Heart rate variability in the prediction of survival in patients with cancer: A systematic review and meta-analysis

PurposeAlthough the predictive value of vagal nerve activity, indexed by heart rate variability (HRV), has been confirmed in a variety of diseases, its value in the prediction of survival in cancer patients still remains controversial. The aim of this meta-analysis was to evaluate the predictive value of HRV in cancer patients in an evidence based manner.MethodsA systematic review and meta-analysis was conducted through a comprehensive search of the PubMed, EMBASE and the Cochrane Central Library databases for all studies regarding HRV, vagal nerve activity and cancer. Pooled data of overall survival was analyzed.ResultsSix studies with 1286 patients were included in our meta analysis. Analysis of the pooled data revealed that overall survival was significantly longer in the higher HRV group than in the lower HRV group (HR 0.70, 95% CI [0.60, 0.82]; P < 0.001, I2 = 27%).ConclusionThe current evidence indicates a predictive value of HRV in the survival of patients with cancer and higher vagal nerve activity might predict longer survival, but the results should be applied with caution considering the heterogeneity between included studies.     

Facial emotion perception in patients with epilepsy: A systematic review with meta-analysis

Facial emotion perception is a fundamental social competency relying on a specialised, yet distributed, neural network. This review aimed to determine whether patients with epilepsy have facial emotion perception accuracy impairments overall, or for a subset of emotions (anger, disgust, happiness, sadness, fear, and surprise), and the relationship to epilepsy type, demographic/treatment variables, and brain organisation. Database searches used PRISMA guidelines with strict inclusion/exclusion criteria. Thirty included studies assessed patients with temporal lobe (TLE; n = 709), frontocentral (FCE; n = 22), and genetic generalised (GGE; n = 48) epilepsy. Large deficits emerged in patients with epilepsy compared to controls (n = 746; Hedges’ g = 0.908–1.076). Patients with TLE were significantly impaired on all emotions except surprise; patients with GGE were significantly impaired in anger, disgust, and fear perception. Meta-regression of patients with TLE revealed younger age at testing was associated with lower accuracy. This review provides evidence for marked global deficits of emotion perception in epilepsy, with differential emotion-specific impairment patterns in patients with TLE and GGE.     

Thromboprophylaxis in non-surgical cancer patients

Acutely ill medical patients with cancer and cancer patients requiring non-surgical therapy are considered as non-surgical cancer patients and are at moderate to high risk of venous thromboembolism (VTE): approximately 10-30% of these patients may develop asymptomatic or symptomatic deep-vein thrombosis (DVT) or pulmonary embolism (PE), and the latter is a leading contributor to deaths in hospital. Other medical conditions associated with a high risk of VTE include cardiac disease, respiratory disease, inflammatory bowel disease, rheumatological and infectious diseases. Pre-disposing risk factors in non-surgical cancer patients include a history of VTE, immobilisation, history of metastatic malignancy, complicating infections, increasing age, obesity hormonal or antiangiogenic therapies, thalidomide and lenalidomide therapy. Heparins, both unfractionated (UFH) and low molecular weight heparin (LMWH) and fondaparinux have been shown to be effective agents in prevention of VTE in the medical setting with patients having a history of cancer. UFH and LMWH along with semuloparin also have a role in outpatients with cancer receiving chemotherapy. However, it has not yet been possible to demonstrate a significant effect on mortality rates in this population. UFH has a higher rate of bleeding complications than LMWH. Thromboprophylaxis has been shown to be effective in medical patients with cancer and may have an effect on cancer outcomes. Thromboprophylaxis in patients receiving chemotherapy remains controversial and requires further investigation. There is no evidence for the use of aspirin, warfarin or mechanical methods. We recommend either LMWH, or fondaparinux for the prevention of VTE in cancer patients with acute medical illnesses and UFH for those with significant severe renal impairment. For ambulatory cancer patients undergoing chemotherapy we recommend LMWH or semuloparin. These are safe and effective agents in the thromboprophylaxis of non-surgical cancer patients.     

The correlation between central and peripheral oxytocin concentrations: A systematic review and meta-analysis

There is growing interest in the role of the oxytocin system in social cognition and behavior. Peripheral oxytocin concentrations are regularly used to approximate central concentrations in psychiatric research, however, the validity of this approach is unclear. Here we conducted a pre-registered systematic search and meta-analysis of correlations between central and peripheral oxytocin concentrations. A search of databases yielded 17 eligible studies, resulting in a total sample size of 516 participants and subjects. Overall, a positive association between central and peripheral oxytocin concentrations was revealed [r = 0.29, 95% CI (0.14, 0.42), p < 0.0001]. This association was moderated by experimental context [Q_b(4), p = 0.003]. While no association was observed under basal conditions (r = 0.08, p = 0.31), significant associations were observed after intranasal oxytocin administration (r = 0.66, p < 0.0001), and after experimentally induced stress (r = 0.49, p = 0.001). These results indicate a coordination of central and peripheral oxytocin release after stress and after intranasal administration. Although popular, the approach of using peripheral oxytocin levels to approximate central levels under basal conditions is not supported by the present results.     

Direct oral anticoagulants in the treatment of acute venous thromboembolism: A systematic review and meta-analysis

Introduction

Acute venous thromboembolism (VTE) is a common disease associated to significant morbidity and mortality.

Materials and methods

We systematically reviewed and meta-analysed clinical outcomes with direct oral anticoagulants (DOAC: dabigatran, rivaroxaban, apixaban or edoxaban) for treatment of acute VTE. We used MEDLINE and CENTRAL, clinical trials registers, conference proceedings, and websites of regulatory agencies to identify randomised clinical trials of DOAC compared with conventional treatment [parenteral anticoagulant followed by a vitamin K antagonist (VKA)] for acute VTE. Two investigators independently extracted data. Relative risk of recurrent VTE, bleeding events, deaths and a net clinical endpoint (composite of recurrent VTE, major bleeding, and death) were estimated using a random effect meta-analysis (RevMan software).

Results

Six trials including 27,127 patients were selected. The risk of recurrent VTE was similar with the DOAC and standard treatment (relative risk 0.91, 95% confidence interval 0.79 to 1.06). The DOAC reduced the risk of major bleeding in comparison with standard treatment (0.62, 0.45 to 0.85) (absolute risk difference, − 0.6%; 95% confidence interval − 1.0% to − 0.3%), but there was heterogeneity across trials in the relative risk of bleeding. No between treatment differences were found in the relative risk of all-cause mortality (0.98, 0.84 to 1.14). The DOAC and conventional treatment differed on the net clinical endpoint (0.85, 0.75 to 0.97). Subgroup analyses in relevant subgroups (index pulmonary embolism, heparin lead-in, age, gender, renal function, presence of cancer), as well as sensitivity analyses, were consistent with the main analysis.

Conclusions

The DOAC seem as effective as, and probably safer than standard treatment of acute VTE. The relative efficacy and safety of the DOAC was consistent across a wide range of patients.     

Effect of cilostazol in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis

Previous studies with small sample size have shown that cilostazol can reduce the risk of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to determine whether cilostazol is effective in patients with aneurysmal SAH. Studies investigating the effect of cilostazol in patients with aneurysmal SAH were identified using Embase.com without language or publication-type restrictions. We used the random-effect model to combine data. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated. Two randomized controlled trials and two quasi-randomized controlled trials with a total of 340 patients were included. The incidence of symptomatic vasospasm (RR = 0.47; 95% CI, 0.31–0.72; p < 0.001), severe vasospasm (RR = 0.48; 95% CI, 0.28–0.82; p = 0.007), vasospasm-related new cerebral infarctions (RR = 0.38; 95% CI, 0.22–0.67; p = 0.001), and poor outcome (RR = 0.57; 95% CI, 0.37–0.88; p = 0.011) were significantly lower in the cilostazol group. The numbers needed to treat for these outcomes were 6.4, 6.3, 5.7, and 5.4, respectively. Mortality rate differences between the two groups were insignificant. No statistical heterogeneity was found for all outcomes. These results show that cilostazol can decrease the incidence of symptomatic vasospasm, severe vasospasm, vasospasm-related new cerebral infarctions, and poor outcome in patients with aneurysmal SAH.     

Seasonal and monthly variability in the incidence of venous thromboembolism. A systematic review and a meta-analysis of the literature

Many studies showed that the occurrence of cardiovascular and cerebrovascular events exhibits a seasonal and monthly variation. Evidences of a seasonal and monthly variation in the incidence of venous thromboembolism (VTE) are more conflicting. We conducted a systematic review and a meta-analysis of the literature to assess the presence of an infradian rhythm of this disease. MEDLINE and EMBASE databases were searched up to January 2010. Monthly and seasonal variation in the incidence of VTE were analysed. We included studies analysing seasonal or monthly aggregation in the incidence of deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) with an objective diagnosis of VTE. Two authors independently reviewed and extracted data. Seventeen studies for a total of about 35,000 patients were included. Twelve studies analysed the seasonal variation and 10 studies the monthly variation of VTE. Our results showed a significantly increased incidence of VTE in winter (chi-square 146.04, p <0.001), with a relative risk (RR) of VTE of 1.143 (99% CI [1.141, 1.144]), and a significantly increased incidence of VTE in January (chi-square 232.57, p <0.001) with an RR of VTE of 1.194 (99% CI 1.186, 1.203). Subgroup analyses including only idiopathic venous thromboembolic events confirmed the results of principal analyses. In conclusion, our data support the presence of an infradian pattern in the incidence of venous thromboembolic events, with a significantly higher risk in Winter and in January. Future studies are needed to better clarify the mechanisms behind this pattern.     

Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer

Introduction

Thrombosis and infections are well known complications of central venous catheters and totally implanted access ports. These complications lead to increased costs due to prolonged hospitalisation, increased antibiotics use and need for replacement.The objectives of the study were to document the occurrence of catheter related thrombosis and infections in patients with central venous catheters and totally implanted chest ports in cancer patients and to investigate whether factor V Leiden is a risk factor for catheter related thrombosis.

Materials and methods

Between February 2002 and November 2004, 43 patients with central venous catheter or totally implanted access port were followed up to document the occurrence of catheter related thrombosis and infections. Patients received chemotherapy either for haematological malignancy or for solid tumours. Factor V Leiden (R506Q) was determined by restriction fragment length polymorphism analysis. Follow-up period ended in April 2007.

Results

Catheter related thrombosis occurred in 4 patients (4/43; 9.3%) with a totally implanted access port. None of the 3 patients with factor V Leiden had catheter related infection or thrombosis. Catheter related infections occurred in 15 patients: 10 patients (23.3%; 10/43) with central venous catheter and 5 patients (11.6%; 5/43) with totally implanted access ports. Time to infection was 32.5 days in the central venous catheter group compared to 88 days in the totally implanted access port group.

Conclusion

A higher incidence of catheter related infections was observed in patients with central venous catheters in contrast to patients with totally implanted access ports were venous thrombosis was more frequent.     

Cognitive telerehabilitation in neurological patients: systematic review and meta-analysis

Neurological Sciences - Telerehabilitation (TR) seems to be an encouraging solution for the delivery of cognitive treatments in patients with neurological disorders. This study was aimed to analyze...     

The effect of aquatic physical therapy in patients with stroke: A systematic review and meta-analysis

ABSTRACT

Objective: The purpose of this study was to evaluate the literature reports of qualitative and quantitative results of physical therapy treatments in the alternative aquatic setting for individuals affected by strokes.

Method: PRISMA guidelines were used to carry out the systematic review and meta-analysis. Three bibliographic databases were searched: MEDLINE, PEDro, and the Cochrane Library. Papers included in the study were required to: (a) have a randomized controlled trial (RCT) design of research; and (b) be published in English; (c) be published during the last 10 years (2008–2018). Only randomized controlled trials were employed in the study. The quality of the clinical trials to be included was evaluated according to the Jadad scale. The internal validity was assessed according to the PEDro scale.

Results: Eleven RCTs were initially identified in the systematic review. Eight of these were involved in the meta-analysis comparing outcomes and follow-up. Eight studies received a Jadad score of three, indicating a high level of quality. The remaining three studies achieved a lower score which indicated lower qualitative level. Nearly all of the results of the quantitative analysis were statistically significant (P < 0,05) and most of them favored of the experimental group subject to aquatic treatment.

Conclusion: Aquatic physical therapy may be a valid means for the rehabilitation of people affected by stroke. The integration of this methodological approach with conventional physical therapy should be considered. However, more studies; a larger number of participants; and varying lengths of follow-up times are necessary.     

Diagnosis of atrial fibrillation in young patients with ischemic stroke: A systematic review and meta-analysis

IntroductionThe recommended cardiac rhythm evaluation to determine the etiology of ischemic stroke (IS) is similar in all patients regardless of their age and includes an electrocardiogram and at least a 24-hour heart rhythm monitoring. However, it is known that the main causes of IS vary according to patients’ age. There is a higher preponderance of arterial dissections and patent foramen ovale in younger patients, while atrial fibrillation (AF) is more common in older patients.AimsTo determine the proportion of AF in young IS reported in the literature and determine if young IS patients found to have AF had known structural cardiac pathology.MethodsSystematic review of the literature searching PubMed and Embase for articles published since their inception to August 2020. Inclusion criteria were studies including at least 10 patients, aged 14-50 years-old, clinical or radiological diagnosis of IS and quantification of patients found to have AF. We conducted a meta-analysis using a random-effects model and calculated pooled proportions with 95% confidence intervals.Results8331 articles were screened, 154 were selected for full-text review. 43 studies were included in our final analysis (902800 patients). The proportion of AF in young IS overall was 3.1% [95%CI 2.4-3.7], I² 93.88%. Sub-analysis revealed a proportion of AF of 3.8% [95% CI 0.3-7.3] in lower-middle-income economies, versus 5.4% [95% CI 3-7.9] in upper-middle-income economies, and 2.2% [95% CI 1.6-2.8] in high-income economies. Only 3 studies mentioned the proportion of patients with AF that had structural cardiac pathology.ConclusionThe proportion of AF in young IS was low. More studies are needed to better understand if young IS patients diagnosed with AF had a priori known structural cardiac pathology that could increase the probability of finding AF. This could lead to a reevaluation of the need for 24 hours cardiac rhythm evaluation in young patients without cardiac pathology.     

Late epileptic seizures following cerebral venous thrombosis: a systematic review and meta-analysis

Neurological Sciences - Identifying late epileptic seizures (LS) following cerebral venous thrombosis (CVT) can be useful for prognosis and management. We systematically reviewed the literature to...     

Physical activity in patients with deep venous thrombosis: a systematic review

Objectives

We performed a systematic review to assess the benefits or risks of physical activity in patients with an acute or previous DVT of the leg.

Data sources

PubMed, EMBASE and Science Citation Index were searched without language restrictions up to July 2007. Bibliographies of retrieved articles and personal files were also searched.

Review methods

Randomized trials and prospective cohort studies that included patients with acute or previous DVT, described an exercise intervention or exercise exposure, and described any related clinical outcome were selected. Data were independently extracted by 2 investigators.

Results

Seven randomized trials and two prospective observational studies were included. Early exercise, compared with bed rest, was associated with a similar short-term risk of pulmonary embolism in patients with acute DVT and led to more rapid resolution of limb pain. In patients with acute DVT, a 6 month daily walking program led to similar degrees of vein recanalization and improvement in quality of life as controls. In patients with previous DVT, 30 min of vigorous treadmill exercise did not worsen venous symptoms and improved calf muscle flexibility; a 6 month exercise training program improved calf muscle strength and pump function; and high levels of physical activity at one month tended to be associated with reduced severity of postthrombotic symptoms during the subsequent 3 months.

Conclusions

Early walking exercise is safe in patients with acute DVT and may help to reduce acute symptoms. Exercise training does not increase leg symptoms acutely in patients with a previous DVT and may help to prevent or improve the postthrombotic syndrome.     

A systematic review and meta-analysis on the prevalence and clinical characteristics of dysphagia in patients with dermatomyositis

Background

Dermatomyositis (DM) is a rare autoimmune disease characterized by distinctive skin rash, muscle inflammation with symmetrical and progressive muscle weakness, and elevated serum levels of muscle-associated enzymes. DM may affect skeletal muscles involved in swallowing, leading to dysphagia, which can negatively impact individual's physical and psychosocial well-being. Despite this, dysphagia in patients with DM remains poorly understood. This systematic review and meta-analysis aimed to evaluate the prevalence and clinical features of dysphagia in patients with DM and juvenile DM (JDM).

Methods

Four electronic databases were systematically searched until September 2022. Studies with patients with DM or JDM and dysphagia were included. The pooled prevalence of all included studies was calculated, and the clinical characteristics of dysphagia were qualitatively analyzed.

Key Results

Thirty-nine studies with 3335 patients were included. The overall pooled prevalence of dysphagia was 32.3% (95% CI: 0.270, 0.373) in patients with DM and 37.7% (95% CI: −0.031, 0.785) in patients with JDM. Subgroup analyses revealed that Sweden had the highest prevalence (66.7% [95% CI: 0.289, 1.044]), whereas Tunisia had the lowest prevalence (14.3% [95% CI: −0.040, 0.326]). Moreover, South America had the highest prevalence (47.0% [95% CI: 0.401, 0.538]), whereas Africa had the lowest prevalence (14.3% [95% CI: −0.040, 0.326]). Dysphagia in patients with DM and JDM was characterized by both oropharyngeal and esophageal dysfunctions, with predominant difficulties in motility.

Conclusions & Inferences

Our findings showed that dysphagia affects one in three patients with DM or JDM. However, the documentation on the diagnosis and management of dysphagia in the literature is inadequate. Our results highlighted the need to use both clinical and instrumental assessments to evaluate swallowing function in this population.     

A systematic review and meta-analysis of the fertility of patients with schizophrenia and their unaffected relatives

Bundy H, Stahl D, MacCabe JH. A systematic review and meta‐analysis of the fertility of patients with schizophrenia and their unaffected relatives. Objective: We aimed to systematically evaluate the empirical evidence for the commonly held view that the reduced reproductive output in patients with schizophrenia is compensated for by an increased fitness in unaffected relatives. Secondary aims were to quantify the magnitude of the fertility disadvantage and the apparent gender difference in fertility of patients with schizophrenia. Method: We carried out a systematic review and meta‐analysis of studies investigating the fertility of patients with schizophrenia, their siblings, their parents and the general population. Results: Patients with schizophrenia had reduced fertility compared with the general population, [Fertility Ratio (FR) = 0.39 (95% Confidence Interval (CI) = 0.35–0.44)]. Siblings of patients with schizophrenia had somewhat fewer offspring than the general population (FR = 0.96, 95% CI = 0.93–1.00). Parents of patients with schizophrenia had fertility similar to the general population (FR = 1.17, 95% CI = 0.94–1.46). Men had a greater impairment in fertility than women, both in patients (FR = 0.54, 95% CI = 0.50–0.57) and in their unaffected siblings (FR = 0.81, 95% CI = 0.71–0.92). Conclusion: Compensatory fitness advantage in siblings and parents cannot explain the maintenance of schizophrenia in the population. Alternative explanations include mutation‐selection balance and the role of quantitative traits.     

两种手术方式对Chiari畸形Ⅰ型合并脊髓空洞的系统评价及meta分析

目的 系统评价后颅窝减压（posterior fossa decompression,PFD）和后颅窝减压加硬膜成形术（posterior fossa decompression plus duraplasty,PFDD）在Chiari畸形Ⅰ型合并脊髓空洞患者中的有效性及安全性。方法 检索Embase、Cochrane、Pubmed、Ovid、Medline、ScienceDirect、谷歌学术、万方、知网等数据库自建库到2019年的文献,筛选文中对PFD与PFDD进行了比较的随机对照研究或非随机对照研究,统计术后临床症状和影像学改善情况、并发症等指标,运用Revman（5.3版本）进行数据分析。结果 最终纳入10篇文献,共3 188例,PFDD组1 383例,PFD组1 805例。在脊髓空洞改善率（OR：5.53;95%CI：2.86,10.69）、症状缓解率（OR：2.53;95%CI：1.30,4.91）、并发症发生率（OR：3.46;95%CI：1.40,8.59）、脑脊液漏发生率（OR：9.36;95%CI：2.63,33.34）、假性硬脑膜膨出率（OR：1.89;95%CI：1.28,2.79）方面PFDD组高于PFD组（P<0.05）。在切口感染发生率（OR：1.44;95%CI：0.57,3.59）、皮下积液发生率（OR：1.71;95%CI：0.50,5.80）方面两种术式无差异（P>0.05）。结论 针对Chiari畸形Ⅰ型合并脊髓空洞的患者,PFDD的有效性优于PFD。     

两种手术方式对Chiari畸形Ⅰ型合并脊髓空洞的系统评价及meta分析

目的系统评价后颅窝减压(posterior fossa decompression,PFD)和后颅窝减压加硬膜成形术(posterior fossa decompression plus duraplasty,PFDD)在Chiari畸形Ⅰ型合并脊髓空洞患者中的有效性及安全性。方法检索Embase、Cochrane、Pubmed、Ovid、Medline、Science Direct、谷歌学术、万方、知网等数据库自建库到2019年的文献,筛选文中对PFD与PFDD进行了比较的随机对照研究或非随机对照研究,统计术后临床症状和影像学改善情况、并发症等指标,运用Revman(5. 3版本)进行数据分析。结果最终纳入10篇文献,共3 188例,PFDD组1 383例,PFD组1 805例。在脊髓空洞改善率(OR:5. 53; 95%CI:2. 86,10. 69)、症状缓解率(OR:2. 53; 95%CI:1. 30,4. 91)、并发症发生率(OR:3. 46; 95%CI:1. 40,8. 59)、脑脊液漏发生率(OR:9. 36; 95%CI:2. 63,33. 34)、假性硬脑膜膨出率(OR:1. 89; 95%CI:1. 28,2. 79)方面PFDD组高于PFD组(P 0. 05)。在切口感染发生率(OR:1. 44; 95%CI:0. 57,3. 59)、皮下积液发生率(OR:1. 71; 95%CI:0. 50,5. 80)方面两种术式无差异(P 0. 05)。结论针对Chiari畸形Ⅰ型合并脊髓空洞的患者,PFDD的有效性优于PFD。