being increasingly studied as a treatment strategy for a variety of different clinical conditions, including low back pain (LBP). We set out to conduct an evidence map of yoga for the treatment, prevention and recurrence of acute or chronic low back pain (cLBP).MethodsWe searched Medline, Cochrane Database of Systematic Reviews, EMBASE, Allied and Complementary Medicine Database and ClinicalTrials.gov for randomized controlled trials (RCT), systematic reviews or planned studies on the treatment or prevention of acute back pain or cLBP. Two independent reviewers screened papers for inclusion, extracted data and assessed the quality of included studies.ResultsThree eligible systematic reviews were identified that included 10 RCTs (n = 956) that evaluated yoga for non-specific cLBP. We did not identify additional RCTs beyond those included in the systematic reviews. Our search of ClinicalTrials.gov identified one small (n = 10) unpublished trial and one large (n = 320) planned clinical trial. The most recent good quality systematic review indicated significant effects for short- and long-term pain reduction (n = 6 trials; standardized mean difference [SMD] −0.48; 95% CI, −0.65 to −0.31; I² = 0% and n = 5; SMD −0.33; 95% CI, −0.59 to −0.07; I² = 48%, respectively). Long-term effects for back specific disability were also identified (n = 5; SMD −0.35; 95% CI, −0.55 to −0.15; I² = 20%). No studies were identified evaluating yoga for prevention or treatment of acute LBP.ConclusionEvidence suggests benefit of yoga in midlife adults with non-specific cLBP for short- and long-term pain and back-specific disability, but the effects of yoga for health-related quality of life, well- being and acute LBP are uncertain. Without additional studies, further systematic reviews are unlikely to be informative.     

A meta-analysis of the bradykinin B2 receptor gene − 58C/T polymorphism with hypertension

Background and objectiveNumerous studies have attempted to associate ? 58C/T polymorphism of bradykinin B2 receptor gene (BDKRB2) with hypertension, whereas results were often irreproducible. We performed a meta-analysis aiming to provide a comprehensive evaluation of this polymorphism and hypertension.MethodsCase-control reports published in English were searched totaling four studies with six populations (823 cases and 916 controls). Random-effects model was applied irrespective of between-study heterogeneity, and study quality was assessed in duplicate.ResultsCompared with ? 58C allele carriers, those with ? 58T allele had a lower yet nonsignificant risk for hypertension (OR = 0.86; 95% CI: 0.68–1.09; P = 0.21). Lack of significance persisted after combining those with genotypes ? 58TC and ? 58TT together (OR = 0.87; 95% CI: 0.67–1.09; P = 0.21) or with ? 58TC and ? 58CC together (OR = 0.75; 95% CI: 0.48–1.18; P = 0.22) in association with hypertension. Sensitivity analyses by race indicated that comparison of ? 58T versus ? 58C generated a protective effect for hypertension in Asians (OR = 0.77; 95% CI: 0.58–1.02; P = 0.07) and African-Americans (OR = 0.65; 95% CI: 0.43–0.98; P = 0.04), but a risk effect in Caucasians (OR = 1.22; 95% CI: 0.92–1.61; P = 0.17). No publication bias was observed.ConclusionsOur results suggested that ? 58T allele exhibited a protective effect on hypertension in Asians and African-Americans, yet a risk effect in Caucasians.     

Association of fentanyl use in rapid sequence intubation with post-intubation hypotension

BackgroundThe anesthesia literature has reported that pre-intubation fentanyl use is associated with post-intubation hypotension which is a risk factor of poor post-emergency department (ED) prognosis. However, little is known about the relations between fentanyl use for intubation and post-intubation hypotension in the ED. We aimed to determine whether pretreatment with fentanyl was associated with a higher risk of post-intubation hypotension in the ED.MethodsWe conducted a secondary analysis of data of ED airway management collected from a multicenter prospective study of 14 Japanese EDs from February 2012 through November 2016. We included all adult non-cardiac-arrest patients who underwent rapid sequence intubation for medical indication. Patients were divided into fentanyl and non-fentanyl groups. The primary outcome was post-intubation hypotension (systolic blood pressure ≤90 mm Hg) in the ED.ResultsOf 1263 eligible patients, 466 (37%) patients underwent pretreatment with fentanyl. The fentanyl group had a higher risk of post-intubation hypotension (17% vs. 6%; unadjusted OR, 1.73; 95%CI, 1.01–2.97; P = 0.048) compared to the non-fentanyl group. In the multivariable analysis adjusting for age, sex, weight, principal indication, sedatives, intubator's specialty, number of intubation attempts, and patient clustering within EDs, the fentanyl group had a higher risk of post-intubation hypotension (adjusted OR, 1.87; 95%CI, 1.05–3.34; P = 0.03) compared to the non-fentanyl group. In the sensitivity analysis using propensity score matching, this association remained significant (OR, 3.17; 95%CI, 1.96–5.14; P < 0.01).ConclusionIn this prospective multicenter study of ED airway management, pretreatment with fentanyl in rapid sequence intubation was associated with higher risks of post-intubation hypotension.     

Association of angiotensin-converting enzyme polymorphism with coronary artery disease in Iranian patients with unipolar depression

ObjectivesMajor depressive disorder (MDD) is an increasingly recognized risk factor of coronary artery disease (CAD). The aim of this study was to assess the relationship between renin-angiotensin system (RAS) genetic polymorphisms and CAD in a sample of depressed Iranian patients.Design and methodsA total of 191 patients with a history of unipolar depression were enrolled in a case/control study. The presence of MDD was reconfirmed at study entry using DSM-IV criteria and CAD was diagnosed by coronary angiography. Genotyping of six RAS genes polymorphisms was performed by a modified PCR-RFLP method.ResultsDD genotype of ACE I/D was independently associated with the incidence of CAD in depressed patients (P = 0.011, OR = 9.41, 95% CI: 1.68–17.81). Moreover, serum creatinine (P = 0.033, OR = 11.91, 95%CI: 7.23–15.62) was an independent predictor of CAD among depressed individuals.ConclusionACE I/D polymorphism may play a major role in the development of CAD amongst Iranian depressed patients.     

The association of gasping and outcome,in out of hospital cardiac arrest: A systematic review and meta-analysis

ObjectiveGasping is common after cardiac arrest, and its frequency decreases over time. The aim of this study was to conduct a meta-analysis to evaluate the association of gasping and survival to discharge in patients who suffered out-of-hospital cardiac arrest.MethodsRelevant studies were identified by searching in PubMed, Medline, Embase, OVID, Web of Science and Google Scholar. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to assess the association of gasping and on out-of-hospital cardiac arrest outcomes. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored.ResultsIndividual patient data was obtained from 10,797 participants suffered out-of-hospital cardiac arrest in five cohort studies of 4 articles. A fixed effects model suggested that patients with gasping were 3.525 times (95% CI: 3.028–4.104; P < 0.01) more likely to survive to discharge than those without gasping, and there was no heterogeneity among studies (P = 0.564). Also it may be a favorable factor for return of spontaneous circulation (RR: 2.170; 95% CI: 1.691, 2.785) with high heterogeneity (Q = 5.26; P = 0.022).ConclusionsFindings of this meta-analysis demonstrated that gasping is common after cardiac arrest, and is associated with increased survival to discharge. Patients who are cardiac arrest with gasping should be promptly resuscitated.