Variations in the origin of the deep femoral artery: A meta‐analysis

The deep femoral artery (DFA) is the largest branch of the femoral artery (FA) and is responsible for vascularization of the thigh muscles. Knowledge of the anatomical variations in its origin point is important for surgeons and interventional radiologists. The aim of our study was to provide a comprehensive evidence‐based assessment of its anatomical properties. An extensive search through the major electronic databases was conducted to find all articles reporting data on the anatomical characteristics of the DFA. No date limits or language restrictions were imposed. A total of 25 articles (n = 2,502 lower limbs) were included in the meta‐analysis. Six different patterns of origin of the DFA from the FA were identified, the most common type being a posterior origin (38.8%, 95% CI 22.8–49.5%). The DFA most commonly branched off in the proximal third of the thigh, with a prevalence of 47.6% (95% CI 35.8–59.2%). The pooled mean distance of the DFA from its point of origin to the mid‐inguinal point was 41.15 mm (95% CI 32.39–53.73). The point and level of origin of the DFA from the FA varies widely in the general population. Owing to this variability, accurate anatomical knowledge regarding the DFA is crucial for clinicians if iatrogenic injuries are to be avoided during procedures in the femoral region. Clin. Anat. 30:106–113, 2017. © 2016 Wiley Periodicals, Inc.     

Obesity aggravates COVID‐19: A systematic review and meta‐analysis

Obesity and COVID‐19 are both worldwide epidemics now. There may be some potential relationships between them, but little is known. This study was done to explore this relationship through literature search, systematic review, and meta‐analysis. Pubmed, Embase, WOS, Cochrane, CNKI, Wanfang, and Sinomed databases were searched to collect literature concerning obesity and COVID‐19. Systematic review and meta‐analysis were conducted after literature screening, quality assessment, and data extraction. A total of 180 articles were initially searched after duplicate removal, and 9 were finally included in our analysis. Results show that severe COVID‐19 patients have a higher body mass index than non‐severe ones (WMD = 2.67; 95% CI, 1.52‐3.82); COVID‐19 patients with obesity were more severely affected and have a worse outcome than those without (OR = 2.31; 95% CI, 1.3‐4.12). Obesity may aggravate COVID‐19.     

Tendon and neurovascular injuries of the distal radius after pinning with Kirschner Wires: A meta‐analysis of cadaveric studies

Tendon and nerve structures are at risk when displaced fractures of the distal radius are pinned using K‐wires. The aim of this meta‐analysis (MA) is to examine the published evidence of such complications in cadavers. Eight studies met our inclusion criteria. The meta‐analytical results were as follows: (a) 2.87% and 30.5% tendon involvement at the radial styloid process (RSP) and the dorso‐radial area of the distal radius, respectively; (b) 3.5% and 1.1% tendon involvement when the percutaneous pinning (PP) and the limited open pinning (LOP) techniques were used, respectively; (c) 16.1% and 3.4% nerve involvement at the RSP and the dorso‐radial area of the distal radius, respectively; (d) in 35.7% the nerve was speared and in 64.3% it touched the K‐wire at the styloid area; (e) 61.3% cephalic vein involvement in the styloid area; (f) the second branch of the sensitive branch of the radial nerve (SBRN) was the closest to a wire inserted into the RSP; (g) the mean (±SD) distance between a branch of the SBRN and a styloid wire was 2.17 ± 0.82 mm. Our results for nerve and tendon injury frequencies in the RSP were close to those in clinical meta‐analytical studies, offering an excellent statistical model of evidence synthesis based on cadaveric studies to assess the frequency of such injuries in clinical practice. However, this cadaveric MA yielded more accurate data than the previously reported clinical MA in assessing the real risk of injury of such structures in the distal radius in terms of their proximity to the inserted K‐wires. Clin. Anat. 28:545–550, 2015. © 2015 Wiley Periodicals, Inc.     

Link between insomnia and perinatal depressive symptoms: A meta‐analysis

Evidence shows the possible link between insomnia and perinatal depressive symptoms. In order to find a convergent quantitative answer, we collected data via the search of Medline, EMBASE and reference tracking, which included nine studies (a total sample of 1,922 women). An aggregate effect size estimate (correlation coefficient) was generated using the comprehensive meta‐analysis software. For the meta‐analytic procedure, a random effects model was set a priori. Moderating factors, including study design, method of assessment of depression, geographical origin of data, publication year, mean age, % married, breastfeeding rate, quality and type of data, % primiparous and history of depression, were examined via categorical or univariate mixed‐effects (method of moments) meta‐regression methods. Heterogeneity and publication bias were examined using standard meta‐analytic approaches. We found a significant, medium‐size relationship between insomnia and perinatal depressive symptoms (point estimate, 0.366; 95% confidence interval [CI], 0.205–0.508; p < 0.001; n = 9) and this was significantly heterogeneous (Q, 118.77; df, 8; p < 0.001; I², 93.26%). The effect size estimate was significant for studies reporting no history of depression (point estimate, 0.364; 95% CI, 0.035–0.622; p < 0.05; n = 5) and for study design. With meta‐regression, no moderating factor (age, marriage rate, breastfeeding rate, pregnancy history or publication year) significantly mediated the effect size estimate. The depression assessment scale used, but not other categorical variables, explained the magnitude of heterogeneity. We found that insomnia during the perinatal period is associated with depressive symptoms, which warrants screening pregnant mothers for insomnia and depression.     

Associations between FCGR polymorphisms and immune thrombocytopenia: A meta‐analysis

Several studies already explored associations between Fc gamma receptor (FCGR) polymorphisms and immune thrombocytopenia (ITP), but the results of these studies were not consistent. Consequently, we conducted a meta‐analysis of relevant studies to better analyse the effects of FCGR polymorphisms on individual susceptibility to ITP. PubMed, Web of Science, Embase and CNKI were searched for eligible studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Totally 17 studies were eligible for analyses (1200 cases and 1723 controls). Significant associations with ITP were observed for FCGR3A F158V polymorphism in dominant (P < 0.0001, OR = 0.47, 95% CI 0.39‐0.57), recessive (P < 0.0001, OR = 2.03, 95% CI 1.58‐2.61), overdominant (P < 0.0001, OR = 1.42, 95% CI 1.19‐1.69) and allele (P < 0.0001, OR = 0.58, 95% CI 0.51‐0.65) models in overall analyses. But we did not observe any significant associations with ITP for FCGR2A H131R and FCGR2B I232T polymorphisms in overall analyses. Subgroup analyses by ethnicity yielded similar positive results for FCGR3A F158V polymorphism in both Asians and Caucasians. Furthermore, subgroup analyses by type of disease revealed that FCGR2A H131R polymorphism was significantly associated with childhood‐onset ITP, and FCGR3A F158V polymorphism was significantly associated with both childhood‐onset and adult‐onset ITP. In summary, our findings suggested that FCGR2A H131R polymorphism may serve as a potential genetic biomarker of childhood‐onset ITP, while FCGR3A F158V polymorphism may serve as a potential genetic biomarker of both childhood‐onset and adult‐onset ITP.     

No association of genetic variants in BDNF with major depression: A meta‐ and gene‐based analysis

Major depressive disorder (MDD) is a complex psychiatric condition with strong genetic predisposition. The association of MDD with genetic polymorphisms, such as Val66Met (rs6265), in the brain derived neurotrophic factor (BDNF), have been reported in many studies and the results were conflicting. In this study, we performed a systematic literature search and conducted random‐effects meta‐analysis to evaluate genetic variants in BDNF with MDD. A gene‐based analysis was also conducted to investigate the cumulative effects of genetic polymorphisms in BDNF. A total of 28 studies from 26 published articles were included in our analysis. Meta‐analysis yielded an estimated odds ratio (OR) of 0.96 (95% CI: 0.89–1.05; P = 0.402) for Val66Met (rs6265), 0.83 (95% CI: 0.67–1.04; P = 0.103) for 11757C/G, 1.16 (95% CI: 0.74–1.82; P = 0.527) for 270T/C, 1.03 (95% CI: 0.18–5.75; P = 0.974) for 712A/G and 0.98 (95% CI: 0.85–1.14; P = 0.831) for rs988748. The gene‐based analysis indicated that BDNF is not associated with MDD (P > 0.21). Our updated meta‐ and novel gene‐based analyses provide no evidence of the association of BDNF with major depression. © 2012 Wiley Periodicals, Inc.     

A meta‐analysis of the effects of internet‐ and computer‐based cognitive‐behavioral treatments for anxiety

Internet‐and computer‐based cognitive‐behavioral treatments have been introduced as novel approaches to deliver standard, quality treatment that may reduce barriers to care. The purpose of this review is to quantitatively summarize the literature examining the treatment effects of Internet‐ or computer‐based treatment (ICT) on anxiety. Nineteen randomized controlled ICT trials were identified and subjected to fixed and random effects meta‐analytic techniques. Weighted mean effect sizes (Cohen's d) showed that ICT was superior to waitlist and placebo assignment across outcome measures (ds=.49–1.14). The effects of ICT also were equal to therapist‐delivered treatment across anxiety disorders. However, conclusions were limited by small sample sizes, the rare use of placebo controls, and other methodological problems. In addition, the number of available studies limited the opportunity to conduct analyses by diagnostic group; there was preliminary support for the use of ICT for panic disorder and phobia. Large, well‐designed, placebo‐controlled trials are needed to confirm and extend the results of this meta‐analysis. © 2008 Wiley Periodicals, Inc. J Clin Psychol 65: 1–21, 2009.     

Prevalence and burden of dengue infection in Europe: A systematic review and meta‐analysis

Imported dengue cases are thought to be important source for transmission of autochthonous dengue in Europe. We aimed to investigate the prevalence of dengue in Europe, its severity, and factors associated with it. Out of 5287 reports resulting from the search of nine electronic search engines, we included 174 reports. Meta‐analysis was performed by pooling the event rate and 95% confidence interval (CI). Subgroup meta‐analyses were performed to test the effect of the covariates. Among 20 284 reported cases, 130 autochthonous dengue cases were reported in eight countries with the highest number of cases reported in Israel (n = 41). The highest number of imported dengue cases was in Germany (n = 6638) then France (n = 6610). Most cases were imported from Southeast Asia (n = 2533) especially Thailand. Dengue infection cases increased with time, with 4157 cases reported in 2010. Second dengue infection and dengue serotype 2 were positively associated with dengue severity. The proportion of autochthonous dengue infection increased with time to reach 14.8% (95% CI, 7.6‐26.9) in 2015. The pooled proportion of severe dengue was 6.18% (95% CI, 2.7‐13.3). The United Kingdom and France had the highest rate of severe dengue (25%; 95% CI, 6.3‐62.3, and 21.4%; 95% CI, 24.5‐18.7, respectively). This change may be due to the surveillance efforts instead of true biological phenomenon; thus, the lack of surveillance is an obvious limitation. In conclusion, imported and autochthonous dengue has been increasing in Europe. Severe dengue began to increase recently in Europe. European health authorities should pay more attention for the diagnosis and control of dengue infection among returning travelers, especially the travelers with fever of unknown origin.     

Birth prevalence of achondroplasia: A systematic literature review and meta‐analysis

Achondroplasia is a genetic disorder that results in disproportionate short stature. The true prevalence of achondroplasia is unknown as estimates vary widely. This systematic literature review and meta‐analysis was conducted to better estimate worldwide achondroplasia birth prevalence. PubMed, Embase, Scielo, and Google Scholar were searched, complemented by manual searching, for peer‐reviewed articles published between 1950 and 2019. Eligible articles were identified by two independent researchers using predefined selection criteria. Birth prevalence estimates were extracted for analysis, and the quality of evidence was assessed. A meta‐analysis using a quality effects approach based on the inverse variance fixed effect model was conducted. The search identified 955 unique articles, of which 52 were eligible and included. Based on the meta‐analysis, the worldwide birth prevalence of achondroplasia was estimated to be 4.6 per 100,000. Substantial regional variation was observed with a considerably higher birth prevalence reported in North Africa and the Middle East compared to other regions, particularly Europe and the Americas. Higher birth prevalence was also reported in specialized care settings. Significant heterogeneity (Higgins I² of 84.3) was present and some indication of publication bias was detected, based on visual asymmetry of the Doi plot with a Furuya‐Kanamori index of 2.73. Analysis of pooled data from the current literature yields a worldwide achondroplasia birth prevalence of approximately 4.6 per 100,000, with considerable regional variation. Careful interpretation of these findings is advised as included studies are of broadly varying methodological quality.     

Psychological interventions to improve sleep in college students: A meta‐analysis of randomized controlled trials

Sleep disturbances and insomnia are common in college students, and reduce their quality of life and academic performance. The aim of this meta‐analysis was to evaluate the efficacy of psychological interventions aimed at improving sleep in college students. A meta‐analysis was conducted with 10 randomized controlled trials with passive control conditions (N = 2,408). The overall mean effect size (Hedges’ g) of all sleep‐related outcomes within each trial was moderate to large (g = 0.61; 95% confidence interval: 0.41?0.81; numbers‐needed‐to‐treat = 3). Effect sizes for global measures of sleep disturbances were g = 0.79; 95% confidence interval: 0.52?1.06; and for sleep‐onset latency g = 0.65; 95% confidence interval: 0.36?0.94. The follow‐up analyses revealed an effect size of g = 0.56; 95% confidence interval: 0.45?0.66 for the combined sleep‐related outcomes based on three studies. No significant covariates were identified. These results should be interpreted cautiously due to an overall substantial risk of bias, and in particular with regard to blinding of participants and personnel. Nevertheless, they provide evidence that psychological interventions for improving sleep are efficacious among college students. Further research should explore long‐term effects and potential moderators of treatment efficacy in college students.     

50 years of rational‐emotive and cognitive‐behavioral therapy: A systematic review and meta‐analysis

Objective

Rational emotive behavior therapy (REBT), introduced by Albert Ellis in the late 1950s, is one of the main pillars of cognitive‐behavioral therapy. Existing reviews on REBT are overdue by 10 years or more. We aimed to summarize the effectiveness and efficacy of REBT since its beginnings and investigate the alleged mechanisms of change.

Method

Systematic search identified 84 articles, out of which 68 provided data for between‐group analyses and 39 for within‐group analyses.

Results

We found a medium effect size of REBT compared to other interventions on outcomes (d = 0.58) and on irrational beliefs (d = 0.70), at posttest. For the within‐group analyses, we obtained medium effects for both outcomes (d = 0.56) and irrational beliefs (d = 0.61). Several significant moderators emerged.

Conclusion

REBT is a sound psychological intervention. Directions for future studies are outlined, stemming from the limitations of existing ones.

     

Origin and prevalence of the accessory phrenic nerve: A meta‐analysis and clinical appraisal

The accessory phrenic nerve (APN) is a common anatomical variant with differing reports of prevalence in the literature. It can be injured during operative procedures to the neck and thorax or by regional anesthetic techniques in its vicinity. Our aim was to provide a comprehensive evidence‐based assessment of the prevalence and origins of the APN. The databases PubMed, China National Knowledge Infrastructure, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science were searched comprehensively, followed by assessment of eligibility and extraction of data concerning the APN. The data were pooled into a meta‐analysis. A total of 17 studies were included in the meta‐analysis. Fourteen studies (n = 1,941 hemi‐necks) reported data on APN prevalence resulting in an overall pooled prevalence estimate of 36.5%. Nine studies (n = 941 APNs) reported data on the origin of the APN. Most commonly the APN originated from the ansa cervicalis (16.5%) followed by the nerve to the subclavius (15.8%). Subgroup analysis on the basis of laterality and geographic region revealed no statistically significant findings. The APN is a highly variable anatomical structure present in over one third of the population, most often originating from the ansa cervicalis or the nerve to the subclavius. Clinicians need to be aware of the varying constellation of symptoms that can arise from APN injury. Ultimately, knowledge of APN variation could provide for better outcomes and reduction of iatrogenic injuries, particularly in high‐risk patients prone to long‐term complications from diaphragmatic dysfunction. Clin. Anat. 30:1077–1082, 2017. © 2017 Wiley Periodicals, Inc.     

In search of the best evidence for life review therapy to reduce depressive symptoms in older adults: A meta‐analysis of randomized controlled trials

Life review builds on a naturally occurring process in later life and entails attributing meaning to positive and negative memories across the lifespan. The current meta‐analysis focuses on the best evidence of life review as a therapeutic intervention to reduce depressive symptoms in older adults. A systematic literature search resulted in eleven randomized controlled trials. The meta‐analysis showed a large effect. When two outliers were removed, the effect size was moderate and was maintained at three months follow‐up. Heterogeneity was low with no clear publication bias in spite of differences in interventions and study designs. Hence, the best available evidence shows that life review therapy has moderate effects on depressive symptoms in older adults.