Is rifaximin better than nonabsorbable disaccharides in hepatic encephalopathy?: A meta-analysis

Background:The purpose of the present meta-analysis was to compare the efficacy of rifaximin and nonabsorbable disaccharides (NADs) in hepatic encephalopathy (HE).Methods:After the registration of the present meta-analysis on INPLASY, all procedures were performed according to PRISMA 2020. Relevant literature was retrieved on PubMed, Embase, and the Cochrane Library up to September 5, 2021. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the enrolled studies, and Review Manager software (version 5.3) was used to analyze the clinical efficacy, blood ammonia and adverse effects.Results:Six studies with 559 patients were included in the present meta-analysis. There were no significant differences in the basic characteristics of the included studies. Analysis of the complete resolution of HE showed that rifaximin was better than NADs (risk ratio [RR] = 1.87, 95% confidence interval [CI] = 1.03–3.39, P = .04). However, there were no significant differences in mental status (RR = 1.04, 95% CI = 0.92–1.18, P = .53), blood ammonia level (standard mean difference = −0.02, 95% CI = −0.40–0.02, P = .08), or drug adverse drug effects (OR = 0.43, 95% CI = 0.10–1.77, I² = 56%, P = .24) between the rifaximin and NADs treatment groups.Conclusion:Rifaximin is not superior to NADs in the treatment of HE.     

The efficiency and safety of methimazole and propylthiouracil in hyperthyroidism: A meta-analysis of randomized controlled trials

Purpose:The aim of this study was to evaluate the efficiency and safety of methimazole (MMI) and propylthiouracil (PTU) in the treatment of hyperthyroidism.Methods:Articles were searched through the PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and QVIP. The primary outcomes were clinical efficacy and thyroid hormone levels in MMI and PTU groups. The secondary outcomes were liver function indexes and adverse reactions in MMI and PTU groups. Results were expressed as weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs). The Begg test was applied to assess the publication bias.Results:Totally, 16 randomized controlled trials were retained in this meta-analysis with 973 patients receiving MMI and 933 receiving PTU. The levels of triiodothyronine (T₃) (WMD = −1.321, 95% CI: −2.271 to −0.372, P = .006), thyroxine (T₄) (WMD = −37.311, 95% CI: −61.012 to −13.610, P = .002), Free T3 (FT3) (WMD = −1.388, 95% CI: −2.543 to −0.233, P = .019), Free T₄ (FT₄) (WMD = −3.613, 95% CI: −5.972 to −1.255, P = .003), and the risk of liver function damage (OR = 0.208, 95% CI: 0.146–0.296, P < .001) in the MMI group were lower than those in the PTU group. The thyroid-stimulating hormone level (WMD = 0.787, 95% CI: 0.380–1.194, P < .001) and the risk of hypothyroidism (OR = 2.738, 95% CI: 1.444–5.193, P = .002) were higher in the MMI group than those in the PTU group.Conclusions:Although MMI might have higher risk of hypothyroidism than PTU, the efficacy of MMI may be better than PTU in patients with hyperthyroidism regarding reducing T₃, T₄, FT₃, and FT₄ levels, decreasing the risk of liver function damage and increasing the level of thyroid-stimulating hormone.Register number:osf.io/ds637 (https://osf.io/search/).     

Copeptin levels predict left ventricular systolic function in STEMI patients: A 2D speckle tracking echocardiography-based prospective observational study

In the present study, we aimed to investigate whether copeptin values on admission are related to left ventricle (LV) systolic function and its improvement at 6 months in ST-segment elevation myocardial infarction (STEMI) patients.In this single-center, prospective observational study, we included 122 STEMI patients from January 2016 to November 2016. LV systolic functions in the form of global longitudinal strain (GLS) in addition to conventional echocardiography parameters were evaluated on admission and at 6-month. Serum copeptin levels were determined using an ultrasensitive immunofluorescence assay.The study population was divided into 2 groups according to median values of copeptin. GLS was significantly lower in patients with high copeptin levels compared to those with low copeptin levels at early stage and 6-month (−16% (16–16.5) vs −15% (15–15.5), P < .001 and −18% (18–19) vs −16% (16–16.25), P < .001, respectively). Copeptin values were negatively correlated with an early and 6-month GLS (r = –0.459 at early stage and r = –0.662 at 6-month). In addition, we observed that copeptin values were negatively correlated with the improvement of GLS at 6-month follow-up (r = −0.458, P < .001 and r = −0.357, P = .005, respectively).Serum copeptin levels in STEMI patients at the time of admission may predict early and 6-month LV systolic function assessed by two-dimensional GLS. To the best of our knowledge, this study is the first to specifically address the relationship between copeptin values and GLS in STEMI patients.     

Bispectral index monitoring of the clinical effects of propofol closed-loop target-controlled infusion: Systematic review and meta-analysis of randomized controlled trials

Background:To investigate whether closed-loop systems under bispectral index anesthesia depth monitoring can reduce the intraoperative propofol dosage.Methods:All randomized controlled trials (RCTs) on reducing propofol dosage under closed-loop systems were collected, and the literature was screened out, the abstracts and full texts were carefully read, and the references were tracked, data extraction and quality evaluation were conducted on the included research, and the RevMan5.3 software was used for meta-analysis. The main results were propofol and the incidence of adverse reactions such as hypertensive hypotension and postoperative cognitive dysfunction. A total of 879 cases were included in 8 articles, including 450 occurrences in the closed-loop system group and 429 cases in the open-loop system group.Results:Compared with manual control, closed-loop systems under bispectral index anesthesia depth monitoring reduced the dose of propofol (MD: −0.62, 95% CI: −1.08–−0.16, P = .008), with heterogeneity (I² = 80%). Closed-loop systems significantly reduced the incidence of abnormal blood pressure (MD: −0.02, 95%CI: −0.05–0.01, P = .15, I² = 74%) and postoperative cognitive dysfunction (MD: −0.08, 95% CI: −0.14 −0.01, P = .02, I² = 94%).Conclusion:Bispectral index monitoring of propofol closed-loop target-controlled infusion system can reduce the amount of propofol, reduce the incidence of adverse reactions such as hypertensive or hypotension and postoperative cognitive dysfunction.     

Visceral Obesity Predicts Significant Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is associated with visceral obesity. However, the association between visceral adipose tissue (VAT) area and fibrosis in NAFLD patients has not been completely established. This study was aimed to determine the relationship between the computed tomography-measured VAT area and significant fibrosis in NAFLD patients. A total of 324 NAFLD patients and 132 controls were evaluated by liver biopsy. NAFLD was diagnosed based on histological examinations and alcohol consumption <20 g/day. The NAFLD patients showed a higher age and gender-adjusted VAT area than the control group (86.1 ± 2.3 vs 56.7 ± 3.7, P < 0.001). The VAT area increased across the control, NAFLD without significant fibrosis, and NAFLD with significant fibrosis groups (54.9 ± 3.5, 80.6 ± 2.4, and 123.4 ± 6.4, P < 0.001). This association persisted after adjusting for multiple confounders (P for trend = 0.028). A multivariate regression analysis demonstrated the VAT area was independently associated with NAFLD with significant fibrosis (F2–F4) (odds ratio [OR] 1.21 95% confidence interval [CI] 1.07–1.37 per 10 cm² increase of VAT area; OR 2.62 [per 1 – standard deviation (SD)] 95% CI 1.41–4.86). Moreover, a multivariate logistic regression analysis revealed the VAT area was independently associated with nonalcoholic steatohepatitis (NASH) in NAFLD (OR 1.17 95% CI 1.05–1.32 per 10 cm² increase of VAT area; OR 2.21 [per 1 – SD] 95% CI 1.25–3.89). Increased VAT area is independently associated with NASH or significant fibrosis and VAT might be a central target for lifestyle modifications in NAFLD patients.     

Evaluation of astragaloside IV in hepatic fibrosis: A meta-analysis

To evaluate the effect of astragaloside IV for hepatic fibrosis.The multiple databases like Pubmed, Embase, Cochrane databases, and China National Knowledge database were used to search for the relevant studies, and full-text articles involved in the evaluation on effect of astragaloside IV for hepatic fibrosis. Review Manager 5.2 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted.Finally, 7 eligible studies were eventually satisfied the included criteria. Alanine aminotransferase (ALT) in model was higher than astragaloside group (mean difference [MD] = −58.01, 95% confidential interval (CI) [−93.97, −22.05], P = .002; I² = 99%). The meta-analysis suggested that aspartate aminotransferase (AST) in model group was more than that in astragaloside group (MD = −39.94, 95% CI [−129.38, 49.50], P = .38; I² = 100%). Model group had higher α - smooth muscle actin (α-SMA) than astragaloside group (MD was −1.13, P of heterogeneity <.0001, I² = 94%, Z = 5.18, P of over effect <.0001). Transforming growth factor β (TGF-β) in model group was higher than that in astragaloside group (MD was −0.55, P of heterogeneity <.00001, I² = 97%, Z = 2.54, P of over effect = .01). Limited publication bias was observed in this study.Astragaloside IV is a potential clinical drug for the treatment of liver fibrosis considering liver function and hepatic fibrosis related protein factor in experimental rats are improved.     

No Association of SERPINE1 ?675 Polymorphism With Sepsis Susceptibility: A Meta-Analysis

The serine protease inhibitor clade E member 1 (SERPINE1) gene has been suggested to exert great influence on the development of sepsis. But there is little overlap in the results of association between SERPINE1 −675 4G/5G polymorphism and sepsis.To get a more precise estimation of this association, we conducted a meta-analysis with a relatively larger sample size including 1806 cases and 2239 controls. Odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the relationship between −675 4G/5G polymorphism and sepsis susceptibility. Subgroup analyses were conducted based on ethnicity and source of controls.The results showed that there was no association of the SERPINE1 polymorphism and sepsis susceptibility (5G5G vs 4G4G: OR = 0.87, CI = 0.75–1.03; 5G5G+4G5G vs 4G4G: OR = 0.93, CI = 0.84–1.02; 5G5G vs 4G4G+4G5G: OR = 0.96, CI = 0.83–1.11; 5G vs 4G: OR = 0.94, CI = 0.86–1.01; 4G5G vs 4G4G: OR = 0.90, CI = 0.80–1.01). Nor did any subgroup analysis indicate a significant association.In conclusion, −675 4G/5G polymorphism in the SERPINE1 gene may not be associated with the risk of sepsis.     

Programmed intermittent epidural bolus in parturients: A meta-analysis of randomized controlled trials

Background:To evaluate the efficacy and safety of programmed intermittent epidural bolus (PIEB) in parturientsMethods:The PubMed, Embase, and the Cochrane Library (from inception to July 2021) were searched for identification of randomized placebo-controlled trials in which PIEB was applied in parturients. The outcomes were the effect of analgesia, satisfaction score, mode of delivery, duration of labor, neonatal condition, and adverse events. The pooled odds ratios (OR), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated using random- and fixed-effects models.Results:PIEB was found to be associated with decreased total consumption of ropivacaine (WMD = −15.83, 95% CI: −19.06 to −12.60, P < .00001; I² = 61%; P for heterogeneity = .04), total consumption of sufentanil (WMD = −4.93, 95% CI: −6.87 to 2.98, P < .00001; I² = 68%; P for heterogeneity = .05), numbers of patients who require patient-controlled epidural analgesia bolus (OR = 0.27, 95% CI: 0.14–0.51, P < .0001; I² = 65%; P for heterogeneity = .01), the number of attempts (WMD = −4.12, 95% CI: −7.21 to −1.04, P = .009; I² = 100%; P for heterogeneity < .00001), rate of breakthrough pain (OR = 0.47, 95% CI: 0.28–0.80, P = .005; I² = 47%; P for heterogeneity = .09). Eight studies focus on the duration of analgesia. After by meta-analysis, we found that the pain visual analogue scale (VAS) score at 30 minutes, 2 hours, 4 hours, and 5 hours in PIEB group was significantly lower when compared with control group, (WMD = −0.15, 95% CI: −0.26 to −0.04, P = .006; I² = 0%; P for heterogeneity = .64), (WMD = −0.79, 95% CI: −1.32 to 0.25, P = .004; I² = 97%; P for heterogeneity < .00001), (WMD = −1.00, 95% CI: −1.08 to −0.91, P < .00001; I² = 0%; P for heterogeneity = .67), (WMD = −1.81, 95% CI: −3.23 to −0.39, P = .01; I² = 98%; P for heterogeneity < .00001), respectively. Nineteen studies discussed the mode of delivery between 2 groups. The results suggest that the rate of normal delivery is significantly higher in PIEB group compared with control group (OR = 1.37, 95% CI: 1.08–1.75, P = .01). The time of first and second stage of labor are significantly shorter in PIEB group compared with control group, the result is (WMD = −10.52, 95% CI: −14.74 to 4.76, P < .00001; I² = 0%; P for heterogeneity = .86), (WMD = −1.48, 95% CI: −2.26 to −0.69, P = .0002; I² = 35%; P for heterogeneity = .10), respectively. Thirteen studies concerned the satisfaction score of patients. The satisfaction score of patients in the PIEB group was significantly higher when compared with control group (WMD = 0.91, 95% CI: 0.42–1.39, P = .0003; I² = 98%; P for heterogeneity < .00001). The Apgar score at 1, 5 minutes in PIEB group are significantly higher (WMD = 0.07, 95% CI: 0.02–0.13 P = .007; I² = 55%; P for heterogeneity = .04), (WMD = −0.08, 95% CI: −0.12 to −0.05, P < .00001; I² = 21%; P for heterogeneity = .27), respectively.Conclusions:PIEB is a good alternative for labor analgesia with better analgesic effect, maternal and infant outcome.     

The comparison of ketamine with tramadol for postoperative pain relief on children following adenotonsillectomy or tonsillectomy: A meta-analysis of randomized controlled trials

Introduction:The comparison of ketamine with tramadol for pain control remains controversial in pediatric adenotonsillectomy or tonsillectomy. We conduct a systematic review and meta-analysis to explore the efficacy of ketamine vs tramadol for pain relief in children following adenotonsillectomy or tonsillectomy.Methods:We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2019 for randomized controlled trials (RCTs) assessing the effect of ketamine vs tramadol for pediatric adenotonsillectomy or tonsillectomy. This meta-analysis is performed using the random-effects model.Results:Six RCTs are included in the meta-analysis. Overall, compared to ketamine group for pediatric adenotonsillectomy or tonsillectomy, tramadol is associated with substantially lower CHEOPS at 1 h (SMD = 1.56; 95% CI = 0.20–2.92; P = .02; low quality) and longer first time of additional pain medication (SMD = −0.47; 95% CI = −0.74 to −0.19; P = .0008; low quality), but demonstrates no obvious effect on CHEOPS at 6 h (SMD = 0.51; 95% CI = −1.17 to 2.19; P = .55; low quality), sedation scale at 1 h (SMD = −0.80; 95% CI = −3.07 to 1.48; P = .49; low quality) or additional pain medication (RR = 1.31; 95% CI = 0.85–2.02; P = .23; moderate quality).Conclusions:Tramadol may be better to alleviate the postoperative pain after pediatric adenotonsillectomy or tonsillectomy.     

Effectiveness of empowerment-based intervention on HbA1c and self-efficacy among cases with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials

Objective:The aim of this study was to determine the effect of empowerment-based interventions on glucose metabolism control and psychosocial self-efficacy in people with type 2 diabetes mellitus (T2DM).Methods:The Cochrane Library, Embase, PubMed, and Web of Science electronic databases were searched up to 22 February 2021 for randomized controlled trials (RCTs) that evaluated the effectiveness of empowerment-based intervention versus conventional treatment in type 2 diabetes cases. At least two investigators independently screened the literature, extracted data and evaluated the methodological quality. We calculated the pooled effect size using the mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) through RevMan V 5.4.1.Results:Fifteen randomized controlled trials (RCTs) were eligible for inclusion in the present study. A total of 2344 adults (1128 in the intervention groups and 1216 in the control) were covered. Five of these studies involved 671 cases of psychosocial self-efficacy, and 4 studies included 622 cases of diabetes knowledge. The meta-analysis showed that compared to routine care, empowerment-based intervention was associated with reduced glycated hemoglobin levels (SMD −0.20; 95% CI −0.31 to −0.08; Z = 3.40, P < .001, I² = 42%), increased diabetes empowerment scores (SMD 0.24; 95% CI 0.10–0.37; Z = 3.42, P < .001, I² = 0%), and increased diabetes knowledge scores (SMD 0.96; 95% CI 0.55–1.36; Z = 4.61, P < .001, I² = 80%).Conclusions:Empowerment-based intervention in adults with T2DM results in improvements in glycated hemoglobin, psychosocial self-efficacy and diabetes knowledge.     

Comparison of clinical efficacy of robotic right colectomy and laparoscopic right colectomy for right colon tumor: A systematic review and meta-analysis

Background:The purpose of this study was to compare the clinical efficacy of robotic right colectomy (RRC) and laparoscopic right colectomy (LRC) in the treatment of right colon tumor.Methods:We systematically searched PubMed, Web of science, EMBASE ClinicalTrials.gov and Cochrane Central Register for studies (studies published between January 2011 and June 2020). The included studies compared the clinical efficacy of RRC and LRC in the treatment of right colon tumor, and analyzed the perioperative data.Results:Our meta-analysis included 10 studies involving 1180 patients who underwent 2 surgical procedures, RRC and LRC. This study showed that compared with LRC, there was no significant difference in first flatus passage (weighted mean difference [WMD]: −0.37, 95% CI: −1.09–0.36, P = .32), hospital length of stay (WMD: −0.23, 95% CI: −0.73–0.28, P = .32), reoperation (OR: 1.66, 95% CI: 0.67–4.10, P = .27), complication (OR: 0.83, 95% CI: 0.60–1.14, P = .25), mortality (OR: 0.45, 95% CI: 0.02–11.22, P = .63), wound infection (OR: 0.65, 95% CI: 0.34–1.25, P = .20), and anastomotic leak (OR: 0.73, 95% CI: 0.33–1.63, P = .44). This study showed that compared with LRC, the lymph nodes retrieved (WMD: 1.47, 95% CI: −0.00–2.94, P = .05) of RRC were similar, with slight advantages, and resulted in longer operative time (WMD: 65.20, 95% CI: 53.40–77.01, P < .00001), less estimated blood loss (WMD: −13.43, 95% CI: −20.65–6.21, P = .0003), and less conversion to open surgery (OR: 0.30, 95% CI: 0.17–0.54, P < .0001).Conclusions:RRC is equivalent to LRC with respect to first flatus passage, hospital length of stay, reoperation, complication, and results in less conversion to LRC.     

Relationship of MTHFR Gene 677C→T Polymorphism,Homocysteine, and Estimated Glomerular Filtration Rate Levels With the Risk of New-Onset Diabetes

East Asian patients with diabetes have a higher risk for renal complications and strokes than Europeans. We aimed to evaluate the effect of methylenetetrahydrofolate reductase (MTHFR) gene 677C→T polymorphism, which was associated with a higher stroke risk and was common in the Chinese population, as well as homocysteine and estimated glomerular filtration rate (eGFR) levels on the risk of new-onset diabetes (NOD).A total of 2422 subjects without diabetes were followed-up for 7 years. NOD was defined as fasting plasma glucose ≥7.0 mmol/L or self-reported physician diagnosis of diabetes.Compared with subjects with MTHFR 677CC genotype, those with TT genotype had a higher risk of NOD in females (odds ratio 2.78, 95% confidence interval 1.39–5.56) but not in males (0.80, 0.40–1.61, P for interaction = 0.008). Furthermore, MTHFR 677C→T polymorphism was more strongly associated with the risk of NOD among females with higher body mass index (BMI, ≥23 vs <23 kg/m², P for interaction = 0.009) or lower high-density lipoprotein-cholesterol (HDL-C, <1.3 vs ≥1.3 mmol/L, P for interaction = 0.015) levels. Hyperhomocysteinemia (≥16 vs <10 μmol/L) was not significantly associated with NOD in males (0.88, 0.42–1.85) or females (1.52, 0.65–3.57). However, mildly decreased eGFR (<90 vs 90–120 mL/min/1.73 m²) was associated with NOD mainly in males (1.96, 1.01–3.78; females, 0.74, 0.32–1.72, P for interaction = 0.134).Females with MTHFR 677TT genotype had a significantly higher risk of NOD, particularly those with higher BMI or low HDL-C levels. The higher risk of NOD associated with mildly decreased eGFR also warrants more investigation. Our results provide insights into the ethnic differences of diabetic complications between East Asian patients and Europeans.     

Effects of depth of neuromuscular blockade on the BIS-guided propofol requirement: A randomized controlled trial

Background:Deep neuromuscular blockade is considered beneficial for improving the surgical space condition during laparoscopic surgery. Adequacy of the surgical space condition may affect the anesthetists’ decision regarding titration of depth of anesthesia. We investigated whether deep neuromuscular blockade reduces the propofol requirement under bispectral index monitoring compared to moderate neuromuscular blockade.Methods:Adult patients undergoing elective laparoscopic colorectal surgery were randomly allocated to a moderate or deep group. A train-of-four count of 1–2 in the moderate group, and a post-tetanic count of 1–2 in the deep group, were maintained by continuous infusion of rocuronium. The induction and maintenance of anesthesia were achieved by target-controlled infusion of propofol and remifentanil. The dose of propofol was adjusted to maintain the bispectral index in the range of 40–50. The remifentanil dose was titrated to maintain the systolic blood pressure to within 20% of the ward values.Results:A total of 82 patients were included in the analyses. The mean±SD dose of propofol was 7.54 ± 1.66 and 7.42 ± 1.01 mg·kg⁻¹·h⁻¹ in the moderate and deep groups, respectively (P = .104). The mean±SD dose of remifentanil was 4.84 ± 1.74 and 4.79 ± 1.77 μg kg⁻¹ h⁻¹ in the moderate and deep groups, respectively (P = .688). In comparison to the moderate group, the deep group showed significantly lower rates of intraoperative patient movement (42.9% vs 22.5%, respectively, P = .050) and additional neuromuscular blocking agent administration (76% vs 53%, respectively, P = .007). Postoperative complications, including pulmonary complications, wound problems and reoperation, were not different between the two groups.Conclusion:Deep neuromuscular blockade did not reduce the bispectral index-guided propofol requirement compared to moderate neuromuscular blockade during laparoscopic colon surgery, despite reducing movement of the patient and the requirement for a rescue neuromuscular blocking agent.Trial registration:Clinicaltrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT03890406","term_id":"NCT03890406"}}NCT03890406)     

Low tricuspid annular plane systolic excursion is associated with a poor outcome in patients with COVID-19: A systematic review and meta-analysis

Background: This systematic review and meta-analysis aimed to assess whether tricuspid annular plane systolic excursion (TAPSE) could be used as a prognostic tool in patients with coronavirus disease 19 (COVID-19).Methods:Studies on the relationship between TAPSE and COVID-19 since February 2021. Standardized mean difference (SMD) and 95% confidence intervals were used to assess the effect size. The potential for publication bias was assessed using a contour-enhanced funnel plot and Egger test. A meta-regression was performed to assess if the difference in TAPSE between survivors and nonsurvivors was affected by age, sex, hypertension or diabetes.Results:Sixteen studies comprising 1579 patients were included in this meta-analysis. TAPSE was lower in nonsurvivors (SMD −3.24 (−4.23, −2.26), P < .00001; I² = 71%), and a subgroup analysis indicated that TAPSE was also lower in critically ill patients (SMD −3.85 (−5.31, −2.38,), P < .00001; I² = 46%). Heterogeneity was also significantly reduced, I² < 50%. Pooled results showed that patients who developed right ventricular dysfunction had lower TAPSE (SMD −5.87 (−7.81, −3.92), P = .004; I² = 82%). There was no statistically significant difference in the TAPSE of patients who sustained a cardiac injury vs those who did not (SMD −1.36 (−3.98, 1.26), P = .31; I² = 88%). No significant publication bias was detected (P = .8147) but the heterogeneity of the included studies was significant. A meta-regression showed that heterogeneity was significantly greater when the incidence of hypertension was <50% (I² = 91%) and that of diabetes was <30% (I² = 85%).Conclusion:Low TAPSE levels are associated with poor COVID-19 disease outcomes. TAPSE levels are modulated by disease severity, and their prognostic utility may be skewed by pre-existing patient comorbidities.Trial retrospectively registered (February 12, 2021):PROSPERO CRD42021236731     

Association Between the MUC5B Promoter Polymorphism rs35705950 and Idiopathic Pulmonary Fibrosis: A Meta-analysis and Trial Sequential Analysis in Caucasian and Asian Populations

Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a poor prognosis. A number of studies reported the association between MUC5B promoter polymorphism rs35705950 and IPF, but substantial inconsistent findings were observed and the strength of association remains unclear.The aim of the study was to investigate the association between rs35705950 and IPF in different ethnic populations.PubMed, EMBASE, Web of Science, and CENTRAL were searched from their inception to April 15, 2015. Allelic and phenotypic comparisons were conducted separately, as were comparisons in Caucasian and Asian populations. A meta-analysis with trial sequential analysis was conducted.Nine studies presented in 7 full-text articles were included, encompassing 2733 IPF patients and 5044 controls. Six studies were carried out in the Caucasian population, and 3 in the Asian population. Minor T allele was associated with an increased risk of IPF compared with G allele (odds ratio [OR] 4.85, 95% confidence interval [CI] 3.79–6.21, P = 5.88 × 10⁻³⁶), as were TG and TT genotypes compared with GG genotype (TG vs GG: OR 6.20, 95% CI 5.14–7.48, P = 1.70 × 10⁻⁸¹; TT vs GG: OR 11.29, 95% CI 5.69–22.40, P = 4.22 × 10⁻¹²), in an allele dose-dependent manner. These observations were confirmed in trial sequential analysis in both populations. The strength of association was more remarkable in the Caucasian population than in the Asian population, and no homozygous TT genotype was detected in the Asian population in our study.Our study revealed strong association between the MUC5B promoter rs35705950 polymorphism and the risk of IPF. The strength of association between rs35705950 minor T allele and IPF susceptibility was particularly evident in the Caucasian population, and milder but still significant in the Asian population.     

The impact of exercise training for chronic heart failure patients with cardiac resynchronization therapy: A systematic review and meta-analysis

Background and objective:Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT).Methods:PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software.Results:Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41–33.23; P < .00001, I² = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41–122.48; P = .01, I² = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO₂) (MD 3.05 ml/kg/minute, 95% CI 2.53–3.56; P < .00001, I² = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44–8.49; P = .006, I² = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD −19.96, 95% CI −21.57 to −18.34; P < .00001, I² = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group.Conclusion:During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.     

Association of transferrin G258A and transferrin receptor A82G polymorphisms with the risk of Parkinson disease in certain area

Background:It has been reported that polymorphisms of transferrin (TF) G258A and transferrin receptor (TFR) A82G might be associated with susceptibility to Parkinson disease (PD).Objective:Owing to limitation of sample size and inconclusive results, we conducted a meta-analysis to clarify the association.Methods:By searching PubMed, Embase, Chinese National Knowledge Infrastructure, China Biological Medicine Database, and Wanfang Databases, the published articles about studies of the association of the TF G258A, TFR A82G gene polymorphisms with the risk of PD were collected. Q-statistics and I² statistics were calculated to examine heterogeneity and summary odds ratios (ORs) and 95% confidence intervals (95%CI) were evaluated the association.Results:Five studies assessed the relationship between TF G258A and risk of PD. A significant increased protective of A allele and AA genotype was observed in allele model and recessive model (the allele model A vs G: OR = 0.54, 95%CI 0.40–0.72, P < .001; the recessive model AA vs GA + GG: OR = 0.32, 95%CI 0.20–0.52, P < .001). The remaining models of the TF G258A genotype showed no significant association with PD risk, while the protective tendency were increased (the heterozygote model GA vs GG: OR = 0.93, 95%CI 0.61–1.43, P = .75; the homozygous model AA vs GG: OR = 0.47, 95%CI 0.21–1.04, P = .06; the dominant model GA + AA vs GG: OR = 0.75, 95%CI 0.50–1.11, P = .15). There was also a lack of association between TFR A82G polymorphism and PD (the allele model G vs A: OR = 0.92, 95%CI 0.75–1.13, P = .43; the heterozygote model AG vs AA: OR = 1.17, 95%CI 0.79–1.71, P = .43; the homozygous model GG vs AA: OR = 0.91, 95%CI 0.60–139, P = .66; the dominant model AG + GG vs AA: OR = 1.05, 95%CI 0.73–1.49, P = .81; the recessive model GG vs AG +AA: OR = 0.80, 95%CI 0.59–1.09, P = .16).Conclusion:Our study suggests that TF G258A polymorphism may be associated with PD, while TFR A82G polymorphism may not contribute to PD based on the current evidence.     

PRISMA: accuracy of response entropy and bispectral index to predict the transition of consciousness during sevoflurane anesthesia: A systematic review and meta-analysis

Background:Bispectral index (BIS) and response entropy (RE) are used to monitor the depth of anesthesia.Objectives:To collect published data and compare the accuracy of BIS and RE in detecting the transition of consciousness during sevoflurane anesthesia.Data sources:Studies indexed in the PubMed, Embase, or Cochrane databases.Study eligibility criteria:

• 1.Monitoring of sevoflurane anesthesia depth with BIS and RE simultaneously;
• 2.Use of prediction probability values to evaluate prediction accuracy; and
• 3.The full text of the published study is available and contains sufficient data for further analyses.

Participants:Patients who need to use BIS and RE to monitor sevoflurane anesthesia depth simultaneously.Interventions:A random-effects model was fitted using RevMan 5.3. Subgroup analyses were performed on patient age. The Cochrane I² methodology was used to determine the heterogeneity of the statistical results, while GRADE Pro served to assess the quality of evidence.Results:Overall, 195 articles were identified, of which 7 were finally included. The meta-analysis results showed that BIS is more accurate than RE in predicting loss of consciousness (LOC) during sevoflurane anesthesia (MD, .06; 95% confidence interval [CI], .02–.09; P = .009; I² = 92%). In contrast, there was no significant difference between BIS and RE for recovery of consciousness (ROC; MD, .01; 95% CI, .00–.02; P = .79; I² = 83%). Subgroup analyses revealed no significant differences in LOC (MD, .02; 95% CI, .01–.05; P = .13; I² = 60%) and ROC (MD, −.01; 95% CI, −.06–.04; P = .58; I² = 95%) in children. However, the results in adults demonstrated that BIS is more accurate than RE in predicting LOC (MD, −.07; 95% CI, .05–.10; P = .002; I² = 76%).Limitations:First, this meta-analysis was affected by a large study heterogeneity. Second, this analysis only included publications in English, therefore, some studies may have been omitted.Conclusion:BIS is more accurate than RE in predicting LOC during sevoflurane anesthesia in adults. However, no significant differences were identified in children.Registration number (PROSPERO):CRD42020163119     

Does tranexamic acid reduce risk of mortality on patients with hemoptysis?: A protocol for systematic review and meta-analysis

Background:Although tranexamic acid (TXA), a readily accessible antifibrinolytic agent, is widely adopted in hemorrhage scenarios, its role on mortality in patients with hemoptysis remains uncertain. New evidence is yet to be generated to evaluate the risk of mortality after using TXA in patients with hemoptysis.Methods:PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were searched from inception to May 2020. Randomized controlled trials and observational studies that evaluated the effect of TXA on patients with hemoptysis were included. Data were independently extracted by 2 reviewers and synthesized using a random-effects model.Main results:Five studies with a total of 20,047 patients were analyzed. When compared with the control, administration of TXA was associated with a reduction in short-term mortality (risk ratio = 0.78, 95% confidence interval [CI] 0.72–0.85; I² = 0), shorter bleeding time (mean difference = − 24.61 hours, 95% CI − 35.96 to −13.26, I² = 0), shorter length of hospital stay (mean difference = −1.94 days, 95% CI −2.48 to −1.40, I² = 0), and lower need for intervention (risk ratio = 0.38, 95% CI 0.16–0.87, I² = 0) in patients with hemoptysis. Compared with control, administration of TXA did not cause increased major or minor adverse effects.Conclusions:TXA provided benefits in terms of a lower short-term mortality rate, less bleeding time, shorter length of hospital stays, and less need for intervention in patients with hemoptysis. Use of TXA was not associated with increased adverse effects.     

Effects of perioperative erythropoietin administration on acute kidney injury and red blood cell transfusion in patients undergoing cardiac surgery: A systematic review and meta-analysis

Background:The renoprotective effects of erythropoietin (EPO) are well-known; however, the optimal timing of EPO administration remains controversial. Red blood cell (RBC) transfusion is an independent risk factor for cardiac surgery-associated acute kidney injury (CSA-AKI). We aimed to evaluate the efficacy of EPO on CSA-AKI and RBC transfusion according to the timing of administration.Methods:We searched the Cochrane Library, EMBASE, and MEDLINE databases for randomized controlled trials. The primary outcome was the incidence of CSA-AKI following perioperative EPO administration, and the secondary outcomes were changes in serum creatinine, S-cystatin C, S-neutrophil gelatinase-associated lipocalin, urinary neutrophil gelatinase-associated lipocalin, length of hospital and intensive care unit (ICU) stay, volume of RBC transfusion, and mortality. The subgroup analysis was stratified according to the timing of EPO administration in relation to surgery.Results:Eight randomized controlled trials with 610 patients were included in the study. EPO administration significantly decreased the incidence of CSA-AKI (odds ratio: 0.60, 95% confidence interval [CI]: 0.43–0.85, P = .004; I ² = 52%; P for heterogeneity = .04), intra-operative RBC transfusion (standardized mean difference: −0.30, 95% CI: −0.55 to −0.05, P = .02; I ² = 15%, P for heterogeneity = .31), and hospital length of stay (mean difference: −1.54 days, 95% CI: −2.70 to −0.39, P = .009; I ² = 75%, P for heterogeneity = .001) compared with control groups. Subgroup analyses revealed that pre-operative EPO treatment significantly reduced the incidence of CSA-AKI, intra-operative RBC transfusion, serum creatinine, and length of hospital and ICU stay.Conclusion:Pre-operative administration of EPO may reduce the incidence of CSA-AKI and RBC transfusion, but not in patients administered EPO during the intra-operative or postoperative period. Therefore, pre-operative EPO treatment can be considered to improve postoperative outcomes by decreasing the length of hospital and ICU stay in patients undergoing cardiac surgery.