Efectos de la terapia con videojuegos comerciales sobre el equilibrio postural en pacientes con esclerosis múltiple: revisión sistemática y metaanálisis de ensayos clínicos controlados aleatorizados

IntroductionCommercial video games are considered an effective tool to improve postural balance in different populations. However, the effectiveness of these video games for patients with multiple sclerosis (MS) is unclear.ObjectivesTo analyse existing evidence on the effects of commercial video games on postural balance in patients with MS.Material and methodWe conducted a systematic literature search on 11 databases (Academic-Search Complete, AMED, CENTRAL, CINAHL, WoS, IBECS, LILACS, Pubmed/Medline, Scielo, SPORTDiscus, and Science Direct) using the following terms: “multiple sclerosis”, videogames, “video games”, exergam*, “postural balance”, posturography, “postural control”, balance. Risk of bias was analysed by 2 independent reviewers. We conducted 3 fixed effect meta-analyses and calculated the difference of means (DM) and the 95% confidence interval (95% CI) for the Four Step Square Test, Timed 25-Foot Walk, and Berg Balance Scale.ResultsFive randomized controlled trials were included in the qualitative systematic review and 4 in the meta-analysis. We found no significant differences between the video game therapy group and the control group in Four Step Square Test (DM: –.74; 95% CI, –2.79-1.32; P = .48; I² = 0%) and Timed 25-Foot Walk scores (DM: .15; 95% CI, –1.06-.76; P = .75; I² = 0%). We did observe intergroup differences in BBS scores in favour of video game therapy (DM: 5.30; 95% CI, 3.39-7.21; P < .001; I² = 0%), but these were not greater than the minimum detectable change reported in the literature.ConclusionsThe effectiveness of commercial video game therapy for improving postural balance in patients with MS is limited.     

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.     

Comparison of anterior cervical discectomy and fusion with the zero-profile device versus plate and cage in treating cervical degenerative disc disease: A meta-analysis

Zero-profile device was applied to diminish the irritation of the esophagus in the treatment of cervical degenerative disc disease. However, the clinical application of the zero-profile device has not been testified with clinical evidence. The aim of the meta-analysis was to systematically compare the safety and effectiveness of anterior cervical discectomy and fusion with zero-profile device with plate and cage for the treatment of cervical degenerative disc disease. Electronic searches of PubMed and Embase were conducted up to May 2015. Relevant studies were included. Weighted mean difference (WMD) and 95% confidence intervals (CI) were assessed for continuous data. Risk ratio (RR) and 95% CI were assessed for dichotomous data. P value <0.05 was considered to be significant. Eleven studies were included in the meta-analysis. Compared with plate and cage, zero-p is associated with lower operation time of two-level surgery, less intraoperative blood loss, higher subsidence rate, higher JOA score, lower incidence of dysphagia in short-term (RR: 0.72, 95% CI [0.58, 0.90], P = 0.005, I² = 22%) and long-term (RR: 0.12, 95% CI [0.05, 0.30], P < 0.00001, I² = 0%) and lower Cobb angle of multilevel surgery (WMD: −3.16, 95% CI: [−4.35, −1.97], P < 0.00001, I² = 0%). No significant difference was found in one-level and two-level Cobb angle, fusion rate and operation time of one-level and three-level surgery. Both zero-p implantation and the plate and cage have respective advantages and disadvantages.     

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.     

Habitual sleep duration associated with self-reported and objectively determined cardiometabolic risk factors

BackgroundSelf-reported short or long sleep duration has been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodologic issues.MethodsAdult respondents of the 2007–2008 US National Health and Nutrition Examination Survey (NHANES) were examined in a cross-sectional analysis (N = 5649). Self-reported sleep duration was categorized as very short (<5 h), short (5–6 h), normal (7–8 h), or long (⩾9 h). Obesity, diabetes mellitus (DM), hypertension, and hyperlipidemia were objectively assessed by self-reported history. Statistical analyses included univariate comparisons across sleep duration categories for all variables. Binary logistic regression analyses and cardiometabolic factor as outcome, with sleep duration category as predictor, were assessed with and without covariates. Observed relationships were further assessed for dependence on race/ethnicity.ResultsIn adjusted analyses, very short sleep was associated with self-reported hypertension (odds ratio [OR], 2.02, [95% confidence interval {CI},1.45–2.81]; P < 0.0001), self-reported hyperlipidemia (OR, 1.96 [95% CI, 1.43–2.69]; P < 0.0001), objective hyperlipidemia (OR, 1.41 [95% CI, 1.04–1.91]; P = 0.03), self-reported DM (OR, 1.76 [95% CI, 1.13–2.74]; P = 0.01), and objective obesity (OR, 1.53 [95% CI, 1.03–1.43]; P = 0.005). Regarding short sleep (5–6 h), in adjusted analyses, elevated risk was seen for self-reported hypertension (OR, 1.22 [95% CI, 1.02–1.45]; P = 0.03) self-reported obesity (OR, 1.21 [95% CI, 1.03–1.43]; P = 0.02), and objective obesity (OR, 1.17 [95% CI, 1.00–1.38]; P < 0.05). Regarding long sleep (⩾9 h), no elevated risk was found for any outcomes. Interactions with race/ethnicity were significant for all outcomes; race/ethnicity differences in patterns of risk varied by outcome studied. In particular, the relationship between very short sleep and obesity was strongest among blacks and the relationship between short sleep and hypertension is strongest among non-Hispanic whites, blacks, and non-Mexican Hispanics/Latinos.ConclusionsShort sleep duration is associated with self-reported and objectively determined adverse cardiometabolic outcomes, even after adjustment for many covariates. Also, these patterns of risk depend on race/ethnicity.     

Attached to the web — harmful use of the Internet and its correlates

Background and aimsThe aim of this study was to test the validity of the Finnish version of the Internet Addiction Test and the correlates of harmful use of the Internet.MethodsOne thousand eight hundred and twenty-five students (45.5% men and 54.5% women, mean age 24.7 years, S.D. = 5.7) filled in a web-based questionnaire including IAT, reasons for use of the Internet, distress, social support, and substance use.ResultsMen had a statistically significantly higher mean score on the IAT than women. Subjects with self-reported use of cannabis had higher mean score on the IAT compared to non-users (39.5 [11.3] vs 35.8 [10.8]). The total IAT score was associated with “adult entertainment” (OR = 1.07, 95%CI: 1.06–1.08, P < 0.001), “playing games” (OR = 1.05, 95%CI: 1.04–1.06, P < 0.001), “chatting” (OR = 1.07, 95%CI: 1.06–1.08, P < 0.001) and “discussion” (OR = 1.08, 95%CI: 1.07–1.09, P < 0.001) as reasons for Internet use. The IAT score had a significant negative correlation with social support (r = ?0.24, P < 0.001) and a significant positive correlation with the CAGE score (r = 0.18, P < 0.001). Using factor analysis, we found a single factor solution with a Cronbach's α of 0.92.ConclusionsThe IAT seems to provide a valid measurement of harmful use of the Internet, as the score was significantly associated with variables tapping psychopathology.     

Further evidence for genetic association of CACNA1C and schizophrenia: New risk loci in a Han Chinese population and a meta-analysis

CACNA1C (12p13.3) has been implicated as a susceptibility gene for schizophrenia by several replicated genome wide association studies. While these results have been consistent among studies in European populations, the findings in East Asian populations have varied. To test whether CACNA1C is a risk gene for schizophrenia, we conducted a case–control study in 5897 schizophrenic patients and 6323 healthy control subjects selected from Han Chinese population. Our study replicated the positive associations of rs1006737 (P = 0.0108, OR = 1.16, 95% CI: 1.03–1.29) and rs1024582 (P = 0.0062, OR = 1.18, 95% CI: 1.05–1.33), and identified a novel risk locus, rs2007044 (P = 0.0053, OR = 1.08, 95% CI: 1.02–1.14). A meta-analysis of rs1006737 combining our study and previous studies was conducted in a total of 8222 schizophrenia cases and 24,661 healthy controls. In the meta-analysis, the association between rs1006737 and schizophrenia remained significant (OR = 1.14, 95% CI: 1.07–1.22, P = 0.0001). Stratified analysis showed no heterogeneity between East Asian and European ancestries (χ²[1] = 0.07, P = 0.795), and the difference in pooled ORs between ancestries was not significant (Z = 0.25, P = 0.801). Our results provide further support for associations of rs1006737 and rs1024582 with schizophrenia, identify a new risk locus rs2007044 in a Han Chinese population, and further establish CACNA1C as an important susceptibility gene for the disease across world populations.     

The efficacy and safety of teriflunomide based therapy in patients with relapsing multiple sclerosis: A meta-analysis of randomized controlled trials

The aim of this study was to evaluate the efficacy and safety of teriflunomide in reducing the frequency of relapses and progression of physical disability in patients with relapsing multiple sclerosis (RMS). Literatures were searched in Pubmed, Medline and Embase to screen citations from January 1990 to April 2015. Studies of parallel group design comparing teriflunomide and placebo for RMS were screened. After independent review of 234 citations by two authors, seven studies were identified as meeting the inclusion criteria. The results showed teriflunomide (7 and 14 mg) could significantly reduce annualized relapse rate and teriflunomide at the higher dose could also decrease the disability progression (risk ratio (RR) = 0.69, 95% confidence interval (CI): 0.55–0.87). And teriflunomide significantly reduce annualized rates of relapses with sequelae-EDSS/FS, relapses leading to hospitalization, and relapses requiring IV corticosteroids. Patients treated with teriflunomide 14 mg have a lower annualized rate of relapses with sequelae-investigator (RR = 0.37, 95% CI: 0.26–0.52). Teriflunomide 7 mg has a higher incidence of diarrhea (RR = 1.73, 95% CI: 1.32–2.26) and hair thinning (RR = 1.99, 95% CI: 1.4–2.81), while teriflunomide 14 mg has a higher incidence of diarrhea (RR = 1.71, 95% CI: 1.34–2.18), hair thinning (RR = 2.81, 95% CI: 2.02–3.91) and nausea (RR = 1.65, 95% CI: 1.03–2.31) compared with placebo. The incidence of elevated alanine aminotransferase levels was also higher with teriflunomide than with placebo. However, the incidence of serious adverse events was similar across groups. In conclusion, teriflunomide significantly reduces annualized relapse rates and disability progression with a similar safety and tolerability profile to placebo.     

Acute bouts of exercise induce a suppressive effect on lymphocyte proliferation in human subjects: A meta-analysis

ObjectiveLymphocyte proliferative responses are commonly used to assess immune function in clinical settings, yet it is unclear how proliferative capacity is altered by exercise. This analysis aims to quantitatively assess the proliferative response of lymphocytes following an acute bout of exercise.MethodsElectronic databases were searched for articles containing the keywords “exercise” OR “acute” OR “aerobic” OR “resistance training” OR “immune function” AND “proliferation” AND “lymphocyte.” Initial results yielded 517 articles of which 117 were reviewed in full. Twenty-four articles met the inclusion criteria. Calculated standardized mean difference (SMD) and corresponding standard errors (SE) were integrated using random-effect models.ResultsAnalyses uncovered evidence for suppression of proliferative capacity following acute exercise in general (SMD = −0.18, 95% CI: −0.21, −0.16) with long duration, high intensity exercise exhibiting a moderate suppressive effect (SMD = −0.55, 95% CI: −0.86, −0.24). Discordant proliferative responses for long duration, high intensity exercise in competitive versus non-competitive settings were identified with enhanced proliferation (SMD = 0.46, 95% CI: 0.03, 0.89) observed following competitive events and a large suppressive effect detected for similar activities outside of a competitive environment (SMD: −1.28, 95% CI: −1.61, −0.96) (p = 0.02).ConclusionEvidence suggests lymphocyte proliferation is suppressed following acute bouts of exercise, with exercise lasting longer than one hour having a greater magnitude of effect regardless of exercise intensity. Variations in observed effect sizes across intensity, duration, and competitive environment further highlight our need to acknowledge the impact of study designs in advancing our understanding of exercise immunology.     

Dexmedetomidine as an anesthetic adjuvant for intracranial procedures: Meta-analysis of randomized controlled trials

This meta-analysis aimed to systematically collect the current evidence regarding the efficacy and safety of dexmedetomidine (DEX) as an anesthetic adjuvant for patients undergoing intracranial surgery. A systematic literature search of randomized controlled trials (RCT) was conducted to compare DEX with placebo or opioids in patients undergoing intracranial procedures. Hemodynamic data, opioid consumption, and recovery parameters were pooled. Eight RCT were included. Results showed that patients treated with DEX required less intraoperative treatment for hypertension and hypotension (risk ratio [RR] = 0.48, 95% confidence interval [CI] 0.31–0.75, p = 0.001; and RR = 0.66, 95% CI 0.43–1.01, p = 0.05, respectively) and less postoperative treatment for hypertension and tachycardia (RR = 0.37, 95% CI 0.17–0.79, p = 0.01; and RR = 0.14, 95% CI 0.03–0.59, p = 0.007, respectively) compared with placebo. Patients also had lower mean arterial pressure and heart rate when extubated (mean difference [MD] = −9.74 mmHg, 95% CI −12.35 to −7.12, p < 0.00001; and MD = −16.35 beats/minute, 95% CI −20.00 to −12.70, p < 0.00001, respectively), a lower intraoperative additional fentanyl consumption (MD = −0.78 μg/kg, 95% CI −1.51 to −0.05, p = 0.04), and lower postoperative antiemetic requests (RR = 0.51, 95% CI 0.33–0.80, p = 0.003). DEX may not increase extubation time, postoperative P_aCO₂, or the risk of perioperative bradycardia. Only a small number of RCT are available, but meta-analysis shows evidence that DEX as an anesthetic adjuvant during intracranial procedures leads to better perioperative hemodynamic control, less intraoperative opioid consumption, and fewer postoperative antiemetic requests.     

“Muscle Pics”, a new body-checking behavior in muscle dysmorphia?

Background and aimsThe internalization of ideal hypermuscular body and pro-muscularity media's influence have shown their importance in muscle dysmorphia development. The aim of the current study is to have a better understanding of links between specific body checking behaviors and muscle dysmorphia in social network context.MethodsIn total, 342 students practicing weightlifting at the university gym in Bordeaux answered to a survey with sociodemographic information and body checking symptoms including taking specific selfies of muscles and muscularity “Muscle Pics” and the MDDI (Muscle Dysmorphic Disorder Inventory).ResultsMuscle dysmorphia was prevalent in 18.7% of our population (64 students). We observed that muscle dysmorphia was correlated to “Muscle Pics”, “Follow-up”, “Message”, “Selfie”, and gym mirror checking with significant results (P < 0.01). Also, « Muscle Pics » were linked to APEDs use, pro-muscularity websites, fitness model comparison and gym mirror checking (P < 0.01). For muscle dysmorphia, “Muscle Pics” have strong predictive results (OR = 5.10, P = 0.000) and (OR = 4.08, P = 0.000) for adjusted. “Follow up” (OR = 4.76, P = 0.000) and (OR = 3.83, P = 0.000) for adjusted, “Muscle Pics Selfie” (OR = 11.20, P = 0.000) and (OR = 11.55, P = 0.000) for adjusted, “Muscle Pics Message” (OR = 4.49, P = 0.001) and (OR = 5.78, P = 0.001) for adjusted.Conclusion“Muscle Pics” showed several links with muscle dysmorphia for global score “drive for size”, “functional impairment” but not for “appearance intolerance” dimension. Pro-muscularity websites, fitness model comparisons and gym mirror checking are linked to muscle dysmorphia and “Muscle Pics”. Future research on “Muscle Pics” will help to provide a better understanding of muscle dysmorphia and its link with pro-muscularity influence websites.     

Risk factors for remote seizure development in patients with cerebral vein and dural sinus thrombosis

PurposeWe aimed to define the possible risk factors for acute and remote seizures in patients with cerebral vein and sinus thrombosis (CVST).MethodNinety-four patients were recruited prospectively at Al-Zahra Hospital, Isfahan, Iran, between April 2007 and April 2012. To identify seizure predictors, we compared demographic, clinical and imaging factors between patients with or without acute and remote seizures.ResultsOf the 94 patients, 32 (34%) experienced at least one seizure after CVST development. Bivariate analysis showed a significant association of remote seizure with loss of consciousness at presentation (P = 0.05, OR: 5.11, 95%CI: 1.07–24.30), supratentorial lesions (P = 0.02, OR: 9.04, 95%CI: 1.04–78.55), lesions in the occipital lobe (P = 0.00, OR: 12.75, 95%CI: 2.28–71.16), lesions in the temporal and parietal lobes, thrombophilia (P = 0.03, OR: 5.87, 95%CI: 1.21–28.39), seizure in the acute phase (P = 0.00, OR: 13.14, 95%CI: 2.54–201.2) and sigmoid sinus thrombosis (P = 0.00, OR: 12.5, 95%CI: 2.23–69.79). Seizures in the acute phase were also more common in patients with paresis (P = 0.00, OR: 4.88, 95%CI: 1.91–12.46), hemorrhagic lesions indicated by imaging (P = 0.02, OR: 2.77, 95%CI: 1.08–7.10), supratentorial lesions, lesions in the frontal (P = 0.01, OR: 3.81, 95%CI: 1.28–11.31) and parietal lobes (P = 0.00, OR: 5.16, 95%CI: 2–13.29), thrombophilia and history of miscarriage (P = 0.03, OR: 2.91, 95%CI: 1.07–7.91). No factor predicted acute or remote seizure in a multiple logistic regression analysis.ConclusionOur results demonstrate that seizure development in the acute phase is the most significant factor for development of remote seizure. Parenchymal lesions in the supratentorial area were also found to be associated with both acute and remote seizures. However, no factor was predictive of acute or remote seizures in a multivariate analysis.     

Is ADHD severity in adults associated with the lifetime prevalence of comorbid depressive episodes and anxiety disorders?

PurposeThe objective of the present study was to examine the association between ADHD severity and the lifetime prevalence of comorbid depressive episodes and anxiety disorders in adults with ADHD.Subjects/materials and methodsAnalyses were based on data of the Conner's Adult ADHD Rating Scale (CAARS) and a parent study examining the epidemiology of adult ADHD in 17 GP practices in Budapest, Hungary. Subjects between 18 and 60 years were included in the screening phase (n = 3529). Out of 279 positively screened subjects 161 participated in a clinical interview and completed the CAARS to confirm the diagnosis. We applied four diagnostic criteria: “DSM-IV”; “No-onset” (DSM-IV criteria without the specific requirement for onset); “Symptoms-only” (DSM-IV symptom criterion only); and “Reduced symptoms-only” (DSM-IV symptom criterion with a reduced threshold for symptom count). The MINI PLUS 5.0 was used to assess psychiatric comorbidity.ResultsADHD severity, as measured by the CAARS ADHD Index, showed a significant positive association with the prevalence of comorbid depressive episodes in all but the “ADHD_No-onset” group (“DSM-IV”: F[1.23] = 8.39, P = 0.0081; “No-onset”: F(1.27) = 0.97, P = 0.3346; “Symptoms-only”: F[1.55] = 30.79, P < 0.0001; “Reduced symptoms-only”: F(1.62) = 26.69, P < 0.0001).Discussion and conclusionResults indicate that ADHD symptom severity increases in association with lifetime comorbidity with depression.     

Les conduites suicidaires dans le trouble bipolaire de type 1

ObjectivesBipolar disorder is one of the most common and severe psychiatric conditions. It is frequently complicated by suicidal behaviors, and patients with BD are among those at higher risk of suicide. The aims of our study were to evaluate the predictive factors of suicidal behaviors in patients with BD type 1, through the assessment of their socio-demographic, clinical and evolutionary characteristics as well as to study the implications of the childhood traumas and impulsivity as predictive factors for suicidal behaviors in these patients with bipolar disorder.MethodsOne hundred patients with bipolar disorder type 1were recruited in order to conduct a cross-sectional, analytical and comparative study. The recruitment involved a first group made up of 40 patients suffering from type 1 bipolar disorder with a history of suicidal acts. This group was compared with a second group made up of 60 patients with no history of attempted suicide. We used a pre-established collection sheet for collecting socio-demographic, clinical and therapeutic data. We also used the Childhood Trauma Questionnaire for the assessment of childhood adversities, the Barratt Impulsivity Scale in its eleventh version for the assessment of impulsivity levels and the Global Assessment of Functioning Scale for the evaluation of overall functioning.ResultsThe suicidal behaviors in patients with bipolar disorder were significantly associated with: female gender (P < 0.001), professional instability (P = 0.002), family history of BD (P = 0.02), family history of other psychiatric disorders (P = 0.003), frequency of depressive episodes (P = 0.002), shorter remission (P = 0.025), more subsyndromal symptoms (P = 0.029), sexual abuse dimension (P = 0.009), and a high level of impulsivity (P < 0.001). The predictive factors for suicidal behaviors in multivariate analysis, after adjusting for the confounding variables were: childhood sexual abuse (P = 0.01; adjusted OR 4.5; 95% CI 1.44–14.2), a high level of impulsivity (P = 0.002; adjusted OR 6.6; 95% CI 2–20), a higher rate of depressive episodes (P = 0.003; adjusted OR 5; 95% CI 1.69–14.2) and more subyndromal symptoms (P = 0.007; adjusted OR 5.8; 95% CI 1.63–20).ConclusionsSuicide prevention is an important mental health subject. It would be imperative to include systematic screening for childhood adversities and adequate management of bipolar disorder and impulsivity.     

Efficacy and safety of prostaglandin E1 plus lipoic acid combination therapy versus monotherapy for patients with diabetic peripheral neuropathy

The aim of this report was to evaluate the efficacy and safety of prostaglandin E1 (PGE1) plus lipoic acid (LA) for the treatment of diabetic peripheral neuropathy (DPN) compared with that of PGE1 or LA monotherapy. Randomized controlled trials (RCT) published up to 3 August 2014 were reviewed. A random or fixed effect model was used to analyze outcomes expressed as risk ratios (RR) or mean difference (MD) with a 95% confidence interval (CI). I² statistic was used to assess heterogeneity. Subgroup and sensitivity analyses were performed. The outcomes measured were as follows: clinical efficacy, median motor nerve conduction velocity (MNCV), median sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV and adverse effects. Thirty-one RCT with 2676 participants were included. Clinical efficacy of PGE1 + LA combination therapy was significantly better than monotherapy (p < 0.00001, RR = 1.32, 95% CI 1.26 to 1.38). Compared with monotherapy, PGE1 + LA combination therapy led to significant improvements in median MNCV (p < 0.00001, MD = 4.69, 95% CI 3.16 to 6.23), median SNCV (p < 0.00001, MD = 5.46, 95% CI 4.04 to 6.88), peroneal MNCV (p < 0.00001, MD = 5.19, 95% CI 3.71 to 6.67) and peroneal SNCV (p < 0.00001, MD = 5.50, 95% CI 3.30 to 7.70). There were no serious adverse events associated with drug intervention. PGE1 + LA combination therapy is superior to PGE1 or LA monotherapy for improvement of neuropathic symptoms and nerve conduction velocities in patients with DPN. These findings should be further validated by larger well-designed and high-quality RCT.     

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.     

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.     

A meta-analysis of bevacizumab alone and in combination with irinotecan in the treatment of patients with recurrent glioblastoma multiforme

Combining bevacizumab with irinotecan is a new chemotherapy regimen for patients with recurrent glioblastoma multiforme (GBM). Recent phase II trials suggest that this combined chemotherapy is beneficial to patients, but the subsequent adverse events may lead to treatment discontinuation. No comparison has yet demonstrated conclusively that the combined chemotherapy is more beneficial than single-agent chemotherapy. Thus, a meta-analysis was conducted to assess the efficacy and safety of bevacizumab compared to bevacizumab combined with irinotecan for the treatment of recurrent GBM. A total of 480 patients were included in the study, with 183 patients (38.1%) in the bevacizumab group and 297 patients (61.9%) in the bevacizumab plus irinotecan group. The median overall survival was 8.63 months (95% confidence interval [CI], 8.54–8.72 months) and 8.91 months (95% CI, 8.69–9.13 months), respectively. The mean objective response rate (complete response plus partial response rate) was 33.9% (95% CI, 18.1–52.1%) and 45.8% (95% CI, 28.2–66.7%), respectively. The 6-month progression-free survival rates (PFS-6) were 38.8% (95% CI, 18.8–57.0%) and 48.3% (95% CI, 25.4–54.3%), respectively. The rate of discontinuation was 5.5% and 20.0%, respectively. Compared with patients treated with bevacizumab only, those in the bevacizumab plus irinotecan group had higher PFS-6 (p = 0.046), objective response (p = 0.013) and rate of discontinuation (p = 0.000) but there was no statistically significant difference in overall survival between the groups (p = 0.487). Thus, although the combination of bevacizumab and irinotecan may increase the rate of discontinuation, it provided no obvious improvement in overall survival in patients with recurrent GBM. Therefore, the benefits of drug combination are outweighed by the treatment discontinuity and quality of life effects of drug toxicity and should be considered on an individual patient basis only.     

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.     

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.