Meditation for asthma: Systematic review and meta-analysis

Objective: To conduct a comprehensive review and meta-analysis of the effectiveness of meditation on a variety of asthma outcomes. Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO and AMED in June 2016 to identify randomized controlled trials (RCTs) investigating the effectiveness of meditation in adults with asthma. No restriction was put on language or year of publication. Study quality was assessed using The Cochrane Risk of Bias Assessment Tool. Meta-analysis was carried out using RevMan 5.3. Results: Four RCTs involving 201 patients met the inclusion criteria. Quality of studies was inconsistent with only one study reporting adequate allocation concealment. Disease-specific quality of life was assessed in two trials; a pooled result involving 62 intervention and 65 control participants indicated a significant improvement in quality of life in the meditation group compared to the control group (SMD 0.40, 95% CI 0.05–0.76). A pooled result from all four studies indicated the uncertain effect of meditation in forced expiratory volume in 1 s (FEV₁) (SMD ?0.67, 95% CI ?2.17 to 0.82). Results from the individual trials suggest that meditation may be helpful in reducing perceived stress and the use of short-term rescue medication. Conclusion: Our review suggests that there is some evidence that meditation is beneficial in improving quality of life in asthma patients. As two out of four studies in our review were of poor quality, further trials with better methodological quality are needed to support or refute this finding.     

Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care

BackgroundEmpirical studies examined the associations between hospital competition and quality of care by using different methodology, measures, patient groups and geographic locations; however, results remained inconclusive. This study aimed to apply meta-analysis to evaluate the effect of hospital competition on quality of care and to explore the potential implications to care for senior patients.MethodsA systematic review and meta-analysis combining results from various studies to obtain an overall outcome was performed. Measure of effect size, I² test, meta-regression to find sources of heterogeneity, tests for publication bias, sensitivity analysis and cumulative analysis were performed. The mean effect size is estimated by coefficient and standard error with P values less than 0.05 which was considered statistically significant.ResultsBased on the selection criteria, only 11 studies were eligible for this meta-analysis. The pooled effect of hospital competition on quality of care was reported by all of the 11 included studies. Results of the meta-analysis suggested that hospital competition reduced quality of care, but the overall effect was relatively insignificant from a statistical perspective (Point estimate = 0.008, 95% CI = -0.004 ˜ 0.020, P > 0.05).ConclusionsHospital competition slightly increased mortality rates of acute myocardial infarction, but not statistically significant. The negative impact may be lessened over time as medical technology, practices, and techniques improve. Older patients with complex care needs may be at risk for poorer quality of care related to hospital competition.     

Thrombocytopenia for prediction of hepatocellular carcinoma recurrence: Systematic review and meta-analysis

AIM: To investigate the association between thrombocytopenia and relapse after treatment for hepatocellular carcinoma (HCC).METHODS: We searched the PubMed, EMBASE, and Web of Science databases to obtain eligible studies. The hazard ratios (HRs) values and 95% confidence intervals (CIs) were pooled by random effects model. Subsequently, we estimated the heterogeneity, performed a sensitivity analysis, determined the publication bias, and performed subgroup and meta-regression analyses. Study quality was assessed by using the Oxford Center for Evidence Based Medicine tool.RESULTS: We identified 18 eligible studies by retrieval (published during 2000-2014). Out of the 4163 patients with HCC who were recruited, 2746 (66.0%) experienced recurrence. In general, our meta-analysis suggested that low platelet count (PLT) before therapy significantly increased the probability of postoperative recurrence (HR = 1.53, 95%CI: 1.29-1.81). PLT was also valuable in the prediction of intrahepatic distant recurrence (HR = 1.49, 95%CI: 1.25-1.77). Subgroup and meta-regression analyses identified various therapeutic modalities as the source of a high degree of heterogeneity. The pooled HR values showed no obvious change when a single study was removed, but otherwise, an opposite-effects model was used. In addition, no significant publication bias was detected.CONCLUSION: Thrombocytopenia before treatment might be an inexpensive and useful predictor of postoperative recurrence in patients with HCC.     

The ultrastructure of urate crystals in gout

Using correlative scanning and transmission electron microscopic techniques, we studied the ultrastructure of natural and synthetic monosodium urate crystals. The internal architecture of both natural and synthetic urates consists of an interconnecting electron lucent network. This network is different in crystals from tophi, suggesting crystal formation about an electron lucent nidal matrix. Urate crystals from articular cartilage surfaces have smooth faces supporting the hypothesis that acute goat is a two phase process involving first the precipitation of urate crystals in the synovial fluid and second the adherence to the crystals of proteins and cells with the consequent inflammatory response.     

Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis

AIM: To evaluate whether Helicobacter pylori(H. pylori) eradication therapy benefits patients with functional dyspepsia(FD).METHODS: Randomized controlled trials(RCTs) investigating the efficacy and safety of H. pylori eradication therapy for patients with functional dyspepsia published in English(up to May 2015) were identified by searching Pub Med, EMBASE, and The Cochrane Library. Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed as a pooled risk ratio(RR) or a standard mean difference(SMD). All data were analyzed with Review Manager 5.3 and Stata 12.0.RESULTS: This systematic review included 25 RCTs with a total of 5555 patients with FD. Twenty-three of these studies were used to evaluate the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR was 1.23(95%CI: 1.12-1.36, P 0.0001). H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at ≥ 1 year(RR = 1.24; 95%CI: 1.12-1.37, P 0.0001) but not during short-term follow-up at 1 year(RR = 1.26; 95%CI: 0.83-1.92, P = 0.27). Seven studies showed no benefit of H. pylori eradication therapy on quality of life with an SMD of-0.01(95%CI:-0.11 to 0.08, P = 0.80). Six studies demonstrated that H. pylori eradication therapy reduced the development of peptic ulcer disease compared to no eradication therapy(RR = 0.35; 95%CI: 0.18-0.68, P = 0.002). Eight studies showed that H. pylori eradication therapy increased the likelihood of treatment-related side effects compared to no eradication therapy(RR = 2.02; 95%CI: 1.12-3.65, P = 0.02). Ten studies demonstrated that patients who received H. pylori eradication therapy were more likely to obtain histologic resolution of chronic gastritis compared to those who did not receive eradication therapy(RR = 7.13; 95%CI: 3.68-13.81, P 0.00001).CONCLUSION: The decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment.     

Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis

BackgroundPrevious reviews and meta-analyses demonstrated effects of cognitive interventions in dementia, but none specifically considered residents with dementia in long-term care (LTC) facilities.ObjectiveTo analyse the efficacy of cognitive interventions in institutionalised individuals with dementia.MethodsAfter identifying 27 articles, a systematic review was performed. A meta-analysis was calculated for 15 studies of the randomized controlled trials regarding effects on relevant outcomes. Fixed-effects meta-analyses were conducted using standardized mean differences (SMD) of changes from baseline pooled using the inverse variance method.ResultsWhen comparing cognitive interventions to passive control groups, the meta-analysis revealed significant moderate effects on global cognition (SMD = 0.47, 95% CI 0.27–0.67), autobiographical memory (0.67, 0.02–1.31), and behavioral and psychological symptoms in dementia (BPSD; 0.71, 0.06–1.36). Significant small effects were detected for quality of life (QoL; 0.37, 0.05–0.70). Moderate effects on activities of daily living (0.28; −0.02 to 0.58) failed to reach significance; no effects were found on depression (0.22; −0.08 to 0.51). Significant moderate effects of global cognition (0.55; 0.22–0.89) and depression (0.64; 0.21–1.07) were also found for cognitive interventions contrasting active control groups. No harmful events related to the participation in the interventions were observed.ConclusionCognitive interventions are safe and effective for residents with dementia in LTC. However, while it seems clear that cognitive benefits can specifially be assigned to these forms of intervention, further research is necessary to clarify whether the effects on BPSD and QoL reflect unspecific changes due to additional attention. Furthermore, future studies will have to determine which intervention type yields the largest benefits.     

Systematic review and meta-analysis: islet autotransplantation after pancreatectomy for minimizing diabetes

Objective Islet autotransplantation (IAT) may decrease the morbidity and mortality of postpancreatectomy diabetes mellitus. The current systematic review and meta‐analysis examined the rate of insulin independence (II) and mortality after IAT post‐total (TP) or partial pancreatectomy (PP). Methods Ovid MEDLINE, EMBASE, Web of Science, SCOPUS and reference lists were searched until 31 January 2011. Eligible studies enrolled adult patients with IAT post‐TP or PP, regardless of study design, sample size and language. Two investigators identified eligible studies and extracted data independently. From each study, 95% confidence intervals (CIs) were estimated and pooled using random effects meta‐analysis. Results Fifteen observational studies were eligible (11 IAT post‐TP, two post‐PP and two including both). The II rates for IAT post‐TP at last follow‐up and transiently during the study were 4·62 per 100 person‐years (95% CI: 1·53–7·72) and 8·34 per 100 person‐years (95% CI: 3·32–13·37), respectively. In the later group, patients achieved transient II lasting 15·57 months (95% CI: 10·35–20·79). The II rate at last follow‐up for IAT post‐PP was 24·28 per 100 person‐years (95% CI: 0·00–48·96). Whereas the 30‐day mortality for IAT post‐TP and post‐PP was 5% (95% CI: 2–10%) and 0, respectively, the long‐term mortality was 1·38 per 100 person‐years (95% CI: 0·66–2·11) and 0·70 per 100 person‐years (95% CI: 0·00–1·80) respectively. Conclusions IAT postpancreatectomy offers some patients a chance for insulin independence. Better data reporting are essential to establish the risks and benefits of IAT after pancreatic surgery.     

Tobacco smoking and intestinal metaplasia: Systematic review and meta-analysis

Background

The evaluation of specific risk factors for early endpoints in the gastric carcinogenesis pathway may further contribute to the understanding of gastric cancer aetiology.

Aims

To quantify the relation between smoking and intestinal metaplasia through systematic review and meta-analysis.

Methods

Articles providing data on the association between smoking and intestinal metaplasia were identified in PubMed^®, Scopus^® and Web of Science™, searched until April 2014, and through backward citation tracking. Summary odds ratio estimates and 95% confidence intervals were computed using the DerSimonian and Laird method. Heterogeneity was quantitatively assessed using the I² statistic.

Results

A total of 32 articles were included in this systematic review and 19 provided data for meta-analysis. Smoking was defined as ever vs. never (crude estimates, six studies, summary odds ratio = 1.54, 95% confidence interval: 1.12–2.12, I² = 67.4%; adjusted estimates, seven studies, summary odds ratio = 1.26, 95% confidence interval: 0.98–1.61, I² = 65.0%) and current vs. non-smokers (crude estimates, seven studies, summary odds ratio = 1.27, 95% confidence interval: 0.88–1.84, I² = 73.4%; adjusted estimates, two studies, summary odds ratio 1.49, 95% confidence interval: 0.99–2.25, I² = 0.0%).

Conclusion

The weak and non-statistically significant association found through meta-analysis of the available evidence does not confirm smoking as an independent risk factor for intestinal metaplasia.     

Systematic review of the prevalence of gout and hyperuricaemia in Australia

Aims: Gout is a growing health problem worldwide especially in affluent countries, such as Australia. Gout and hyperuricaemia are associated with the metabolic syndrome, diabetes mellitus, obesity and hypertension. More importantly, Australia has a growing prevalence of these important health problems. The aim of this study was to systematically review published information regarding the prevalence of gout and hyperuricaemia in Australia. Methods: A systematic search was undertaken of the MEDLINE, EMBASE and Web of Science databases, as well as relevant websites for journal articles and reports relating to the prevalence of hyperuricaemia and gout in Australia. Results: Twenty‐five journal articles and five reports were included in the review. Data collected in a standardised way show gout increased in prevalence from 0.5% population prevalence to 1.7% population prevalence from 1968 to 1995/1996. There has been a significant rise in the prevalence of gout in the Australian Aboriginal population from 0% in 1965 to 9.7% in men and 2.9% in women in 2002. Consistent with the rise in gout prevalence, serum uric acid in blood donors has increased from 1959 to 1980 (17% in 30‐ to 40‐year‐old men). Conclusions: The rate of gout and hyperuricaemia in Australia is high in relation to comparable countries and is increasing. The prevalence of gout in elderly male Australians is second only to New Zealand, which has the highest reported rate in the world. Further research on Aboriginal and Torres Strait Islander gout and hyperuricaemia is required as a result of the lack of contemporary data.     

Heart involvement in Rheumatoid Arthritis: Systematic review and meta-analysis

Objective

The aim of our study was to conduct a systematic review with meta-analysis of the current case–control studies about the valvular and pericardial involvement in patients with Rheumatoid Arthritis (RA), asymptomatic for cardiovascular diseases.

Methods

Case–control studies were identified by searching PubMed (1975–2010) and the Cochrane Central Register of Controlled Trials (CENTRAL) (1975–2010). Participants were adult patients with RA asymptomatic for cardiovascular diseases, and the outcome measure was the presence of cardiac involvement.

Results

Quantitative synthesis included 10 relevant studies out of 2326 bibliographic citations that had been found. RA resulted significantly associated to pericardial effusion (OR 10.7; 95% CI 5.0–23.0), valvular nodules (OR 12.5; 95% CI 2.8–55.4), tricuspidal valve insufficiency (OR 5.3; 95% CI 2.4–11.6), aortic valve stenosis (OR 5.2; 95% CI 1.1–24.1), mitral valve insufficiency (OR 3.4; 95% CI 1.7–6.7), aortic valve insufficiency (OR 1.7; 95% CI 1.0–2.7), combined valvular alterations (OR 4.3; 95% CI 2.3–8.0), mitral valve thickening and/or calcification (OR 5.0; 95% CI 2.0–12.7), aortic valve thickening and/or calcification (OR 4.4; 95% CI 1.1–17.4), valvular thickening and/or calcification (OR 4.8; 95% CI 2.2–10.5), and mitral valve prolapse (OR 2.2; 95% CI 1.2–4.0).

Conclusions

Our systematic review pointed out the strength and the grade of both pericardial and cardiac valvular involvement in RA patients. Our findings underscore the importance of an echocardiographic assessment at least in clinical research when RA patients are involved. Moreover, further research is needed to understand the possible relationship of our findings and the increased cardiovascular mortality.     

Dexamethasone for the prevention of acute mountain sickness: Systematic review and meta-analysis

Background

AMS is a disease that occurs when accessing high altitude (HA) or upon exposure to a higher altitude after acclimatising over 3000 m. Evidence shows that drugs can prevent AMS. The function of dexamethasone for preventing AMS is important. No systematic review has previously been published about the effect of dexamethasone. The effect of intervention is unclear, which has limited the use of dexamethasone in the prevention of AMS.

Methods

We searched PubMed and Embase for studies from inception to July 2013. We selected randomised controlled trials including dexamethasone versus placebo as prophylaxis for AMS. The studies included were required to provide a clear dose of dexamethasone, the final altitude and clear diagnostic criteria used to judge the AMS severity of symptoms and incidence. Finally, 8 studies were included in this review. There were 116 participants in the experimental groups and 110 in the control groups. Three different doses of dexamethasone were used in these studies (8, 12, and 16 mg/d).

Result

Eight of the 79 considered studies were eventually added to the meta-analysis. We used the fixed-effect model (RevMan 5.0) based on the heterogeneity (I² = 0%, p = 0.43). Dexamethasone could reduce the incidence of AMS with an odds ratio of 6.03 (95% CI, 2.23 to 21.00) for dexamethasone compared with placebo; the p value for overall effect was less than 0.00001.

Conclusions

Our systematic review suggests that oral dexamethasone is effective in preventing AMS. Additionally, there is some evidence that the effect of dexamethasone is related to height and dosage.     

Global burden of COPD: systematic review and meta-analysis.

The aim of this study was to quantify the global prevalence of chronic obstructive pulmonary disease (COPD) by means of a systematic review and random effects meta-analysis. PubMed was searched for population-based prevalence estimates published during the period 1990-2004. Articles were included if they: 1) provided total population or sex-specific estimates for COPD, chronic bronchitis and/or emphysema; and 2) gave method details sufficiently clearly to establish the sampling strategy, approach to diagnosis and diagnostic criteria. Of 67 accepted articles, 62 unique entries yielded 101 overall prevalence estimates from 28 different counties. The pooled prevalence of COPD was 7.6% from 37 studies, of chronic bronchitis alone (38 studies) was 6.4% and of emphysema alone (eight studies) was 1.8%. The pooled prevalence from 26 spirometric estimates was 8.9%. The most common spirometric definitions used were those of the Global Initiative for Chronic Obstructive Lung Disease (13 estimates). There was significant heterogeneity, which was incompletely explained by subgroup analysis (e.g. age and smoking status). The prevalence of physiologically defined chronic obstructive pulmonary disease in adults aged > or =40 yrs is approximately 9-10%. There are important regional gaps, and methodological differences hinder interpretation of the available data. The efforts of the Global Initiative for Chronic Obstructive Lung Disease and similar groups should help to standardise chronic obstructive pulmonary disease prevalence measurement.     

Effectiveness and safety of Liuhe Pill for treating gout: A protocol for a systematic review and meta-analysis

Background:Liuhe Pill as a famous traditional Chinese medicine formula is usually used to treat gout, acute pancreatitis, and cellulitis in China. But at present, there is no systematic evaluation report on its therapeutic effectiveness and safety of Liuhe Pill for treating gout. This protocol aims to assess the efficacy and safety of Liuhe Pill for treating gout.Methods:We will search the Web of Knowledge, EMBASEWANFANG DATA, China National Knowledge Infrastructure (CNKI), PubMed, ClinicalTrials.gov and Cochrane Library from inception to October 31, 2021 to retrieve relevant studies. We will also search citations of relevant primary and review. Authors of abstract in the meeting will be further searched in PubMed for potential full articles. To minimize the risk of publication bias, we will conduct a comprehensive search that included strategies to find published and unpublished studies. Two authors independently judged study eligibility and extracted data. Heterogeneity will be examined by computing the Q statistic and I² statistic.Results:This study assessed the efficiency and safety of Liuhe Pill for treating gout.Conclusions:This study will provide reliable evidence-based evidence for the clinical application of Liuhe Pill for treating gout.     

Distance management of inflammatory bowel disease:Systematic review and meta-analysis

AIM:To review the effectiveness of distance management methods in the management of adult inflammatory bowel disease(IBD)patients.METHODS:A systematic review and meta-analysis of randomized controlled trials comparing distance management and standard clinic follow-up in the management of adult IBD patients.Distance management intervention was defined as any remote management method in which there is a patient self-management component whereby the patient interacts remotely via a self-guided management program,electronic interface,or self-directs open access to clinic follow up.The search strategy included electronic databases(Medline,PubMed,CINAHL,The Cochrane Central Register of Controlled Trials,EMBASE,KTPlus,Web of Science,and SCOPUS),conference proceedings,and internet search for web publications.The primary outcome was the mean difference in quality of life,and the secondary outcomes included mean difference in relapse rate,clinic visit rate,and hospital admission rate.Study selection,data extraction,and risk of bias assessment were completed by two independent reviewers.RESULTS:The search strategy identified a total of4061 articles,but only 6 randomized controlled trials met the inclusion and exclusion criteria for the systematic review and meta-analysis.Three trials involved telemanagement,and three trials involved directed patient self-management and open access clinics.The total sample size was 1463 patients.There was a trend towards improved quality of life in distance management patients with an end IBDQ quality of life score being 7.28(95%CI:-3.25-17.81)points higher than standard clinic follow-up.There was a significant decrease in the clinic visit rate among distance management patients mean difference-1.08(95%CI:-1.60--0.55),but no significant change in relapse rate or hospital admission rate.CONCLUSION:Distance management of IBD significantly decreases clinic visit utilization,but does not significantly affect relapse rates or hospital admission rates.     

Botulinum toxin injections after surgery for Hirschsprung disease:Systematic review and meta-analysis

BACKGROUND A large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective surgery. Persistent obstructive symptoms may result in faecal stasis that can develop into Hirschsprung-associated enterocolitis, a potential life-threatening condition. Important treatment to improve faecal passage is internal anal sphincter relaxation using botulinum toxin injections.AIM To give an overview of all empirical evidence on the effectiveness of botulinum toxin injections in patients with Hirschsprung disease.METHODS A systematic review and meta-analysis was done by searching PubMed,EMBASE and the Cochrane Library, using entry terms related to:(1)Hirschsprung disease; and(2) Botulinum toxin injections. 14 studies representing278 patients met eligibility criteria. Data that were extracted were proportion of patients with improvement of obstructive symptoms or less enterocolitis after injection, proportion of patients with adverse effects and data on type botulinum toxin, mean dose, average age at first injection and patients with associatedsyndromes. Random-effects meta-analysis was used to aggregate effects and random-effects meta-regression was used to test for possible confounding factors.RESULTS Botulinum toxin injections are effective in treating obstructive symptoms in on average 66% of patients [event rate(ER) = 0.66, P = 0.004, I2 = 49.5, n = 278 patients]. Type of botulinum toxin, average dose, average age at first injections and proportion of patients with associated syndromes were not predictive for this effect. Mean 7 duration of improvement after one botulinum toxin injections was6.4 mo and patients needed on average 2.6 procedures. There was a significant higher response rate within one month after botulinum toxin injections compared to more than one month after Botulinum toxin injections(ER = 0.79, vs ER = 0.46,Q = 19.37, P 0.001). Botulinum toxin injections were not effective in treating enterocolitis(ER 0.58, P = 0.65, I2 = 71.0, n = 52 patients). There were adverse effects in on average 17% of patients(ER = 0.17, P 0.001, I2 = 52.1, n = 187 patients), varying from temporary incontinence to mild anal pain.CONCLUSION Findings from this systematic review and meta-analysis indicate that botulinum toxin injections are effective in treating obstructive symptoms and that adverse effects were present, but mild and temporary.     

Mortality and survival in systemic sclerosis: Systematic review and meta-analysis

Objective

To determine the mortality, survival, and causes of death in patients with systemic sclerosis (SSc) through a meta-analysis of the observational studies published up to 2013.

Methods

We performed a systematic review and meta-analysis of the observational studies in patients with SSc and mortality data from entire cohorts published in MEDLINE and SCOPUS up to July 2013.

Results

A total of 17 studies were included in the mortality meta-analysis from 1964 to 2005 (mid-cohort years), with data from 9239 patients. The overall SMR was 2.72 (95% CI: 1.93–3.83). A total of 43 studies have been included in the survival meta-analysis, reporting data from 13,529 patients. Cumulative survival from onset (first Raynaud?s symptom) has been estimated at 87.6% at 5 years and 74.2% at 10 years, from onset (non-Raynaud?s first symptom) 84.1% at 5 years and 75.5% at 10 years, and from diagnosis 74.9% at 5 years and 62.5% at 10 years. Pulmonary involvement represented the main cause of death.

Conclusions

SSc presents a larger mortality than general population (SMR = 2.72). Cumulative survival from diagnosis has been estimated at 74.9% at 5 years and 62.5% at 10 years. Pulmonary involvement represented the main cause of death.