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Zhu J, Li W. Role of metabolites in mediating the effect of triacylglycerol on aplastic anemia. Hematology 2024; 29:2379178. [PMID: 39017035 DOI: 10.1080/16078454.2024.2379178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Observational studies have found a link between lipid metabolism disorders and aplastic anemia (AA). However, due to confounding variables and reverse causation, it is difficult to conclude such a causal link. The precise mechanism and potential implications of lipid metabolism disorder in AA remain unclear, necessitating further studies in this area. METHOD This study aimed to examine the causal relationship between 38 different subtypes of triacylglycerols and AA using two-sample Mendelian randomization (MR). Additionally, two-step MR analyses were conducted to investigate the mediating effects of vitamin A to oleoyl-linoleoyl-glycerol (18:1-18:2) ratio. RESULTS MR analysis showed that triacylglycerol (53:3) levels were positively associated with the risk of AA [inverse variance weighting (IVW): odds ratio (OR) = 1.131,95% confidence interval (CI):1.029-1.243, P = 0.011; Bayesian weighted MR (BWMR): OR = 1.137,95% CI:1.031-1.254, P = 0.010]. Triacylglycerol (53:3) level showed no inverse causality with AA (IVW:P = 0.834; BWMR:P = 0.349). Mediation analyses showed that increasing the vitamin A to oleoyl-linoleoyl-glycerol (18:1-18:2) ratio can decrease the risk of AA. CONCLUSION This study revealed the association between vitamin A to oleoyl-linoleoyl-glycerol (18:1-18:2) ratio, triacylglycerol (53:3) levels and AA, and indicated that lowering triacylglycerol (53:3) levels can reduce the risk of AA.
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Affiliation(s)
- Jingkui Zhu
- Department of Hematology, Jiujiang University Affiliated Hospital, Jiujiang, Jiangxi, People's Republic of China
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2
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Wang H, Wang L, Zeng X, Zhang S, Huang Y, Zhang Q. Inflammatory bowel disease and risk for hemorrhoids: a Mendelian randomization analysis. Sci Rep 2024; 14:16677. [PMID: 39030236 DOI: 10.1038/s41598-024-66940-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/05/2024] [Indexed: 07/21/2024] Open
Abstract
Observational studies have reported an association between inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), and hemorrhoids (HEM). However, the presence of a causal relationship within this observed association remains to be confirmed. Consequently, we utilized the Mendelian randomization (MR) method to assess the causal effects of IBD on hemorrhoids. We validated the association between IBD and hemorrhoids in humans based on genome-wide association studies (GWAS) data. To investigate the causal relationship between IBD and hemorrhoids, we performed a two-sample Mendelian randomization study using training and validation sets. The genetic variation data for IBD, CD, UC, and hemorrhoids were derived from published genome-wide association studies (GWAS) of individuals of European. Two-sample Mendelian randomization and Multivariable Mendelian randomization (MVMR) were employed to determine the causal relationship between IBD (CD or UC) and hemorrhoids. Genetically predicted overall IBD was positively associated with hemorrhoids risk, with ORs of 1.02 (95% CIs 1.01-1.03, P = 4.39 × 10-4) and 1.02 (95% CIs 1.01-1.03, P = 4.99 × 10-5) in the training and validation sets, respectively. Furthermore, we found that CD was positively associated with hemorrhoids risk, with ORs of 1.02 (95% CIs 1.01-1.03, P = 4.12 × 10-6) and 1.02 (95% CIs 1.01-1.02, P = 3.78 × 10-5) for CD in the training and validation sets, respectively. In addition, we found that UC in the training set was positively associated with hemorrhoids risk (ORs 1.02, 95% CIs 1.01-1.03, P = 4.65 × 10-3), while no significant causal relationship between UC and hemorrhoids was shown in the validation set (P > 0.05). However, after MVMR adjustment, UC in the training set was not associated with an increased risk of hemorrhoids. Our study showed that there is a causal relationship between CD and hemorrhoids, which may suggest that clinicians need to prevent the occurrence of hemorrhoids in CD patients.
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Affiliation(s)
- HanYu Wang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lu Wang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - XiaoYu Zeng
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - ShiPeng Zhang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yong Huang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - QinXiu Zhang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Hua S, Ma C. Testing the homogeneity of odds ratio across strata for combined bilateral and unilateral data. PLoS One 2024; 19:e0307276. [PMID: 39024202 PMCID: PMC11257320 DOI: 10.1371/journal.pone.0307276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
Bilateral and unilateral combined data are commonly involved in clinical trials or observational studies designed to test the treatment effectiveness on paired organs or bodily parts within individual subjects. It is essential to examine if the treatment effect is consistent across different subgroups such as age, gender, or disease severity for understanding how the treatment works for various patient populations. In this paper, we propose three large-sample homogeneity tests of odds ratio in the stratified randomization setting using correlated combined data. Our simulation results show that the score test exhibits robust empirical type I error control and demonstrates strong power characteristics compared to other methods proposed. We apply the proposed tests to real-world datasets of acute otitis media and myopia to illustrate their practical application and utility.
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Affiliation(s)
- Shuangcheng Hua
- Department of Biostatistics, University at Buffalo, Buffalo, New York, United States of America
| | - Changxing Ma
- Department of Biostatistics, University at Buffalo, Buffalo, New York, United States of America
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Shen J, Ye Q, Luo F, Yu T, Miao J, Wang W, Yuan H. Causal relationship between multiple sclerosis and primary Sjögren's syndrome: a two-sample mendelian randomization study. Metab Brain Dis 2024:10.1007/s11011-024-01379-8. [PMID: 39017967 DOI: 10.1007/s11011-024-01379-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
This study aims to investigate the causal relationship between primary Sjögren's syndrome (SS) and multiple sclerosis (MS) using a two-sample Mendelian randomization (MR) analysis to provide insights into their common mechanisms and implications for therapeutic strategies. We utilized data from Genome-Wide Association Studies (GWAS) for primary SS (1,290 cases and 213,145 controls) and MS (4,888 cases and 10,395 controls), restricted to European ancestry. Instrumental variables (IVs) were selected based on genetic variants associated with primary SS. The primary MR method was Inverse Variance Weighted (IVW), supplemented by MR Egger, Weighted Median, Simple Mode, and Weighted Mode algorithms to assess the bidirectional causal relationships between MS and primary SS. Sensitivity analyses, including MR-PRESSO and leave-one-out analysis, were conducted to ensure the robustness of our findings. After excluding SNPs with pleiotropic effects, 42 and 5 SNPs were identified as robust IVs for primary SS and MS, respectively. Our analysis revealed a significant protective effect of MS on primary SS, with IVW showing an OR of 0.896 (95% CI: 0.841-0.954, P = 0.001). No significant heterogeneity or horizontal pleiotropy was detected, supporting the reliability of the results. Our findings suggest a potential protective effect of MS against primary SS, indicating a negative causal association between these two autoimmune diseases. This adds valuable genetic evidence to the understanding of the complex interplay between primary SS and MS, offering new avenues for research and therapeutic interventions.
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Affiliation(s)
- Jie Shen
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Qiao Ye
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Fang Luo
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Tianhang Yu
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Jinli Miao
- The Yangtze River Delta Biological Medicine Research and Development Center of Zhejiang Province, Yangtze Delta Region Institution of Tsinghua University, Hangzhou, 314006, Zhejiang, China
| | - Wenmin Wang
- The Yangtze River Delta Biological Medicine Research and Development Center of Zhejiang Province, Yangtze Delta Region Institution of Tsinghua University, Hangzhou, 314006, Zhejiang, China
| | - Hui Yuan
- Department of Logistics Support, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, 314000, Zhejiang, China.
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Minvielle Moncla LH, Briend M, Sokhna Sylla M, Mathieu S, Rufiange A, Bossé Y, Mathieu P. Mendelian randomization reveals interactions of the blood proteome and immunome in mitral valve prolapse. COMMUNICATIONS MEDICINE 2024; 4:108. [PMID: 38844506 PMCID: PMC11156961 DOI: 10.1038/s43856-024-00530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Mitral valve prolapse (MVP) is a common heart disorder characterized by an excessive production of proteoglycans and extracellular matrix in mitral valve leaflets. Large-scale genome-wide association study (GWAS) underlined that MVP is heritable. The molecular underpinnings of the disease remain largely unknown. METHODS We interrogated cross-modality data totaling more than 500,000 subjects including GWAS, 4809 molecules of the blood proteome, and genome-wide expression of mitral valves to identify candidate drivers of MVP. Data were investigated through Mendelian randomization, network analysis, ligand-receptor inference and digital cell quantification. RESULTS In this study, Mendelian randomization identify that 33 blood proteins, enriched in networks for immunity, are associated with the risk of MVP. MVP- associated blood proteins are enriched in ligands for which their cognate receptors are differentially expressed in mitral valve leaflets during MVP and enriched in cardiac endothelial cells and macrophages. MVP-associated blood proteins are involved in the renewal-polarization of macrophages and regulation of adaptive immune response. Cytokine activity profiling and digital cell quantification show in MVP a shift toward cytokine signature promoting M2 macrophage polarization. Assessment of druggability identify CSF1R, CX3CR1, CCR6, IL33, MMP8, ENPEP and angiotensin receptors as actionable targets in MVP. CONCLUSIONS Hence, integrative analysis identifies networks of candidate molecules and cells involved in immune control and remodeling of the extracellular matrix, which drive the risk of MVP.
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Affiliation(s)
| | - Mewen Briend
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Mame Sokhna Sylla
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Samuel Mathieu
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Anne Rufiange
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Yohan Bossé
- Department of Molecular Medicine, Laval University, Quebec City, QC, Canada
| | - Patrick Mathieu
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada.
- Department of Surgery, Laval University, Quebec City, QC, Canada.
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Johnson BA, Callaway KJ, Vegiraju M, Ramakrishnan S, Ogola GO, Mohr DC, Waddimba AC. Study protocol of a systematic review and metaanalysis of stress and burnout among general surgery residents. Proc AMIA Symp 2024; 37:640-645. [PMID: 38910816 PMCID: PMC11188834 DOI: 10.1080/08998280.2024.2346398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 04/05/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Chronic workplace stress and burnout are impediments to physicians' professional fulfillment, healthcare organizations' efficiency, and patient care quality/safety. General surgery residents are especially at risk due to the complexity of their training. We report the protocol of a metaanalysis of chronic stress and burnout among Accreditation Council for Graduate Medical Education (ACGME)-affiliated general surgery residents in the era after duty-hour reforms, plus downstream effects on their health and clinical performance. Methods The proposed systematic review and metaanalysis (PROSPERO registration CRD42021277626) will synthesize/pool data from studies of chronic stress and burnout among general surgery residents at ACGME-affiliated programs. The timeframe under review is subdivided into three intervals: (a) after the 2003 duty-hour restrictions but before 2011 reforms, (b) after the 2011 reforms but before the coronavirus pandemic, and (c) the first 3 years after the pandemic's outbreak. Only studies reporting outcomes based on validated instruments will be included. Qualitative studies, commentaries/editorials, narrative reviews, and studies not published in English will be excluded. Multivariable analyses will adjust for sample characteristics and the methodological quality of included studies. Conclusions The metaanalysis will yield evidence reflecting experiences of North American-based general surgery residents in the years after ACGME-mandated duty-hour restructuring.
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Affiliation(s)
- Brett A. Johnson
- Department of Surgery, General Medical Education, Baylor University Medical Center, Dallas, Texas, USA
| | - Kayla J. Callaway
- College of Medicine, Texas A&M University Health Sciences Center, Dallas, Texas, USA
- Houston Methodist Hospital, Texas Medical Center, Houston, Texas, USA
| | - Monica Vegiraju
- College of Medicine, Texas A&M University Health Sciences Center, Dallas, Texas, USA
| | - Sudha Ramakrishnan
- Baylor Health Sciences Library, Baylor Scott and White, Dallas, Texas, USA
| | - Gerald O. Ogola
- Department of Surgery, Division of Surgical Research, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - David C. Mohr
- Veterans Health Administration, National Center for Organizational Development, Cincinnati, Ohio, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Anthony C. Waddimba
- College of Medicine, Texas A&M University Health Sciences Center, Dallas, Texas, USA
- Department of Surgery, Division of Surgical Research, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Scott and White Research Institute, Dallas, Texas, USA
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7
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Wang Y, DelRocco N, Lin L. Comparisons of various estimates of the I2 statistic for quantifying between-study heterogeneity in meta-analysis. Stat Methods Med Res 2024; 33:745-764. [PMID: 38502022 DOI: 10.1177/09622802241231496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Assessing heterogeneity between studies is a critical step in determining whether studies can be combined and whether the synthesized results are reliable. The I 2 statistic has been a popular measure for quantifying heterogeneity, but its usage has been challenged from various perspectives in recent years. In particular, it should not be considered an absolute measure of heterogeneity, and it could be subject to large uncertainties. As such, when using I 2 to interpret the extent of heterogeneity, it is essential to account for its interval estimate. Various point and interval estimators exist for I 2 . This article summarizes these estimators. In addition, we performed a simulation study under different scenarios to investigate preferable point and interval estimates of I 2 . We found that the Sidik-Jonkman method gave precise point estimates for I 2 when the between-study variance was large, while in other cases, the DerSimonian-Laird method was suggested to estimate I 2 . When the effect measure was the mean difference or the standardized mean difference, the Q -profile method, the Biggerstaff-Jackson method, or the Jackson method was suggested to calculate the interval estimate for I 2 due to reasonable interval length and more reliable coverage probabilities than various alternatives. For the same reason, the Kulinskaya-Dollinger method was recommended to calculate the interval estimate for I 2 when the effect measure was the log odds ratio.
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Affiliation(s)
- Yipeng Wang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Natalie DelRocco
- Department of Population and Public Health Sciences, Division of Biostatistics, University of Southern California, Los Angeles, CA, USA
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Gao Y, Wang Z, Yu J, Chen L. Thyroid cancer and cardiovascular diseases: a Mendelian randomization study. Front Cardiovasc Med 2024; 11:1344515. [PMID: 38725832 PMCID: PMC11080944 DOI: 10.3389/fcvm.2024.1344515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/04/2024] [Indexed: 05/12/2024] Open
Abstract
Background Multiple observational studies have shown associations between thyroid cancer (TC) and cardiovascular diseases (CVDs). However, the results were inconsistent, and the potential causal genetic relationship remains unclear. Methods The genetic instruments of TC and CVDs were derived from data obtained through genome-wide association studies (GWAS). We performed the two-sample Mendelian randomization(MR) methods to investigate the causality of TC on CVDs. Summary-level statistics for CVDs, including heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), ischemic stroke (IS) and venous thromboembolism (VTE). The primary method employed in this MR analysis was the Inverse Variance Weighted (IVW) approach, and four additional algorithms were used: MR-Egger, weighted median, simple mode, and weighted mode. Additionally, we assessed the reliability of the causal relationship through pleiotropy, heterogeneity and leave-one-out sensitivity analysis. Results In this MR analysis, we only detected causality of genetically predicted TC on HF (IVW method, odds ratio (OR) = 1.00134, 95% confidence interval (CI): 1.00023-1.00244, p = 0.017). However, There were no causal associations of TC with CAD, MI, AF, IS, and VTE. Conclusion Our results confirmed the causal association between TC and HF. It is crucial to closely monitor the incidence of HF in TC patients and give comprehensive clinical intervention based on conventional treatment.
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Affiliation(s)
- Yamei Gao
- Department of Oncology, Tianjin Binhai New Area Dagang Hospital, Tianjin, China
| | - Zhijia Wang
- Department of Cardiovascular Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinsheng Yu
- Department of Oncology, Tianjin Binhai New Area Dagang Hospital, Tianjin, China
| | - Lijun Chen
- Department of Oncology, Tianjin Binhai New Area Dagang Hospital, Tianjin, China
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Li W, Zhou Q, Zhou L, Cao L, Zhu C, Dai Z, Lin S. Causal role of immune cell phenotypes in idiopathic sudden sensorineural hearing loss: a bi-directional Mendelian randomization study. Front Neurol 2024; 15:1368002. [PMID: 38694774 PMCID: PMC11061525 DOI: 10.3389/fneur.2024.1368002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/05/2024] [Indexed: 05/04/2024] Open
Abstract
Background A growing body of evidence suggests that immunological processes have a significant role in developing idiopathic sudden sensorineural hearing loss (SSHL). However, few studies have examined the association between immune cell phenotype and SSHL using Mendelian Randomization (MR). Methods The online genome-wide association studies (GWAS) database was used to compile data from GWAS covering 731 immunophenotypes and SSHL. Inverse variance weighted (IVW) analysis was primarily used for MR study, and single nucleotide polymorphisms (SNPs) associated with immunophenotypes served as dependent variables. A sensitivity study and the false discovery rate (FDR) correction were used to examine the MR hypothesis. In addition, the possibility of reverse causality between immunophenotype and SSHL was validated by reverse MR. Reverse MR was analyzed in a manner consistent with forward MR. Results After FDR correction and sensitivity analysis, we screened 7 immunophenotypes, including IgD+ CD38dim %lymphocyte (95% CI: 1.0019, 1.0742, p = 3.87 × 10-2, FDR = 1.15 × 10-2); Unsw mem AC (95% CI: 1.004, 1.2522, p = 4.23 × 10-2, FDR = 2.25 × 10-2); CD86+ myeloid DC AC (95% CI: 1.0083, 1.1147, p = 2.24 × 10-2, FDR = 4.27 × 10-2); CD33dim HLA DR- AC (95% CI: 1.0046, 1.0583, p = 2.12 × 10-2, FDR = 4.69 × 10-2); SSC-A on CD8br (95% CI: 1.0028, 1.1461, p = 4.12 × 10-2, FDR = 4.71 × 10-2); CD45RA- CD4+ %T cell (95% CI: 1.0036, 1.0503, p = 2.32 × 10-2, FDR = 4.82 × 10-2); DP (CD4+CD8+) AC (95% CI: 1.011, 1.2091, p = 2.78 × 10-2, FDR = 4.97 × 10-2). There was a strong causal relationship with SSHL onset, and the reliability of the results was verified. Furthermore, the immunological cell profile and SSHL did not appear to be closely associated, as shown by reverse MR analysis. Conclusion Our study provides more support for the current hypothesis that immunophenotypes and the pathophysiology of SSHL are closely associated. Further validation is needed to assess the role of these immunophenotypes in SSHL.
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Affiliation(s)
- Wanqing Li
- Department of Otolaryngology, Ruian People’s Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiang Zhou
- Department of Otolaryngology, Ruian People’s Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linsa Zhou
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Longhe Cao
- Department of Otolaryngology, Ruian People’s Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chuansai Zhu
- Department of Otolaryngology, Ruian People’s Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhijian Dai
- Department of Otolaryngology, Ruian People’s Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sen Lin
- Department of Otolaryngology, Ruian People’s Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Christodoulou VN, Varvarousis DN, Ntritsos G, Dimopoulos D, Giannakeas N, Vasileiadis GI, Korompilias A, Ploumis A. Robotic assisted and exoskeleton gait training effect in mental health and fatigue of multiple sclerosis patients. A systematic review and a meta-analysis. Disabil Rehabil 2024:1-12. [PMID: 38616570 DOI: 10.1080/09638288.2024.2338197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/28/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Robotic and Exoskeleton Assisted Gait Training (REAGT) has become the mainstream gait training module. Studies are investigating the psychosocial effects of REAGT mostly as secondary outcomes. Our systematic review and meta-analysis aims to investigate the effects of REAGT in MS patients' mental health and fatigue. MATERIALS AND METHODS We searched the electronic databases (Scopus, PubMed, Pedro, Cochrane Trials, Dare) for RCT studies fulfilling our inclusion criteria. A meta-analysis of available assessment tools was conducted calculating the summary mean differences in two different timepoints, before and after the intervention using random-effects models. RESULTS The systematic search of the electronic databases identified 302 studies. Seven RCT studies were considered eligible for data extraction and meta-analysis, according to our eligibility criteria. We were able to obtain adequate data to proceed with a quantitative synthesis for QoL SF36-MC (Mental Component), QoL SF-36 mental and psychosocial subscales, Multiple Sclerosis Quality of Life-54-Mental Health Composite (MSQoL-54-MHC), Patient's Health Questionnaire (PHQ-9) and Fatigue Severity Scale (FSS). CONCLUSIONS Overall, REAGT seems to have a positive effect to Quality of Life, especially in MS patients' perspective of General and Mental Health and a slight positive effect in depression as measured by PHQ-9.Implications for rehabilitationMultiple Sclerosis (MS) decreases physical and non-physical aspects of patients' quality of life perspective.Rehabilitation strategy must take into consideration the non-physical effects of a training intervention.Robotic and Exoskeleton Gait Training has a positive effect in MS patients' non-physical quality of life and a slight positive effect in depression.
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Affiliation(s)
| | | | - Georgios Ntritsos
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece
- Department of Informatics and Telecommunications, University of Ioannina, Ioannina, Greece
| | - Dimitrios Dimopoulos
- Department of Physical Medicine and Rehabilitation (PMR), University of Ioannina, Ioannina, Greece
| | - Nikolaos Giannakeas
- Department of Informatics and Telecommunications, University of Ioannina, Ioannina, Greece
| | - Georgios I Vasileiadis
- Department of Physical Medicine and Rehabilitation (PMR), University of Ioannina, Ioannina, Greece
| | | | - Avraam Ploumis
- Department of Physical Medicine and Rehabilitation (PMR), University of Ioannina, Ioannina, Greece
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11
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Lin L, Yu H, Xue Y, Wang L, Zhu P. Proteome-wide mendelian randomization investigates potential associations in heart failure and its etiology: emphasis on PCSK9. BMC Med Genomics 2024; 17:59. [PMID: 38383373 PMCID: PMC10882912 DOI: 10.1186/s12920-024-01826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a prevalent clinical syndrome with diverse etiologies. It is crucial to identify novel therapeutic targets based on underlying causes. Here, we aimed to use proteome-wide Mendelian randomization (MR) analyses to identify the associations between genetically predicted elevated levels of circulating proteins and distinct HF outcomes, along with specific HF etiologies. METHODS Protein quantitative trait loci (pQTL) data for circulating proteins were sourced from the Atherosclerosis Risk in Communities (ARIC) study, encompassing 7,213 individuals and profiling 4,657 circulating proteins. Genetic associations for outcomes were obtained from the HERMES Consortium and the FinnGen Consortium. Colocalization analysis was employed to assess the impact of linkage disequilibrium on discovered relationships. For replication, two-sample MR was conducted utilizing independent pQTL data from the deCODE study. Multivariable MR (MVMR) and two-step MR were further conducted to investigate potential mediators. RESULTS Two proteins (PCSK9 and AIDA) exhibited associations with HF in patients with coronary heart disease (CHD), and four proteins (PCSK9, SWAP70, NCF1, and RELT) were related with HF in patients receiving antihypertensive medication. Among these associations, strong evidence from subsequent analyses supported the positive relationship between genetically predicted PCSK9 levels and the risk of HF in the context of CHD. Notably, MVMR analysis revealed that CHD and LDL-C did not exert a complete mediating effect in this relationship. Moreover, two-step MR results yielded valuable insights into the potential mediating proportions of CHD or LDL-C in this relationship. CONCLUSIONS Our findings provide robust evidence supporting the association between PCSK9 and concomitant HF and CHD. This association is partly elucidated by the influence of CHD or LDL-C, underscoring the imperative for additional validation of this connection and a thorough exploration of the mechanisms through which PCSK9 directly impacts ischemic HF.
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Affiliation(s)
- Lichao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Huizhen Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, People's Republic of China
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, People's Republic of China
- Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China
- Department of Cardiology in South Branch, Fujian Provincial Hospital, Fuzhou, People's Republic of China
| | - Yan Xue
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Liman Wang
- Department of Pharmacy in South Branch, Fujian Provincial Hospital, Fuzhou, People's Republic of China
| | - Pengli Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, People's Republic of China.
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.
- Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China.
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12
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Yuan Z, Kang Y, Mo C, Huang S, Qin F, Zhang J, Wang F, Jiang J, Yang X, Liang H, Ye L. Causal relationship between gut microbiota and tuberculosis: a bidirectional two-sample Mendelian randomization analysis. Respir Res 2024; 25:16. [PMID: 38178098 PMCID: PMC10765819 DOI: 10.1186/s12931-023-02652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Growing evidence from observational studies and clinical trials suggests that the gut microbiota is associated with tuberculosis (TB). However, it is unclear whether any causal relationship exists between them and whether causality is bidirectional. METHODS A bidirectional two-sample Mendelian randomization (MR) analysis was performed. The genome-wide association study (GWAS) summary statistics of gut microbiota were obtained from the MiBioGen consortium, while the GWAS summary statistics of TB and its specific phenotypes [respiratory tuberculosis (RTB) and extrapulmonary tuberculosis (EPTB)] were retrieved from the UK Biobank and the FinnGen consortium. And 195 bacterial taxa from phylum to genus were analyzed. Inverse variance weighted (IVW), MR-Egger regression, maximum likelihood (ML), weighted median, and weighted mode methods were applied to the MR analysis. The robustness of causal estimation was tested using the heterogeneity test, horizontal pleiotropy test, and leave-one-out method. RESULTS In the UK Biobank database, we found that 11 bacterial taxa had potential causal effects on TB. Three bacterial taxa genus.Akkermansia, family.Verrucomicrobiacea, order.Verrucomicrobiales were validated in the FinnGen database. Based on the results in the FinnGen database, the present study found significant differences in the characteristics of gut microbial distribution between RTB and EPTB. Four bacterial taxa genus.LachnospiraceaeUCG010, genus.Parabacteroides, genus.RuminococcaceaeUCG011, and order.Bacillales were common traits in relation to both RTB and TB, among which order.Bacillales showed a protective effect. Additionally, family.Bacteroidacea and genus.Bacteroides were identified as common traits in relation to both EPTB and TB, positively associating with a higher risk of EPTB. In reverse MR analysis, no causal association was identified. No significant heterogeneity of instrumental variables (IVs) or horizontal pleiotropy was found. CONCLUSION Our study supports a one-way causal relationship between gut microbiota and TB, with gut microbiota having a causal effect on TB. The identification of characteristic gut microbiota provides scientific insights for the potential application of the gut microbiota as a preventive, diagnostic, and therapeutic tool for TB.
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Affiliation(s)
- Zongxiang Yuan
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Yiwen Kang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Chuye Mo
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Shihui Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Fang Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Junhan Zhang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Fengyi Wang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China.
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-Constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Xiaoxiang Yang
- Department of Infectious Diseases in Children, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, 530003, Guangxi, China.
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China.
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-Constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, China.
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-Constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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13
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Lim W, Moon S, Lee NR, Shin HG, Yu SY, Lee JE, Kim I, Ko KP, Park SK. Group I pharmaceuticals of IARC and associated cancer risks: systematic review and meta-analysis. Sci Rep 2024; 14:413. [PMID: 38172159 PMCID: PMC10764325 DOI: 10.1038/s41598-023-50602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
We aimed to summarize the cancer risk among patients with indication of group I pharmaceuticals as stated in monographs presented by the International Agency for Research on Cancer working groups. Following the PRISMA guidelines, a comprehensive literature search was conducted using the PubMed database. Pharmaceuticals with few studies on cancer risk were identified in systematic reviews; those with two or more studies were subjected to meta-analysis. For the meta-analysis, a random-effects model was used to calculate the summary relative risks (SRRs) and 95% confidence intervals (95% CIs). Heterogeneity across studies was presented using the Higgins I square value from Cochran's Q test. Among the 12 group I pharmaceuticals selected, three involved a single study [etoposide, thiotepa, and mustargen + oncovin + procarbazine + prednisone (MOPP)], seven had two or more studies [busulfan, cyclosporine, azathioprine, cyclophosphamide, methoxsalen + ultraviolet (UV) radiation therapy, melphalan, and chlorambucil], and two did not have any studies [etoposide + bleomycin + cisplatin and treosulfan]. Cyclosporine and azathioprine reported increased skin cancer risk (SRR = 1.32, 95% CI 1.07-1.62; SRR = 1.56, 95% CI 1.25-1.93) compared to non-use. Cyclophosphamide increased bladder and hematologic cancer risk (SRR = 2.87, 95% CI 1.32-6.23; SRR = 2.43, 95% CI 1.65-3.58). Busulfan increased hematologic cancer risk (SRR = 6.71, 95% CI 2.49-18.08); melphalan was associated with hematologic cancer (SRR = 4.43, 95% CI 1.30-15.15). In the systematic review, methoxsalen + UV and MOPP were associated with an increased risk of skin and lung cancer, respectively. Our results can enhance persistent surveillance of group I pharmaceutical use, establish novel clinical strategies for patients with indications, and provide evidence for re-categorizing current group I pharmaceuticals into other groups.
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Affiliation(s)
- Woojin Lim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
| | - Sungji Moon
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
- Interdisciplinary Program in Cancer Biology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Ho Gyun Shin
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Su-Yeon Yu
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Seoul National University College of Human Ecology, Seoul, 08826, Republic of Korea
| | - Inah Kim
- Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, 04763, Republic of Korea
| | - Kwang-Pil Ko
- Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea.
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
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14
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Filis P, Varvarousis D, Ntritsos G, Dimopoulos D, Filis N, Giannakeas N, Korompilias A, Ploumis A. Rotationplasty outcomes assessed by gait analysis following resection of lower extremity bone neoplasms. Bone Jt Open 2023; 4:817-824. [PMID: 37907080 PMCID: PMC10618047 DOI: 10.1302/2633-1462.411.bjo-2023-0101.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Aims The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals. Methods The MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest. Results Three studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184). Conclusion Rotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
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Affiliation(s)
- Panagiotis Filis
- Department of Medical Oncology, University of Ιoannina, Ιoannina, Greece
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios Varvarousis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Georgios Ntritsos
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Dimitrios Dimopoulos
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Nikolaos Filis
- Medical School, University of Ioannina, Ιoannina, Greece
| | - Nikolaos Giannakeas
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Anastasios Korompilias
- Division of Orthopaedic Surgery, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Avraam Ploumis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
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15
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Xue H, Zeng L, Liu S. Susceptibility and severity of COVID-19 and risk of psychiatric disorders in European populations: a Mendelian randomization study. Front Psychiatry 2023; 14:1253051. [PMID: 37867774 PMCID: PMC10585067 DOI: 10.3389/fpsyt.2023.1253051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Background Observational studies have suggested that COVID-19 increases the prevalence of psychiatric disorders, but the results of such studies are inconsistent. This study aims to investigate the association between COVID-19 and the risk of psychiatric disorders using Mendelian randomization (MR) analysis. Methods We used summary statistics from COVID-19 Host Genetics Initiative genome-wide association study (GWAS) of COVID-19 involving 2,586,691 participants from European ancestry. Genetic variations of five psychiatric disorders including autism spectrum disorder (ASD) (N = 46,351), bipolar disorder (BID) (N = 51,710), major depressive disorder (MDD) (N = 480,359), anxiety disorder (N = 83,566), and schizophrenia (SCZ) (N = 77,096) were extracted from several GWAS of European ancestry. The inverse-variance weighted (IVW) method as the main MR analysis conducted. We further performed sensitivity analyzes and heterogeneity analyzes as validation of primary MR results. Results The IVW analysis found that COVID-19 hospitalization phenotype was the risk factor for BID (OR = 1.320, 95% CI = 1.106-1.576, p = 0.002) and SCZ (OR = 1.096, 95% CI = 1.031-1.164, p = 0.002). Moreover, we detected a significant positive genetic correlation between COVID-19 severity and two psychiatric traits, BID (OR = 1.139, 95% CI = 1.033-1.256, p = 0.008) and SCZ (OR = 1.043, 95% CI = 1.005-1.082, p = 0.024). There was no evidence supporting the causal relationship between COVID-19 susceptibility and psychiatric disorders. Conclusion Our results found that the COVID-19 hospitalization phenotype and COVID-19 severity phenotype might be the potential risks of BID and SCZ in European populations. Therefore, patients infected with SARS-CoV-2 should have enhanced monitoring of their mental status.
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Affiliation(s)
- Hua Xue
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, China
| | - Li Zeng
- Department of Respiratory, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Shuangjuan Liu
- Department of Neurology, Qionglai People’s Hospital, Chengdu, China
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16
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Kulinskaya E, Hoaglin DC. Estimation of heterogeneity variance based on a generalized Q statistic in meta-analysis of log-odds-ratio. Res Synth Methods 2023; 14:671-688. [PMID: 37381621 PMCID: PMC10946484 DOI: 10.1002/jrsm.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/01/2023] [Accepted: 05/06/2023] [Indexed: 06/30/2023]
Abstract
For estimation of heterogeneity varianceτ 2 in meta-analysis of log-odds-ratio, we derive new mean- and median-unbiased point estimators and new interval estimators based on a generalized Q statistic,Q F , in which the weights depend on only the studies' effective sample sizes. We compare them with familiar estimators based on the inverse-variance-weights version of Q ,Q IV . In an extensive simulation, we studied the bias (including median bias) of the point estimators and the coverage (including left and right coverage error) of the confidence intervals. Most estimators add 0.5 to each cell of the 2 × 2 table when one cell contains a zero count; we include a version that always adds 0.5 . The results show that: two of the new point estimators and two of the familiar point estimators are almost unbiased when the total sample size n ≥ 250 and the probability in the Control arm (p iC ) is 0.1, and when n ≥ 100 andp iC is 0.2 or 0.5; for 0.1 ≤ τ 2 ≤ 1 , all estimators have negative bias for small to medium sample sizes, but for larger sample sizes some of the new median-unbiased estimators are almost median-unbiased; choices of interval estimators depend on values of parameters, but one of the new estimators is reasonable whenp iC = 0.1 and another, whenp iC = 0.2 orp iC = 0.5 ; and lack of balance between left and right coverage errors for small n and/orp iC implies that the available approximations for the distributions ofQ IV andQ F are accurate only for larger sample sizes.
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Affiliation(s)
| | - David C. Hoaglin
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMassachusettsUSA
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17
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Zhang Z, Cheng L, Ning D. Gut microbiota and sepsis: bidirectional Mendelian study and mediation analysis. Front Immunol 2023; 14:1234924. [PMID: 37662942 PMCID: PMC10470830 DOI: 10.3389/fimmu.2023.1234924] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Background There is a growing body of evidence that suggests a connection between the composition of gut microbiota and sepsis. However, more research is needed to better understand the causal relationship between the two. To gain a deeper insight into the association between gut microbiota, C-reactive protein (CRP), and sepsis, we conducted several Mendelian randomization (MR) analyses. Methods In this study, publicly available genome-wide association study (GWAS) summary statistics were examined to determine the correlation between gut microbiota and sepsis, including various sepsis subgroups (such as under 75, 28-day death, Critical Care Units (ICU), 28-day death in ICU). Initially, two-sample and reverse Mendelian randomization (MR) analyses were conducted to identify causality between gut microbiota and sepsis. Subsequently, multivariable and two-step MR analyses revealed that the relationship between microbiota and sepsis was mediated by CRP. The robustness of the findings was confirmed through several sensitivity analyses. Findings In our study, we revealed positive correlations between 24 taxa and different sepsis outcomes, while 30 taxa demonstrated negative correlations with sepsis outcomes. Following the correction for multiple testing, we found that the Phylum Lentisphaerae (OR: 0.932, p = 2.64E-03), class Lentisphaeria, and order Victivallales (OR: 0.927, p = 1.42E-03) displayed a negative relationship with sepsis risk. In contrast, Phylum Tenericutes and class Mollicutes (OR: 1.274, p = 2.89E-03) were positively related to sepsis risk and death within 28 days. It is notable that Phylum Tenericutes and class Mollicutes (OR: 1.108, p = 1.72E-03) also indicated a positive relationship with sepsis risk in individuals under 75. From our analysis, it was shown that C-reactive protein (CRP) mediated 32.16% of the causal pathway from Phylum Tenericutes and class Mollicutes to sepsis for individuals under 75. Additionally, CRP was found to mediate 31.53% of the effect of the genus Gordonibacter on sepsis. Despite these findings, our reverse analysis did not indicate any influence of sepsis on the gut microbiota and CRP levels. Conclusion The study showcased the connection between gut microbiota, CRP, and sepsis, which sheds new light on the potential role of CRP as a mediator in facilitating the impact of gut microbiota on sepsis.
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Affiliation(s)
- Zhi Zhang
- Department of Health Management, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Lin Cheng
- Regenerative Medicine Institute, School of Medicine, National University of Ireland (NUI), Galway, Ireland
| | - Dong Ning
- Discipline of Physiology, Human Biology Building, School of Medicine, National University of Ireland (NUI), Galway, Ireland
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18
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Lowet DS, Vaida F, Hesselink JR, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Huang M, Max JE. Novel Oppositional Defiant Disorder or Conduct Disorder 24 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2023; 36:53-62. [PMID: 37559510 PMCID: PMC10840932 DOI: 10.1176/appi.neuropsych.20220094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The authors sought to identify predictive factors of new-onset or novel oppositional defiant disorder or conduct disorder assessed 24 months after traumatic brain injury (TBI). METHODS Children ages 5 to 14 years who had experienced TBI were recruited from consecutive hospital admissions. Soon after injury, participants were assessed for preinjury characteristics, including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, and family function, and the presence and location of lesions were documented by MRI. Psychiatric outcomes, including novel oppositional defiant disorder or conduct disorder, were assessed 24 months after injury. RESULTS Of the children without preinjury oppositional defiant disorder, conduct disorder, or disruptive behavior disorder not otherwise specified who were recruited in this study, 165 were included in this sample; 95 of these children returned for the 24-month assessment. Multiple imputation was used to address attrition. The prevalence of novel oppositional defiant disorder or conduct disorder was 23.7 out of 165 (14%). In univariable analyses, novel oppositional defiant disorder or conduct disorder was significantly associated with psychosocial adversity (p=0.049) and frontal white matter lesions (p=0.016) and was marginally but not significantly associated with SES. In the final multipredictor model, frontal white matter lesions were significantly associated with novel oppositional defiant disorder or conduct disorder (p=0.021), and psychosocial adversity score was marginally but not significantly associated with the outcome. The odds ratio of novel oppositional defiant disorder or conduct disorder among the children with versus those without novel depressive disorder was significantly higher for girls than boys (p=0.025), and the odds ratio of novel oppositional defiant disorder or conduct disorder among the children with versus those without novel attention-deficit hyperactivity disorder (ADHD) was significantly higher for boys than girls (p=0.006). CONCLUSION Approximately 14% of children with TBI developed oppositional defiant disorder or conduct disorder. The risk for novel oppositional defiant disorder or conduct disorder can be understood from a biopsychosocial perspective. Sex differences were evident for comorbid novel depressive disorder and comorbid novel ADHD.
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Affiliation(s)
- Daniel S. Lowet
- University of California, San Diego, Department of Psychiatry
| | - Florin Vaida
- University of California, San Diego, Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics
| | | | | | | | | | - Erin D. Bigler
- Brigham Young University, Department of Psychology
- University of Utah, TBI and Concussion Center, Department of Neurology
| | | | | | - Tony T. Yang
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences
| | - Olga Tymofiyeva
- University of California, San Francisco, Department of Radiology and Biomedical Imaging
| | - Mingxiong Huang
- University of California, San Diego, Department of Radiology
| | - Jeffrey E. Max
- University of California, San Diego, Department of Psychiatry
- Rady Children’s Hospital, San Diego
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19
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Kulinskaya E, Hoaglin DC. On the Q statistic with constant weights in meta-analysis of binary outcomes. BMC Med Res Methodol 2023; 23:146. [PMID: 37344771 DOI: 10.1186/s12874-023-01939-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Cochran's Q statistic is routinely used for testing heterogeneity in meta-analysis. Its expected value (under an incorrect null distribution) is part of several popular estimators of the between-study variance, [Formula: see text]. Those applications generally do not account for use of the studies' estimated variances in the inverse-variance weights that define Q (more explicitly, [Formula: see text]). Importantly, those weights make approximating the distribution of [Formula: see text] rather complicated. METHODS As an alternative, we are investigating a Q statistic, [Formula: see text], whose constant weights use only the studies' arm-level sample sizes. For log-odds-ratio (LOR), log-relative-risk (LRR), and risk difference (RD) as the measures of effect, we study, by simulation, approximations to distributions of [Formula: see text] and [Formula: see text], as the basis for tests of heterogeneity. RESULTS The results show that: for LOR and LRR, a two-moment gamma approximation to the distribution of [Formula: see text] works well for small sample sizes, and an approximation based on an algorithm of Farebrother is recommended for larger sample sizes. For RD, the Farebrother approximation works very well, even for small sample sizes. For [Formula: see text], the standard chi-square approximation provides levels that are much too low for LOR and LRR and too high for RD. The Kulinskaya et al. (Res Synth Methods 2:254-70, 2011) approximation for RD and the Kulinskaya and Dollinger (BMC Med Res Methodol 15:49, 2015) approximation for LOR work well for [Formula: see text] but have some convergence issues for very small sample sizes combined with small probabilities. CONCLUSIONS The performance of the standard [Formula: see text] approximation is inadequate for all three binary effect measures. Instead, we recommend a test of heterogeneity based on [Formula: see text] and provide practical guidelines for choosing an appropriate test at the .05 level for all three effect measures.
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Affiliation(s)
- Elena Kulinskaya
- School of Computing Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, Norwich, UK.
| | - David C Hoaglin
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 368 Plantation Street, Worcester, Massachusetts 01605, USA
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Dai Z, Xu W, Ding R, Peng X, Shen X, Song J, Du P, Wang Z, Liu Y. Two-sample Mendelian randomization analysis evaluates causal associations between inflammatory bowel disease and osteoporosis. Front Public Health 2023; 11:1151837. [PMID: 37304119 PMCID: PMC10250718 DOI: 10.3389/fpubh.2023.1151837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Over the past few years, multiple observational studies have speculated a potential association between inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), and osteoporosis. However, no consensus has been reached regarding their interdependence and pathogenesis. Herein, we sought to further explore the causal associations between them. Methods We validated the association between IBD and reduced bone mineral density in humans based on genome-wide association studies (GWAS) data. To investigate the causal relationship between IBD and osteoporosis, we performed a two-sample Mendelian randomization study using training and validation sets. Genetic variation data for IBD, CD, UC, and osteoporosis were derived from published genome-wide association studies in individuals of European ancestry. After a series of robust quality control steps, we included eligible instrumental variables (SNPs) significantly associated with exposure (IBD/CD/UC). We adopted five algorithms, including MR Egger, Weighted median, Inverse variance weighted, Simple mode, and Weighted mode, to infer the causal association between IBD and osteoporosis. In addition, we evaluated the robustness of Mendelian randomization analysis by heterogeneity test, pleiotropy test, leave-one-out sensitivity test, and multivariate Mendelian randomization. Results Genetically predicted CD was positively associated with osteoporosis risk, with ORs of 1.060 (95% CIs 1.016, 1.106; p = 0.007) and 1.044 (95% CIs 1.002, 1.088; p = 0.039) for CD in the training and validation sets, respectively. However, Mendelian randomization analysis did not reveal a significant causal relationship between UC and osteoporosis (p > 0.05). Furthermore, we found that overall IBD was associated with osteoporosis prediction, with ORs of 1.050 (95% CIs 0.999, 1.103; p = 0.055) and 1.063 (95% CIs 1.019, 1.109; p = 0.005) in the training and validation sets, respectively. Conclusion We demonstrated the causal association between CD and osteoporosis, complementing the framework for genetic variants that predispose to autoimmune disease.
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Affiliation(s)
- Zhujiang Dai
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
| | - Weimin Xu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
| | - Rui Ding
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
| | - Xiang Peng
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
| | - Xia Shen
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
| | - Jinglue Song
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
| | - Peng Du
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
| | - Zhongchuan Wang
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
| | - Yun Liu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Colorectal Cancer Research Center, Shanghai, China
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21
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Chand RR, Blyth FM, Khalatbari-Soltani S. Healthy dietary indices and noncancer pain: a systematic review of cross-sectional and longitudinal studies. Pain 2023; 164:e177-e189. [PMID: 36083185 DOI: 10.1097/j.pain.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Pain is a global public health problem given its high prevalence and incidence, long duration, and social and economic impact. There is growing interest in nutrition as potential modifiable risk factor related to pain; however, the associations between healthy dietary patterns and pain have not yet been well established. Thus, we aimed to systematically review and synthesise current cross-sectional and longitudinal evidence on the relationship between a priori healthy dietary patterns and noncancer pain among adults aged ≥18 years. We identified relevant published cross-sectional and longitudinal studies by systematically searching several electronic databases from inception to September 2021. Risk of bias was assessed using the modified Newcastle-Ottawa scale for cohort studies. A total of 14 cross-sectional and 6 longitudinal studies were included in the review. These studies measured different dietary scores/indices, such as different measures of adherence to the Mediterranean diet and the dietary inflammatory index. Pain ascertainment methods and pain measurements used differed across studies. All 20 of the included studies had different study designs and statistical analysis. Of these studies, 10 reported an inverse association between adherence to a healthy dietary pattern and pain, 5 reported mixed results, and 5 reported no associations. Despite notable heterogeneity, 50% of included observational studies reported that adherence to a healthy diet, particularly the Mediterranean diet, is inversely associated with pain. Of note, the cross-sectional design of most studies precludes any causal interpretation. Moreover, limited and inconsistent evidence from longitudinal studies highlights the need for further studies.
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Affiliation(s)
- Rani R Chand
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
| | - Fiona M Blyth
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
| | - Saman Khalatbari-Soltani
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
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22
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Zhao L, Zhao W, Cao J, Tu Y. Causal relationships between migraine and microstructural white matter: a Mendelian randomization study. J Headache Pain 2023; 24:10. [PMID: 36793015 PMCID: PMC9933315 DOI: 10.1186/s10194-023-01550-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Migraine is a disabling neurological disorder with the pathophysiology yet to be understood. The microstructural alteration in brain white matter (WM) has been suggested to be related to migraine in recent studies, but these evidence are observational essentially and cannot infer a causal relationship. The present study aims to reveal the causal relationship between migraine and microstructural WM using genetic data and Mendelian randomization (MR). METHODS We collected the Genome-wide association study (GWAS) summary statistics of migraine (48,975 cases / 550,381 controls) and 360 WM imaging-derived phenotypes (IDPs) (31,356 samples) that were used to measure microstructural WM. Based on instrumental variables (IVs) selected from the GWAS summary statistics, we conducted bidirectional two-sample MR analyses to infer bidirectional causal associations between migraine and microstructural WM. In forward MR analysis, we inferred the causal effect of microstructural WM on migraine by reporting the odds ratio (OR) that quantified the risk change of migraine for per 1 standard deviation (SD) increase of IDPs. In reverse MR analysis, we inferred the causal effect of migraine on microstructural WM by reporting the β value that represented SDs of changes in IDPs were caused by migraine. RESULTS Three WM IDPs showed significant causal associations (p < 3.29 × 10- 4, Bonferroni correction) with migraine and were proved to be reliable via sensitivity analysis. The mode of anisotropy (MO) of left inferior fronto-occipital fasciculus (OR = 1.76, p = 6.46 × 10- 5) and orientation dispersion index (OD) of right posterior thalamic radiation (OR = 0.78, p = 1.86 × 10- 4) exerted significant causal effects on migraine. Migraine exerted a significant causal effect on the OD of left superior cerebellar peduncle (β = - 0.09, p = 2.78 × 10- 4). CONCLUSIONS Our findings provided genetic evidence for the causal relationships between migraine and microstructural WM, bringing new insights into brain structure for the development and experience of migraine.
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Affiliation(s)
- Lei Zhao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wenhui Zhao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jin Cao
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Yiheng Tu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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23
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Campos-Jara R, Martínez-Salazar C, Campos-Jara C, Fernández JM, Martínez-García D, Contreras-Osorio F. Pharmacological treatment for challenging behavior in adults with intellectual disability: Systematic review and meta-analysis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2023:S1888-9891(23)00004-6. [PMID: 37839961 DOI: 10.1016/j.rpsm.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Few evidence on the use of antipsychotics in people with intellectual disabilities and challenging behaviors, generates the need to develop studies that contribute to collect, compare and synthesize the available information. The present systematic review and meta-analysis aims to determine the clinical efficacy of antipsychotic medication in reducing critical episodes in this population. METHODS We searched Web of Science, Scopus, EBSCO, Embase, and PubMed for randomized controlled trials of antipsychotic medication versus placebo. Preliminarily yielded 1354 abstracts and citations; six studies with 274 subjects met the inclusion criteria of studies with experimental design, longitudinal type, with pre- and post-intervention measurements. RESULTS There is evidence for the use of psychotropic drugs in the acute management of challenging behaviors in patients with intellectual disability (SMD=-0.85; 95% CI=-1.69 to -0.01; p=0.05). CONCLUSIONS Our results coincide with the recommendations on the efficacy of the use of antipsychotics. Although our study provides evidence, the limited number of studies included in this research does not allow us to obtain totally conclusive results, although it can be considered as a guide for future studies.
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Affiliation(s)
| | - Cristian Martínez-Salazar
- Department of Physical Education, Sports, and Recreation, Pedagogy in Physical Education, School of Education and Social Sciences and Humanities, Universidad de La Frontera, Temuco 4780000, Chile
| | - Christian Campos-Jara
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | | | - Darío Martínez-García
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
| | - Falonn Contreras-Osorio
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile.
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24
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Tzeng IS. A Practical Approach in Refining Binary Outcome for Treatment Effect of COVID-19 According to Geographical Diversity. Trop Med Infect Dis 2023; 8:tropicalmed8020083. [PMID: 36828499 PMCID: PMC9964378 DOI: 10.3390/tropicalmed8020083] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
The recent COVID-19 pandemic has drawn attention to health and economics worldwide. Initially, diseases only ravage local populations, while a pandemic could aggravate global economic burdens. Lopinavir/Ritonavir is an anti-HIV drug that was used on small scale patients during SARS, but its effectiveness for COVID-19 treatment is still unclear. Previous studies or meta-analysis have retrieved clinical data of subgroup analysis to evaluate the efficacy and safety of Lopinavir/Ritonavir for the treatment of COVID-19 in a few affected regions. However, geographical diversity and small number of studies bias correction were not achieved in such subgroup analysis of published meta-analysis. The present study demonstrates a practical approach in refining the binary outcome for COVID-19 treatment of Lopinavir/Ritonavir according to geographical location diversity and small number of studies (less than or equal to five) for subgroup analysis. After performing practical approach, the risk of adverse event with LPV/RTV for treatment of COVID-19 becomes nonsignificant compared to previous meta-analysis. Furthermore, we also notice heterogeneity of random effect of meta-analysis may be declined after proposed adjustment. In conclusion, proposed practical approach is recommend for performing a subgroup analysis to avoid concentration in a single geographical location and small number of studies bias.
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Affiliation(s)
- I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
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25
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Dybvik JS, Svendsen M, Aune D. Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies. Eur J Nutr 2023; 62:51-69. [PMID: 36030329 PMCID: PMC9899747 DOI: 10.1007/s00394-022-02942-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/15/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Vegetarian diets have been associated with reduced risk of ischemic heart disease (IHD). However, results regarding cardiovascular disease (CVD) overall and stroke are less clear. We conducted a systematic review and meta-analysis of prospective cohort studies on CVD, IHD and stroke risk among vegetarians or vegans versus nonvegetarians to clarify these associations. METHODS PubMed and Ovid Embase databases were searched through August 12, 2021. Prospective cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for incidence or mortality from CVD, IHD and stroke, comparing vegetarians and vegans to nonvegetarians were included. Risk of bias (RoB) was assessed using ROBINS-I and the strength of evidence was assessed using World Cancer Research Fund (WCRF) criteria. Summary RRs (95% CIs) were estimated using a random effects model. RESULTS Thirteen cohort studies (844,175 participants, 115,392 CVD, 30,377 IHD, and 14,419 stroke cases) were included. The summary RR for vegetarians vs. nonvegetarians was 0.85 (95% CI: 0.79-0.92, I2 = 68%, n = 8) for CVD, 0.79 (95% CI: 0.71-0.88, I2 = 67%, n = 8) for IHD, 0.90 (95% CI: 0.77-1.05, I2 = 61%, n = 12) for total stroke, and for vegans vs. nonvegetarians was 0.82 (95% CI: 0.68-1.00, I2 = 0%, n = 6) for IHD. RoB was moderate (n = 8) to serious (n = 5). The associations between vegetarian diets and CVD and IHD were considered probably causal using WCRF criteria. CONCLUSIONS Vegetarian diets are associated with reduced risk of CVD and IHD, but not stroke, but further studies are needed on stroke. These findings should be considered in dietary guidelines. REVIEW REGISTRATION No review protocol registered.
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Affiliation(s)
- Jarle Sæby Dybvik
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mette Svendsen
- grid.5510.10000 0004 1936 8921Department of Nutrition Sciences, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Dagfinn Aune
- grid.55325.340000 0004 0389 8485Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway ,grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK ,Department of Nutrition, Oslo New University College, Oslo, Norway ,grid.4714.60000 0004 1937 0626Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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26
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Filis P, Varvarousis D, Ntritsos G, Dimopoulos D, Filis N, Giannakeas N, Korompilias A, Ploumis A. Prosthetic reconstruction following resection of lower extremity bone neoplasms: A systematic review and meta-analysis. J Bone Oncol 2022; 36:100452. [PMID: 36105628 PMCID: PMC9465097 DOI: 10.1016/j.jbo.2022.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022] Open
Abstract
Prosthetics are the mainstay in surgery after resection of extremity bone tumors. For these patients gait parameters deteriorated compared to healthy individuals. Further refinement of surgical techniques is required. New rehabilitation strategies and follow-up programming are needed.
Prosthetic reconstructive procedures have become the mainstay in contemporary surgical treatment following resection of extremity bone neoplasms. Given that these patients are of young age most of the time, achievement of robust functional outcomes is of paramount importance. The aim of this study is to assess the impact of this procedure on the gait parameters of cancer patients compared to healthy individuals. The Medline, Scopus and Cochrane databases were systematically searched until January 2022 for eligible studies. Gait parameters measured by gait analysis after prosthetic reconstruction were the outcomes of interest. Eight cohort studies were included in our analysis. From these, seven studied prosthetic reconstruction of the knee (distal femur or proximal tibia) and only one exclusively studied prostetic reconstructions of the proximal femur. Compared to healthy individuals a significant decrease was evident in gait velocity (-0.16 m/sec, 95 %CI: −0.23 to −0.09, p-value < 0.001), in stride length (-6.07 %height, 95 %CI: −9,36 to −2.78, p-value < 0.001), in cadence (-3.96 stride/min, 95 %CI: −5.41 to −2.51, p-value < 0.001) and significant increase in cycle time (0.10 s, 95 %CI: 0.03 to 0.17, p-value = 0.005). Prosthetic reconstruction following lower limb tumor resection significantly affects the gait of patients. This knowledge can be utilized for further refinement of surgical techniques, rehabilitation strategies and follow-up programming.
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Affiliation(s)
- Panagiotis Filis
- Department of Medical Oncology, University of Ιoannina, 45110 Ιoannina, Greece.,Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Dimitrios Varvarousis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, 45110 Ioannina, Greece
| | - Georgios Ntritsos
- Department of Informatics and Telecommunications, University of Ioannina, 47100 Arta, Greece
| | - Dimitrios Dimopoulos
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, 45110 Ioannina, Greece
| | - Nikolaos Filis
- Medical School, University of Ioannina, 45110 Ιoannina, Greece
| | - Nikolaos Giannakeas
- Department of Informatics and Telecommunications, University of Ioannina, 47100 Arta, Greece
| | - Anastasios Korompilias
- Division of Orthopaedic Surgery, Department of Surgery, University of Ioannina Medical School, 45110 Ioannina, Greece
| | - Avraam Ploumis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, 45110 Ioannina, Greece
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27
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Lv L, Lang X, Zhang S, Wang C, Wang Q. Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:987522. [PMID: 36148069 PMCID: PMC9485597 DOI: 10.3389/fcvm.2022.987522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Importance The safety and efficacy of different surgical repairs of supravalvar aortic stenosis (SVAS) are inconsistent. Objective To compare the prognosis of single-, two- and three-patch repair for patients with SVAS. Data sources PubMed, EMBASE, Cochrane Library, Web of Science, and clinicaltrials.gov were searched until April 17, 2022. Study selection Study reported SVAS patients treated with single-, two- or three-patch repair. Data extraction and synthesis Two reviewers independently extracted the data of study characteristics and clinical outcomes. Multiple pairwise and frequentist network meta-analyses were conducted. And a fixed-effect model was used when no heterogeneity existed. Main outcomes and measures Outcomes included the rate of reintervention, aortic insufficiency, early mortality and late mortality, cardiopulmonary bypass (CPB) time, cross-clamping (CCP) time, and postoperative/ follow-up pressure gradient. Binary variables were evaluated by odds ratio (OR) and its 95% confidence interval (CI), while continuous variables were assessed by standardized mean difference (SMD) and its 95% CI. Results Twenty-seven retrospective cohort studies were included, comprising 1,162 patients, undergoing single-patch (46.6% of cases), two-patch (33.9%), and three-patch repair (19.4%). Two-patch method had a lower rate of reintervention compared with single-patch (OR = 0.47, 95 % CI 0.28–0.89), and three-patch (OR = 0.31, 95 % CI 0.15–0.64). This finding also applied to juvenile and non-Asian patients. Three-patch method had a lower rate of aortic insufficiency compared with single-patch (OR = 0.11, 95 % CI 0.01–0.63), and two-patch (OR = 0.11, 95 % CI 0.02–0.83). But this repair had the longest CCP time, which was significantly longer than that of single- (SMD = 0.76, 95 % CI 0.36–1.17) or two-patch repair (SMD = 0.61, 95 % CI 0.06–1.16). No significant difference was found in mortality and pressure gradient among three procedures. Conclusion and relevance Two-patch repair has the lowest reintervention rate and relatively reasonable operation time. Complex and severe SVAS is suggested to be treated with two-patch repair. Further prospective studies of a reasonable sample size will be required with a special focus on the use of different patch materials and surgeons' unique working experience. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022328146.
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Affiliation(s)
- Lizhi Lv
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyue Lang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Simeng Zhang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Qiang Wang
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28
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Neves L, Correia AI, Castro SL, Martins D, Lima CF. Does music training enhance auditory and linguistic processing? A systematic review and meta-analysis of behavioral and brain evidence. Neurosci Biobehav Rev 2022; 140:104777. [PMID: 35843347 DOI: 10.1016/j.neubiorev.2022.104777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
It is often claimed that music training improves auditory and linguistic skills. Results of individual studies are mixed, however, and most evidence is correlational, precluding inferences of causation. Here, we evaluated data from 62 longitudinal studies that examined whether music training programs affect behavioral and brain measures of auditory and linguistic processing (N = 3928). For the behavioral data, a multivariate meta-analysis revealed a small positive effect of music training on both auditory and linguistic measures, regardless of the type of assignment (random vs. non-random), training (instrumental vs. non-instrumental), and control group (active vs. passive). The trim-and-fill method provided suggestive evidence of publication bias, but meta-regression methods (PET-PEESE) did not. For the brain data, a narrative synthesis also documented benefits of music training, namely for measures of auditory processing and for measures of speech and prosody processing. Thus, the available literature provides evidence that music training produces small neurobehavioral enhancements in auditory and linguistic processing, although future studies are needed to confirm that such enhancements are not due to publication bias.
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Affiliation(s)
- Leonor Neves
- Centro de Investigação e Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal
| | - Ana Isabel Correia
- Centro de Investigação e Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal
| | - São Luís Castro
- Centro de Psicologia da Universidade do Porto (CPUP), Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto (FPCEUP), Porto, Portugal
| | - Daniel Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; NIHR Maudsley Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, UK
| | - César F Lima
- Centro de Investigação e Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal.
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29
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Moncla LHM, Mathieu S, Sylla MS, Bossé Y, Thériault S, Arsenault BJ, Mathieu P. Mendelian randomization of circulating proteome identifies actionable targets in heart failure. BMC Genomics 2022; 23:588. [PMID: 35964012 PMCID: PMC9375407 DOI: 10.1186/s12864-022-08811-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Heart failure (HF) is a prevalent cause of mortality and morbidity. The molecular drivers of HF are still largely unknown. Results We aimed to identify circulating proteins causally associated with HF by leveraging genome-wide genetic association data for HF including 47,309 cases and 930,014 controls. We performed two-sample Mendelian randomization (MR) with multiple cis instruments as well as network and enrichment analysis using data from blood protein quantitative trait loci (pQTL) (2,965 blood proteins) measured in 3,301 individuals. Nineteen blood proteins were causally associated with HF, were not subject to reverse causality and were enriched in ligand-receptor and glycosylation molecules. Network pathway analysis of the blood proteins showed enrichment in NF-kappa B, TGF beta, lipid in atherosclerosis and fluid shear stress. Cross-phenotype analysis of HF identified genetic overlap with cardiovascular drugs, myocardial infarction, parental longevity and low-density cholesterol. Multi-trait MR identified causal associations between HF-associated blood proteins and cardiovascular outcomes. Multivariable MR showed that association of BAG3, MIF and APOA5 with HF were mediated by the blood pressure and coronary artery disease. According to the directional effect and biological action, 7 blood proteins are targets of existing drugs or are tractable for the development of novel therapeutics. Among the pathways, sialyl Lewis x and the activin type II receptor are potential druggable candidates. Conclusions Integrative MR analyses of the blood proteins identified causally-associated proteins with HF and revealed pleiotropy of the blood proteome with cardiovascular risk factors. Some of the proteins or pathway related mechanisms could be targeted as novel treatment approach in HF. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-022-08811-2.
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Affiliation(s)
- Louis-Hippolyte Minvielle Moncla
- Genomic Medecine and Molecular Epidemiology Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec, G1V-4G5, Canada
| | - Samuel Mathieu
- Genomic Medecine and Molecular Epidemiology Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec, G1V-4G5, Canada
| | - Mame Sokhna Sylla
- Genomic Medecine and Molecular Epidemiology Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec, G1V-4G5, Canada
| | - Yohan Bossé
- Department of Molecular Medicine, Laval University, Quebec, Canada
| | - Sébastien Thériault
- Department of Molecular Biology, Medical Biochemistry and Pathology, Laval University, Quebec, Canada
| | - Benoit J Arsenault
- Genomic Medecine and Molecular Epidemiology Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec, G1V-4G5, Canada.,Department of Medicine, Laval University, Quebec, Canada
| | - Patrick Mathieu
- Genomic Medecine and Molecular Epidemiology Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec, G1V-4G5, Canada. .,Department of Surgery, Laval University, Quebec, Canada.
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30
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Wang H, Luo Q, Ding X, Chen L, Zhang Z. Trimethylamine N-oxide and its precursors in relation to blood pressure: A mendelian randomization study. Front Cardiovasc Med 2022; 9:922441. [PMID: 35935641 PMCID: PMC9354484 DOI: 10.3389/fcvm.2022.922441] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Previous studies have demonstrated that trimethylamine N-oxide (TMAO) and its precursors, including choline, betaine, and carnitine, are closely associated with blood pressure (BP) changes. Nevertheless, with the limitation of reverse causality and confounder in observational studies, such a relationship remains unclear. We aimed to assess the causal relationship of TMAO and its precursors with BP by the Mendelian Randomization (MR) approach. Method In this study, two-sample MR was used to reveal the causal effect of TMAO and its precursors on BP. Pooled data of TMAO and its precursors was from genome-wide association studies (GWAS) which includes summary data of human metabolome in 2,076 European participants from Framingham Heart Study. Summary-level data for BP was extracted from the International Consortium of Blood Pressure-Genome Wide Association Studies. Inverse variance weighted (IVW), MR Egger regression, Maximum likelihood, Weighted median, and MR pleiotropy residual sum and outlier test (MR-PRESSO) were used in this MR analysis. Results A total of 160 independent SNP loci were associated with TMAO and three precursors, including 58 associated with TMAO, 29 associated with choline, 44 associated with betaine, and 29 associated with carnitine, were selected. MR results suggested that a 1 unit increase in TMAO should be associated with a 1SD increase in systolic BP mmHg (beta: 0.039, SE, 0.072, p = 0.020). Additionally, our findings also indicated that a 1 unit increase in carnitine should be associated with a 1SD increase in systolic BP mmHg (beta: 0.055, SE: 0.075, p = 0.039). This result was also confirmed by sensitivity analysis methods such as Maximum likelihood, MR-PRESSO, and Weighted median. No effects of betaine or choline on systolic or diastolic BP were observed in the present study. Conclusion Our study provides evidence of a causal relationship of TMAO and its precursors with BP, suggesting that mediating the generation of TMAO would be beneficial for lowering BP.
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Affiliation(s)
- Han Wang
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Qiang Luo
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Xunshi Ding
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Lifang Chen
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Zheng Zhang
- Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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Yilmaz AE. How reliable are the multiple comparison methods for odds ratio? J Appl Stat 2022; 49:3141-3163. [PMID: 36035608 PMCID: PMC9415621 DOI: 10.1080/02664763.2022.2104229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The homogeneity tests of odds ratios are used in clinical trials and epidemiological investigations as a preliminary step of meta-analysis. In recent studies, the severity or mortality of COVID-19 in relation to demographic characteristics, comorbidities, and other conditions has been popularly discussed by interpreting odds ratios and using meta-analysis. According to the homogeneity test results, a common odds ratio summarizes all of the odds ratios in a series of studies. If the aim is not to find a common odds ratio, but to find which of the sub-characteristics/groups is different from the others or is under risk, then the implementation of a multiple comparison procedure is required. In this article, the focus is placed on the accuracy and reliability of the homogeneity of odds ratio tests for multiple comparisons when the odds ratios are heterogeneous at the omnibus level. Three recently proposed multiple comparison tests and four homogeneity of odds ratios tests with six adjustment methods to control the type-I error rate are considered. The reliability and accuracy of the methods are discussed in relation to COVID-19 severity data associated with diabetes on a country-by-country basis, and a simulation study to assess the powers and type-I error rates of the tests is conducted.
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Dammen LV, Finseth TT, McCurdy BH, Barnett NP, Conrady RA, Leach AG, Deick AF, Van Steenis AL, Gardner R, Smith BL, Kay A, Shirtcliff EA. Evoking stress reactivity in virtual reality: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 138:104709. [PMID: 35644278 DOI: 10.1016/j.neubiorev.2022.104709] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/08/2022] [Accepted: 05/21/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Virtual reality (VR) research probes stress environments that are infeasible to create in the real world. However, because research simulations are applied to narrow populations, it remains unclear if VR simulations can stimulate a broadly applicable stress-response. This systematic review and meta-analysis was conducted on studies using VR stress tasks and biomarkers. METHODS Included papers (N = 52) measured cortisol, heart rate (HR), galvanic skin response (GSR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory sinus arrhythmia (RSA), parasympathetic activity (RMSSD), sympathovagal balance (LF/HF), and/or salivary alpha-amylase (sAA). Effect sizes (ES) and confidence intervals (CI) were calculated based on standardized mean change of baseline-to-peak biomarker levels. RESULTS From baseline-to-peak (ES, CI), analyses showed a statistically significant change in cortisol (0.56, 0.28-0.83), HR (0.68, 0.53-0.82), GSR (0.59, 0.36-0.82), SBP (.55, 0.19-0.90), DBP (.64, 0.23-1.05), RSA (-0.59, -0.88 to -0.30), and sAA (0.27, 0.092-0.45). There was no effect for RMSSD and LF/HF. CONCLUSION VR stress tasks elicited a varied magnitude of physiological stress reactivity. VR may be an effective tool in stress research.
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Affiliation(s)
- Lotte van Dammen
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Tor T Finseth
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA.
| | - Bethany H McCurdy
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Neil P Barnett
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Roselynn A Conrady
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Alexis G Leach
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Andrew F Deick
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | | | - Reece Gardner
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Brandon L Smith
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Anita Kay
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
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Merle JL, Thayer AJ, Larson MF, Pauling S, Cook CR, Rios JA, McGinnis JL, Sullivan MM. Investigating strategies to increase general education teachers' adherence to evidence-based social-emotional behavior practices: A meta-analysis of the single-case literature. J Sch Psychol 2022; 91:1-26. [PMID: 35190070 DOI: 10.1016/j.jsp.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/30/2021] [Accepted: 11/30/2021] [Indexed: 12/17/2022]
Abstract
Educational researchers have produced a variety of evidence-based practices (EBP) to address social, emotional, and behavioral (SEB) needs among students. Yet, these practices are often insufficiently adopted and implemented with fidelity by teachers to produce the beneficial outcomes associated with the EBP, leaving students at risk for developing SEB problems. If ignored, SEB problems can lead to other negative outcomes, such as academic failure. Therefore, implementation strategies (i.e., methods and procedures designed to promote implementation outcomes) are needed to improve teachers' uptake and delivery of EBPs with fidelity. This meta-analysis sought to examine the types and magnitude of effect of implementation strategies that have been designed and tested to improve teacher adherence to SEB EBPs. Included studies (a) used single case experimental designs, (b) employed at least one implementation strategy, (c) targeted general education teachers, and (d) evaluated adherence as a core dimension of fidelity related to the delivery of EBPs. In total, this study included 28 articles and evaluated 122 effect sizes. A total of 15 unique implementation strategies were categorized. Results indicated that, on average, implementation strategies were associated with increases in teacher adherence to EBPs above baseline and group-based pre-implementation trainings alone (g = 2.32, tau = 0.77). Moderator analysis also indicated that larger effects were associated with implementation strategies that used a greater number of unique behavior change techniques (p < .001). Implications and future directions for research and practice regarding use of implementation strategies for general education teachers are discussed.
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Du H, Jiang G, Ke Z. Bootstrap-Based Between-Study Heterogeneity Tests in Meta-Analysis. MULTIVARIATE BEHAVIORAL RESEARCH 2022:1-20. [PMID: 35067135 DOI: 10.1080/00273171.2021.1997701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Meta-analysis combines pertinent information from existing studies to provide an overall estimate of population parameters/effect sizes, as well as to quantify and explain the differences between studies. However, testing between-study heterogeneity is one of the most challenging tasks in meta-analysis research. Existing methods for testing heterogeneity, such as the Q test and likelihood ratio (LR) test, have been criticized for their failure to control Type I error rate and/or failure to attain enough statistical power. Although better reference distribution approximations have been proposed in the literature, their application is limited. Additionally, when the interest is to test whether the size of the heterogeneity is larger than a specific level, existing methods are far from mature. To address these issues, we propose new heterogeneity tests. Specifically, we combine bootstrap methods with existing heterogeneity tests (i.e., the maximum LR test, the restricted maximum LR test, and the Q test) to overcome the reference distribution issue and denote them as B-ML-LRT, B-REML-LRT, and B-Q, respectively. Simulation studies were conducted to examine and compare the performance of the proposed methods with the regular LR test, the regular Q test, and the Kulinskaya's improved Q test in both random- and mixed-effects meta-analyses. Based on the results of Type I error rates and statistical power, B-REML-LRT is recommended. Additionally, the improved Q test is also recommended when it is applicable. An R package boot.heterogeneity is provided to facilitate the implementation of the proposed tests.
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Affiliation(s)
- Han Du
- Department of Psychology, University of California, Los Angeles
| | - Ge Jiang
- Department of Educational Psychology, University of Illinois at Urbana-Champaign
| | - Zijun Ke
- Department of Psychology, Sun Yat-sen University
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Basic V, Zhang B, Domert J, Pellas U, Tot T. Integrative meta-analysis of gene expression profiles identifies FEN1 and ENDOU as potential diagnostic biomarkers for cervical squamous cell carcinoma. Oncol Lett 2021; 22:840. [PMID: 34712364 PMCID: PMC8548783 DOI: 10.3892/ol.2021.13101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/16/2021] [Indexed: 12/23/2022] Open
Abstract
Cervical carcinoma is a global public health burden. Given that it is usually asymptomatic at potentially curative stages, the development of clinically accurate tests is critical for early detection and individual risk stratification. The present study performed an integrative meta-analysis of the transcriptomes from 10 cervical carcinoma cohorts, with the aim of identifying biomarkers that are associated with malignant transformation of cervical epithelium, and establish their clinical applicability. From among the top ranked differentially expressed genes, flap structure-specific endonuclease 1 (FEN1) and poly (U)-specific endoribonuclease (ENDOU) were selected for further validation, and their clinical applicability was assessed using immunohistochemically stained microarrays comprising 110 tissue cores, using p16 and Ki67 staining as the comparator tests. The results demonstrated that FEN1 expression was significantly upregulated in 65% of tumor specimens (P=0.0001), with no detectable expression in the non-tumor tissues. Furthermore, its expression was significantly associated with Ki67 staining in tumor samples (P<0.0001), but no association was observed with p16 expression or the presence of human papilloma virus types 16/18, patient age, tumor grade or stage. FEN1 staining demonstrated lower sensitivity than p16 (69.3 vs. 96.8%) and Ki67 (69.3 vs. 76.3%); however, the specificity was identical to p16 and higher than that of Ki67 (100 vs. 71.4%).ENDOU staining was consistent with the microarray results, demonstrating 1% positivity in tumors and 40% positivity in non-tumor tissues. Gene set enrichment analysis of cervical tumors overexpressing FEN1 revealed its association with enhanced growth factor signaling, immune response inhibition and extracellular matrix remodeling, whereas tumors with low ENDOU expression exhibited inhibition of epithelial development and differentiation processes. Taken together, the results of the present study demonstrate the feasibility of the integrative meta-analysis approach to identify relevant biomarkers associated with cervical carcinogenesis. Thus, FEN1 and ENDOU may be useful diagnostic biomarkers for squamous cervical carcinoma. However, further studies are required to determine their diagnostic performance in larger patient cohorts and validate the results presented here.
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Affiliation(s)
- Vladimir Basic
- Pathology and Cytology Dalarna, County Hospital Falun, Falun 791 82, Sweden
- Clinical Research Center Dalarna, Uppsala University, Falun 791 82, Sweden
| | - Boxi Zhang
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm 171 65, Sweden
| | - Jakob Domert
- Pathology and Cytology Dalarna, County Hospital Falun, Falun 791 82, Sweden
| | - Ulrika Pellas
- Clinical Research Center Dalarna, Uppsala University, Falun 791 82, Sweden
| | - Tibor Tot
- Pathology and Cytology Dalarna, County Hospital Falun, Falun 791 82, Sweden
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Kyriakopoulos C, Ntritsos G, Gogali A, Milionis H, Evangelou E, Kostikas K. Tocilizumab administration for the treatment of hospitalized patients with COVID-19: A systematic review and meta-analysis. Respirology 2021; 26:1027-1040. [PMID: 34605114 PMCID: PMC8661720 DOI: 10.1111/resp.14152] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022]
Abstract
Tocilizumab has been repurposed against the ‘cytokine storm’ in the setting of coronavirus disease 2019 (COVID‐19). Our aim was to evaluate the efficacy of tocilizumab in the management of hospitalized COVID‐19 patients. We searched MEDLINE, CENTRAL and medRxiv for studies of tocilizumab in hospitalized COVID‐19 patients. Primary objective was the effectiveness of tocilizumab on mortality. Secondary objectives included the need for invasive mechanical ventilation (IMV), composite endpoints of mortality or IMV and intensive care unit (ICU) admission or IMV, length of hospitalization and differences in mortality in subgroups (ICU and non‐ICU patients and patients receiving or not receiving concomitant corticosteroids). We included 52 studies (nine randomized controlled trials [RCTs] and 43 observational) with a total of 27,004 patients. In both RCTs and observational studies, the use of tocilizumab was associated with a reduction in mortality; 11% in RCTs (risk ratio [RR] 0.89, 95% CI 0.82 to 0.96) and 31% in observational studies (RR 0.69, 95% CI 0.58 to 0.83). The need for IMV was reduced by 19% in RCTs (RR 0.81, 95% CI 0.71 to 0.93), while no significant reduction was observed in observational studies. Both RCTs and observational studies showed a benefit from tocilizumab on the composite endpoint of mortality or IMV. Tocilizumab improved mortality both in ICU and non‐ICU patients. Reduction in mortality was evident in observational studies regardless of the use of systemic corticosteroids, while that was not the case in the RCTs. Tocilizumab was associated with lower mortality and other clinically relevant outcomes in hospitalized patients with moderate‐to‐critical COVID‐19.
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Affiliation(s)
- Christos Kyriakopoulos
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Georgios Ntritsos
- Department of Hygiene and Epidemiology, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Athena Gogali
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Haralampos Milionis
- Internal Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
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Blanchard A, Chihuri S, DiGuiseppi CG, Li G. Risk of Self-harm in Children and Adults With Autism Spectrum Disorder: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2130272. [PMID: 34665237 PMCID: PMC8527356 DOI: 10.1001/jamanetworkopen.2021.30272] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Multiple studies have reported that people with autism spectrum disorder (ASD) are at a higher risk for self-injurious behavior and suicide. However, the magnitude of this association varies between studies. OBJECTIVE To appraise the available epidemiologic studies on the risk of self-injurious behavior and suicidality among children and adults with ASD. DATA SOURCES PubMed, Embase, CINAHL, PsycINFO, and Web of Science were systematically searched for epidemiologic studies on the association between ASD and self-injurious behavior and suicidality. Databases were searched from year of inception to April through June 2020. No language, age, or date restrictions were applied. STUDY SELECTION This systematic review and meta-analysis included studies with an observational design and compared self-injurious behavior (defined as nonaccidental behavior resulting in self-inflicted physical injury but without intent of suicide or sexual arousal) and/or suicidality (defined as suicidal ideation, suicide attempt, or suicide) in children (aged <20 years) or adults (aged ≥20 years) with ASD. DATA EXTRACTION AND SYNTHESIS Information on study design, study population, ASD and self-harm definitions, and outcomes were extracted by independent investigators. Study quality was assessed using the Newcastle-Ottawa Scale. Overall summary odds ratios (ORs) and 95% CIs were estimated using DerSimonian-Laird random-effects models. MAIN OUTCOMES AND MEASURES The ORs for the associations of ASD with self-injurious behavior and suicidality were calculated. Analyses were stratified by study setting and age groups as planned a priori. RESULTS The search identified 31 eligible studies, which were of moderate to high quality. Of these studies, 16 (52%) were conducted in children, 13 (42%) in adults, and 2 (6%) in both children and adults. Seventeen studies assessed the association between ASD and self-injurious behavior and reported ORs that ranged from 1.21 to 18.76, resulting in a pooled OR of 3.18 (95% CI, 2.45-4.12). Sixteen studies assessed the association between ASD and suicidality and reported ORs that ranged from 0.86 to 11.10, resulting in a pooled OR of 3.32 (95% CI, 2.60-4.24). In stratified analyses, results were consistent between clinical and nonclinical settings and between children and adults. CONCLUSIONS AND RELEVANCE This study found that ASD was associated with a substantial increase in odds of self-injurious behavior and suicidality in children and adults. Further research is needed to examine the role of primary care screenings, increased access to preventive mental health services, and lethal means counseling in reducing self-harm in this population.
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Affiliation(s)
- Ashley Blanchard
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Stanford Chihuri
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Carolyn G. DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Yu X, Deng MG, Tang ZY, Zhang ZJ. Urticaria and increased risk of rheumatoid arthritis: a two-sample Mendelian randomisation study in European population. Mod Rheumatol 2021; 32:736-740. [PMID: 34918120 DOI: 10.1093/mr/roab052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/24/2021] [Accepted: 07/29/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND In recent years, a growing body of observational studies suggest that urticaria is associated with a higher risk of rheumatoid arthritis (RA). However, the causal association between urticaria and RA remains unknown. OBJECTIVE To investigate the causal relationship of urticaria and RA in European populations by Mendelian randomisation (MR) approach. METHODS We conducted two-sample MR analyses. Eleven single-nucleotide polymorphisms associated with urticaria were used as instrumental variables. The summary data on urticaria were derived from FinnGen Data Freeze 2. The summary data on RA were obtained from a published meta-analysis using European samples. Four MR methods were applied to the MR estimates. Three heterogeneity tests, including Cochran's Q test, single variant analysis, and leave-one-out variant analysis, were used. The pleiotropy and horizontal pleiotropy among instrumental variables were assessed with MR-Egger regression intercept, MR pleiotropy residual sum and outlier global test, and PhenoScanner. RESULTS The MR analysis suggested that urticaria was causally associated with RA (odds ratio = 1.114, 95% confidence interval = 1.024-1.211, p = .011). No genetic pleiotropy or horizontal pleiotropy was revealed by MR-Egger regression intercept and MR pleiotropy residual sum and outlier global test. The sensitivity analysis results were relatively robust. CONCLUSIONS The MR analysis suggested there was sufficient evidence to indicate urticaria is the cause of RA.
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Affiliation(s)
- Xue Yu
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan, China
| | - Ming-Gang Deng
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, China
| | - Zi-Ying Tang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, China
| | - Zhi-Jiang Zhang
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan, China
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Moore RA, Fisher E, Häuser W, Bell RF, Perrot S, Bidonde J, Makri S, Straube S. Pharmacological therapies for fibromyalgia (fibromyalgia syndrome) in adults - an overview of Cochrane Reviews. Hippokratia 2021. [DOI: 10.1002/14651858.cd013151.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group; Pain Research Unit, Churchill Hospital; Oxford UK
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy; Technische Universität München; München Germany
| | - Rae Frances Bell
- Emerita, Regional Centre of Excellence in Palliative Care; Haukeland University Hospital; Bergen Norway
| | - Serge Perrot
- Service de Médecine Interne et Thérapeutique; Hôtel Dieu, Université Paris Descartes, INSERM U 987; Paris France
| | - Julia Bidonde
- School of Rehabilitation Science, College of Medicine; University of Saskatchewan; Saskatoon Canada
| | - Souzi Makri
- Cyprus League Against Rheumatism; Nicosia Cyprus
| | - Sebastian Straube
- Department of Medicine, Division of Preventive Medicine; University of Alberta; Edmonton Canada
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Cairns M, Prendergast LA. On ratio measures of heterogeneity for meta-analyses. Res Synth Methods 2021; 13:28-47. [PMID: 34328266 DOI: 10.1002/jrsm.1517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/11/2022]
Abstract
As a measure of heterogeneity in meta-analysis, the coefficient of variation (CV) has been recently considered, providing researchers with a complement to the very popular I 2 measure. While I 2 measures the proportion of total variance that is due to variance of the random effects, the CV is the ratio of the standard deviation of the random effects to the effect of interest. Consequently, the CV provides a different measure of the extent of heterogeneity in a meta-analysis relative to the effect being measured. However, very large CV values can occur when the effect is small making interpretation difficult. The purpose of this article is two-fold. First, we consider variants of the CV that exist in the interval 0 , 1 which may be preferable for some researchers. Second, we provide interval estimators for the CV and its variants with excellent coverage properties. We perform simulation studies based on simulated and real data sets and draw comparisons between the methods. For both the CV and its transformations, we recommend confidence intervals using the propagating imprecision method or, as a simpler alternative but at the expense of slightly worse performance in terms of coverage, combining reduced-coverage confidence intervals for the two parameters. These interval estimators typically have better coverage properties for the CV measure than those previously considered.
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Affiliation(s)
- Maxwell Cairns
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
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van Aert RCM, Schmid CH, Svensson D, Jackson D. Study specific prediction intervals for random-effects meta-analysis: A tutorial: Prediction intervals in meta-analysis. Res Synth Methods 2021; 12:429-447. [PMID: 33939307 PMCID: PMC8361666 DOI: 10.1002/jrsm.1490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 11/07/2022]
Abstract
The pooled estimate of the average effect is of primary interest when fitting the random-effects model for meta-analysis. However estimates of study specific effects, for example those displayed on forest plots, are also often of interest. In this tutorial, we present the case, with the accompanying statistical theory, for estimating the study specific true effects using so called 'empirical Bayes estimates' or 'Best Unbiased Linear Predictions' under the random-effects model. These estimates can be accompanied by prediction intervals that indicate a plausible range of study specific true effects. We coalesce and elucidate the available literature and illustrate the methodology using two published meta-analyses as examples. We also perform a simulation study that reveals that coverage probability of study specific prediction intervals are substantially too low if the between-study variance is small but not negligible. Researchers need to be aware of this defect when interpreting prediction intervals. We also show how empirical Bayes estimates, accompanied with study specific prediction intervals, can embellish forest plots. We hope that this tutorial will serve to provide a clear theoretical underpinning for this methodology and encourage its widespread adoption.
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Kulinskaya E, Hoaglin DC, Bakbergenuly I, Newman J. A Q statistic with constant weights for assessing heterogeneity in meta-analysis. Res Synth Methods 2021; 12:711-730. [PMID: 33969638 DOI: 10.1002/jrsm.1491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022]
Abstract
The conventional Q statistic, using estimated inverse-variance (IV) weights, underlies a variety of problems in random-effects meta-analysis. In previous work on standardized mean difference and log-odds-ratio, we found superior performance with an estimator of the overall effect whose weights use only group-level sample sizes. The Q statistic with those weights has the form proposed by DerSimonian and Kacker. The distribution of this Q and the Q with IV weights must generally be approximated. We investigate approximations for those distributions, as a basis for testing and estimating the between-study variance (τ2 ). A simulation study, with mean difference as the effect measure, provides a framework for assessing accuracy of the approximations, level and power of the tests, and bias in estimating τ2 . Two examples illustrate estimation of τ2 and the overall mean difference. Use of Q with sample-size-based weights and its exact distribution (available for mean difference and evaluated by Farebrother's algorithm) provides precise levels even for very small and unbalanced sample sizes. The corresponding estimator of τ2 is almost unbiased for 10 or more small studies. This performance compares favorably with the extremely liberal behavior of the standard tests of heterogeneity and the largely biased estimators based on inverse-variance weights.
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Affiliation(s)
- Elena Kulinskaya
- School of Computing Sciences, University of East Anglia, Norwich, UK
| | - David C Hoaglin
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Joseph Newman
- School of Computing Sciences, University of East Anglia, Norwich, UK
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Martins D, Paduraru M, Paloyelis Y. Heterogeneity in response to repeated intranasal oxytocin in schizophrenia and autism spectrum disorders: A meta-analysis of variance. Br J Pharmacol 2021; 179:1525-1543. [PMID: 33739447 DOI: 10.1111/bph.15451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Intranasal oxytocin (OT) has been suggested as a putative adjunctive treatment for patients with schizophrenia and autism spectrum disorders (ASD). Here, we examine available evidence from trials investigating the effects of repeated administrations of intranasal OT on the core symptoms of patients with schizophrenia and ASD, focusing on its therapeutic efficacy and heterogeneity of response (meta-ANOVA). Repeated administration of intranasal OT does not improve most of the core symptoms of schizophrenia and ASD, beyond a small tentative effect on schizophrenia general symptoms. However, we found significant moderator effects for dose in schizophrenia total psychopathology and positive symptoms, and percentage of included men and duration of treatment in schizophrenia general symptoms. We found evidence of heterogeneity (increased variance) in the response of schizophrenia negative symptoms to intranasal OT compared with placebo, suggesting that subgroups of responsive and non-responsive patients might coexist. For other core symptoms of schizophrenia, or any of the core symptom dimensions in ASD, the response to repeated treatment with intranasal OT did not show evidence of heterogeneity.
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Affiliation(s)
- Daniel Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Paduraru
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Zhang C, Wang X, Chen M, Wang T. A comparison of hypothesis tests for homogeneity in meta-analysis with focus on rare binary events. Res Synth Methods 2021; 12:408-428. [PMID: 34231330 DOI: 10.1002/jrsm.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/01/2021] [Accepted: 02/03/2021] [Indexed: 11/06/2022]
Abstract
Analysis of rare binary events is an important problem for biomedical researchers. Due to the sparsity of events in such problems, meta-analysis that integrates information across multiple studies can be applied to increase the efficiency of statistical inference. Although it is critical to examine whether the effect sizes are homogeneous across all studies, a comprehensive review of homogeneity tests has been lacking, and in particular, no attention has been paid to infrequent dichotomous outcomes. We systematically review statistical methods for homogeneity testing. By conducting an extensive simulation analysis and two case studies, we examine the performance of 30 tests in meta-analysis of rare binary outcomes. When using log-odds ratio as the association measure, our simulation results suggest that there is no uniform winner. However, we recommend the test proposed by Kulinskaya and Dollinger (BMC Med Res Methodol, 2015, 15), which uses a gamma distribution to approximate the null distribution, for its generally good performance; for very rare events coupled with small within-study sample sizes, in addition to the Kulinskaya-Dollinger test, we further recommend the conditional score test based on the random-effects hypergeometric model proposed by Liang and Self (Biometrika, 1985, 72:353-358). One should be cautious about the use of the Wald tests, the Lipsitz tests (Biometrics, 1998, 54:148-160), and tests proposed by Bhaumik et al (J Am Stat Assoc, 2012, 107:555-567).
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Affiliation(s)
- Chiyu Zhang
- Department of Statistical Science, Southern Methodist University, Dallas, Texas, USA
| | - Xinlei Wang
- Department of Statistical Science, Southern Methodist University, Dallas, Texas, USA
| | - Min Chen
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, Texas, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Tao Wang
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
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Short-Term Exposure to Fine Particulate Matter and Hospitalizations for Acute Lower Respiratory Infection in Korean Children: A Time-Series Study in Seven Metropolitan Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010144. [PMID: 33379204 PMCID: PMC7795137 DOI: 10.3390/ijerph18010144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022]
Abstract
Although several studies have evaluated the association between fine particulate matter (PM2.5) and acute lower respiratory infection (ALRI) in children, their results were inconsistent Therefore, we aimed to evaluate the association between short-term exposure to PM2.5 and ALRI hospitalizations in children (0–5 years) living in seven metropolitan cities of Korea. The ALRI hospitalization data of children living in seven metropolitan cities of Korea from 2008 to 2016 was acquired from a customized database constructed based on National Health Insurance data. The time-series data in a generalized additive model were used to evaluate the relationship between ALRI hospitalization and 7-day moving average PM2.5 exposure after adjusting for apparent temperature, day of the week, and time trends. We performed a meta-analysis using a two-stage design method. The estimates for each city were pooled to generate an average estimate of the associations. The average PM2.5 concentration in 7 metropolitan cities was 29.0 μg/m3 and a total of 713,588 ALRI hospitalizations were observed during the 9-year study period. A strong linear association was observed between PM2.5 and ALRI hospitalization. A 10 μg/m3 increase in the 7-day moving average of PM2.5 was associated with a 1.20% (95% CI: 0.71, 1.71) increase in ALRI hospitalization. While we found similar estimates in a stratified analysis by sex, we observed stronger estimates of the association in the warm season (1.71%, 95% CI: 0.94, 2.48) compared to the cold season (0.31%, 95% CI: −0.51, 1.13). In the two-pollutant models, the PM2.5 effect adjusted by SO2 was attenuated more than in the single pollutant model. Our results suggest a positive association between PM2.5 exposure and ALRI hospitalizations in Korean children, particularly in the warm season. The children need to refrain from going out on days when PM2.5 is high.
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Bakbergenuly I, Hoaglin DC, Kulinskaya E. Methods for estimating between‐study variance and overall effect in meta‐analysis of odds ratios. Res Synth Methods 2020; 11:426-442. [DOI: 10.1002/jrsm.1404] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/22/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | - David C. Hoaglin
- Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester Massachusetts USA
| | - Elena Kulinskaya
- School of Computing Sciences University of East Anglia Norwich UK
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van Aert RCM, Jackson D. A new justification of the Hartung-Knapp method for random-effects meta-analysis based on weighted least squares regression. Res Synth Methods 2019; 10:515-527. [PMID: 31111673 PMCID: PMC6973024 DOI: 10.1002/jrsm.1356] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/09/2022]
Abstract
The Hartung-Knapp method for random-effects meta-analysis, that was also independently proposed by Sidik and Jonkman, is becoming advocated for general use. This method has previously been justified by taking all estimated variances as known and using a different pivotal quantity to the more conventional one when making inferences about the average effect. We provide a new conceptual framework for, and justification of, the Hartung-Knapp method. Specifically, we show that inferences from fitted random-effects models, using both the conventional and the Hartung-Knapp method, are equivalent to those from closely related intercept only weighted least squares regression models. This observation provides a new link between Hartung and Knapp's methodology for meta-analysis and standard linear models, where it can be seen that the Hartung-Knapp method can be justified by a linear model that makes a slightly weaker assumption than taking all variances as known. This provides intuition for why the Hartung-Knapp method has been found to perform better than the conventional one in simulation studies. Furthermore, our new findings give more credence to ad hoc adjustments of confidence intervals from the Hartung-Knapp method that ensure these are at least as wide as more conventional confidence intervals. The conceptual basis for the Hartung-Knapp method that we present here should replace the established one because it more clearly illustrates the potential benefit of using it.
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Affiliation(s)
| | - Dan Jackson
- Statistical Innovation Group, Advanced Analytics Centre, AstraZeneca, Cambridge, United Kingdom
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Liao W, Zheng Y, Bi S, Zhang B, Xiong Y, Li Y, Fang W, Xiao S, Yang L, Thea A, Liu J. Carotid stenosis prevalence after radiotherapy in nasopharyngeal carcinoma: A meta-analysis. Radiother Oncol 2019; 133:167-175. [PMID: 30935575 DOI: 10.1016/j.radonc.2018.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/11/2018] [Accepted: 11/20/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Radiotherapy (RT) is the most effective treatment for nasopharyngeal carcinoma (NPC) but may cause stenosis of the carotid arteries. This meta-analysis evaluates the prevalence of carotid stenosis after radiation therapy. MATERIALS AND METHODS Online search for studies reporting carotid stenosis in patients with NPC who received radiation therapy (RT) compared to NPC patients who did not receive RT and compared to healthy controls. RESULTS Twelve studies were included for a total analysis of 1928 patients (837 received RT and 1091 were controls). RT patients showed a statistically significant higher incidence of overall stenosis (pooled risk ratio = 4.17 [2.44, 7.10], p < 0.00001) and an even greater incidence of significant stenosis (50% or more) (pooled risk ratio = 8.72 [3.53, 21.55], p < 0.00001). Analyzing by individual blood vessels showed that the RT patients had significantly higher incidence of stenosis in common carotid artery (CCA), external carotid artery (ECA), carotid bulb, CCA and internal carotid artery (ICA), and CCA/ICA/carotid bulb. CONCLUSIONS NPC patients who receive RT have increased risk of developing carotid stenosis, and should be screened after treatment.
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Affiliation(s)
- Wang Liao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, USA
| | - Yuqiu Zheng
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Shangqing Bi
- Department of Geratology, Bao'an TCM Hospital Group, Shenzhen, China
| | - Bei Zhang
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Ying Xiong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenli Fang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Songhua Xiao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lianhong Yang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Anderson Thea
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, USA
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China; Laboratory of RNA and Major Diseases of Brain and Heart, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China.
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van Aert RCM, van Assen MALM, Viechtbauer W. Statistical properties of methods based on the Q-statistic for constructing a confidence interval for the between-study variance in meta-analysis. Res Synth Methods 2019; 10:225-239. [PMID: 30589219 PMCID: PMC6590162 DOI: 10.1002/jrsm.1336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022]
Abstract
The effect sizes of studies included in a meta‐analysis do often not share a common true effect size due to differences in for instance the design of the studies. Estimates of this so‐called between‐study variance are usually imprecise. Hence, reporting a confidence interval together with a point estimate of the amount of between‐study variance facilitates interpretation of the meta‐analytic results. Two methods that are recommended to be used for creating such a confidence interval are the Q‐profile and generalized Q‐statistic method that both make use of the Q‐statistic. These methods are exact if the assumptions underlying the random‐effects model hold, but these assumptions are usually violated in practice such that confidence intervals of the methods are approximate rather than exact confidence intervals. We illustrate by means of two Monte‐Carlo simulation studies with odds ratio as effect size measure that coverage probabilities of both methods can be substantially below the nominal coverage rate in situations that are representative for meta‐analyses in practice. We also show that these too low coverage probabilities are caused by violations of the assumptions of the random‐effects model (ie, normal sampling distributions of the effect size measure and known sampling variances) and are especially prevalent if the sample sizes in the primary studies are small.
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Affiliation(s)
- Robbie C M van Aert
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands.,Department of Sociology, Utrecht University, Utrecht, the Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
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Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, Kontinen V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev 2018; 12:CD012033. [PMID: 30570761 PMCID: PMC6360925 DOI: 10.1002/14651858.cd012033.pub4] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Inadequate pain management after surgery increases the risk of postoperative complications and may predispose for chronic postsurgical pain. Perioperative ketamine may enhance conventional analgesics in the acute postoperative setting. OBJECTIVES To evaluate the efficacy and safety of perioperative intravenous ketamine in adult patients when used for the treatment or prevention of acute pain following general anaesthesia. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase to July 2018 and three trials registers (metaRegister of controlled trials, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP)) together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We sought randomised, double-blind, controlled trials of adults undergoing surgery under general anaesthesia and being treated with perioperative intravenous ketamine. Studies compared ketamine with placebo, or compared ketamine plus a basic analgesic, such as morphine or non-steroidal anti-inflammatory drug (NSAID), with a basic analgesic alone. DATA COLLECTION AND ANALYSIS Two review authors searched for studies, extracted efficacy and adverse event data, examined issues of study quality and potential bias, and performed analyses. Primary outcomes were opioid consumption and pain intensity at rest and during movement at 24 and 48 hours postoperatively. Secondary outcomes were time to first analgesic request, assessment of postoperative hyperalgesia, central nervous system (CNS) adverse effects, and postoperative nausea and vomiting. We assessed the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS We included 130 studies with 8341 participants. Ketamine was given to 4588 participants and 3753 participants served as controls. Types of surgery included ear, nose or throat surgery, wisdom tooth extraction, thoracotomy, lumbar fusion surgery, microdiscectomy, hip joint replacement surgery, knee joint replacement surgery, anterior cruciate ligament repair, knee arthroscopy, mastectomy, haemorrhoidectomy, abdominal surgery, radical prostatectomy, thyroid surgery, elective caesarean section, and laparoscopic surgery. Racemic ketamine bolus doses were predominantly 0.25 mg to 1 mg, and infusions 2 to 5 µg/kg/minute; 10 studies used only S-ketamine and one only R-ketamine. Risk of bias was generally low or uncertain, except for study size; most had fewer than 50 participants per treatment arm, resulting in high heterogeneity, as expected, for most analyses. We did not stratify the main analysis by type of surgery or any other factor, such as dose or timing of ketamine administration, and used a non-stratified analysis.Perioperative intravenous ketamine reduced postoperative opioid consumption over 24 hours by 8 mg morphine equivalents (95% CI 6 to 9; 19% from 42 mg consumed by participants given placebo, moderate-quality evidence; 65 studies, 4004 participants). Over 48 hours, opioid consumption was 13 mg lower (95% CI 10 to 15; 19% from 67 mg with placebo, moderate-quality evidence; 37 studies, 2449 participants).Perioperative intravenous ketamine reduced pain at rest at 24 hours by 5/100 mm on a visual analogue scale (95% CI 4 to 7; 19% lower from 26/100 mm with placebo, high-quality evidence; 82 studies, 5004 participants), and at 48 hours by 5/100 mm (95% CI 3 to 7; 22% lower from 23/100 mm, high-quality evidence; 49 studies, 2962 participants). Pain during movement was reduced at 24 hours (6/100 mm, 14% lower from 42/100 mm, moderate-quality evidence; 29 studies, 1806 participants), and 48 hours (6/100 mm, 16% lower from 37 mm, low-quality evidence; 23 studies, 1353 participants).Results for primary outcomes were consistent when analysed by pain at rest or on movement, operation type, and timing of administration, or sensitivity to study size and pain intensity. No analysis by dose was possible. There was no difference when nitrous oxide was used. We downgraded the quality of the evidence once if numbers of participants were large but small-study effects were present, or twice if numbers were small and small-study effects likely but testing not possible.Ketamine increased the time for the first postoperative analgesic request by 54 minutes (95% CI 37 to 71 minutes), from a mean of 39 minutes with placebo (moderate-quality evidence; 31 studies, 1678 participants). Ketamine reduced the area of postoperative hyperalgesia by 7 cm² (95% CI -11.9 to -2.2), compared with placebo (very low-quality evidence; 7 studies 333 participants). We downgraded the quality of evidence because of small-study effects or because the number of participants was below 400.CNS adverse events occurred in 52 studies, while 53 studies reported of absence of CNS adverse events. Overall, 187/3614 (5%) participants receiving ketamine and 122/2924 (4%) receiving control treatment experienced an adverse event (RR 1.2, 95% CI 0.95 to 1.4; high-quality evidence; 105 studies, 6538 participants). Ketamine reduced postoperative nausea and vomiting from 27% with placebo to 23% with ketamine (RR 0.88, 95% CI 0.81 to 0.96; the number needed to treat to prevent one episode of postoperative nausea and vomiting with perioperative intravenous ketamine administration was 24 (95% CI 16 to 54; high-quality evidence; 95 studies, 5965 participants). AUTHORS' CONCLUSIONS Perioperative intravenous ketamine probably reduces postoperative analgesic consumption and pain intensity. Results were consistent in different operation types or timing of ketamine administration, with larger and smaller studies, and by higher and lower pain intensity. CNS adverse events were little different with ketamine or control. Perioperative intravenous ketamine probably reduces postoperative nausea and vomiting by a small extent, of arguable clinical relevance.
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Affiliation(s)
- Elina Cv Brinck
- Department of Anesthesiology, Intensive Care and Pain Medicine, Division of Anesthesiology, Töölö Hospital, Helsinki University and Helsinki University Hospital, Topeliuksenkatu 5, Helsinki, Finland, PB 266 00029
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