Bisphosphonates and atrial fibrillation: Bayesian meta-analyses of randomized controlled trials and observational studies

Background  

Occurrence of atrial fibrillation (AF) amongst bisphosphonate users has been increasingly reported but results are conflicting. We performed a Bayesian meta-analysis to address the possible association between the occurrence of AF and bisphosphonate use and estimated the posterior probability of development of AF with bisphosphonate use.     

Are observational data on therapeutic outcome trustworthy?

Abstract

Randomized controlled trials have become the golden standard to assess the effectiveness of a therapeutic action. Observational studies can be used to monitor effects of routinely applied therapeutic procedures. The validity of such studies can always be questioned and the results must be assessed in light of possible sources of bias. This issue is exemplified by the analysis of more than 10,000 patients admitted for coronary artery by-pass surgery in Gothenburg early in this century.     

Angiotensin-converting enzyme inhibition and renal protection in nondiabetic patients: the data of the meta-analyses

ESRD represents a major health problem. The number of patients who enter kidney replacement programs has increased at an average of 7% per year in the past 10 yr. A large number of experimental and clinical studies have demonstrated that chronic nephropathies share common pathogenic mechanisms that contribute to renal disease progression, even independent of the original cause. Clinical studies found a significant correlation between the extent of urinary protein excretion and the rate of GFR decline in both diabetic and nondiabetic chronic nephropathies. Randomized trials, in particular the Ramipril Efficacy In Nephropathy (REIN) study, also showed that treatments that reduce proteinuria (namely angiotensin-converting enzyme [ACE] inhibitors) are renoprotective and limit progression to ESRD. Meta-analyses of randomized clinical trials also evaluated the role of proteinuria and of ACE inhibition therapy in chronic renal disease progression. Their findings were consistent with those of the REIN study and confirmed in larger series of patients the predictive value of proteinuria and the renoprotective effect of proteinuria reduction by ACE inhibition therapy. Thus, the meta-analyses may confirm and extend previous findings generated by randomized clinical trials. Conceivably, well-designed studies in properly selected and carefully monitored patients who are at increased risk continue to be the best approach to test novel hypotheses. The meta-analyses, however, represent a valuable tool to evaluate the consistency and generalizability of trial results to larger cohorts of patients.     

The prevalence and effect of publication bias in orthopaedic meta-analyses

Background  

Meta-analyses of randomized, controlled trials are considered the highest level-of-evidence, thus strongest source of information. However, questions concerning the validity of meta-analyses in orthopaedic surgery emerged recently. Among the most common sources for errors is publication bias. This describes the fact that studies with small or non-significant outcomes are less likely to be published, thus less likely to be identified and included in systematic reviews and meta-analyses. In this study we asked three questions: (1) Whether publication bias is assessed in orthopaedic meta-analyses, (2) What the actual prevalence of publication bias is, and (3) what effect publication bias has on the outcomes of orthopaedic meta-analyses.     

The perils of portliness: causes and consequences of visceral adiposity

Although an individual's total fat mass predicts morbidities such as coronary artery disease and diabetes, the anatomical distribution of adipose tissue is a strong and independent predictor of such adverse health outcomes. Thus, obese individuals with most of their fat stored in visceral adipose depots generally suffer greater adverse metabolic consequences than similarly overweight subjects with fat stored predominantly in subcutaneous sites. A fuller understanding of the biology of central obesity will require information regarding the genetic and environmental determinants of human fat topography and of the molecular mechanisms linking visceral adiposity to degenerative metabolic and vascular disease. Here we attempt to summarize the growing body of data relevant to these key areas and, in particular, to illustrate how recent advances in adipocyte biology are providing the basis for new pathophysiological insights.     

Survival benefit of partial nephrectomy: Reconciling experimental and observational data

Given recent epidemiological and practice trends, small kidney cancers are poised to become a focus of modern-day surgical care provided by urologists and urologic oncologists. For the past decade, partial nephrectomy has been viewed as preferable to radical nephrectomy for the treatment of many patients with early-stage kidney cancer, partly because observational studies suggest a survival benefit with nephron sparing. More recently, European Organisation for Research and Treatment of Cancer 30904—a phase 3 randomized control trial—demonstrated better survival for patients treated with radical vs. partial nephrectomy. Shortly thereafter, an instrumental variable analysis reported a survival advantage with partial nephrectomy. Although seemingly contradictory, these studies are potentially reconcilable when considering methodological differences and other empiric work.     

The perils of esophageal prosthesis placement in malignant tracheoesophageal fistula.

Endoesophageal prostheses are sometimes used in palliative therapy of esophageal carcinoma. Placement or subsequent manipulation of these devices may require general anesthesia, and these anesthetics are fraught with potential complications, both from the patient's illness and from the prosthesis itself. The two patients in our report presented anesthetic challenges, including acute upper airway obstruction occurring outside the operating theater and management of malignant tracheoesophageal fistula.     

The perils of pointing the finger: a lesson for Dr. Haygarth

Mr. William Russ Pugh, well known for his anaesthetic activities, and probably the first in Australia to administer ether anaesthesia for a surgical operation in May 1847, was involved in several court cases in Launceston, Tasmania in 1842 and 1843. At that time Tasmania was known as Van Diemen's Land. Two of the most dramatic cases ensued after a young doctor, Dr. Burton George Haygarth, a recent arrival in the colony of Van Diemen's Land, was persuaded to accuse Pugh of manslaughter. Because of Pugh's standing in Launceston the cases attracted enormous public attention and support for Pugh. The outcome for Dr. Haygarth was very unpleasant and not something which he had anticipated.