• Title/Summary/Keyword: Meta-analyses

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Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett's esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis

  • Igor Logetto Caetite Gomes;Diogo Turiani Hourneaux de Moura;Igor Braga Ribeiro;Sergio Barbosa Marques;Alexandre de Sousa Carlos;Beanie Conceicao Medeiros Nunes;Bruno Salomao Hirsch;Guilherme Henrique Peixoto de Oliveira;Roberto Paolo Trasolini;Wanderley Marques Bernardo;Eduardo Guimaraes Hourneaux de Moura
    • Clinical Endoscopy
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    • v.57 no.2
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    • pp.181-190
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    • 2024
  • Background/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett's esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported. Methods: An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], -0.03; 95% confidence interval [CI], -0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, -0.03; 95% CI, -0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate. Conclusions: Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.

The Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder(III) - Pharmacologic Treatment - (주의력결핍 과잉행동장애 한국형 치료 권고안(III) - 약물치료 -)

  • Yoo, Hee-Jeong;Yang, Su-Jin;Shin, Dong-Won;Kang, Hwa-Yeon;Kim, Bung-Nyun;Kim, Ji-Hoon;Ahn, Dong-Hyun;Yoo, Han-Ik;Cheon, Keun-Ah;Hong, Hyun-Ju
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.18 no.1
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    • pp.16-25
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    • 2007
  • The objective of this review is to propose the Korean practice guideline for pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). For making the guideline, the authors used the evidence-base approaches derived from a detailed review of literature including wide range of controlled clinical trials, studies of side effects of drugs, toxicological reports, and meta-analyses published in United States and Europe, as well as inside Korea. The review committee composed of experts in ADHD inkoreahasreviewedtheparameter. The practice parameter for pharmacological treatment describes the use of stimulants, atomoxetine, modafinil, bupropion, tricyclic antidepressants, and alpha-adrenergic agonists and their side effects. The recommendations of pharmacological treatment are proposed at the end of the article.

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The Effect of Air Pollution on Allergic Diseases Considering Meteorological Factors in Metropolitan Cities in Korea (서울 및 6대 광역시의 기상요인을 고려한 대기오염이 주요 알레르기질환에 미치는 영향)

  • Kim, Hyo-Mi;Heo, Jin-A;Park, Yoon-Hyung;Lee, Jong-Tae
    • Journal of Environmental Health Sciences
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    • v.38 no.3
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    • pp.184-194
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    • 2012
  • Objectives: We investigated the effects of air pollution on allergic diseases (allergic rhinitis, asthma, atopic dermatitis) in metropolitan cities in Korea, adjusting for meteorological factors. Methods: Data on daily hospital visits and hospital admissions for 2003-2010 was obtained from the National Health Insurance Cooperation. Meteorological data was obtained from the Korea Meteorological Administration. We then calculated daily mean temperature, daily mean humidity, daily mean air pressure at sea level, and diurnal temperature range. We used data on air pollution provided by the National Institute of Environmental Research. Maximum daily eight-hour average ozone concentrations and the daily mean $PM_{10}$ were used. We estimated excess risk and 95% confidence interval for the increasing interquatile range (IQR) of each air pollutant using Generalized Additive Models (GAM) that appropriate for time series analysis. Results: In this study, we observed an association between ozone and hospital visits for allergic rhinitis, asthma, and atopic dermatitis in all metropolitan cities, adjusting for temperature, humidity, air pressure at sea level, diurnal temperature range, and day of the week. Ozone was associated with hospital visits for allergic rhinitis, asthma, and atopic dermatitis across all metropolitan cities. However $PM_{10}$ was associated with allergic-related diseases in only select cities. Also, ozone and $PM_{10}$ were associated with hospital admission for asthma in all cities except Gwangju. Hospitalization for the other diseases failed to show consistent association with air pollutants. Conclusion: In the findings of this study, there was a significant association between air pollutants and allergic-related diseases. More detailed research subdivided age group or conducting meta-analyses combining data of all cities is required.

Free flap thrombosis in patients with hypercoagulability: A systematic review

  • Biben, Johannes Albert;Atmodiwirjo, Parintosa
    • Archives of Plastic Surgery
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    • v.46 no.6
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    • pp.572-579
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    • 2019
  • Background Even with satisfactory anastomosis technique and adequate experience of the surgeon, flap loss due to thrombosis can still occur due to the patient's underlying condition. Patients with hypercoagulability due to etiologies such as malignancy, hereditary conditions, and acquired thrombophilia are among those who could benefit from free flap procedures. This review aimed to evaluate the risk of free flap thrombosis in patients with hypercoagulability and to identify the most effective thromboprophylaxis regimen. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The PubMed, Embase, and Cochrane Library databases were explored. Types of free flaps, types of hypercoagulable states, thrombosis prevention protocols, thrombosis complication rates, and flap vitality outcomes were reviewed. Samples from the included studies were pooled to calculate the relative risk of free flap thrombosis complications in patients with hypercoagulability compared to those without hypercoagulability. Results In total, 885 articles underwent title, abstract, and full-text screening. Six articles met the inclusion criteria. The etiologies of hypercoagulability varied. The overall incidence of thrombosis and flap loss in hypercoagulable patients was 13% and 10.3%, respectively. The thrombosis risk was two times higher in hypercoagulable patients (P=0.074) than in controls. Thromboprophylaxis regimens were variable. Heparin was the most commonly used regimen. Conclusions Hypercoagulability did not significantly increase the risk of free flap thrombosis. The most effective thromboprophylaxis regimen could not be determined due to variation in the regimens. Further well-designed studies should be conducted to confirm this finding.

The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (III) - Pharmacological Treatment - (주의력결핍 과잉행동장애 한국형 치료 권고안 개정안(III) - 약물치료 -)

  • Kim, Hyo-Won;Kim, Eunjoo;Kim, Ji-Hoon;Park, Jangho;Bahn, Geon Ho;Lee, Yeon Jung;Jhung, Kyungun;Shin, Dongwon
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.28 no.2
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    • pp.70-83
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    • 2017
  • The objective of this review is the revision of the Korean practice parameters for the pharmacological treatment of attention-deficit hyperactivity disorder (ADHD) based on the change in the diagnostic system from DSM-IV-TR to DSM-5 and psychopharmacological developments. For the evidence-based approach, the authors conducted a review of the literature, including controlled clinical trials, studies of the side effects of drugs, toxicology and meta-analyses from the United States and Europe, as well as recent research conducted in Korea. The review committee composed of Korean experts on ADHD reviewed the revised parameters. This revised version reveals how to use central nervous system psychostimulants, non-stimulants such as atomoxetine and alpha2 agonists, and other medication for ADHD, and how to manage the adverse effects of such medication. At the end of this revised version, the authors propose recommendations for the pharmacotherapy of ADHD.

Treatment of Isoniazid-Resistant Pulmonary Tuberculosis

  • Jhun, Byung Woo;Koh, Won-Jung
    • Tuberculosis and Respiratory Diseases
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    • v.83 no.1
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    • pp.20-30
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    • 2020
  • Tuberculosis (TB) remains a threat to public health and is the leading cause of death globally. Isoniazid (INH) is an important first-line agent for the treatment of TB considering its early bactericidal activity. Resistance to INH is now the most common type of resistance. Resistance to INH reduces the probability of treatment success and increases the risk of acquiring resistance to other first-line drugs such as rifampicin (RIF), thereby increasing the risk of multidrug-resistant-TB. Studies in the 1970s and 1980s showed high success rates for INH-resistant TB cases receiving regimens comprised of first-line drugs. However, recent data have indicated that INH-resistant TB patients treated with only firs-tline drugs have poor outcomes. Fortunately, based on recent systematic meta-analyses, the World Health Organization published consolidated guidelines on drug-resistant TB in 2019. Their key recommendations are treatment with RIF-ethambutol (EMB)-pyrazinamide (PZA)-levofloxacin (LFX) for 6 months and no addition of injectable agents to the treatment regimen. The guidelines also emphasize the importance of excluding resistance to RIF before starting RIF-EMB-PZA-LFX regimen. Additionally, when the diagnosis of INH-resistant TB is confirmed long after starting the first-line TB treatment, the clinician must decide whether to start a 6-month course of RIF-EMB-PZA-LFX based on the patient's condition. However, these recommendations are based on observational studies, not randomized controlled trials, and are thus conditional and based on low certainty of the effect estimates. Therefore, further work is needed to optimize the treatment of INH-resistant TB.

Evaluation of Healthcare Organization Based Management Program in Korea - Using Chronic Care Model - (국내 보건의료기관 기반 청소년 비만관리 프로그램 현황 - 만성질환 관리모형을 중심으로 -)

  • Go, Dun Sol;Choi, Min Jae;Hong, Seok Won;Lee, Seon Heui;Kim, Young Eun;Noh, Jin Won
    • Korea Journal of Hospital Management
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    • v.21 no.1
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    • pp.14-31
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    • 2016
  • Obesity of adolescents causes mental and physical problems as well as social problems, which need prevention and management. Although a number of systematic reviews and meta-analyses on obesity programs for adolescents were conducted, there is no study evaluating the programs based on CCM(Chronic Care Model), an organizing framework for improving chronic illness care. This study was conducted to review the features of studies in obesity management programs and interventions of the selected studies were evaluated in terms of inclusion of components of the Chronic Care Model. 4 databases were searched for relevant studies in obesity management programs, which were published from 1994 to 2014 in Korea. Results were analyzed in a qualitative way. 14 studies were satisfied inclusion criteria. The interventions most frequently utilized the elements of self-management support(66.7%) and only 1 of the studies included more than three components of CCM. This study presents the direction of health policies about managements of metabolic syndrome, which means that we identified effective process of the obesity management programs for adolescents in Korea and also this study will be used as a basic information for the development of obesity management program.

The Farnesyl Protein Transferase Inhibition Activity of Chalcone Derivatives (Chalcone 유도체의 Farnesyl Protein Transferase 저해활성)

  • Yu, Seong-Jae;Myung, Pyung-Keun;Kwon, Byung-Mok;Lee, Seung-Ho;Sung, Nack-Do
    • Applied Biological Chemistry
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    • v.42 no.3
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    • pp.252-255
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    • 1999
  • Inhibition activities$(pI_{50})$ of chalcone derivatives as substrate with farnesyl protein transferase(FPTase) were determined in vitro. The structure activity relationships(SAR) between the activity and physicochemical parameters of X & Y-substituents on the phenyl groups were analyzed by Free-Wilson and Hansch method. X-substituents on the benzoyl group have the more important role to inhibition activity than Y-substituents on the styryl group. Among them, none substituent, 8 showed the highest FPTase inhibition activity$(pI_{50}=4.30)$. Particularly, the SAR equation could be formulated, showing a parabolic relationship between the activity and hydrophobicity(logP) where the optimal value$({\Sigma}logP)_{opt}$ was 3.915. And also the activity depends on the steric effect(Es > 0) with X-substituent and the resonance effect(R < 0) with electron donating Y-substituents. Based on the results of SAR analyses, the interactions between substrates and receptor, FPTase, could be assumed.

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Relationship between Breast Cancer and Levels of Serum Thyroid Hormones and Antibodies: a Meta-analysis

  • Shi, Xin-Zhu;Jin, Xing;Xu, Peng;Shen, Hong-Mei
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.16
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    • pp.6643-6647
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    • 2014
  • The breast and the thyroid are hormone responsive organs that are closely related with changes of endocrine function and glandular disease. An association between thyroid disorders and breast cancer (BC) risk has been suggested, although the results are inconclusive. The purpose of the present study was to summarize evidence supporting a relationship between BC and the level of thyroid hormones and antibodies. The MEDLINE and EMBASE electronic databases were searched for studies published between 2000 and 2014. The pooled effects were presented as weighted mean differences (WMD) with 95% confidence intervals (CI) using fixed or random effect models. We summarized the results of 8 cross-sectional studies with 4, 189 participants. The overall pooled results showed that the levels of $FT_3$ and $FT_4$ were significantly increased in patients with BC (WMD=1.592 pmol/l; 95% CI: 0.15-3.033 and WMD=0.461 ng/dl; 95% CI: 0.015-0.906; p=0.043). The TPOAb level in patients with BC was higher than that in the control group (WMD=81.4 IU/ml; 95% CI: 78.7-84.0; p=0.000). The overall pooled results of the TgAb with random effects analyses showed that the TgAb level was significantly increased in patients with BC (WMD=101.3 IU/ml; 95% CI: 48.7-153.9; p=0.000). The present results indicated that the serum levels of $FT_3$, TPOAb and TgAb are significantly higher in patients with breast cancer than in healthy controls.

Higher dextrose delivety via TPN related to the development of hyperglycemia in non-diabetic critically ill patients

  • Lee, Ho-Sun;Koh, Shin-Ok;Park, Moo-Suk
    • Nutrition Research and Practice
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    • v.5 no.5
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    • pp.450-454
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    • 2011
  • The beneficial effects of total parenteral nutrition (TPN) in improving the nutritional status of malnourished patients during hospital stays have been well established. However, recent randomized trials and meta-analyses have reported an increased rate of TPN-associated complications and mortality in critically ill patients. The increased risk of complications during TPN therapy has been linked to the development of hyperglycemia, especially during the first few days of TPN therapy. This retrospective study was conducted to determine whether the amount of dextrose from TPN in the 1st week in the intensive care unit (ICU) was related to the development of hyperglycemia and the clinical outcome. We included 88 non-diabetic critically ill patients who stayed in the medical ICU for more than two days. The subjects were 65 ${\pm}$ 16 years old, and the mean APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission was 20.9${\pm}$7.1. The subjects received 2.3${\pm}$1.4 g/kg/day of dextrose intravenously. We divided the subjects into two groups according to the mean blood glucose (BG) level during the 1st week of ICU stay: <140 mg/dl vs ${\geq}$ 140 mg/dl. Baseline BG and the amount of dextrose delivered via TPN were significantly higher in the hyperglycemia group than those in the normoglycemia group. Mortality was higher in the hyperglycemia group than in the normoglycemia group (42.4% vs 12.8%, P=0.008). The amount of dextrose from TPN was the only significant variable in the multiple linear regression analysis, which included age, APACHE II score, baseline blood glucose concentration and dextrose delivery via TPN as independent variables. We concluded that the amount of dextrose delivered via TPN might be associated with the development of hyperglycemia in critically ill patients without a history of diabetes mellitus. The amount of dextrose in TPN should be decided and adapted carefully to maintain blood glucose within the target range.