High circulating VEGF level predicts poor overall survival in lung cancer

Purpose

Vascular endothelial growth factor (VEGF) is considered as the best-validated key regulator of angiogenesis, while the prognostic role of circulating VEGF in lung cancer remains controversial. We conducted a meta-analysis to evaluate the prognostic role of circulating VEGF.

Methods

Nineteen studies with a total number of 2,890 patients were analyzed in our meta-analysis. Hazard ratios (HRs) and their 95 % confidence intervals (CIs) were used to quantify the predictive ability of circulating VEGF on survival.

Results

The pooled HR of all 17 studies evaluating overall survival (OS) was 1.29 (95 % CI 1.19–1.40, p < 0.001), indicating high circulating VEGF predicted poor OS. When grouped by disease stages, the pooled HRs were 0.97 (95 % CI 0.47–1.47, p < 0.001) for operable stage and 1.34 (95 % CI 1.18–1.49, p < 0.001) for inoperable stage. The pooled HRs were 1.28 (95 % CI 1.15–1.42, p < 0.001) for serum and 1.31 (95 % CI 1.13–1.49, p < 0.001) for plasma, when categorized by blood sample. Meta-analysis of circulating VEGF related to progression-free survival (PFS) was performed in 7 studies, and the pooled HR was 1.03 (95 % CI 0.96–1.09).

Conclusions

Our results indicate that high level of circulating VEGF predicts poor OS in lung cancer, yet it does not predict poor PFS.     

Chronic obstructive pulmonary disease: an emerging comorbidity in HIV-infected patients in the HAART era?

Purpose

The objective of our study was to evaluate the presence of respiratory symptoms and chronic obstructive pulmonary disease (COPD) in a human immunodeficiency virus (HIV)-infected outpatient population and to further investigate the role of highly active antiretroviral therapy (HAART) and other possibly associated risk factors.

Methods

We consecutively enrolled in a cross-sectional study HIV-infected patients and HIV-negative age, sex and smoking status matched controls. All participants completed a questionnaire for pulmonary symptoms and underwent a complete spirometry.

Results

We enrolled 111 HIV-infected patients and 65 HIV-negative age- and sex-matched controls. HIV-infected patients had a significantly higher prevalence of any respiratory symptom (p = 0.002), cough (p = 0.006) and dyspnoea (p = 0.02). HIV-infected patients also had a significantly higher prevalence of COPD in respect of HIV-negative controls (p = 0.008). Furthermore, HIV-infected individuals had significantly (p = 0.002) lower forced expiratory volume at one second (FEV1) and FEV1/forced vital capacity (FVC) ratio (Tiffeneau index) (p = 0.028), whereas the total lung capacity (TLC) was significantly higher (p = 0.018). In the multivariate analysis, significant predictors of respiratory symptoms were current smoking [adjusted odds ratio (AOR) 11.18; 95 % confidence interval (CI) 3.89–32.12] and previous bacterial pneumonia (AOR 4.41; 95 % CI 1.13–17.13), whereas the only significant predictor of COPD was current smoking (AOR 5.94; 95 % CI 1.77–19.96). HAART receipt was not associated with respiratory symptoms nor with COPD.

Conclusions

We evidenced a high prevalence of respiratory symptoms and COPD among HIV-infected patients. HIV infection, current cigarette smoking and previous bacterial pneumonia seem to play a significant role in the development of respiratory symptoms and COPD. Thus, our results suggest that the most at-risk HIV-infected patients should be screened for COPD to early identify those who may need specific treatment.     

Lower Health Literacy is Associated with Poorer Health Status and Outcomes in Chronic Obstructive Pulmonary Disease

BACKGROUND

Limited health literacy is associated with poor outcomes in many chronic diseases, but little is known about health literacy in chronic obstructive pulmonary disease (COPD).

OBJECTIVE

To examine the associations between health literacy and both outcomes and health status in COPD.

PARTICIPANTS, DESIGN AND MAIN MEASURES

Structured interviews were administered to 277 subjects with self-report of physician-diagnosed COPD, recruited through US random-digit telephone dialing. Health literacy was measured with a validated three-item battery. Multivariable linear regression, controlling for sociodemographics including income and education, determined the cross-sectional associations between health literacy and COPD-related health status: COPD Severity Score, COPD Helplessness Index, and Airways Questionnaire-20R [measuring respiratory-specific health-related quality of life (HRQoL)]. Multivariable logistic regression estimated associations between health literacy and COPD-related hospitalizations and emergency department (ED) visits.

KEY RESULTS

Taking socioeconomic status into account, poorer health literacy (lowest tertile compared to highest tertile) was associated with: worse COPD severity (+2.3 points; 95 % CI 0.3–4.4); greater COPD helplessness (+3.7 points; 95 % CI 1.6–5.8); and worse respiratory-specific HRQoL (+3.5 points; 95 % CI 1.8–4.9). Poorer health literacy, also controlling for the same covariates, was associated with higher likelihood of COPD-related hospitalizations (OR?=?6.6; 95 % CI 1.3–33) and COPD-related ED visits (OR?=?4.7; 95 % CI 1.5–15). Analyses for trend across health literacy tertiles were statistically significant (p?<?0.05) for all above outcomes.

CONCLUSIONS

Independent of socioeconomic status, poor health literacy is associated with greater COPD severity, greater COPD helplessness, worse respiratory-specific HRQoL, and higher odds of COPD-related emergency health-care utilization. These results underscore that COPD patients with poor health literacy may be at particular risk for poor health-related outcomes.     

Effects of Exercise Training on Sleep Apnea: A Meta-analysis

Background

Several studies have shown a favorable effect of supervised exercise training on obstructive sleep apnea (OSA). This meta-analysis was conducted to analyze the data from these studies on the severity of OSA (primary outcome) in adults. Secondary outcomes of interest included body mass index (BMI), sleep efficiency, daytime sleepiness and cardiorespiratory fitness.

Methods

Two independent reviewers searched PubMed and Embase (from inception to March 6, 2013) to identify studies on the effects of supervised exercise training in adults with OSA. Pre- and postexercise training data on our primary and secondary outcomes were extracted.

Results

A total of 5 studies with 6 cohorts that enrolled a total of 129 study participants met the inclusion criteria. The pooled estimate of mean pre- to postintervention (exercise) reduction in AHI was ?6.27 events/h (95 % confidence interval [CI] ?8.54 to ?3.99; p < 0.001). The pooled estimates of mean changes in BMI, sleep efficiency, Epworth sleepiness scale and VO₂ peak were ?1.37 (95 % CI ?2.81 to 0.07; p = 0.06), 5.75 % (95 % CI 2.47–9.03; p = 0.001), ?3.3 (95 % CI ?5.57 to ?1.02; p = 0.004), and 3.93 mL/kg/min (95 % CI 2.44–5.42; p < 0.001), respectively.

Conclusions

This meta-analysis shows a statistically significant effect of exercise in reducing the severity of sleep apnea in patients with OSA with minimal changes in body weight. Additionally, the significant effects of exercise on cardiorespiratory fitness, daytime sleepiness, and sleep efficiency indicate the potential value of exercise in the management of OSA.     

Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies

Objective

This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC).

Background

Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published.

Methods

A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested.

Results

Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD)?=??0.68; 95 % CI?=??1.20 to ?0.16; p?=?0.0099), shorter incision length (pooled WMD?=??1.37; 95 % CI?=??2.74 to 0.000199; p?=?0.05), less estimated blood loss (pooled WMD?=??20.25; 95 % CI?=??39.25 to ?1.24; p?=?0.037), and more lymph nodes harvested (pooled WMD?=?1.75; 95 % CI?=?0.12 to 3.38; p?=?0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio?=?0.83; 95 % CI?=?0.57 to 1.20; p?=?0.33) or operative time (pooled WMD?=?5.06; 95 % CI?=??2.91 to 13.03; p?=?0.21).

Conclusion

SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other.     

Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis

Aims/hypothesis

This study aimed to systematically review randomised controlled trials comparing the effects of aerobic exercise training (AET), resistance training (RT) and combined training (CT) on glycaemic control and blood lipids in patients with type 2 diabetes mellitus.

Methods

Searches were performed in MEDLINE, EMBASE and the Cochrane Library. Inclusion criteria were: type 2 diabetes mellitus, adult, supervised training and a minimum intervention period of 8 weeks. Pooled effects were calculated by fixed/random effect pairwise and Bayesian fixed/random effects network meta-analyses.

Results

A total of 14 trials enrolling 915 participants were included. AET was more effective than RT in improving HbA_1c levels (mean difference [MD] ?0.20% [?2.2 mmol/mol]; 95% CI ?0.32, ?0.08; p?=?0.0007, 10 trials/515 participants) and fasting glucose (MD ?0.9 mmol/l; 95% CI ?1.71, ?0.09; p?=?0.03, 8 trials/245 participants). Compared with AET, CT resulted in a significantly more pronounced reduction in HbA_1c (MD ?0.17% [?1.87 mmol/mol]; 95% CI ?0.31, ?0.03; p?=?0.02, 9 trials/493 participants). Compared with RT, the MD of the change in HbA_1c (MD ?0.62%, [?6.82 mmol/mol]; 95% CI ?0.95, ?0.30; p?=?0.0002, 5 trials/362 participants], fasting glucose (MD ?1.99 mmol/l; 95% CI ?3.07, ?0.90; p?=?0.0003, 3 trials/99 participants) and triacylglycerols (MD ?0.28 mmol/l; 95% CI ?0.46, ?0.10; p?=?0.003, 4 trials/213 participants) were all in favour of CT. The exclusion of trials with a high risk of bias yielded only non-significant results.

Conclusions/interpretation

The present data suggest that CT might be the most efficacious exercise modality to improve glycaemic control and blood lipids. Interpretation with respect to clinical relevance is limited by the low quality of the studies included and the limited information on the clinically important outcomes or adverse effects of exercise.     

Water infusion versus air insufflation for colonoscopy: a meta-analysis of randomized controlled trials

Background

The aim of this meta-analysis was to determine whether water infusion colonoscopy (WIC) is a more effective diagnostic tool than standard air insufflation colonoscopy (AIC).

Methods

All articles pertinent to a comparison of water-related methods and air insufflation to facilitate insertion of the colonoscope were retrieved from PubMed, Web of Science, Embase, and Cochrane databases. Pooling results were derived by using the Review Manager Software. Outcomes were assessed using the weighted mean difference (MD) with 95 % confidence intervals (CI) for continuous variables and the odds ratios (OR) with 95 % CI for dichotomous variables.

Results

Eighteen studies involving 2,797 patients were included. WIC was associated with a significantly higher cecal intubation rate than AIC (OR = 1.90; 95 % CI 1.21–2.99; p = 0.005). The intubation time was similar for the two types of colonoscopy, but in WIC there was a significantly lower visual analog scale score for abdominal pain than in AIC (MD = ?1.30; 95 % CI ?2.03 to ?0.58; p < 0.001) without sacrificing the polyp detection rate (OR = 1.17; 95 % CI 0.78–1.77; p = 0.44). Statistically, the patient’s willingness to repeat colonoscopy was significantly greater for WIC than for AIC (OR = 1.74; 95 % CI 1.14–2.67; p < 0.01). Furthermore, in the subgroup for trainees, the WIC group achieved a higher cecal intubation rate (OR = 1.83; 95 % CI 1.15–2.93; p = 0.01) and a shorter intubation time (MD = ?1.72 min; 95 % CI ?3.34 to ?0.11; p = 0.04) than the AIC group.

Conclusions

In contrast to AIC, WIC improved cecal intubation, alleviated abdominal pain, and increased patients’ willingness to repeat the procedure.     

Comparison between single-incision and conventional three-port laparoscopic appendectomy: a meta-analysis from eight RCTs

Purpose

To assess the efficacy and safety of single-incision laparoscopic appendectomy (SILA), we conducted a meta-analysis of randomized controlled trials (RCTs) comparing conventional three-port laparoscopic appendectomy (CTLA).

Methods

RCTs comparing the effects of SILA and CTLA were searched for in PubMed, the Cochrane Central Register of Controlled Trials, and Embase. Operative time, the pain visual analogue scales scores (VAS scores), dose of analgesics, postoperative complications, hospital charges, and duration of postoperative hospitalization in SILA and CTLA were pooled and compared by meta-analysis. Odds ratios and weighted mean differences (WMDs) were calculated with 95 % confidence intervals (CIs) to evaluate the effect of SILA.

Result

Eight original RCTs investigating 760 adults and 684 children, 1,444 patients in total, of whom 721 received SILA only and 723 received CTLA only, met the inclusion criteria. Both in adults and children, the mean operative time was significantly longer in SILA than CTLA (WMD5.45, 95 % CI 2.15 to 8.75, p?=?0.01). Compared with CTLA, in children, SILA have higher analgesic consumption (WMD 0.69, 95 % CI 0.08 to 1.3, p?=?0.03) and greater hospital charges (WMD 0.87, 95 % CI 1.26 to 1.48, p?=?0.005), which was not statistically different in adults (p?>?0.05). Pooling the results for SILA and CTLA revealed no significant difference in VAS scores, wound infection rate, overall complications, and postoperative hospital stay.

Conclusion

SILA failed to show any obvious advantages over CTLA in perioperative and postoperative outcomes. Therefore, it represents a possible alternative to conventional three-port laparoscopic appendectomy.     

Collateral Damage: Depressive Symptoms in the Partners of COPD Patients

Background

Depression is a frequent comorbidity in COPD patients and is associated with greater physical impairment, increased health-care utilization, and worse outcomes. The presence of depressive symptoms in the partners of COPD patients has not been evaluated.

Methods

We evaluated the partners of 230 consecutive COPD patients included in a prospective study. Depressive symptoms were evaluated using Beck’s Depression Inventory (BDI) on the first day of admission for COPD exacerbation. Patients were followed-up for 1 year.

Results

Significant depressive symptoms were present in 39.6 % of the COPD patients and in 40.9 % of their partners. Beck scores were higher in the partners of patients with severe airflow obstruction and in those with ≥2 exacerbations and ≥1 hospitalizations for COPD exacerbation during the 1-year follow-up. The BDI score of the patients’ partners was significantly correlated with the BDI score of the COPD patients (r _s = 0.422). In multivariate analysis, depressive symptoms in the COPD patients were an independent predictor of depressive symptoms in their partners (OR 4.136, 95 % CI 1.991–8.594; p < 0.001).

Conclusions

A large proportion of the partners of COPD patients present significant depressive symptoms. The identification of those patients and their partners represents a possible target for intervention.     

Is there a benefit in using magnetic resonance imaging in the prediction of preoperative neoadjuvant therapy response in locally advanced rectal cancer?

Objective

This meta-analysis aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in predicting responses in patients with locally advanced rectal cancer after preoperative neoadjuvant therapy.

Methods

Articles in English language relating to the accuracy of MRI for this utility were retrieved. Methodological quality was assessed by Quality Assessment of Diagnostic Accuracy Studies tool. Pooled estimation and subgroup analysis data were obtained by statistical analysis.

Results

Fourteen studies involved 751 pathologically confirmed patients met the inclusion criteria. Methodological quality was relatively high. To predict histopathological response in locally advanced rectal cancer by MRI, the pooled sensitivity and specificity were 0.78 [95 % confidence intervals (CI), 0.65, 0.87] and 0.81 (95 % CI, 0.72, 0.87), respectively. Positive likelihood ratio and negative likelihood ratio were 4.1 (95 %CI, 2.9, 5.8) and 0.27 (95 % CI, 0.17, 0.43), respectively. Subgroup analysis showing that imaging was performed at 3.0 T MRI devices had higher pooled sensitivity (0.92, 95 % CI, 0.84, 1.00) than the subgroup of MRI with ≤1.5 T (0.68, 95 % CI, 0.53, 0.82) (p?<?0.05).The sensitivity and specificity of T2-weighted imaging (T2WI) with diffusion-weighted imaging (DWI) were 0.92 (95 % CI, 0.81, 1.00) and 0.75 (95 % CI, 0.54, 0.95); those of T2WI alone were 0.64 (95 % CI, 0.47, 0.82) and 0.88 (95 % CI, 0.81, 0.94) (p?>?0.05).

Conclusion

This meta-analysis indicates that MRI is an accurate tool in predicting pathologic response after preoperative therapy in patients with locally advanced rectal cancer. It is suggested to perform MRI by 3.0 T devices, which might be sensitive to identify responder. The addition of DWI to T2WI showed a non-significant improvement in sensitivity, which deserves further investigation.     

Angiotensin-converting enzyme gene polymorphism in north Indian population with obstructive sleep apnea

Background

A deletion of 287-bp Alu repeat of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene is associated with hypertension.

Purpose

The aim of this study is to determine the frequency of ACE (I/D) polymorphism in patients with obstructive sleep apnea (OSA).

Methods

Genotyping of ACE (I/D) gene polymorphism and estimation of serum angiotensin-converting enzyme (SACE) activity were done in 813 subjects who underwent polysomnography. Of these, 395 were apneics and 418 were non-apneics.

Results

The frequencies of II genotype (OR = 1.8, 95 % CI 1.26–2.60, p?=?0.001) and I allele (OR = 1.4, 95 % CI 1.13–1.69, p?=?0.001) of ACE gene were found to be significantly increased in patients with OSA as compared to patients without OSA. Frequency of II genotype was significantly decreased (OR = 0.46, 95 % CI 0.28–0.77, p?=?0.003) in OSA patients with hypertension. In contrast, the frequencies of ID (OR?=?1.80, 95 % CI 1.08–2.99, p?=?0.024) and DD genotypes (OR?=?2.15, 95 % CI 1.30–3.57, p?=?0.003) were significantly increased in this group. The activity of SACE was significantly decreased in the apneic group as compared to the non-apneic group (OR?=?0.99, 95 % CI 0.98–1.00, p?=?0.04).

Conclusions

The findings suggest that II genotype confers susceptibility towards development of OSA whereas DD genotype confers susceptibility towards hypertension irrespective of OSA.     

Nontuberculosis Mycobacterium Disease is a Risk Factor for Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study

Background

The aim of this study was to evaluate the association between chronic obstructive pulmonary disease (COPD) and nontuberculosis mycobacterium (NTM) disease.

Methods

We used data from the National Health Insurance Research Database of Taiwan in this study. The NTM cohort contained 3,005 patients, and each case was randomly frequency matched by age, sex, income, occupation, and index year with four people from the general population without NTM infections. Multivariate Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHR) of COPD in the NTM cohort compared with the non-NTM cohort.

Results

The incidence of COPD was 3.08-fold higher (21.75 vs. 6.11 per 1,000 person-years) in the NTM cohort than in the non-NTM cohort. The aHR of COPD comparing the NTM cohort with the non-NTM cohort was 3.57 (95 % CI 2.56–4.97) for women and 2.89 (95 % CI 2.31–3.61) for men. The aHR of COPD was higher in the patients with NTM infection and a comorbidity such as bronchopneumonia, pneumonia, diabetes, asthma, and heart disease. The Mycobacterium avium-intracellulare complex group (MAC) and the non-MAC group were isolated in the NTM cohort. The MAC group had a higher aHR of COPD than the non-NTM cohort (aHR = 3.72, 95 % CI 2.94–4.72). The cumulative incidence of COPD in the NTM cohort was higher than in the non-NTM cohort (P < 0.0001, log rank test).

Conclusions

Physicians should be aware of indolent NTM disease that increases the risk of COPD.     

Comparative-Effectiveness of Revascularization Versus Routine Medical Therapy for Stable Ischemic Heart Disease: A Population-Based Study

BACKGROUND

Randomized studies have shown optimal medical therapy to be as efficacious as revascularization in stable ischemic heart disease (IHD). It is not known if these efficacy results are reflected by real-world effectiveness.

OBJECTIVE

To evaluate the comparative effectiveness of routine medical therapy versus revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in stable IHD.

DESIGN

Observational cohort study.

PATIENTS

Stable IHD patients from 1 October 2008 to 30 September 2011, identified using a Registry of all angiography patients in Ontario, Canada.

INTERVENTION

Revascularization, defined as PCI/CABG within 90 days after index angiography.

MAIN MEASURES

Death, myocardial infarction (MI) or repeat PCI/CABG. Revascularization was compared to medical therapy using a) multivariable Cox-proportional hazard models with therapy strategy treated as a time-varying covariate; and b) a propensity score matched analysis. Post-angiography medication use was determined.

KEY RESULTS

We identified 39,131 stable IHD patients, of whom 15,139 were treated medically, and 23,992 were revascularized (PCI?=?15,604; CABG?=?8,388). Mean follow-up was 2.5 years. Revascularization was associated with fewer deaths (HR 0.76; 95 % CI 0.68–0.84; p?<?0.001) ,MIs (HR 0.78; 95 % CI 0.72–0.85; p?<?0.001) and repeat PCI/CABG (HR 0.59; 95 % CI 0.50–0.70; p?<?0.001) than medical therapy. In the propensity-matched analysis of 12,362 well–matched pairs of revascularized and medical therapy patients, fewer deaths (8.6 % vs 12.7 %; HR 0.75; 95 % CI 0.69–0.81; p?<?0.001) , MIs (11.7 % vs 14.4 %; HR 0.84; 95 % CI 0.77–0.93 p?<?0.001) and repeat PCI/CABG ( 17.4 % vs 24.1 %;HR 0.67; 95 % 0.63–0.71; p?<?0.001) occurred in revascularized patients, over the 4.1 years of follow-up. The revascularization patients had higher uptake of clopidogrel (70.3 % vs 27.2 %; p?<?0.001), β-blockers (78.2 % vs 76.7 %; p?=?0.010), and statins (94.7 % vs 91.5 %, p?<?0.001) in the 1-year post-angiogram.

CONCLUSIONS

Stable IHD patients treated with revascularization had improved risk-adjusted outcomes in clinical practice, potentially due to under-treatment of medical therapy patients.     

A systematic review and meta-analysis of comparative studies on the efficacy of extended pelvic lymph node dissection in patients with clinically localized prostatic carcinoma

Purpose

Pelvic lymph node dissection (PLND) has been performed during radical prostatectomy in nearly all patients with clinically localized prostatic carcinoma (PCa), while the specific regions that needed to be removed demonstrated bifurcation among urologist. However, clinical studies comparing extended PLND (ePLND) with standard PLND (sPLND) and limited PLND (lPLND) reveal conflicting, or even opposing results.

Methods

All controlled trials comparing ePLND with sPLND or lPLND were identified through comprehensive searches of the PubMed, Cochrane Library and Embase databases. A systematic review and meta-analysis of these studies were then performed.

Results

Eighteen studies with a total of 8,914 patients were included. Regardless of being compared with sPLND or lPLND, ePLND significantly improved LN retrieval [ePLND vs. sPLND: weighted mean difference (WMD) 11.93, 95 % confidence interval (CI) 9.91–13.95, p < 0.00001; ePLND vs. lPLND: WMD 8.27, 95 % CI 3.53–13.01, p = 0.0006] and the detection of more LNs positive of metastasis [risk ratio (RR) 3.51, 95 % CI 2.14–5.75, p < 0.00001; RR 3.50, 95 % CI 2.20–5.55, p < 0.00001, respectively]. EPLND decreased the complication rate, but the differences were not statistically significant (RR 1.52, 95 % CI 0.87–2.65, p = 0.14; RR 1.52, 95 % CI 0.67–3.45, p = 0.32, respectively). Operating time, estimated blood loss, length of hospital stay and biochemical recurrence (BCR) were statistically insignificant between techniques.

Conclusions

ePLND shows benefits associated with increased LNs yield, LNs positivity, and safety, significantly with no risk of side effects. However, ePLND did not decrease BCR. Additional high-quality, well-designed randomized controlled trials and comparative studies with long-term follow-up results are required to define the optimal procedure for patients with clinically localized PCa.     

Midodrine for Orthostatic Hypotension: A Systematic Review and Meta-Analysis of Clinical Trials

OBJECTIVE

To perform a systematic review and meta-analysis of clinical trials evaluating the efficacy and safety of midodrine in orthostatic hypotension (OH).

METHODS

We searched major databases and related conference proceedings through June 30, 2012. Two reviewers independently selected studies and extracted data. Random-effects meta-analysis was used to pool the outcome measures across studies.

RESULTS

Seven trials were included in the efficacy analysis (enrolling 325 patients, mean age 53 years) and two additional trials were included in the safety analysis. Compared to placebo, the mean change in systolic blood pressure was 4.9 mmHg (p?=?0.65) and the mean change in mean arterial pressure from supine to standing was ?1.7 mmHg (p?=?0.45). The change in standing systolic blood pressure before and after giving midodrine was 21.5 mmHg (p?<?0.001). A significant improvement was seen in patients’ and investigators’ global assessment symptoms scale (a mean difference of 0.70 [95 % CI 0.30–1.09; p?<?0.001] and 0.80 [95 % CI 0.76–0.85; p?<?0.001], respectively). There was a significant increase in risk of piloerection, scalp pruritis, urinary hesitancy/retention, supine hypertension and scalp paresthesia after giving midodrine. The quality of evidence was limited by imprecision, heterogeneity and increased risk of bias.

CONCLUSION

There is insufficient and low quality evidence to support the use of midodrine for OH.     

Is Liver-Specific Gadoxetic Acid-Enhanced Magnetic Resonance Imaging a Reliable Tool for Detection of Hepatocellular Carcinoma in Patients with Chronic Liver Disease?

Background

Gadoxetic acid is a recently developed hepatobiliary-specific contrast material used for magnetic resonance imaging (MRI) which enables highly sensitive detection of hepatocellular carcinoma (HCC).

Aim

We performed a meta-analysis of all available studies of the diagnostic performance of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for detection of HCC in patients with chronic liver disease.

Methods

Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis.

Results

Across 10 studies of 570 patients, Gd-EOB-MRI sensitivity was 0.91 (95 % CI 0.77, 0.97) and specificity was 0.93 (95 % CI 0.85, 0.97). Overall, LR+ was 13.6 (95 % CI 5.6, 33.2), LR? was 0.10 (95 % CI 0.04, 0.27), and DOR was 140.36 (95 % CI 28, 696). Among patients with high pre-test probabilities, MRI enabled confirmation of HCC; among patients with low pre-test probabilities, MRI enabled exclusion of HCC. Worst-case-scenario (pre-test probability, 50 %) post-test probabilities were 93 and 9 % for positive and negative MRI results, respectively. In studies in which both Gd-EOB-MRI and contrast enhanced computed tomography (CE-CT) were performed, Gd-EOB-MRI was more sensitive than CE-CT (0.93 vs. 0.78; p < 0.05). Subgroup analysis suggested average lesion size (<2 vs. >2 cm) did not affect the diagnostic accuracy of the test (p > 0.05).

Conclusions

A limited number of small studies suggest Gd-EOB-MRI has good diagnostic performance in the detection of HCC among patients with chronic liver disease. It is also confirmed to be a reliable tool for evaluation of small early-stage HCC.     

Combination of Radiofrequency Ablation with Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis

Background

Recent studies suggest that the combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may have a synergistic effect for hepatocellular carcinoma (HCC).

Aims

The aim of this meta-analysis was to compare the effectiveness of combination of RFA and TACE with that of RFA alone in patients with HCC.

Methods

Randomized controlled trials and retrospective cohort studies comparing RFA plus TACE with RFA alone for HCC were included into this meta-analysis. Study quality was rated with a standardized scale and the strength of evidence was also rated by using the grading of recommendations assessment, development, and evaluation system (GRADE system).

Results

Meta-analyses showed that the combination of RFA and TACE was obviously associated with higher survival rates (odds ratio [OR]_1-year = 2.14, 95 % confidence interval [95 % CI] 1.57–2.91, P < 0.001; OR_3-year = 1.98, 95 % CI 1.28–3.07, P = 0.001; OR_5-year = 2.70, 95 % CI 1.42–5.14, P = 0.003). The overall quality of evidence was judged to be low by using the GRADE system.

Conclusions

The combination of TACE with RFA can improve the overall survival rate and provides better prognosis for patients with HCC, but more randomized controlled trials using large sample size are needed to provide sufficient evidence.     

Association of Genetic Variants in GNβ3 with Functional Dyspepsia: A Meta-Analysis

Background

Functional dyspepsia (FD) is a functional upper gastrointestinal disorder. The etiology and pathogenesis of FD remain unclear, with genetic factors playing an important role. Previous studies investigated the association of C825T in GNβ3 with FD, with conflicting results reported.

Aims

The aim of this meta-analysis is to assess the association of genetic variants in GNβ3 with FD.

Methods

We performed a systematic literature search in PubMed, Cochrane Library, Google Scholar, and Web of Knowledge, and conducted a meta-analysis to assess the association of C825T in GNβ3 with FD. For sensitivity analysis, we analyzed the association between C825T and subtypes of FD. We also performed meta-analyses separately for individual ethnic groups/countries of origin.

Results

A total of eight studies met the eligibility criteria and were included in our analyses. Our meta-analysis finds no association between 825CC and FD (OR 1.19, 95 % CI 0.84–1.67, p = 0.328). However, the association is significant under an additive model (OR 0.59, 95 % CI 0.38–0.92, p = 0.018). Sensitivity analysis indicated a significant association of C825T with FD in participants from Korea but not in those from Japan, Europe, or the United States. We also detected a significant association of this SNP with dysmotility.

Conclusions

The genetic variant C825T in GNβ3 is significantly associated with FD under an additive model and the association is race-specific. Further studies with larger samples sizes are needed to validate our findings and to explore the potential mechanism underlying the association.     

Treatment outcomes of transcatheter arterial chemoembolization combined with local ablative therapy versus monotherapy in hepatocellular carcinoma: a meta-analysis

Purpose

To evaluate the effectiveness comparing the combination of TACE with local ablative therapy and monotherapy on the treatment of HCC using meta-analytical techniques.

Methods

Randomized controlled trials and clinical studies comparing TACE plus local ablative therapy with monotherapy for HCC were included in this meta-analysis. Response rate, 1-, 2-, 3-, and 5-year survival rate, and overall survival (OS) were analyzed and compared.

Results

Eighteen studies included a total of 2,120 patients with HCC 1,071 and 1,049 patients for treatment with combination therapy and monotherapy, respectively. The combination therapy group had a significantly better survival in terms of 1-, 2-, 3-, and 5-year survival rate (RR 1.10, 95 % CI 1.03–1.18, P = 0.005; RR 1.20, 95 % CI 1.10–1.30, P < 0.0001; RR 1.43, 95 % CI 1.18–1.73, P < 0.0001; RR 1.40, 95 % CI 1.22–1.61, P < 0.0001, respectively), OS (HR 0.66, 95 % CI 0.51–0.85, P = 0.001), and response rate (RR 1.54, 95 % CI 1.09–2.18, P = 0.013) than that monotherapy group in patients with HCC.

Conclusions

The meta-analysis indicates that the combination of TACE with local ablative therapy was superior to monotherapy in the treatment for patients with HCC.     

Exhaled Nitric Oxide Predicts Eosinophilic Airway Inflammation in COPD

Purpose

Chronic obstructive pulmonary disease (COPD) with eosinophilic airway inflammation may represent a unique phenotype, possibly with shared features of COPD and asthma. The role of exhaled nitric oxide (eNO) in identifying COPD patients with sputum eosinophilia was examined in this study.

Methods

Ninety COPD patients without past medical history of asthma or allergic diseases were prospectively enrolled, and their eNO, lung function, and cellular profile of induced sputum were measured. Eosinophil cationic protein and IgE in sputum and venous blood also were determined. Subjects with and without sputum eosinophilia (>3 %) were compared. The role of eNO in the prediction of sputum eosinophilia was assessed in a logistic regression model.

Results

Patients with sputum eosinophilia had significantly higher levels of eNO (29 vs. 18 ppb, p = 0.01) than those without. The difference in serum total IgE (168 vs. 84.9 IU/ml, p = 0.057) and percentages of positive allergen test results (48.3 vs. 29.5 %, p = 0.082) showed a trend toward significance. The sputum eosinophil level was significantly correlated to the eNO level (r = 0.485, p < 0.001). The eNO level at the cutoff of 23.5 ppb had the maximum sum of sensitivity (62.1 %) and specificity (70.5 %). The unadjusted and adjusted odds ratios of a higher eNO level (>23.5 ppb) in the prediction of sputum eosinophilia were 3.909 (confidence interval (CI) 1.542–9.91, p = 0.004) and 4.329 (CI 1.306–14.356, p = 0.017), respectively.

Conclusions

eNO is a good marker to identify COPD patients with eosinophilic airway inflammation.