Decompressive craniectomy in neurocritical care

Recently, several randomized controlled trials (RCT) investigating the effectiveness of decompressive craniectomy in the context of neurocritical illnesses have been completed. Thus, a meta-analysis to update the current evidence regarding the effects of decompressive craniectomy is necessary. We searched PUBMED, EMBASE and the Cochrane Central Register of Controlled Trials. Other sources, including internet-based clinical trial registries and grey literature, were also searched. After searching the literature, two investigators independently performed literature screening, assessing the quality of the included trials and extracting the data. The outcome measures included the composite outcome of death or dependence and the risk of death. Ten RCT were included: seven RCT were on malignant middle cerebral artery infarction (MCAI) and three were on severe traumatic brain injury (TBI). Decompressive craniectomy significantly reduced the risk of death for patients suffering malignant MCAI (risk ratio [RR] 0.46, 95% confidence interval [CI]: 0.36–0.59, P < 0.00001) in comparison with no reduction in the risk of death for patients with severe TBI (RR: 0.83, 95% CI: 0.48–1.42, P = 0.49). However, there was no significant difference in the composite risk of death or dependence at the final follow-up between the decompressive craniectomy group and the conservative treatment group for either malignant MCAI or severe TBI. The present meta-analysis indicates that decompressive craniectomy can significantly reduce the risk of death for patients with malignant MCAI, although no evidence demonstrates that decompressive craniectomy is associated with a reduced risk of death or dependence for TBI patients.     

Metabolic syndrome and stroke: A meta-analysis of prospective cohort studies

Background and aimThe relationships between metabolic syndrome (MetS) and risk of incident stroke are inconsistent. We summarized the evidence by a meta-analysis of prospective cohort studies.Methods and resultsWe searched the PubMed, EMBASE, and Google Scholar databases from their inception until June 2016 for prospective cohort studies investigating this research question, relevant information was extracted by two independent investigators, and then aggregated using the fixed-effects models.We identified 16 studies, including 116,496 participants who were initially free of cardiovascular diseases. Comparing the persons without MetS, those with MetS have a significantly higher risk of incident stroke, and the pooled relative risk (RR) was 1.70 (95% confidence interval (CI): 1.49–1.95). Subgroup analyses suggested that women were more sensitive to this effect (with an RR of 1.83, 95% CI: 1.31–2.56) than men (RR = 1.47 (95% CI: 1.22–1.78). And those with MetS have a significantly higher risk of ischemic stroke (RR = 2.12, 95% CI: 1.46–3.08) than hemorrhagic stroke (RR = 1.48, 95% CI: 0.98–2.24).ConclusionsThis meta-analysis suggests that metabolic syndrome might be an important risk factor of stroke, particularly among women and those with ischemic stroke.     

Risk factors for re-bleeding of aneurysmal subarachnoid hemorrhage: Meta-analysis of observational studies

ObjectiveThe mortality of re-bleeding following aneurysmal subarachnoid hemorrhage is high, and surviving patients often have poor clinical condition and worse outcome than patients with a single bleed. In this study, we performed an updated systematic review and meta-analysis to determine the most common risk factors for re-bleeding in this patient population, with the goal of providing neurologists, neurosurgeons, neuro-interventionalists with a simple and fast method to evaluate the re-bleeding risk for aneurysmal subarachnoid hemorrhage.MethodWe conducted a thorough meta-analysis of the risk factors associated with re-bleeding or re-rupture of intracranial aneurysms in cases published between 2000 and 2013. Pooled mean difference was calculated for the continuous variables (age), and pooled odds ratio (OR) was calculated for categorical factors. If heterogeneity was significant (p < 0.05), a random effect model was applied; otherwise, a fixed model was used. Testing for pooled effects and statistical significance for each potential risk factor were analyzed using Review Manager software.ResultsOur literature search identified 174 articles. Of these, only seven retrospective studies met the inclusion criteria. These seven studies consisted of 2470 patients, 283 of which had aneurysmal re-bleeding, resulting in a weighted average rate of re-bleeding of 11.3% with 95% confidence interval [CI]: 10.1–12.6. In this population, sex (OR 1.46; 95% CI: 1.11–1.92), high systolic blood pressure [SBP] (OR 2.52; 95% CI: 1.40–4.53), aneurysm size (OR 3.00; 95% CI: 2.06–4.37), clinical condition (Hunt & Hess) (OR 4.94; 95% CI: 2.29,10.68), and Fisher grade (OR 2.29; 95% CI: 1.45, 3.61) were statistically significant risk factors for re-bleeding.ConclusionSex, high SBP, high Fisher grade, aneurysm size larger than 10 mm, and poor clinical condition were independent risk factors for aneurysmal re-bleeding. The importance of early aneurysm intervention and careful consideration of patient risk factors should be emphasized to eliminate the risk of re-bleeding and poor outcome.     

Family history of autoimmune diseases is associated with an increased risk of autism in children: A systematic review and meta-analysis

BackgroundWe conducted a systematic review and meta-analysis to summarize the current evidence on the relationship between family history of autoimmune diseases (ADs) and risk of autism in children, as current evidence suggests inconsistent results.MethodsWe identified relevant studies by searching PubMed, EmBase, and Web of Science databases up to Dec 2014. Risk estimates from individual studies were pooled using random-effects models. Sub-groups analyses were conducted by some study-level factors. Publication bias was assessed by funnel plots, Egger's regression test and Begg–Mazumdar test.ResultsA total of 11 articles were included in the meta-analysis, including 3 cohort studies, 6 case-control studies, and 2 cross-sectional studies. The meta-analysis showed that family history of all ADs combined was associated with a 28% (95% CI: 12–48%) higher risk of autism in children. For some specific ADs, evidence synthesis for risk of autism in children showed a statistically significant association with family history of hypothyroidism (OR = 1.64, 95% CI: 1.07–2.50), type 1 diabetes (OR = 1.49, 95% CI: 1.23–1.81), rheumatoid arthritis (OR = 1.51, 95% CI: 1.19–1.91), and psoriasis (OR = 1.59, 95% CI: 1.28–1.97). The results varied in some subgroups.ConclusionAn overall increased risk of autism in children with family history of ADs was identified. More mechanistic studies are needed to further explain the association between family history of ADs and increased risk of autism in children.     

A meta-analysis of treating acute traumatic brain injury with calcium channel blockers

The purpose of this systematic review was to evaluate and meta-analyse the current evidence for the use of calcium channel blockers (CCBs) in the treatment of acute traumatic brain injury (TBI) and traumatic subarachnoid haemorrhage (tSAH). A systematic search of clinical trials.gov, Cochrane library databases, EMBASE, MEDLINE, Web of science search and WHO trial registry, plus hand-searching of grey literature, was undertaken in March 2013. Two reviewers independently extracted the data using a pre-defined data extraction form. RevMan 5 software was used to synthesise data and calculate the risk ratio (RR) based on event rates as well as the 95% confidence interval (CI). Finally, nine RCTs with a total of 2182 patients were included. Meta-analysis showed that there was no difference between CCBs and control groups for rates of mortality (n = 1337, 5 RCTs, RR 0.93 CI 0.77–1.12). In a subgroup tSAH analysis, the difference was not significant (n = 389, 2 RCTs, RR 0.73 CI 0.53–1.02). There were slightly fewer unfavourable outcomes in the treatment group, but the difference was not statistically significant (n = 2101, 8 RCTs, RR 0.90 CI 0.76–1.08). In the subgroup tSAH analysis, again, the difference did not reach statistical significance (n = 1074, 5 RCTs, RR 0.95 CI 0.73–1.24). It seems that larger, well-designed RCTs are necessary in order to ascertain any clinical benefit CCBs may or may not have for the treatment of acute TBI.     

Association between diabetes and risk of suicide death: A meta-analysis of 3 million participants

BackgroundResults of the relationships between diabetes and the risk of suicide death are inconclusive. This meta-analysis was conducted to assess this association.MethodsWe systematically searched PubMed, EMBASE, Web of Science and the Cochrane Library up to February 29, 2016 for relevant observational studies regarding the association between diabetes and risk of suicide. Random-effects models were used to calculate summary relative risk (RR) and 95% confidence interval (CI).Results6 observational studies (8 independent reports) with a total of 3,075,214 participants and 3038 suicide deaths events were included in the meta-analysis. Overall, diabetes was not associated with risk of suicide deaths, with significant heterogeneity among studies observed (Summary RR = 1.61, 95% CI: 0.91–2.83, Pheterogeneity < 0.001, I² = 97.2%). No publication bias was detected across studies, and both the subgroup analysis and sensitivity analysis suggested that the general result was robust.ConclusionOur meta-analysis based on more than 3 million participants indicates that diabetes is not associated with increased risk of suicide death. Further well-designed prospective cohort studies are needed to confirm the findings of this meta-analysis.     

Clinical epidemiology of posttraumatic epilepsy in a group of Chinese patients

ObjectiveTo explore the incidence, types of onset, and risk factors of posttraumatic epilepsy (PTE).MethodsThis is a retrospective follow-up study of patients discharged from the Affiliated Hospital of the Medical College of the Chinese People's Armed Police Forces between September 2004 and September 2008 with a diagnosis of traumatic brain injury (TBI).ResultsComplete clinical information was available on 2826 patients. Of the 2826 TBI patients, 141 developed PTE, providing an incidence rate of 5.0%. Twenty-four cases (0.8%) had posttraumatic seizures (PTS), of which 16 (66.7%) continued to experience after the acute phase of their TBI, accounting for 5.0% of the total PTE cases. A total of 125 cases (88.7%) were diagnosed as presenting with late-stage seizures, occurring from 10 days to three years after TBI (93/141 (66.0%) presented within six months after the TBI, 14/141 (9.9%) between six and twelve months, 22/141 (15.7%) between one and two years and only 12/141 (8.5%) between two and three years after the TBI. The severity of PTE was rated mild, medium, and severe in 3.6%, 6.9%, and 17% of the TBI patients. Multiple regression analysis was carried out to identify factors contributing to the risk of developing PTE. Five parameters contributed to the model: Older age, greater severity of brain injury, abnormal neuroimaging, surgical treatment, and early-stage seizures.ConclusionAge, severity of brain injury, neuroimaging results, treatment methods, and early-stage seizures are independent risk factors of PTE.     

Growth hormone treatment and risk of recurrence or development of secondary neoplasms in survivors of pediatric brain tumors

Growth hormone (GH) is increasingly used for treatment of pediatric brain tumors. However, controversy remains over its safety. This meta-analysis assessed whether GH treatment was associated with risk of recurrence or development of secondary neoplasm for brain tumors in children. Systematic computerized searches of PubMed and Web of Knowledge were performed. Pooled relative risks (RR) with 95% confidence interval (CI) for recurrence and/or secondary neoplasm in children who were treated with GH versus those who did not receive GH were calculated. Ten studies were included. The pooled recurrence rates were 21.0% and 44.3% in the GH-treated group and non-GH-treated group, respectively. The pooled RR for recurrence was 0.470 (95% CI 0.372–0.593; z = 6.33, p = 0.000). Begg’s test (p = 0.060) and Egger’s test (p = 0.089) suggested there was no significant publication bias. The pooled RR in sensitivity analysis was 0.54 (95% CI 0.37–0.77; z = 3.32, p = 0.001), which showed the result was robust. The pooled RR for secondary neoplasm was 1.838 (95% CI 1.053–3.209; z = 2.14, p = 0.032). Begg’s test (p = 1.000) and Egger’s test (p = 0.553) suggested there was no significant publication bias. We found no evidence that GH therapy is associated with an increased risk of recurrence for pediatric brain tumors. However, because of our small sample size, the association of GH therapy with an increased risk of secondary neoplasm is uncertain. Further prospective cohorts are needed.     

Omega-3 fatty acids intake and risks of dementia and Alzheimer's disease: A meta-analysis

BackgroundWe systematically reviewed the association of omega-3 fatty acids intake with the incidence of dementia and Alzheimer's disease (AD) in this meta-analysis of prospective cohort studies, as evidence from previous studies suggests inconsistent results.MethodsWe identified relevant studies by searching PubMed, EmBase, and Web of Science databases up to June 2013. Prospective cohort studies reporting on associations of dietary intake of long-chain omega-3 fatty acids or fish with the incidence of dementia and AD were eligible.ResultsComparing the highest to lowest category of long-chain omega-3 fatty acids intake and fish intake, the pooled relative risks (RRs) for dementia were 0.97 (95% CI 0.85–1.10) and 0.84 (95% CI 0.71–1.01), respectively. Evidence synthesis for AD risk did not show a statistically significant association with long-chain omega-3 fatty acids intake (RR = 0.89, 95% CI 0.74–1.08). However, a higher intake of fish was associated with a 36% (95% CI 8–56%) lower risk of AD. Dose–response meta-analysis showed that an increment of 100 g per week of fish intake was associated with an 11% lower risk of AD (RR = 0.89, 95% CI 0.79–0.99). There was limited evidence of heterogeneity across studies or within subgroups.ConclusionA higher intake of fish was associated with a lower risk of AD. However, there was no statistical evidence for similar inverse association between long-chain omega-3 fatty acids intake and risk of dementia or AD, nor was there inverse association between fish intake and risk of dementia.     

Risk of severe and repetitive traumatic brain injury in persons with epilepsy: A population-based case–control study

BackgroundWhile traumatic brain injury (TBI) can lead to epilepsy, individuals with preexisting epilepsy or seizure disorder (ESD), depending on the type of epilepsy and the degree of seizure control, may have a greater risk of TBI from seizure activity or medication side effects. The joint occurrence of ESD and TBI can complicate recovery as signs and symptoms of TBI may be mistaken for postictal effects. Those with ESD are predicted to experience more deleterious outcomes either because of having a more severe TBI or because of the cumulative effects of repetitive TBI.MethodsWe conducted a case–control study of all emergency department visits and hospital discharges for TBI from 1998 through 2011 in a statewide population. The severity of TBI, repetitive TBI, and other demographic and clinical characteristics were compared between persons with TBI with preexisting ESD (cases) and those without (controls). Significant differences in proportions were evaluated with confidence intervals. Logistic regression was used to examine the association of the independent variables with ESD.ResultsDuring the study period, 236,164 individuals sustained TBI, 5646 (2.4%) of which had preexisting ESD. After adjustment for demographic and clinical characteristics, cases were more likely to have sustained a severe TBI (OR = 1.49; 95% CI = 1.38–1.60) and have had repetitive TBI (OR = 1.54; 95% CI = 1.41–1.69).ConclusionThe consequences of TBI may be greater in individuals with ESD owing to the potential for a more severe or repetitive TBI. Seizure control is paramount, and aggressive management of comorbid conditions among persons with ESD and increased awareness of the hazard of repetitive TBI is warranted. Furthermore, future studies are needed to examine the long-term outcomes of cases in comparison with controls to determine if the higher risk of severe or repetitive TBI translates into permanent deficits.     

Post-traumatic epilepsy associations with mental health outcomes in the first two years after moderate to severe TBI: A TBI Model Systems analysis

PurposeResearch suggests that there are reciprocal relationships between mental health (MH) disorders and epilepsy risk. However, MH relationships to post-traumatic epilepsy (PTE) have not been explored. Thus, the objective of this study was to assess associations between PTE and frequency of depression and/or anxiety in a cohort of individuals with moderate-to-severe TBI who received acute inpatient rehabilitation.MethodsMultivariate regression models were developed using a recent (2010–2012) cohort (n = 867 unique participants) from the TBI Model Systems (TBIMS) National Database, a time frame during which self-reported seizures, depression [Patient Health Questionnaire (PHQ)-9], and anxiety [Generalized Anxiety Disorder (GAD-7)] follow-up measures were concurrently collected at year-1 and year-2 after injury.ResultsPTE did not significantly contribute to depression status in either the year-1 or year-2 cohort, nor did it contribute significantly to anxiety status in the year-1 cohort, after controlling for other known depression and anxiety predictors. However, those with PTE in year-2 had 3.34 times the odds (p = .002) of having clinically significant anxiety, even after accounting for other relevant predictors. In this model, participants who self-identified as Black were also more likely to report clinical symptoms of anxiety than those who identified as White. PTE was the only significant predictor of comorbid depression and anxiety at year-2 (Odds Ratio 2.71; p = 0.049).ConclusionsOur data suggest that PTE is associated with MH outcomes 2 years after TBI, findings whose significance may reflect reciprocal, biological, psychological, and/or experiential factors contributing to and resulting from both PTE and MH status post-TBI. Future work should consider temporal and reciprocal relationships between PTE and MH as well as if/how treatment of each condition influences biosusceptibility to the other condition.     

Epidemiological evidence for the link between sleep duration and high blood pressure: A systematic review and meta-analysis

ObjectivesWe aim to assess if the relationship between short or long sleep duration and hypertension is present among adults from epidemiological evidence and to investigate the relationship quantitatively.MethodsWe performed a comprehensive search of cross-sectional and longitudinal studies using PubMed and the Cochrane Library through February 2012. Our search was supplemented by reviewing reference lists of original and relevant reviews. After the related data were extracted by two investigators independently, pooled odds ratios (ORs) or relative risks (RRs) were estimated using a random-effects model or a fixed-effects model. Publication bias was evaluated, while sensitivity and meta-regression analyses were performed.ResultsTwenty-four adult studies met our inclusion criteria, with ages ranging from 18 to 106 years. Twenty-one studies involving 225,858 subjects were included in the meta-analysis. The pooled results from the cross-sectional studies showed that short sleep duration was associated with a greater risk for hypertension (OR, 1.21; 95% confidence interval [CI], 1.09–1.34; P < 0.001), and long sleep duration also increased the risk for hypertension (OR, 1.11; 95% CI, 1.04–1.18; P = 0.003). There was no evidence of publication bias. Pooled analysis from the longitudinal studies indicated a significant association between short sleep duration and hypertension (RR, 1.23; 95% CI, 1.06–1.42; P = 0.005), but an insignificant relationship between long sleep duration and hypertension (RR, 1.02; 95% CI, 0.91–1.14; P = 0.732). The effects of sleep duration differed by gender, location of the population, and definitions of short or long sleep duration. Meta regression analysis including seven variables did not find the sources of heterogeneity.ConclusionsAmong adults, a U-shaped relationship between habitual sleep duration and hypertension was found at the cross-sectional level. Short sleep duration was associated with a higher risk for hypertension even longitudinally. We must pay more attention to this lifestyle factor.     

Traumatic brain injury and PTSD symptoms as a consequence of intimate partner violence

ObjectiveTo effectively diagnose and treat women who have experienced intimate partner violence (IPV), it is important to identify the full range of physical and mental health consequences, including hidden wounds such as traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). We aimed to identify the occurrence of IPV-related TBI and associated PTSD symptoms among women veterans who experienced IPV.MethodsA web-based survey was administered in 2014 to a national sample of U.S. women veterans. Among 411 respondents (75% participation rate), 55% reported IPV during their lives. These participants (N = 224) completed screening measures of IPV-related TBI, PTSD, and past-year IPV and comprised the current sample.ResultsA total of 28.1% (n = 63) met criteria for IPV-related TBI history, and 12.5% (n = 28) met criteria for IPV-related TBI with current symptoms. When adjusting for race, income, and past-year IPV, women with IPV-related TBI with current symptoms were 5.9 times more likely to have probable IPV-related PTSD than those with no IPV-related TBI history. Despite symptom overlap between TBI and PTSD, women with IPV-related TBI with current symptoms were significantly more likely to meet criteria for all four DSM-5 PTSD symptom clusters compared to women with an IPV-related TBI history without current symptoms (Cramér's V′s = .34–.42).ConclusionFindings suggest there may be clinical utility in screening women who experience lifetime IPV for both TBI and PTSD symptoms in order to help clinicians better target their examinations, treatment, and referrals.     

Physical trauma and risk of multiple sclerosis: A systematic review and meta-analysis of observational studies

BackgroundWe aimed to examine physical trauma as a risk factor for the subsequent diagnosis of MS.MethodsWe searched for observational studies that evaluated the risk for developing MS after physical trauma that occurred in childhood (≤ 20 years) or “premorbid” (> 20 years). We performed a meta-analysis using a random effects model.ResultsWe identified 1362 individual studies, of which 36 case–control studies and 4 cohort studies met the inclusion criteria for the review. In high quality case–control studies, there were statistically significant associations between those sustaining head trauma in childhood (OR = 1.27; 95% CI, 1.12–1.44; p < 0.001), premorbid head trauma (OR = 1.40; 95% CI, 1.08–1.81; p = 0.01), and other traumas during childhood (OR = 2.31; 95% CI, 1.06–5.04; p = 0.04) and the risk of being diagnosed with MS. In lesser quality studies, there was a statistical association between “other traumas” premorbid and spinal injury premorbid. No association was found between spinal injury during childhood, or fractures and burns at any age and the diagnosis of MS. The pooled OR of four cohort studies looking at premorbid head trauma was not statistically significant.ConclusionsThe result of the meta-analyses of high quality case–control studies suggests a statistically significant association between premorbid head trauma and the risk for developing MS. However, cohort studies did not. Future prospective studies that define trauma based on validated instruments, and include frequency of traumas per study participant, are needed.     

The association of renin-angiotensin system blockade use with the risks of cognitive impairment of aging and Alzheimer’s disease: A meta-analysis

A quantitative meta-analysis was performed to evaluate the association of renin-angiotensin system blockade (RASB) use with the incidence of cognitive impairment of aging and Alzheimer’s disease (AD). Pubmed, Embase, and Cochrane Library databases were searched up to October 2015. Ten studies that assessed the relationship between RASB use and the incidence of cognitive impairment of aging or AD were included. When randomized trials and observational studies were combined, the use of RASB was significantly associated with a reduced risk of AD (risk ratio [RR], 0.80; 95% confidence interval [CI] 0.68–0.92) and cognitive impairment of aging (RR, 0.65; 95% CI 0.35–0.94) compared no use of RASB. Meanwhile, in an analysis of subgroups, both subjects with angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) use were lower incidence of AD (RR, 0.87; 95% CI 0.74–1.00; RR, 0.69; 95% CI 0.44–0.93, respectively) than those without, whereas, indirect comparison between ACEI and ARB revealed no significance in the risk of AD (RR, 1.27, 95% CI 0.85–1.89, p = 0.245). In an analysis of cognitive impairment of aging, ARB use (RR, 0.40; 95% CI 0.02–0.78), rather than ACEI use (RR, 0.72; 95% CI 0.36–1.09), was shown to decrease the risk of cognitive impairment of aging. In conclusion, RASB treatments, regardless of the drug class, have benefits on prevention of AD, and the effects of ACEI may analogous to ARB. However, the benefit differs according to drug classes for cognitive impairment of aging, with ARB use, rather than ACEI use, being a potential treatment for reducing the incidence of cognitive impairment of aging.     

The significant impact of Coronavirus disease 2019 (COVID-19) on in-hospital mortality of elderly patients with moderate to severe traumatic brain injury: A retrospective observational study

Background Traumatic brain injury (TBI) is one of the main causes of death and disability among the elderly patient population. This study aimed to assess the predictors of in-hospital mortality of elderly patients with moderate to severe TBI who presented during the Coronavirus disease 2019 (COVID-19) pandemic.MethodsIn this retrospective analytical study, all elderly patients with moderate to severe TBI who were referred to our center between March 2nd, 2020 to August 1st, 2020 were investigated and compared against the TBI patients receiving treatment during the same time period within the year 2019. Patients were followed until discharge from the hospital or death. The demographic, clinical, radiological, and laboratory test data were evaluated. Data were analyzed using SPSS-21 software.FindingsIn this study, 359 elderly patients were evaluated (n = 162, Post-COVID-19). Fifty-four patients of the cohort had COVID-19 disease with a mortality rate was 33.3%. The patients with COVID-19 were 5.45 times more likely to expire before discharge (P < 0.001) than the TBI patients who were not COVID-19 positive. Other variables such as hypotension (OR, 4.57P < 0.001), hyperglycemia (OR, 2.39, P = 0.002), and use of anticoagulant drugs (OR, 2.41P = 0.001) were also associated with in-hospital death. According to the binary logistic regression analysis Age (OR, 1.72; 95% CI: 1.26–2.18; P = 0.033), Coronavirus infection (OR, 2.21; 95% CI: 1.83–2.92; P = 0.011) and Glasgow Coma Scale (GCS) (OR, 3.11; 95% CI: 2.12–4.53; P < 0.001) were independent risk factors correlated with increased risk of in-hospital mortality of elderly patients with moderate to severe TBI.ConclusionOur results showed that Coronavirus infection could increase the risk of in-hospital mortality of elderly patients with moderate to severe TBI significantly.     

The SNP rs1625579 in miR-137 gene and risk of schizophrenia in Chinese population: A meta-analysis

BackgroundSchizophrenia is a severe psychiatric disorder with a high heritability. A single nucleotide polymorphism (SNP) rs1625579 (G/T; T is the common and presumed risk allele) within an intron of miR-137 gene has been recently suggested to contribute to the susceptibility to schizophrenia by a large-scale genome-wide association study (GWAS) in a sample of predominantly European ancestry. However, subsequent genetic association studies in Chinese population yielded inconsistent results.MethodsA meta-analysis reporting the association between rs1625579 and schizophrenia in Chinese population was carried out, pooling 4 eligible case–control studies involving 2847 patients and 3018 controls.ResultsThis meta-analysis demonstrated a significant association between rs1625579 and schizophrenia under the allele model [T versus G, odds ratio (OR):1.20, 95% confidence interval (CI): 1.06–1.36] and the recessive model (TT versus GT + GG; OR: 1.19; 95% CI: 1.04–1.37). Additionally, a marginal significant association under the additive model (TT versus GG; OR: 1.64; 95% CI: 1.00–2.69) was observed. However, no significant association was observed under the dominant model (TT + GT versus GG; OR: 1.58; 95% CI: 0.97–2.59).ConclusionsThis meta-analysis suggested that the SNP rs1625579 in miR-137 gene might be involved in schizophrenia susceptibility in Chinese Han population.     

Combination therapy of varenicline and bupropion in smoking cessation: A meta-analysis of the randomized controlled trials

BackgroundThe effects of the combination therapy of varenicline and bupropion in smoking cessation are still controversial.MethodsDatabases including PubMed, EMBASE, Cochrane Library and Web of Science were scanned without time and language limitation. Subgroup analysis was performed to assess the effect of combination therapy in smokers with different level of nicotine dependence and cigarette consumption.ResultsFour randomized controlled trials involving a total of 1230 smokers were included. Compared with varenicline monotherapy, combination treatment with varenicline and bupropion could significantly improve the abstinence rate at the end of treatment (RR 1.153, 95% CI 1.019 to 1.305, P = 0.024). The benefit existed at 6 months follow-up (RR 1.231, 95% CI 1.017 to 1.490, P = 0.033), disappeared at 12 months follow-up (RR 1.130, 95% CI 0.894 to 1.428, P = 0.305), and mainly concentrated in highly dependent smokers (RR 1.631, 95% CI 1.290 to 2.061, P < 0.001) and heavy smokers (RR 1.515, 95% CI 1.226 to 1.873, P < 0.001) rather than individuals with low nicotine dependence (RR 0.989, 95% CI 0.815 to 1.199, P = 0.907) or low cigarette consumption (RR 0.985, 95% CI 0.800 to 1.212, P = 0.252). For safety outcomes, the combination treatment was associated with more anxiety (RR 1.717, 95% CI 1.176 to 2.505, P = 0.005) and insomnia (RR 1.268, 95% CI 1.076 to 1.494, P = 0.005) symptoms compared with varenicline monotherapy.ConclusionCompared with varenicline monotherapy, combination treatment with varenicline and bupropion can significantly improve the abstinence rate at the end of treatment and 6 months follow-up, mainly in highly dependent smokers and heavy smokers.     

Psychiatric comorbidity in psychogenic nonepileptic seizures compared with epilepsy

ObjectivesPsychogenic nonepileptic seizures (PNESs) are closely linked with psychological distress, but their etiology is not well-understood. We reviewed psychiatric comorbidity in PNESs and epileptic seizures (ESs) with an aim to assist understanding, diagnosis, and management of PNESs.MethodsA search of Web of Science, MEDLINE (PubMed), PsycINFO, and Scopus identified 32 relevant studies on the prevalence of psychiatric comorbidity in PNESs. We used meta-analysis to compare psychiatric comorbidity between PNESs and ESs.ResultsSamples with PNESs had high rates of psychiatric comorbidity overall (53–100%), notably including posttraumatic stress disorder (PTSD), depression, and personality and anxiety disorders. Compared with ESs, samples with PNESs had more psychiatric comorbidity overall (RR: 1.30, 95% CI: 1.14–1.48, p < 0.0001) with significantly elevated risks found for PTSD, personality disorder, and anxiety but not depression.ConclusionsPsychiatric disorders are more common in PNESs than ESs. Because of methodological limitations of available studies, causality cannot be established; prospective longitudinal designs are required.