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  1. Meta-analysis methods for combining multiple expression profiles: comparisons, statistical characterization and an application guideline.

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    Chang, Lun-Ching; Lin, Hui-Min; Sibille, Etienne; Tseng, George C

    2013-12-21

    As high-throughput genomic technologies become accurate and affordable, an increasing number of data sets have been accumulated in the public domain and genomic information integration and meta-analysis have become routine in biomedical research. In this paper, we focus on microarray meta-analysis, where multiple microarray studies with relevant biological hypotheses are combined in order to improve candidate marker detection. Many methods have been developed and applied in the literature, but their performance and properties have only been minimally investigated. There is currently no clear conclusion or guideline as to the proper choice of a meta-analysis method given an application; the decision essentially requires both statistical and biological considerations. We performed 12 microarray meta-analysis methods for combining multiple simulated expression profiles, and such methods can be categorized for different hypothesis setting purposes: (1) HS(A): DE genes with non-zero effect sizes in all studies, (2) HS(B): DE genes with non-zero effect sizes in one or more studies and (3) HS(r): DE gene with non-zero effect in "majority" of studies. We then performed a comprehensive comparative analysis through six large-scale real applications using four quantitative statistical evaluation criteria: detection capability, biological association, stability and robustness. We elucidated hypothesis settings behind the methods and further apply multi-dimensional scaling (MDS) and an entropy measure to characterize the meta-analysis methods and data structure, respectively. The aggregated results from the simulation study categorized the 12 methods into three hypothesis settings (HS(A), HS(B), and HS(r)). Evaluation in real data and results from MDS and entropy analyses provided an insightful and practical guideline to the choice of the most suitable method in a given application. All source files for simulation and real data are available on the author's publication website.

  2. Meta analysis on clinical effectiveness of Chinese medicine physiotherapy combined with tropicamide eye drops for pseudomyopia

    OpenAIRE

    Dan Li; Ling Shen; En-Li Deng

    2018-01-01

    AIM:To evaluate the curative effect of Chinese medicine physiotherapy combined with tropicamide eye drops to treat pseudomyopia in children and adolescent. METHODS: We collected randomized controlled trials from CNKI, CBM, Wanfang database, PubMed, EMBASE and Cochrane Library in 2000-2015, and the improved Jadad scale was used to evaluate the methodology of the literature, and the data was extracted. The Review Manager 5.3 statistical software was used for meta analysis. RESULTS: A total of 5...

  3. Meta-analysis of individual and combined effects of mycotoxins on growing pigs

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    Ines Andretta

    2016-08-01

    Full Text Available ABSTRACT Little is known about the toxicity of concomitantly occurring mycotoxins in pig diets. This study was conducted to evaluate, through meta-analysis, the individual and the combined effects of mycotoxins on pig performance. The meta-analysis followed three sequential analyses (graphical, correlation, and variance-covariance based on a database composed of 85 published papers, 1,012 treatments and 13,196 animals. Contamination of diets with individual mycotoxins reduced (p < 0.05 feed intake by 14 % and weight gain by 17 %, while combined mycotoxins reduced the same responses by 42 % and 45 %, respectively, in comparison with the non-challenged group. The correlation (p < 0.05 between reduction in weight gain (ΔG and reduction in feed intake (ΔFI was 0.67 in individual challenges and 0.93 in combined challenges. The estimated ΔG was –6 % in individual challenges and –7 % in combined challenges when ΔFI was zero, suggesting an increase in the maintenance requirements of challenged animals. Most of ΔG (58 % in individual challenges and 84 % in combined challenges was attributed to the changes in feed efficiency. The association of mycotoxins enhances individual toxic effects and the ΔFI is important in explaining the deleterious effects on the growth of challenged pigs.

  4. Meta analysis on clinical effectiveness of Chinese medicine physiotherapy combined with tropicamide eye drops for pseudomyopia

    Directory of Open Access Journals (Sweden)

    Dan Li

    2018-05-01

    Full Text Available AIM:To evaluate the curative effect of Chinese medicine physiotherapy combined with tropicamide eye drops to treat pseudomyopia in children and adolescent. METHODS: We collected randomized controlled trials from CNKI, CBM, Wanfang database, PubMed, EMBASE and Cochrane Library in 2000-2015, and the improved Jadad scale was used to evaluate the methodology of the literature, and the data was extracted. The Review Manager 5.3 statistical software was used for meta analysis. RESULTS: A total of 5 articles were included in the analysis, with a total sample size of 836 cases. The curative effect of experimental group on pseudomyopia was better than that of control group, and the differences are statistically significant(Z=6.39, PCONCLUSION: Compared with topiramine eye drops alone, combined with traditional Chinese medicine therapy for treating pseudomyopia in children and adolescent is more effective, and is safe and reliable.

  5. Choice of implant combinations in total hip replacement: systematic review and network meta-analysis.

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    López-López, José A; Humphriss, Rachel L; Beswick, Andrew D; Thom, Howard H Z; Hunt, Linda P; Burston, Amanda; Fawsitt, Christopher G; Hollingworth, William; Higgins, Julian P T; Welton, Nicky J; Blom, Ashley W; Marques, Elsa M R

    2017-11-02

    Objective  To compare the survival of different implant combinations for primary total hip replacement (THR). Design  Systematic review and network meta-analysis. Data sources  Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Clinical Trials Register. Review methods  Published randomised controlled trials comparing different implant combinations. Implant combinations were defined by bearing surface materials (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal), head size (large ≥36 mm or small meta-analysis for revision. There was no evidence that the risk of revision surgery was reduced by other implant combinations compared with the reference implant combination. Although estimates are imprecise, metal-on-metal, small head, cemented implants (hazard ratio 4.4, 95% credible interval 1.6 to 16.6) and resurfacing (12.1, 2.1 to 120.3) increase the risk of revision at 0-2 years after primary THR compared with the reference implant combination. Similar results were observed for the 2-10 years period. 31 studies (2888 patients) were included in the analysis of Harris hip score. No implant combination had a better score than the reference implant combination. Conclusions  Newer implant combinations were not found to be better than the reference implant combination (metal-on-polyethylene (not highly cross linked), small head, cemented) in terms of risk of revision surgery or Harris hip score. Metal-on-metal, small head, cemented implants and resurfacing increased the risk of revision surgery compared with the reference implant combination. The results were consistent with observational evidence and were replicated in sensitivity analysis but were limited by poor reporting across studies. Systematic review registration  PROSPERO CRD42015019435. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  6. Treatment effects between monotherapy of donepezil versus combination with memantine for Alzheimer disease: A meta-analysis.

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    Chen, Ruey; Chan, Pi-Tuan; Chu, Hsin; Lin, Yu-Cih; Chang, Pi-Chen; Chen, Chien-Yu; Chou, Kuei-Ru

    2017-01-01

    This is the first meta-analysis to compare the treatment effects and safety of administering donepezil alone versus a combination of memantine and donepezil to treat patients with moderate to severe Alzheimer Disease, particularly regarding cognitive functions, behavioral and psychological symptoms in dementia (BPSD), and global functions. PubMed, Medline, Embase, PsycINFO, and Cochrane databases were used to search for English and non-English articles for inclusion in the meta-analysis to evaluate the effect size and incidence of adverse drug reactions of different treatments. Compared with patients who received donepezil alone, those who received donepezil in combination with memantine exhibited limited improvements in cognitive functions (g = 0.378, p Alzheimer Disease.

  7. Psychotherapy, Pharmacotherapy, and Their Combination for Adolescents with Major Depressive Disorder: A Meta-Analysis

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    Singh, Nikita; Reece, John

    2014-01-01

    This meta-analysis aims to inform clinical practice of treatment strategies for adolescents with major depressive disorder (MDD). The efficacy of three empirically validated treatments was compared to determine the most effective treatment. These were: cognitive-behavioural therapy (CBT), selective serotonin reuptake inhibitor (SSRI)…

  8. Combination therapy versus gemcitabine monotherapy in the treatment of elderly pancreatic cancer: a meta-analysis of randomized controlled trials

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    Jin JM

    2018-03-01

    Full Text Available Jiamin Jin, Chunbo Teng, Tao Li College of Life Science, Northeast Forestry University, Harbin, China Purpose: We aimed to compare the efficacy of combination therapy versus gemcitabine monotherapy in the treatment of elderly pancreatic cancer (PC by using a meta-analysis.Materials and methods: Databases were searched to identify relevant clinical trials. Hazard ratios (HRs were used to estimate overall survival (OS and progression-free survival (PFS. Statistical analyses were conducted by using Comprehensive Meta Analysis software (version 2.0.Results: A total of 3,401 elderly PC patients from six randomized controlled trials were included for analysis. In comparison with gemcitabine alone, combination therapy in elderly PC patients did not significantly improve OS (HR 0.93, 95% CI: 0.82–1.06, p=0.29. Sub-group analysis according to treatment regimens showed that combined chemotherapy significantly improved OS in comparison with gemcitabine alone (HR 0.73, 95% CI: 0.56–0.94, p=0.016, while gemcitabine plus targeted agents did not improve OS (HR 1.02, 95% CI: 0.87–1.19, p=0.83. Additionally, gemcitabine plus nab-paclitaxel significantly improved PFS in elderly PC patients (HR 0.69, 95% CI: 0.52–0.91, p=0.009 in comparison with gemcitabine alone. No publication bias was detected by Begg’s and Egger’s tests for OS.Conclusion: The findings of this study suggest that combined chemotherapy, but not for gemcitabine plus targeted agents, could be recommended for elderly PC patients due to its survival benefits. Further studies are still needed to assess the treatment tolerance of combination chemotherapy in these patient populations. Keywords: pancreatic cancer, elderly, randomized controlled trials, meta-analysis, targeted agents

  9. Tamsulosin combined with solifenacin versus tamsulosin monotherapy for male lower urinary tract symptoms: a meta-analysis.

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    Gong, Mancheng; Dong, Wenjing; Huang, Guiying; Gong, Zhaoyang; Deng, Decheng; Qiu, Shaopeng; Yuan, Runqiang

    2015-01-01

    To evaluate the efficacy and safety of tamsulosin and solifenacin combination therapy compared with tamsulosin monotherapy for male lower urinary tract symptoms (LUTS). We identified all eligible studies that compared tamsulosin and solifenacin combination therapy with tamsulosin monotherapy for male LUTS (up to January 2015). The fixed- or random-effects model was selected depending on the proportion of heterogeneity. Seven articles were identified as eligible for this meta-analysis, with a total of 3063 participants. Synthetic data showed combination therapy had significant improvements in Storage International Prostate Symptom Score (WMD = -0.60; 95% CI: -0.81 to -0.38, P tamsulosin and solifenacin combined therapy group (30.82%) was similar to the tamsulosin monotherapy group (25.75%). Acute urinary retention was seldom reported in the studies and no clinically significant changes regarding Qmax were showed in our meta-analysis. Tamsulosin and solifenacin combination therapy may be a reasonable option for male LUTS patients, especially for those who have significant storage symptoms. However, PVR should be measured during treatment to assess the increase in PVR or the incidence of AUR.

  10. Is the combination of interval and resistance training more effective on physical fitness? A systematic review and Meta-analysis

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    Francisco José de Menezes Júnior

    2017-12-01

    Full Text Available Interval training (HIIT / SIT combined with resistance training (RT has been highlighted as a strategy for the improvement of health-related physical fitness markers (HRPF in adults. Thus, the aim of this meta-analysis was to compare the efficacy of combined training (HIIT / SIT + RT with other exercise protocols on HRPF markers in adults. A systematic search was performed in MEDLINE via PebMed, Cochrane-CENTRAL, SPORTDiscus, LILACS, SCIELO and Scopus databases between January and March 2017, using the following keywords in English and Portuguese: physical fitness, high-intensity interval training, sprint interval training, resistance training and adults. The quality of studies was evaluated using the PEDro scale. After applying both inclusion and exclusion criteria, nine articles were selected (n = 231. The extraction of means and standard deviations from studies was performed independently by two authors and the RevMan software was used to perform the meta-analysis. Combined training interventions lasted from 6 to 12 weeks and generated greater increase in maximal oxygen uptake than other forms of exercise. The combination of interval training and strength training may be considered more effective to improve aerobic capacity levels in adults.

  11. The impact of fixed-dose combination versus free-equivalent combination therapies on adherence for hypertension: a meta-analysis.

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    Du, Li-Ping; Cheng, Zhong-Wei; Zhang, Yu-Xuan; Li, Ying; Mei, Dan

    2018-04-27

    Nonadherence to antihypertensive medication is considered as a reason of inadequate control of blood pressure. This meta-analysis aimed to systemically evaluate the impact of fixed-dose combination (FDC) therapy on hypertensive medication adherence compared with free-equivalent combination therapies. Articles were retrieved from MEDLINE and Embase databases using a combination of terms "fixed-dose combinations" and "adherence or compliance or persistence" and "hypertension or antihypertensive" from January 2000 to June 2017 without any language restriction. A meta-analysis was performed to parallel compare the impact of FDC vs free-equivalent combination on medicine adherence or persistence. Studies were independently reviewed by two investigators. Data from eligible studies were extracted and a meta-analysis was performed using R version 3.1.0 software. A total of nine studies scored as six of nine to eight of nine for Newcastle-Ottawa rating with 62 481 patients with hypertension were finally included for analysis. Results showed that the mean difference of medication adherence for FDC vs free-equivalent combination therapies was 14.92% (95% confidence interval, 7.38%-22.46%). Patients in FDC group were more likely to persist with their antihypertensive treatment, with a risk ratio of 1.84 (95% confidence interval, 1.00-3.39). This meta-analysis confirmed that FDC therapy, compared with free-equivalent combinations, was associated with better medication adherence or persistence for patients with hypertension. It can be reasonable for physicians, pharmacists, and policy makers to facilitate the use of FDCs for patients who need to take two or more antihypertensive drugs. ©2018 Wiley Periodicals, Inc.

  12. The prognostic value of HPV combined p16 status in patients with anal squamous cell carcinoma: a meta-analysis.

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    Sun, Guorui; Dong, Xiaoyuan; Tang, Xiaolong; Qu, Hui; Zhang, Hao; Zhao, Ensheng

    2018-01-30

    Human papillomavirus (HPV) DNA and p16 expression have been identified to be related to the progression of anal squamous cell carcinoma (ASCC). However, the prognostic relevance of combined detection, particularly HPV-/p16+ and HPV+/p16- signatures, is unknown. A meta-analysis of epidemiologic studies was therefore conducted to address this issue. Data were collected from studies comparing overall survival (OS) and disease-free survival (DFS) / disease-specific survival (DSS) / relapse-free survival (RFS) / progression-free survival (PFS) in ASCC patients with HPV and p16 status. The electronic databases of MEDLINE and EMBASE were searched from their inception till 31 May 2017. Study-specific risk estimates were pooled using a fixed-effects model for OS and DFS/DSS/RFS/PFS. Four studies involving a total of 398 ASCC cases were included in this meta-analysis. The pooled results showed that HPV+/p16+ cancers were significantly associated with improved OS (HR = 0.30, 95% CI: 0.17-0.51) and DFS/DSS/RFS/PFS (HR = 0.23, 95% CI: 0.14-0.36). However, patients with HPV-/p16+ or HPV+/p16- do not have a comparably good prognosis compared with HPV+/p16+ patients. The meta-analysis indicated that concomitant detection of HPV-DNA and p16 expression may be of prognostic or therapeutic utility in the evaluation of factors contributing to ASCC. Testing tumor specimens for HPV-DNA and p16 expression might indirectly affect treatment decisions.

  13. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

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    Masoud SAATCHI

    2014-10-01

    Full Text Available Objective: Enterococcus faecalis (E. faecalis is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH. Whether a combination of CH and chlorhexidine (CHX is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. Material and Methods: A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Results: Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles. Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001. Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115. Conclusions: According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate

  14. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

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    SAATCHI, Masoud; SHOKRANEH, Ali; NAVAEI, Hooman; MARACY, Mohammad Reza; SHOJAEI, Hasan

    2014-01-01

    Objective Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. Material and Methods A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Results Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115). Conclusions According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of

  15. Combined application versus topical and intravenous application of tranexamic acid following primary total hip arthroplasty: a meta-analysis.

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    Zhang, Pei; Liang, Yuan; Chen, Pengtao; Fang, Yongchao; He, Jinshan; Wang, Jingcheng

    2017-02-21

    The use of intravenous (IV) or topical tranexamic acid (TXA) in total hip arthroplasty has been proven to be effective and safe in total hip arthroplasty. However, which of these two administration routes is better has not been determined. The combined administration of TXA has been used in total knee arthroplasty with satisfactory results. We hypothesized that combined application of TXA may be the most effective way without increased rate of thrombotic events such as deep vein thrombosis (DVT) and pulmonary embolisms (PE) in patients subjected to primary total hip replacement (THA). A meta-analysis was conducted to compare the efficacy and safety of the combined use of tranexamic acid (TXA) relative to topical or intravenous (IV) use alone for treatment of primary THA. The outcomes included total blood loss, postoperative hemoglobin decline, transfusion rates, and the incidence rates of deep vein thrombosis (DVT) and pulmonary embolisms (PE). We searched electronic databases including PubMed, EMBASE, the Cochrane Library, Web of Science, the Chinese Biomedical Literature database, the CNKI database, and Wanfang Data until September 2016. The references of the included articles were also checked for additional potentially relevant studies. There were no language restrictions for the search. The data of the included studies were analyzed using RevMan 5.3 software. Seven studies met the inclusion criteria, encompassing a total of 1762 patients. Our meta-analysis demonstrated that total blood loss, postoperative hemoglobin decline, and transfusion rates were significantly lower for patients that received the combined treatment compared to patients that received either topical or intravenous administration of TXA. No statistical differences were found in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE). The group that received the combined treatment had lower total blood loss, postoperative hemoglobin decline, and transfusion rates without an

  16. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: A systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Meng Maobin; Cui Yaoli; Lu You; She Bin; Chen Yan; Guan Yongsong; Zhang Ruiming

    2009-01-01

    Background and Purpose: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus radiotherapy (RT) for unresectable hepatocellular carcinoma (UHCC) using meta-analysis of data from the literature involving available randomized controlled trials of TACE in combination with RT compared with that of TACE alone (Therapy I versus II) in treating UHCC. Material and Methods: We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE, CBMdisc, and CNKI as well as employing manual searches. Meta-analysis was performed on the results of homogeneous studies. Analyses subdivided by study design were also performed. Results: We found 17 trials involving 1476 patients. 5 of total were Randomized Controlled Trials (RCTs) and 12 were Non-randomized Controlled Clinical Trials (CCTs). In terms of quality, 5 RCTs were graded B, and 12 CCTs were graded C. Our results showed that Therapy I, compared with Therapy II, significantly improved the survival and the tumor response of patients, and was thus more therapeutically beneficial. Serious adverse events were not increased exception for total bilirubin (TB) level. Conclusions: Therapy I was more therapeutically beneficial. However, considering the strength of the evidence, additional randomized controlled trials are needed before Therapy I can be recommended routinely.

  17. The use of meta-analysis or research synthesis to combine driving simulation or naturalistic study results on driver distraction.

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    Caird, Jeff K; Johnston, Katherine A; Willness, Chelsea R; Asbridge, Mark

    2014-06-01

    Three important and inter-related topics are addressed in this paper. First, the importance of meta-analysis and research synthesis methods to combine studies on traffic safety, in general, and on driver distraction, in particular, is briefly reviewed. Second, naturalistic, epidemiologic, and driving simulation studies on driver distraction are used to illustrate convergent and divergent results that have accumulated thus far in this domain of research. In particular, mobile phone conversation, passenger presence, and text messaging naturalistic studies use meta-analyses and research syntheses to illustrate important patterns of results that are in need of more in-depth study. Third, a number of driver distraction study limitations such as poorly defined dependent variables, lack of methodological detail, and omission of statistical information prevent the integration of many studies into meta-analyses. In addition, the overall quality of road safety studies suffers from these same limitations and suggestions for improvement are made to guide researchers and reviewers. Practical Applications. The use of research synthesis and meta-analysis provide comprehensive estimates of the impact of distractions on driving performance, which can be used to guide public policy and future research. Copyright © 2014 National Safety Council and Elsevier Ltd. All rights reserved.

  18. Sufentanil and Bupivacaine Combination versus Bupivacaine Alone for Spinal Anesthesia during Cesarean Delivery: A Meta-Analysis of Randomized Trials

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    Yan, Jianqin; Wang, Ruike; Wang, Ying; Xu, Mu

    2016-01-01

    Objective The addition of lipophilic opioids to local anesthetics for spinal anesthesia has become a widely used strategy for cesarean anesthesia. A meta-analysis to quantify the benefits and risks of combining sufentanil with bupivacaine for patients undergoing cesarean delivery was conducted. Methods A comprehensive literature search without language or date limitation was performed to identify clinical trials that compared the addition of sufentanil to bupivacaine with bupivacaine alone for spinal anesthesia in healthy parturients choosing cesarean delivery. The Q and I2 tests were used to assess heterogeneity of the data. Data from each trial were combined using relative ratios (RRs) for dichotomous data or weighted mean differences (WMDs) for continuous data and corresponding 95% confidence intervals (95% CIs) for each trial. Sensitivity analysis was conducted by removing one study a time to assess the quality and consistency of the results. Begg’s funnel plots and Egger’s linear regression test were used to detect any publication bias. Results This study included 9 trials containing 578 patients in the final meta-analysis. Sufentanil addition provided a better analgesia quality with less breakthrough pain during surgery than bupivacaine alone (RR = 0.10, 95% CI 0.06 to 0.18, P bupivacaine-alone group (WMD = −1.0 min, 95% CI −1.5 to −0.58, P Bupivacaine and sufentanil combination is superior to that of bupivacaine alone for spinal anesthesia for cesarean delivery in analgesia quality. Women receiving the combined two drugs had less breakthrough pain, shorter sensory block onset time, and longer first analgesic request time. However, the addition of sufentanil to bupivacaine increased the incidence of pruritus. PMID:27032092

  19. Combination of EGFR-TKIs and chemotherapy as first-line therapy for advanced NSCLC: a meta-analysis.

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    OuYang, Pu-Yun; Su, Zhen; Mao, Yan-Ping; Deng, Wuguo; Xie, Fang-Yun

    2013-01-01

    The impact of combining epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and chemotherapy as first-line therapy for patients with advanced non-small-cell lung cancer (NSCLC) remains controversial. Therefore, randomized trials that compared this combined regimen with chemotherapy or EGFR-TKIs monotherapy were included for this meta-analysis. We used published hazard ratios (HRs), if available, or derived treatment estimates from other survival data. Pooled estimates of treatment efficacy of the combined regimen in the entire unselected population and selected patients by EGFR-mutation status and smoking history were calculated. Eight trials eventually entered into this meta-analysis, including 4585 patients. Overall, the combined regimen significantly delayed disease progression (HR = 0.81, 95% CI 0.69-0.95, P = 0.01); subgroup analysis showed significantly higher progression free survival advantages in Asian patients (Pchemotherapy (P = 0.02). In selected patients by EGFR-mutation, both mutation positive (HR = 0.48, 95% CI 0.28-0.83, P = 0.009) and negative (HR = 0.84, 95% CI 0.72-0.98, P = 0.02) patients gained progression free survival benefit from the combined regimen, albeit the magnitude of benefit was marginally larger in mutation positive patients (P = 0.05). In selected patients by smoking history, never/light smokers achieved a great progression free survival benefit from the combined regimen (HR = 0.51, 95% CI 0.35-0.74, P = 0.0004). Unfortunately, the combined regimen had no significant impact on overall survival, irrespective of ethnicity, dose schedules or EGFR-mutation status. Severe anorexia (RR = 2.01, 95% CI 1.11-3.63; P = 0.02) and diarrhea (RR = 2.70, 95% CI 1.94-3.76; Pchemotherapy deserved to be considered in the future, although it is not approved for advanced NSCLC at the moment.

  20. A Meta-Analysis of Arsenic Trioxide Combined with Transcatheter Arterial Chemoembolization for Treatment of Primary Hepatic Carcinoma

    Directory of Open Access Journals (Sweden)

    Ling He

    2016-01-01

    Full Text Available Primary hepatic carcinoma (PHC is one of the most common malignant tumours in the world. More and more research has shown that As2O3 combined with TACE has a good curative effect in treating PHC. The objectives of this study were to evaluate the therapeutic efficacy and safety of As2O3 combined with TACE in treating PHC. The CNKI, VIP, Wanfang, PubMed, and Cochrane databases were searched from their inception until December 2015. Randomized controlled trials (RCTs comparing As2O3 combined with TACE versus TACE alone in treating PHC were identified. Stata SE 12.0 was used for data analysis. 17 RCTs with 1055 patients were included. Meta-analysis showed that, compared with TACE alone, As2O3 combined with TACE showed significant effects in improving the clinical efficacy rate (P<0.01, decreasing the value of alpha-fetoprotein (P<0.01, increasing the one-year survival rate (P<0.01, and improving the quality of life of PHC patients (P<0.01. Fifteen studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, As2O3 combined with TACE therapy appears to be potentially effective in treating PHC and is generally safe. However, further studies with rigorous designs trials and multiregional cooperation trials are needed.

  1. Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression: A systematic review and meta-analysis

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    2012-01-01

    Background Chronic depression represents a substantial portion of depressive disorders and is associated with severe consequences. This review examined whether the combination of pharmacological treatments and psychotherapy is associated with higher effectiveness than pharmacotherapy alone via meta-analysis; and identified possible treatment effect modifiers via meta-regression-analysis. Methods A systematic search was conducted in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ISI Web of Science, BIOSIS, PsycINFO, and CINAHL. Primary efficacy outcome was a response to treatment; primary acceptance outcome was dropping out of the study. Only randomized controlled trials were considered. Results We identified 8 studies with a total of 9 relevant comparisons. Our analysis revealed small, but statistically not significant effects of combined therapies on outcomes directly related to depression (BR = 1.20) with substantial heterogeneity between studies (I² = 67%). Three treatment effect modifiers were identified: target disorders, the type of psychotherapy and the type of pharmacotherapy. Small but statistically significant effects of combined therapies on quality of life (SMD = 0.18) were revealed. No differences in acceptance rates and the long-term effects between combined treatments and pure pharmacological interventions were observed. Conclusions This systematic review could not provide clear evidence for the combination of pharmacotherapy and psychotherapy. However, due to the small amount of primary studies further research is needed for a conclusive decision. PMID:22694751

  2. Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia : A meta-analysis

    NARCIS (Netherlands)

    Karssemeijer, Esther G. A.; Aaronson, Justine A.; Bossers, Willem J.; Smits, Tara; Rikkert, Marcel G. M. Olde; Kessels, Roy P. C.

    2017-01-01

    Combined cognitive and physical exercise interventions have potential to elicit cognitive benefits in older adults with mild cognitive impairment (MCI) or dementia. This meta-analysis aims to quantify the overall effect of these interventions on global cognitive functioning in older adults with MCI

  3. Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia : A meta-analysis

    NARCIS (Netherlands)

    Karssemeijer, Esther G. A.; Aaronson, Justine A.; Bossers, Willem J.; Smits, Tara; Rikkert, Marcel G. M. Olde; Kessels, Roy P. C.

    Combined cognitive and physical exercise interventions have potential to elicit cognitive benefits in older adults with mild cognitive impairment (MCI) or dementia. This meta-analysis aims to quantify the overall effect of these interventions on global cognitive functioning in older adults with MCI

  4. A meta-analysis of the combined effect of housing and environmental enrichment characteristics on the behaviour and performance of pigs

    NARCIS (Netherlands)

    Averos, X.; Brossard, L.; Dourmad, J.Y.; Greef, de K.H.; Edge, H.L.; Edwards, S.A.; Meunier-Salaün, M.C.

    2010-01-01

    To quantify the combined effect of housing conditions and environmental enrichment on the behaviour and performance of pigs, a meta-analysis was performed using information from 45 experiments in 42 published manuscripts. Multiple regression models were applied to evaluate the effects of space

  5. Effect of metformin on the prognosis of diabetic patients combined with gynecologic cancer: A Meta-analysis

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    Zi-long CHEN

    2018-04-01

    Full Text Available Objective To systematically evaluate the effect of metformin on the prognosis of diabetic patients combined with gynecologic cancer. Methods The database including PubMed, Embase, CNKI and Wangfang, were electronically searched with no language restriction from their inception to March 2017 to collect the studies about the effect of metformin on the prognosis of diabetic patients combined with gynecologic cancer. The references in reviews were also searched. According to the inclusion and exclusion criteria, two reviewers screened the literatures independently, extracted data and assessed methodological quality by the Newcastle-Ottawa scale. The primary end points included overall survival (OS and progress free survival (PFS. The outcome measures were the pooled hazard ratios (HR and 95% confidence intervals (95% CI. I2 was performed in a heterogeneity assessment. Publication bias was evaluated by using Begg's funnel plot and Egger's test, and the sensitivity analysis was conducted to confirm robustness. The Meta-analysis was performed using STATA 12.0 software. Results Sixteen eligible retrospective cohort studies were included and the score of quality assessment were ranged from 6 to 9. The Meta-analysis showed that metformin could improve the OS of diabetic patients with gynecologic tumors (HR=0.71, 95%CI 0.59-0.85, P=0.000. Subgroup analysis revealed that metformin could improve the OS of diabetic patients combined with endometrial cancer (HR=0.70, 95%CI 0.54-0.89, P=0.004 and diabetic patients combined with cervical cancer (HR=0.95, 95%CI 0.90-1.00, P=0.048. Meanwhile metformin improved the OS (HR=0.56, 95%CI 0.38-0.83, P=0.004 and PFS (HR=0.45, 95%CI 0.30-0.68, P=0.000 of diabetic patients with ovarian cancer after adjusting for confounders. Conclusions The use of metformin is positive for the prognosis of diabetic patients combined with gynecologic cancer. It may improve the OS of diabetic patients with endometrial cancer and diabetic

  6. Individual and combined effects of multiple global change drivers on terrestrial phosphorus pools: A meta-analysis.

    Science.gov (United States)

    Yue, Kai; Yang, Wanqin; Peng, Yan; Peng, Changhui; Tan, Bo; Xu, Zhenfeng; Zhang, Li; Ni, Xiangyin; Zhou, Wei; Wu, Fuzhong

    2018-07-15

    Human activity-induced global change drivers have dramatically changed terrestrial phosphorus (P) dynamics. However, our understanding of the interactive effects of multiple global change drivers on terrestrial P pools remains elusive, limiting their incorporation into ecological and biogeochemical models. We conducted a meta-analysis using 1751 observations extracted from 283 published articles to evaluate the individual, combined, and interactive effects of elevated CO 2 , warming, N addition, P addition, increased rainfall, and drought on P pools of plant (at both single-plant and plant-community levels), soil and microbial biomass. Our results suggested that (1) terrestrial P pools showed the most sensitive responses to the individual effects of warming and P addition; (2) P pools were consistently stimulated by P addition alone or in combination with simultaneous N addition; (3) environmental and experimental setting factors such as ecosystem type, climate, and latitude could significantly influence both the individual and combined effects; and (4) the interactive effects of two-driver pairs across multiple global change drivers are more likely to be additive rather than synergistic or antagonistic. Our findings highlighting the importance of additive interactive effects among multiple global change drivers on terrestrial P pools would be useful for incorporating P as controls on ecological processes such as photosynthesis and plant growth into ecosystem models used to analyze effects of multiple drivers under future global change. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. Rapid Onset of the Effects of Combined Selective Serotonin Reuptake Inhibitors and Electroacupuncture on Primary Depression: A Meta-Analysis.

    Science.gov (United States)

    Zhang, Yue; Qu, Shan-shan; Zhang, Ji-ping; Sun, Ya-ling; Liu, Wei-lu; Xie, Ling; Huang, Yong; Chen, Jun-qi

    2016-01-01

    To evaluate the efficacy and safety of combined selective serotonin reuptake inhibitors (SSRIs) and electroacupuncture therapies for the early treatment of primary depression. Randomized controlled trials (RCTs) were analyzed to compare therapy combining SSRIs and electroacupuncture to SSRI therapy alone. The RCTs were identified by searching, among others, PubMed, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, and the Chinese Biological Medical Literature Database. Scores from Self-Rated Depression Scale (SDS), the Hamilton Depression Scale (HAMD), the Side Effect Rating Scale (SERS), and the Treatment Emergent Symptom Scale (TESS) were analyzed and coded by two independent investigators and used to evaluate the safety and efficacy of treatment. Statistical analyses were performed using RevMan 5.2 software. Six RCTs were analyzed. The meta-analysis revealed that the combined therapy of SSRIs and electroacupuncture were associated with superior scores on the HAMD, SDS, and SERS measures compared with SSRIs alone after 1-4 weeks of treatment: HAMD scores, mean difference (MD)(1 week), 2.32 (95% confidence interval [CI](1 week), 1.47-3.16, p(1 week)electroacupuncture therapies is more efficient than treatments with SSRIs alone and leads to a better and earlier control of depressive symptoms.

  8. Evaluation of Individual and Combined Applications of Serum Biomarkers for Diagnosis of Hepatocellular Carcinoma: A Meta-Analysis

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    Bin Hu

    2013-12-01

    Full Text Available The clinical value of Serum alpha-fetoprotein (AFP to detect early hepatocellular carcinoma (HCC has been questioned due to its low sensitivity and specificity found in recent years. Other than AFP, several new serum biomarkers including the circulating AFP isoform AFP-L3, des-gamma-carboxy prothrombin (DCP and Golgi protein-73 (GP73 have been identified as useful HCC markers. In this investigation, we review the current knowledge about these HCC-related biomarkers, and sum up the results of our meta-analysis on studies that have addressed the utility of these biomarkers in early detection and prognostic prediction of HCC. A systematic search in PubMed, Web of Science, and the Cochrane Library was performed for articles published in English from 1999 to 2012, focusing on serum biomarkers for HCC detection. Data on sensitivity and specificity of tests were extracted from 40 articles that met the inclusion criteria, and the summary receiver operating characteristic curve (sROC was obtained. A meta-analysis was carried out in which the area under the curve (AUC for each biomarker or biomarker combinations (AFP, DCP, GP73, AFP-L3, AFP + DCP, AFP + AFP-L3, and AFP + GP73 was used to compare the diagnostic accuracy of different biomarker tests. The AUC of AFP, DCP, GP73, AFP-L3, AFP + DCP, AFP + AFP-L3, and AFP + GP73 are 0.835, 0.797, 0.914, 0.710, 0.874, 0.748, and 0.932 respectively. A combination of AFP + GP73 is superior to AFP in detecting HCC and differentiating HCC patients from non-HCC patients, and may prove to be a useful marker in the diagnosis and screening of HCC. In addition, the AUC of GP73, AFP + DCP and AFP + GP73 are better than that of AFP. The clinical value of GP73, AFP + DCP, or AFP + GP73 as serological markers for HCC diagnosis needs to be addressed further in future studies.

  9. Efficacy Comparison of Six Chemotherapeutic Combinations for Osteosarcoma and Ewing's Sarcoma Treatment: A Network Meta-Analysis.

    Science.gov (United States)

    Zhang, Tao; Zhang, Song; Yang, Feifei; Wang, Lili; Zhu, Sigang; Qiu, Bing; Li, Shunhua; Deng, Zhongliang

    2018-01-01

    This study aimed to address the insufficiency of traditional meta-analysis and provide improved guidelines for the clinical practice of osteosarcoma treatment. The heterogeneity of the fixed-effect model was calculated, and when necessary, a random-effect model was adopted. Furthermore, the direct and indirect evidence was pooled together and exhibited in the forest plot and slash table. The surface under the cumulative ranking curve (SUCRA) value was also measured to rank each intervention. Finally, heat plot was introduced to demonstrate the contribution of each intervention and the inconsistency between direct and indirect comparisons. This network meta-analysis included 32 trials, involving a total of 5,626 subjects reported by 28 articles. All the treatments were classified into six chemotherapeutic combinations: dual agent with or without ifosfamide (IFO), multi-agent with or without IFO, and dual agent or multi-agent with IFO and etoposide. For the primary outcomes, both overall survival (OS) and event-free survival (EFS) rates were considered. The multi-agent integrated with IFO and etoposide showed an optimal performance for 5-year OS, 10-year OS, 3-year EFS, 5-year EFS, and 10-year EFS when compared with placebo. The SUCRA value of this treatment was also the highest of these six interventions. However, multi-drug with IFO alone had the highest SUCRA value of 0.652 and 0.516 when it came to relapse and lung-metastasis. It was efficient to some extent, but no significant difference was observed in both outcomes. Chemotherapy, applied as induction or adjuvant treatment with radiation therapy or surgery, is able to increase the survival rate of patients, especially by combining multi-drug with IFO and etoposide, which demonstrated the best performance in both OS and EFS. As for relapse and the lung-metastasis, multiple agents with IFO alone seemed to have the optimal efficiency, although no significant difference was observed here. J. Cell. Biochem. 119: 250

  10. Meta-analysis of gemcitabine and cisplatin combination chemotherapy versus gemcitabine alone for pancreatic cancer

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    Diyu Huang

    2016-01-01

    Conclusions: Overall response rate, stable disease, and progressive disease, as well as 1-year survival rate in patients who received GEM + CIS, were superior to those treated with GEM alone. Combination chemotherapy with GEM and CIS may offer greater benefits in the treatment of pancreatic cancer than that of GEM alone although the combination group had higher hematological toxicities.

  11. The interventional effect of new drugs combined with the Stupp protocol on glioblastoma: A network meta-analysis.

    Science.gov (United States)

    Li, Mei; Song, Xiangqi; Zhu, Jun; Fu, Aijun; Li, Jianmin; Chen, Tong

    2017-08-01

    New therapeutic agents in combination with the standard Stupp protocol (a protocol about the temozolomide combined with radiotherapy treatment with glioblastoma was research by Stupp R in 2005) were assessed to evaluate whether they were superior to the Stupp protocol alone, to determine the optimum treatment regimen for patients with newly diagnosed glioblastoma. We implemented a search strategy to identify studies in the following databases: PubMed, Cochrane Library, EMBASE, CNKI, CBM, Wanfang, and VIP, and assessed the quality of extracted data from the trials included. Statistical software was used to perform network meta-analysis. The use of novel therapeutic agents in combination with the Stupp protocol were all shown to be superior than the Stupp protocol alone for the treatment of newly diagnosed glioblastoma, ranked as follows: cilengitide 2000mg/5/week, bevacizumab in combination with irinotecan, nimotuzumab, bevacizumab, cilengitide 2000mg/2/week, cytokine-induced killer cell immunotherapy, and the Stupp protocol. In terms of serious adverse effects, the intervention group showed a 29% increase in the incidence of adverse events compared with the control group (patients treated only with Stupp protocol) with a statistically significant difference (RR=1.29; 95%CI 1.17-1.43; P<0.001). The most common adverse events were thrombocytopenia, lymphopenia, neutropenia, pneumonia, nausea, and vomiting, none of which were significantly different between the groups except for neutropenia, pneumonia, and embolism. All intervention drugs evaluated in our study were superior to the Stupp protocol alone when used in combination with it. However, we could not conclusively confirm whether cilengitide 2000mg/5/week was the optimum regime, as only one trial using this protocol was included in our study. Copyright © 2017. Published by Elsevier B.V.

  12. Effect of nutritional supplement combined with exercise intervention on sarcopenia in the elderly: A meta-analysis

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    Dan Luo

    2017-10-01

    Full Text Available Objectives: This systematic review was conducted to explore whether nutritional supplement can improve the benefits of exercise intervention on sarcopenia in the elderly. Methods: Databases, including PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CBM, CNKI, WANFANG, and VIP, were searched. All related papers with randomized controlled trials (RCT methodology that were included in the databases from inception to 19 July 2016 were selected for the study. The tool “assessing risk of bias” from Cochrane Handbook 5.10 was used to evaluate the quality of included papers. A meta-analysis of eligible studies was performed using Stata12.0. Data that we were unable to convene or merge were subjected to descriptive analysis. Results: Six trials were included in our study, which included 429 elderly patients with sarcopenia. The overall methodological quality of the trials was moderate. Compared with the exercise group, patients who were given nutritional supplements gained a bigger boost in fat-free mass (standard mean difference (SMD = 5.78, 95% CI: 5.17 to 6.40, P = 0.000 and muscle mass (SMD = 2.048, 95% CI: 0.907 to 3.189, P = 0.000, as well as showed enhancement of keen extension strength (SMD = 1.08, 95% CI: 0.71 to 1.45, P = 0.000 and usual walk speed (SMD = 0.570, 95% CI: 0.19 to 0.95, P = 0.003. Conclusion: Nutritional supplementation may magnify the effect of exercise intervention on sarcopenia elderly in terms of muscle mass, muscle strength, and physical performance. Inconsistencies were present among research studies. More robust studies are needed to determine the most suitable type of nutrient and target population and to explore the actual role of combined intervention in managing sarcopenia in the elderly. Keywords: Sarcopenia, Exercise, Nutritional status, Meta-analysis

  13. Fixed ratio combinations of glucagon like peptide 1 receptor agonists with basal insulin: a systematic review and meta-analysis.

    Science.gov (United States)

    Liakopoulou, Paraskevi; Liakos, Aris; Vasilakou, Despoina; Athanasiadou, Eleni; Bekiari, Eleni; Kazakos, Kyriakos; Tsapas, Apostolos

    2017-06-01

    Basal insulin controls primarily fasting plasma glucose but causes hypoglycaemia and weight gain, whilst glucagon like peptide 1 receptor agonists induce weight loss without increasing risk for hypoglycaemia. We conducted a systematic review and meta-analysis of randomised controlled trials to investigate the efficacy and safety of fixed ratio combinations of basal insulin with glucagon like peptide 1 receptor agonists. We searched Medline, Embase, and the Cochrane Library as well as conference abstracts up to December 2016. We assessed change in haemoglobin A 1c , body weight, and incidence of hypoglycaemia and gastrointestinal adverse events. We included eight studies with 5732 participants in the systematic review. Switch from basal insulin to fixed ratio combinations with a glucagon like peptide 1 receptor agonist was associated with 0.72% reduction in haemoglobin A 1c [95% confidence interval -1.03 to -0.41; I 2  = 93%] and 2.35 kg reduction in body weight (95% confidence interval -3.52 to -1.19; I 2  = 93%), reducing also risk for hypoglycaemia [odds ratio 0.70; 95% confidence interval 0.57 to 0.86; I 2  = 85%] but increasing incidence of nausea (odds ratio 6.89; 95% confidence interval 3.73-12.74; I 2  = 79%). Similarly, switching patients from treatment with a glucagon like peptide 1 receptor agonist to a fixed ratio combination with basal insulin was associated with 0.94% reduction in haemoglobin A 1c (95% confidence interval -1.11 to -0.77) and an increase in body weight by 2.89 kg (95% confidence interval 2.17-3.61). Fixed ratio combinations of basal insulin with glucagon like peptide 1 receptor agonists improve glycaemic control whilst balancing out risk for hypoglycaemia and gastrointestinal side effects.

  14. Incidence of HIV-associated tuberculosis among individuals taking combination antiretroviral therapy: a systematic review and meta-analysis.

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    Tendesayi Kufa

    Full Text Available Knowledge of tuberculosis incidence and associated factors is required for the development and evaluation of strategies to reduce the burden of HIV-associated tuberculosis.Systematic literature review and meta-analysis of tuberculosis incidence rates among HIV-infected individuals taking combination antiretroviral therapy.From PubMed, EMBASE and Global Index Medicus databases, 42 papers describing 43 cohorts (32 from high/intermediate and 11 from low tuberculosis burden settings were included in the qualitative review and 33 in the quantitative review. Cohorts from high/intermediate burden settings were smaller in size, had lower median CD4 cell counts at study entry and fewer person-years of follow up. Tuberculosis incidence rates were higher in studies from Sub-Saharan Africa and from World Bank low/middle income countries. Tuberculosis incidence rates decreased with increasing CD4 count at study entry and duration on combination antiretroviral therapy. Summary estimates of tuberculosis incidence among individuals on combination antiretroviral therapy were higher for cohorts from high/intermediate burden settings compared to those from the low tuberculosis burden settings (4.17 per 100 person-years [95% Confidence Interval (CI 3.39-5.14 per 100 person-years] vs. 0.4 per 100 person-years [95% CI 0.23-0.69 per 100 person-years] with significant heterogeneity observed between the studies.Tuberculosis incidence rates were high among individuals on combination antiretroviral therapy in high/intermediate burden settings. Interventions to prevent tuberculosis in this population should address geographical, socioeconomic and individual factors such as low CD4 counts and prior history of tuberculosis.

  15. Combined EGFR and VEGFR versus single EGFR signaling pathways inhibition therapy for NSCLC: a systematic review and meta-analysis.

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    Xinji Zhang

    Full Text Available BACKGROUND: Lung cancer is a heterogeneous disease with multiple signaling pathways influencing tumor cell survival and proliferation, and it is likely that blocking only one of these pathways allows others to act as salvage or escape mechanisms for cancer cells. Whether combined inhibition therapy has greater anti-tumor activity than single inhibition therapy is a matter of debate. Hence, a meta-analysis comparing therapy inhibiting both VEGFR and EGFR signaling pathways with that inhibiting EGFR signaling pathway alone was performed. METHODOLOGY AND PRINCIPAL FINDINGS: We searched PubMed, EMBASE database and the proceedings of major conferences for relevant clinical trials. Outcomes analyzed were objective tumor response rate (ORR, progression-free survival (PFS, overall survival (OS and toxicity. Besides, subgroup analyses were performed to investigate whether the combined inhibition therapy is best performed using combination of selective agents or a single agent with multiple targets. Six trials recruiting 3,302 patients were included in the analysis. Combined inhibition therapy was associated with a 3% improvement in OS as compared with single-targeted therapy, but this difference was not statistically significant (HR, 0.97; 95% CI, 0.89-1.05; P=0.472. Patients receiving combined inhibition therapy had significant longer PFS than the group with single-targeted therapy (HR, 0.80; 95% CI, 0.67-0.95; P=0.011. There was no difference in the ORR between the groups (OR, 1.44; 95% CI, 0.95-2.18; P=0.085. Subgroup analysis revealed that combined inhibition therapy using combination regimens was associated with statistically significant improvement in both ORR and PFS. Toxicity was greater in combined inhibition therapy. CONCLUSIONS: There is no evidence to support the use of combined inhibition therapy in unselected patients with advanced NSCLC. However, given the significant advantage in ORR and PFS, combined inhibition therapy using combination

  16. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

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    Fabiano Timbó Barbosa

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA has been used in association with general anesthesia (GA for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA, myocardial infarction (MI, length of hospital stay (LHS, length of ICU stay (ICUS, reoperations, blood transfusion (BT, quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD was estimated for continuous variables, and relative risk (RR and risk difference (RD for categorical variables. RESULTS: 17 original articles analyzed. Meta-analysis of mortality (RD = -0.01, 95% CI = -0.03 to 0.01, CVA (RR = 0.79, 95% CI = 0.32-1.95, MI (RR = 0.96, 95% CI = 0.52-1.79 and LHS (MD = -1.94, 95% CI = -3.99 to 0.12 were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50-0.93. ICUS was lower in NA (MD = -2.09, 95% CI = -2.92 to -1.26. CONCLUSION: There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.

  17. Efficacy and safety of interscalene block combined with general anesthesia for arthroscopic shoulder surgery: A meta-analysis.

    Science.gov (United States)

    Yan, Siyi; Zhao, Yanjun; Zhang, Huan

    2018-06-01

    There is controversy regarding the efficacy and safety of using interscalene block (ISB) combined with general anesthesia (GA) for arthroscopic shoulder surgery. Our meta-analysis was undertaken to evaluate the utility of this approach. We searched the PubMed, Cochrane Library, EMBASE, CNKI, VIP and ClinicalTrials.gov databases for randomized controlled trials. The primary endpoint was extubation time. Secondary endpoints included intraoperative heart rate, pain scores on the day of and 1 day after the operation, intraoperative systolic blood pressure and adverse events. Ten RCTs involving 746 patients undergoing arthroscopic shoulder surgery met inclusion criteria. Compared with GA alone, ISB + GA was associated with a shorter extubation time(WMD = -6.13; 95% CI = -8.68 to -3.57; P shoulder surgery, ISB + GA is associated with a lower heart rate, lower pain scores on the day of and 1 day after the operation, a lower intraoperative systolic blood pressure, a shorter extubation time and a lower incidence of adverse events compared with GA alone. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Impact of LABA/LAMA combination on exercise endurance and lung hyperinflation in COPD: A pair-wise and network meta-analysis.

    Science.gov (United States)

    Calzetta, Luigino; Ora, Josuel; Cavalli, Francesco; Rogliani, Paola; O'Donnell, Denis E; Cazzola, Mario

    2017-08-01

    The ability to exercise is an important clinical outcome in COPD, and the improvement in exercise capacity is recognized to be an important goal in the management of COPD. Therefore, since the current interest in the use of bronchodilators in COPD is gradually shifting towards the dual bronchodilation, we carried out a meta-analysis to evaluate the impact of LABA/LAMA combination on exercise capacity and lung hyperinflation in COPD. RCTs were identified after a search in different databases of published and unpublished trials. The aim of this study was to assess the influence of LABA/LAMA combinations on endurance time (ET) and inspiratory capacity (IC), vs. monocomponents. Eight RCTs including 1632 COPD patients were meta-analysed. LABA/LAMA combinations were significantly (P meta-analysis. This meta-analysis clearly demonstrates that if the goal of the therapy is to enhance exercise capacity in patients with COPD, LABA/LAMA combinations consistently meet the putative clinically meaningful differences for both ET and IC and, in this respect, are superior to their monocomponents. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. A systematic review and meta-analysis of traditional insect Chinese medicines combined chemotherapy for non-surgical hepatocellular carcinoma therapy.

    Science.gov (United States)

    Shi, Zhaofeng; Song, Tiebing; Wan, Yi; Xie, Juan; Yan, Yiquan; Shi, Kekai; Du, Yongping; Shang, Lei

    2017-06-28

    On the background of high morbidity and mortality of hepatocellular carcinoma (HCC) and rapid development of traditional Chinese medicine (TCM), we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to assess the clinical effectiveness and safety of traditional insect Chinese medicine and related preparation for non-surgical HCC. RCTs were searched based on standardized searching rules in mainstream medical databases from the inception up to May 2016. Ultimately, a total of 57 articles with 4,651 patients enrolled in this meta-analysis. We found that traditional insect Chinese medicine and related preparation combined chemotherapy show significantly effectiveness and safety in objective response rate (P traditional insect Chinese medicine and related preparations could be recommended as auxiliary therapy combined chemotherapy for HCC therapy.

  20. Role of Esophageal Metal Stents Placement and Combination Therapy in Inoperable Esophageal Carcinoma: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Lai, Andrew; Lipka, Seth; Kumar, Ambuj; Sethi, Sajiv; Bromberg, David; Li, Nanxing; Shen, Huafeng; Stefaniwsky, Lilia; Brady, Patrick

    2018-04-01

    More than 50% of patients with esophageal cancer already have inoperable disease at the time of diagnosis. Controversy surrounds the outcomes of patients with advanced esophageal cancer who receive palliative care by either stent alone or stent plus an additional modality. We set out to perform a systematic review and meta-analysis of studies assessing the use of metal stents as treatment options for symptomatic improvement, survival, and adverse events. We searched Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception until January 14, 2016, as well as other databases for randomized controlled trials (RCTs) comparing esophageal stent versus either esophageal stent plus brachytherapy, radiotherapy, or chemotherapy. For quality assurance purposes throughout the systematic review, multiple independent extractions were performed, and the process was executed as per the standards of the Cochrane collaboration. Primary outcomes were mean change in dysphagia score, overall survival, and quality of life. Secondary outcomes were adverse events including fever, severe pain, aspiration, fistula, stent migration, perforation, and restenosis. Eight RCTs enrolling 732 patients were included with three distinct comparisons: stents combination therapy vs stents alone (5 studies, n = 417), stents alone versus brachytherapy alone (2 studies, n = 274), and stents + brachytherapy vs brachytherapy alone (1 study, n = 41). Stents combination therapy was defined as stents plus radiotherapy, chemotherapy, or both. Mean change in dysphagia scores favored stents combination therapy versus stents alone, and the effect was seen in patients surviving longer than 3 months. Stents combination therapy was also associated with a more favorable overall survival. The risks of stent migration, aspiration pneumonia, and restenosis were lower in the stents combination group compared to stents alone, while the risks of severe pain, hemorrhage, and

  1. LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis

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    Rodrigo GJ

    2017-03-01

    Full Text Available Gustavo J Rodrigo,1 David Price,2,3 Antonio Anzueto,4,5 Dave Singh,6 Pablo Altman,7 Giovanni Bader,8 Francesco Patalano,8 Robert Fogel,7 Konstantinos Kostikas8 1Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay; 2Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; 3Observational and Pragmatic Research Institute, Singapore; 4University of Texas Health Science Center, 5South Texas Veterans Health Care System, San Antonio, TX, USA; 6Medicines Evaluation Unit, National Institute for Health Research Respiratory and Allergy Clinical Research Facility, University Hospital of South Manchester NHS Foundation Trust, University of Manchester, Manchester, England, UK; 7Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 8Novartis Pharma AG, Basel, Switzerland Background: Randomized controlled trials (RCTs indicate that long-acting bronchodilator combinations, such as β2-agonist (LABA/muscarinic antagonist (LAMA, have favorable efficacy compared with commonly used COPD treatments. The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS in adults with stable moderate-to-very-severe COPD. Methods: This systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases included RCTs comparing ≥12 weeks’ LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only. Eligible studies were independently selected by two authors using predefined data fields; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results: Eighteen studies (23 trials were eligible (N=20,185. LABA/LAMA significantly improved trough forced expiratory volume in 1 second (FEV1 from baseline to week 12 versus both LAMA and LABA/ICS (0.07 L and 0.08 L, P<0.0001, with patients more likely to achieve clinically

  2. Radical Cystectomy Compared to Combined Modality Treatment for Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

    International Nuclear Information System (INIS)

    Vashistha, Vishal; Wang, Hanzhang; Mazzone, Andrew; Liss, Michael A.; Svatek, Robert S.; Schleicher, Mary; Kaushik, Dharam

    2017-01-01

    Purpose: To perform a comprehensive comparison of overall survival (OS), disease-specific survival (DSS), progression-free survival (PFS), and treatment-related complications between radical cystectomy (RC) and combined modality treatment (CMT—radiation therapy, concurrent chemotherapy, and maximal transurethral resection of bladder tumor) in the setting of muscle-invasive bladder cancer. Methods and Materials: We searched 7 databases (PubMed, Scopus, EMBASE, Proquest, CINAHL, and (ClinicalTrials.gov)) for randomized, controlled trials and prospective and retrospective studies directly comparing RC with CMT from database inception to March 2016. We conducted meta-analyses evaluating OS, DSS, and PFS with hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Nineteen studies evaluating 12,380 subjects were selected. For the 8 studies encompassing 9554 subjects eligible for meta-analyses, we found no difference in OS at 5 years (HR 0.96, favoring CMT, 95% CI 0.72-1.29; P=.778) or 10 years (HR 1.02, favoring cystectomy, 95% CI 0.73-1.42; P=.905). No difference was observed in DSS at 5 years (HR 0.83, favoring radiation, 95% CI 0.54-1.28; P=.390) or 10 years (HR 1.17, favoring cystectomy, 95% CI 0.89-1.55; P=.264), or PFS at 10 years (HR 0.85, favoring CMT, 95% CI 0.43-1.67; P=.639). The cystectomy arms had higher rates of early major complications, whereas rates of minor complications were similar between the 2 treatments. Conclusion: Current meta-analysis reveals no differences in OS, DSS, or PFS between RC and CMT. Further randomized, controlled trials are necessary to identify the optimal treatment for specific patients.

  3. Psychological, pharmacological, and combined smoking cessation interventions for smokers with current depression: A systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Roberto Secades-Villa

    Full Text Available We conducted a systematic literature review and meta-analysis (ID: CRD42016051017 of smoking cessation interventions for patients with current depression. We examined the effectiveness of smoking cessation treatments in improving abstinence rates and depressive symptoms. The following electronic databases were used for potentially eligible studies: PUBMED, PSYCINFO, DIALNET and WEB OF KNOWLEDGE. The search terms used were: smoking cessation, depressive disorder, depression, mood, depressive, depressed, smoking, smokers, nicotine, nicotine dependence, and tobacco cigarette smoking. The methodological quality of included studies was assessed using the Effective Public Health Practice Project Quality assessment tool (EPHPP. Of the 6,584 studies identified, 20 were eligible and included in the review. Trial designs of studies were 16 randomized controlled trials and 4 secondary studies. Studies included three types of intervention: psychological (6/30%, pharmacological (6/30% or combined (8/40%. Four trials comprised special populations of smokers. Four studies received a strong methodological quality, 7 were scored as moderate and 9 studies received a weak methodological rating. Analyses of effectiveness showed that smoking cessation interventions appear to increase short-term and long-term smoking abstinence in individuals with current depression. Subgroup analyses revealed stronger effects among studies that provided pharmacological treatments than in studies using psychological treatments. However, the evidence is weak due to the small number of studies. Smoking abstinence appears to be associated with an improvement in depressive symptoms. Heterogeneity in protocols in similar types of treatment also prevent firm conclusions being drawn on the effectiveness of any particular treatment model to optimally manage abstinence among depressed smokers. Further research is required to strengthen the evidence base.

  4. Radical Cystectomy Compared to Combined Modality Treatment for Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Vashistha, Vishal [Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio (United States); Wang, Hanzhang [Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (United States); Mazzone, Andrew [Rush Medical College, Rush University Medical Center, Chicago, Illinois (United States); Liss, Michael A.; Svatek, Robert S. [Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (United States); Schleicher, Mary [Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio (United States); Kaushik, Dharam, E-mail: Kaushik@uthscsa.edu [Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (United States)

    2017-04-01

    Purpose: To perform a comprehensive comparison of overall survival (OS), disease-specific survival (DSS), progression-free survival (PFS), and treatment-related complications between radical cystectomy (RC) and combined modality treatment (CMT—radiation therapy, concurrent chemotherapy, and maximal transurethral resection of bladder tumor) in the setting of muscle-invasive bladder cancer. Methods and Materials: We searched 7 databases (PubMed, Scopus, EMBASE, Proquest, CINAHL, and (ClinicalTrials.gov)) for randomized, controlled trials and prospective and retrospective studies directly comparing RC with CMT from database inception to March 2016. We conducted meta-analyses evaluating OS, DSS, and PFS with hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Nineteen studies evaluating 12,380 subjects were selected. For the 8 studies encompassing 9554 subjects eligible for meta-analyses, we found no difference in OS at 5 years (HR 0.96, favoring CMT, 95% CI 0.72-1.29; P=.778) or 10 years (HR 1.02, favoring cystectomy, 95% CI 0.73-1.42; P=.905). No difference was observed in DSS at 5 years (HR 0.83, favoring radiation, 95% CI 0.54-1.28; P=.390) or 10 years (HR 1.17, favoring cystectomy, 95% CI 0.89-1.55; P=.264), or PFS at 10 years (HR 0.85, favoring CMT, 95% CI 0.43-1.67; P=.639). The cystectomy arms had higher rates of early major complications, whereas rates of minor complications were similar between the 2 treatments. Conclusion: Current meta-analysis reveals no differences in OS, DSS, or PFS between RC and CMT. Further randomized, controlled trials are necessary to identify the optimal treatment for specific patients.

  5. Meta-analysis of effects of gender in combination with carcass weight and breed on pork quality.

    Science.gov (United States)

    Trefan, L; Doeschl-Wilson, A; Rooke, J A; Terlouw, C; Bünger, L

    2013-03-01

    Meta-analysis was performed to quantify the effects of gender in combination with carcass weight and breed on pork quality. Altogether published results from 43 references were used. The traits analyzed were pH at 45 min (pH45min) and pH at 24 h (pH24hr) postmortem, objective color attributes lightness (L*), redness (a*), and yellowness (b*; CIE color system), color and marbling scores, drip loss, intramuscular fat content (IMF), and backfat thickness (P2), as well as sensory scores of juiciness and tenderness. Data for 2 muscle types, LM and Musculus semimembranosus (SMM), were used for the analysis. Swine genders were defined as intact/entire male (EM), surgically castrated male (SM), immunocastrated male (IM), and entire female (EF). After standardization of scaled traits (color, marbling scores, juiciness, tenderness) and accounting for cold carcass weight (CW), statistical analysis was performed using mixed models where breed was included as random effect. The analysis found a general effect of gender on each trait and multiple comparisons identified significant differences among the individual genders for L* (lightness), marbling scores, IMF, P2 in LM, and pH24hr in SMM. For these traits, when genders were grouped into gender categories as "castrates" (IM, SM) and "natural genders" (EM, EF), significant differences were found among estimates related to these categories. Furthermore, significant differences were found between castrates and individual gender types, indicating that castrated animals statistically segregated regarding their pork quality and regardless of type of castration. Pork of SM/EM animals has been found to be the fattest/leanest and there is indication that IM pork has the lightest meat color. Carcass weight dependence was found to be nonlinear (quadratic) for a*, P2, and marbling scores, and linear for b* and color scores in LM and pH24hr in SMM. The analysis identified significant breed effects for all traits, with large variation in the

  6. The Covariance Adjustment Approaches for Combining Incomparable Cox Regressions Caused by Unbalanced Covariates Adjustment: A Multivariate Meta-Analysis Study

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    Tania Dehesh

    2015-01-01

    Full Text Available Background. Univariate meta-analysis (UM procedure, as a technique that provides a single overall result, has become increasingly popular. Neglecting the existence of other concomitant covariates in the models leads to loss of treatment efficiency. Our aim was proposing four new approximation approaches for the covariance matrix of the coefficients, which is not readily available for the multivariate generalized least square (MGLS method as a multivariate meta-analysis approach. Methods. We evaluated the efficiency of four new approaches including zero correlation (ZC, common correlation (CC, estimated correlation (EC, and multivariate multilevel correlation (MMC on the estimation bias, mean square error (MSE, and 95% probability coverage of the confidence interval (CI in the synthesis of Cox proportional hazard models coefficients in a simulation study. Result. Comparing the results of the simulation study on the MSE, bias, and CI of the estimated coefficients indicated that MMC approach was the most accurate procedure compared to EC, CC, and ZC procedures. The precision ranking of the four approaches according to all above settings was MMC ≥ EC ≥ CC ≥ ZC. Conclusion. This study highlights advantages of MGLS meta-analysis on UM approach. The results suggested the use of MMC procedure to overcome the lack of information for having a complete covariance matrix of the coefficients.

  7. The Covariance Adjustment Approaches for Combining Incomparable Cox Regressions Caused by Unbalanced Covariates Adjustment: A Multivariate Meta-Analysis Study.

    Science.gov (United States)

    Dehesh, Tania; Zare, Najaf; Ayatollahi, Seyyed Mohammad Taghi

    2015-01-01

    Univariate meta-analysis (UM) procedure, as a technique that provides a single overall result, has become increasingly popular. Neglecting the existence of other concomitant covariates in the models leads to loss of treatment efficiency. Our aim was proposing four new approximation approaches for the covariance matrix of the coefficients, which is not readily available for the multivariate generalized least square (MGLS) method as a multivariate meta-analysis approach. We evaluated the efficiency of four new approaches including zero correlation (ZC), common correlation (CC), estimated correlation (EC), and multivariate multilevel correlation (MMC) on the estimation bias, mean square error (MSE), and 95% probability coverage of the confidence interval (CI) in the synthesis of Cox proportional hazard models coefficients in a simulation study. Comparing the results of the simulation study on the MSE, bias, and CI of the estimated coefficients indicated that MMC approach was the most accurate procedure compared to EC, CC, and ZC procedures. The precision ranking of the four approaches according to all above settings was MMC ≥ EC ≥ CC ≥ ZC. This study highlights advantages of MGLS meta-analysis on UM approach. The results suggested the use of MMC procedure to overcome the lack of information for having a complete covariance matrix of the coefficients.

  8. Efficacy and safety of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinomas compared with radiofrequency ablation alone: A time to event meta-analysis

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    Wang, Xin; Hu, Yanan; Ren, Mudan; Lu, Xin Lan; Lu, Gui Fang; He, Shui Xiang [Dept. of Gastroenterology, First Affiliated Hospital of Xi' an Jiaotong University, Xi' an (China)

    2016-02-15

    To compare the efficacy and safety of combined radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA alone for hepatocellular carcinomas (HCC). Randomized controlled trial (RCT) studies that compared the clinical or oncologic outcomes of combination therapy of TACE and RFA versus RFA for the treatment of HCC were identified through literature searches of electronic databases (Pubmed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, and Google Scholar). Hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence interval (CI) were combined as the effective value to assess the summary effects. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. Six RCTs with 534 patients were eligible for inclusion in this meta-analysis. The meta-analysis showed that the combination of TACE and RFA is associated with a significantly longer overall survival (HR = 0.62, 95% CI: 0.49-0.78, p < 0.001) and recurrence-free survival (HR = 0.55, 95% CI: 0.40-0.76, p < 0.001) in contrast with RFA monotherapy. The seemingly higher incidence of major complications in the combination group compared with RFA group did not reach statistical significance (OR = 1.17, 95% CI: 0.39-3.55, p = 0.78). In patients with HCC, the combination of TACE and RFA is associated with significantly higher overall survival and recurrence-free survival, as compared with RFA monotherapy, without significant difference in major complications.

  9. Efficacy and safety of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinomas compared with radiofrequency ablation alone: A time to event meta-analysis

    International Nuclear Information System (INIS)

    Wang, Xin; Hu, Yanan; Ren, Mudan; Lu, Xin Lan; Lu, Gui Fang; He, Shui Xiang

    2016-01-01

    To compare the efficacy and safety of combined radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA alone for hepatocellular carcinomas (HCC). Randomized controlled trial (RCT) studies that compared the clinical or oncologic outcomes of combination therapy of TACE and RFA versus RFA for the treatment of HCC were identified through literature searches of electronic databases (Pubmed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, and Google Scholar). Hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence interval (CI) were combined as the effective value to assess the summary effects. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. Six RCTs with 534 patients were eligible for inclusion in this meta-analysis. The meta-analysis showed that the combination of TACE and RFA is associated with a significantly longer overall survival (HR = 0.62, 95% CI: 0.49-0.78, p < 0.001) and recurrence-free survival (HR = 0.55, 95% CI: 0.40-0.76, p < 0.001) in contrast with RFA monotherapy. The seemingly higher incidence of major complications in the combination group compared with RFA group did not reach statistical significance (OR = 1.17, 95% CI: 0.39-3.55, p = 0.78). In patients with HCC, the combination of TACE and RFA is associated with significantly higher overall survival and recurrence-free survival, as compared with RFA monotherapy, without significant difference in major complications

  10. Jianpi Bushen, a Traditional Chinese Medicine Therapy, Combined with Chemotherapy for Gastric Cancer Treatment: A Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Chen, Yunbo; Zhang, Guijuan; Chen, Xiaoping; Jiang, Xuefeng; Yuan, Naijun; Wang, Yurong; Hao, Xiaoqian

    2018-01-01

    Objective. To investigate the effects of Jianpi Bushen (JPBS), a traditional Chinese medicine that is used to invigorate the spleen and tonify the kidney, combined with chemotherapy for the treatment of gastric cancer. Methods. Literature retrieval was performed in PubMed, EMBASE, Cochrane Library, MEDLINE, CNKI, Wanfang Data Information Site, and VIP from inception to October 2017. Randomized controlled trials to evaluate the effects of JPBS combined with chemotherapy were identified. The primary reported outcomes were KPS (Karnofsky Performance Status), clinical curative efficiency, immune function, blood system, and nonhematologic system. Review Manager 5.3 (RevMan 5.3) was used for data analysis, and the quality of the studies was also appraised. Results. A total of 26 studies were included with 3098 individuals. The results of the meta-analysis indicated that treatment of gastric cancer with the combination of JPBS and chemotherapy resulted in better outcomes compared to chemotherapy alone. Conclusion. Evidence from the meta-analysis suggested that JPBS combined with chemotherapy has a positive effect on gastric cancer treatment. However, additional rigorously designed and large sample randomized controlled trials are required to confirm the efficacy and safety of this treatment. PMID:29675052

  11. A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions.

    Directory of Open Access Journals (Sweden)

    Xiliang Shang

    Full Text Available The purpose of this meta-analysis was to assess whether there were differences in the outcomes between tenotomy and tenodesis in treating LHBT lesions combined with rotator cuff repairs.Using Medline, Embase, and Cochrane, we searched for articles comparing tenotomy and tenodesis combined with rotator cuff repair which were published before April 2016 with the terms "biceps", "tenotomy", "tenodesis", and "rotator cuff". The controlled clinical studies that met the inclusion and exclusion criteria were assessed for quality of methodology by utilizing the Coleman score.On the basis of the inclusion and exclusion criteria, ten articles (903 patients were included in this meta-analysis. The Coleman score ranged between 40 and 89 in the included studies. The results showed that the incidence of the popeye sign (OR, 2.777, P = 0.000 were higher in tenotomy group compared with tenodesis group when concomitant rotator cuff repair. Statistically significant difference in favor of tenodesis was observed for Constant score (SMD, -0.230, P = 0.025. As for the arm cramping pain, patient satisfaction, VAS score, ASES score and UCLA increased score, the strength and the range of motion, there were no significant differences between tenodesis and tenotomy of the LHBT, corresponding to the currently available results in the literature.Based on this meta-analysis, both tenotomy and tenodesis are effective in pain relief and function improvement in patients with repairable rotator cuff tears. No significant differences in post-operative functional outcome between tenotomy and tenodesis for the treatment of LHBT lesions were observed except for a lower Constant score and higher risk of Popeye deformity in tenotomy.

  12. A Meta-Analysis for Postoperative Complications in Tibial Plafond Fracture: Open Reduction and Internal Fixation Versus Limited Internal Fixation Combined With External Fixator.

    Science.gov (United States)

    Wang, Dong; Xiang, Jian-Ping; Chen, Xiao-Hu; Zhu, Qing-Tang

    2015-01-01

    The treatment of tibial plafond fractures is challenging to foot and ankle surgeons. Open reduction and internal fixation and limited internal fixation combined with an external fixator are 2 of the most commonly used methods of tibial plafond fracture repair. However, conclusions regarding the superior choice remain controversial. The present meta-analysis aimed to quantitatively compare the postoperative complications between open reduction and internal fixation and limited internal fixation combined with an external fixator for tibial plafond fractures. Nine studies with 498 fractures in 494 patients were included in the present study. The meta-analysis found no significant differences in bone healing complications (risk ratio [RR] 1.17, 95% confidence interval [CI] 0.68 to 2.01, p = .58], nonunion (RR 1.09, 95% CI 0.51 to 2.36, p = .82), malunion or delayed union (RR 1.24, 95% CI 0.57 to 2.69, p = .59), superficial (RR 1.56, 95% CI 0.43 to 5.61, p = .50) and deep (RR 1.89, 95% CI 0.62 to 5.80) infections, arthritis symptoms (RR 1.20, 95% CI 0.92 to 1.58, p = .18), or chronic osteomyelitis (RR 0.31, 95% CI 0.05 to 1.84, p = .20) between the 2 groups. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. The Efficacy and Clinical Safety of Various Analgesic Combinations for Post-Operative Pain after Third Molar Surgery: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Alvin Ho Yeung Au

    Full Text Available To run a systematic review and meta-analysis of randomized clinical trials aiming to answer the clinical question "which analgesic combination and dosage is potentially the most effective and safe for acute post-operative pain control after third molar surgery?".A systematic search of computer databases and journals was performed. The search and the evaluations of articles were performed by 2 independent reviewers in 3 rounds. Randomized clinical trials related to analgesic combinations for acute post-operative pain control after lower third molar surgery that matched the selection criteria were evaluated to enter in the final review.Fourteen studies with 3521 subjects, with 10 groups (17 dosages of analgesic combinations were included in the final review. The analgesic efficacy were presented by the objective pain measurements including sum of pain intensity at 6 hours (SPID6 and total pain relief at 6 hours (TOTPAR6. The SPID6 scores and TOTPAR6 scores of the reported analgesic combinations were ranged from 1.46 to 6.44 and 3.24 - 10.3, respectively. Ibuprofen 400mg with oxycodone HCL 5mg had superior efficacy (SPID6: 6.44, TOTPAR6: 9.31. Nausea was the most common adverse effect, with prevalence ranging from 0-55%. Ibuprofen 200mg with caffeine 100mg or 200mg had a reasonable analgesic effect with fewer side effects.This systematic review and meta-analysis may help clinicians in their choices of prescribing an analgesic combination for acute post-operative pain control after lower third molar surgery. It was found in this systematic review Ibuprofen 400mg combined with oxycodone HCL 5mg has superior analgesic efficacy when compared to the other analgesic combinations included in this study.

  14. Is Huachansu Beneficial in Treating Advanced Non-Small-Cell Lung Cancer? Evidence from a Meta-Analysis of Its Efficacy Combined with Chemotherapy

    Directory of Open Access Journals (Sweden)

    Bingduo Zhou

    2015-01-01

    Full Text Available Background. Huachansu, the sterilized water extract of Bufo bufo gargarizans toad skin, is used in China to alleviate the side-effects and enhance the therapeutic effect of chemotherapy in advanced non-small-cell lung cancer (NSCLC. We conducted a meta-analysis to assess Huachansu’s efficacy. Methods. We extensively searched electronic databases (CENTRAL, EMBASE, MEDLINE, CBM, Cochrane Library, CNKI, CEBM, WFDP, CSCD, CSTD, and IPA for randomized controlled trials containing Huachansu plus chemotherapy as the test group and chemotherapy as the control group. Seventeen trials were selected based on the selection criteria. The pooled relative ratio (RR of indicators with 95% confidence interval (95% CI was calculated for efficacy evaluation. Results. The meta-analysis demonstrated a statistically significant improvement in objective tumor response, one-year survival, Karnofsky performance status, pain relief, and alleviation of severe side-effects (nausea and vomiting, leukocytopenia in the test group as compared to the control group, but no significant difference in thrombocytopenia. Conclusions. This study demonstrated the efficacy of Huachansu combined with chemotherapy in the treatment of advanced NSCLC. However, limitations exist and high-quality trials are needed for further verification.

  15. Systematic Review and Meta-Analysis of the Efficacy and Safety of Combined Epinephrine and Corticosteroid Therapy for Acute Bronchiolitis in Infants

    Directory of Open Access Journals (Sweden)

    Kok P. Kua

    2017-06-01

    Full Text Available Objective: To evaluate the effectiveness of combined epinephrine and corticosteroid therapy for acute bronchiolitis in infants.Methods: Four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from their inception to February 28, 2017 for studies involving infants aged less than 24 months with bronchiolitis which assessed the use of epinephrine and corticosteroid combination therapy. The methodological quality of the included studies was assessed using the Cochrane Collaboration's Risk of Bias Tool. A random-effects meta-analysis was used to pool the effect estimates. The primary outcomes were hospital admission rate and length of hospital stay.Results: Of 1,489 citations identified, 5 randomized controlled trials involving 1,157 patients were included. All studies were of high quality and low risk of bias. Results of the meta-analysis showed no significant differences in the primary outcomes. Hospitalization rate was reduced by combinatorial therapy of epinephrine and corticosteroid in only one out of five studies, whereas pooled data indicated no benefit over epinephrine plus placebo. Clinical severity scores were significantly improved in all five RCTs when assessed individually, but no benefit was observed compared to epinephrine monotherapy when the data were pooled together. Pooled data showed that combination therapy was more effective at improving oxygen saturation level (mean difference: −0.70; 95% confidence interval: −1.17 to −0.22, p = 0.004. There was no difference in the risk of serious adverse events in infants treated with the combined epinephrine and corticosteroid therapy.Conclusions: Combination treatment of epinephrine and dexamethasone was ineffective in reducing hospital admission and length of stay among infants with bronchiolitis.

  16. Efficacy of lamivudine and thymosin alpha-1 combination therapy in treatment of HBeAg-positive chronic hepatitis B: a meta-analysis

    Directory of Open Access Journals (Sweden)

    QI Youtao

    2014-07-01

    Full Text Available ObjectiveTo evaluate the efficacy of lamivudine and thymosin alpha-1 combination therapy in the treatment of HBeAg-positive chronic hepatitis B (CHB by meta-analysis. MethodsRandomized controlled trials (RCTs of lamivudine and thymosin alpha-1 combination therapy in treatment of HBeAg-positive CHB (follow-up for at least 24 weeks, from January 1998 to date, were identified by searching Cochrane Library, PubMed, EMBASE, EBSCO, CNKI, Wanfang Data, and CQVIP. Lamivudine monotherapy RCTs were searched for in the same way as control tests. Efficacy was measured by odds ratio. Meta-analysis was carried out with RevMan 5.2 software. ResultsNine RCTs involving 600 patients were included, with 320 cases in the combination therapy group and 280 in the control group. At the end of follow-up, the combination therapy group had significantly higher serum ALT recovery rate, HBV-DNA negative conversion rate, HBeAg negative conversion rate, and HBeAg seroconversion rate than the control group (P<0.01 for all, with pooled odds ratios (95% confidence intervals of 4.84 (3.28, 7.16, 2.09 (1.45, 3.01, 5.32 (3.35, 8.46, and 6.22 (3.78, 10.25, respectively. ConclusionLamivudine and thymosin alpha-1 combination therapy is more likely to achieve sustained response rate than lamivudine monotherapy for HBeAg-positive CHB. More RCTs of high quality and large scale are required to verify this conclusion.

  17. Longitudinal Meta-analysis

    NARCIS (Netherlands)

    Hox, J.J.; Maas, C.J.M.; Lensvelt-Mulders, G.J.L.M.

    2004-01-01

    The goal of meta-analysis is to integrate the research results of a number of studies on a specific topic. Characteristic for meta-analysis is that in general only the summary statistics of the studies are used and not the original data. When the published research results to be integrated

  18. Comparative efficacy of inhaled corticosteroid and long-acting beta agonist combinations in preventing COPD exacerbations: a Bayesian network meta-analysis.

    Science.gov (United States)

    Oba, Yuji; Lone, Nazir A

    2014-01-01

    A combination therapy with inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA) is recommended in severe chronic obstructive pulmonary disease (COPD) patients experiencing frequent exacerbations. Currently, there are five ICS/LABA combination products available on the market. The purpose of this study was to systematically review the efficacy of various ICS/LABA combinations with a network meta-analysis. Several databases and manufacturer's websites were searched for relevant clinical trials. Randomized control trials, at least 12 weeks duration, comparing an ICS/LABA combination with active control or placebo were included. Moderate and severe exacerbations were chosen as the outcome assessment criteria. The primary analyses were conducted with a Bayesian Markov chain Monte Carlo method. Most of the ICS/LABA combinations reduced moderate-to-severe exacerbations as compared with placebo and LABA, but none of them reduced severe exacerbations. However, many studies excluded patients receiving long-term oxygen therapy. Moderate-dose ICS was as effective as high-dose ICS in reducing exacerbations when combined with LABA. ICS/LABA combinations had a class effect with regard to the prevention of COPD exacerbations. Moderate-dose ICS/LABA combination therapy would be sufficient for COPD patients when indicated. The efficacy of ICS/LABA combination therapy appeared modest and had no impact in reducing severe exacerbations. Further studies are needed to evaluate the efficacy of ICS/LABA combination therapy in severely affected COPD patients requiring long-term oxygen therapy.

  19. Effects of Combination Therapy With Immunomodulators on Trough Levels and Antibodies Against Tumor Necrosis Factor Antagonists in Patients With Inflammatory Bowel Disease: A Meta-analysis.

    Science.gov (United States)

    Qiu, Yun; Mao, Ren; Chen, Bai-Li; Zhang, Sheng-Hong; Guo, Jing; He, Yao; Zeng, Zhi-Rong; Ben-Horin, Shomron; Chen, Min-Hu

    2017-09-01

    It is not clear whether combination therapy with immunomodulators affects the immunogenicity of tumor necrosis factor (TNF) antagonists in patients with inflammatory bowel disease. We performed a meta-analysis to quantify the effects of combined immunomodulator therapy on the presence of antibodies against TNF antagonists (antidrug antibodies [ADAs]) and trough levels of anti-TNF agents. We systematically searched publication databases for studies that reported prevalence of ADAs in patients who received anti-TNF agents. Raw data from studies that met the inclusion criteria were pooled to determine effect estimates. We performed subgroup and metaregression analyses to determine the level of heterogeneity among study outcomes. We analyzed findings from 35 studies that met inclusion criteria (results reported from 6790 patients with inflammatory bowel disease). The pooled risk ratio for formation of ADAs in patients receiving combined therapy with immunomodulators, versus that of patients receiving anti-TNF monotherapy, was 0.49 (95% confidence interval, 0.41-0.59; P immunomodulators (standardized mean difference, 0.11; 95% confidence interval, 0.19-0.41; P = .47). Subgroup analyses of patients treated with different TNF antagonists revealed no difference in the formation of ADAs (P = .50 for interaction); the protective effect of immunomodulators did not differ with type of drug patients were given (methotrexate vs thiopurines), or assay for ADA. We observed heterogeneity only among studies of patients with ulcerative colitis (I 2  = 76%). Funnel plot and Egger test analyses indicated publication bias in the studies (P = .001). In a meta-analysis of published studies, we associated combined treatment with immunomodulators with reduced risk of formation of antibodies against TNF antagonists in patients with inflammatory bowel disease. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  20. The Efficacy and Safety of Tamsulosin Combined with Extracorporeal Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Chen, Kai; Mi, Hua; Xu, Guangyu; Liu, Lin; Sun, Xiubin; Wang, Shiping; Meng, Qingrong; Lv, Tao

    2015-10-01

    Many studies have been conducted to investigate adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for urolithiasis. The results from those studies, however, are still inconsistent. Therefore, we performed a meta-analysis to provide an update on the clinical efficacy and safety of tamsulosin combined with SWL for urolithiasis. A systematic search was performed in PubMed, Cochrane Library, and Embase to identify all relevant randomized controlled trials until January 2015. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan), version 5.1. Twenty-one studies (2093 subjects in total) were identified in the current meta-analysis. Compared with a control group, the experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled risk ratio (RR) of 1.20 (95% confidence interval [CI], 1.15-1.26). With respect to the different geographic regions, European and American had a high possibility of improvement in stone expulsion (RR: 1.33, 95% CI, 1.19-1.49). According to the stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11-24 mm), tamsulosin is more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14-1.43) and larger sized stones (RR: 1.49; 95% CI, 1.28-1.75). The effect estimates did not vary markedly when stratified by follow-up durations but varied by dose of tamsulosin. Furthermore, a shorter expulsion time, reduced occurrence of steinstrasse, fewer incidences of colic, and lower analgesic requirements were observed within the experimental group. In addition, tamsulosin is well tolerated, and its adverse events rarely led to dropouts of patients. Overall, evidence suggests that tamsulosin combined with SWL is safe and effective in enhancing stone expulsion for patients with urolithiasis. Furthermore, high-quality, randomized and placebo-controlled trials evaluating the efficacy and

  1. Use and perception of herbal and dietary supplements in the Hutterites of South Dakota.

    Science.gov (United States)

    Peters, Stacy; Shiyanbola, Olayinka

    2013-12-01

    South Dakota is home to 6,000 Hutterites, the largest population of Hutterites in the United States. Observation of frequent supplement use by this population prompted the current survey based study. Use of supplements is on the rise with around 53 percent of Americans reporting at least one herbal and dietary supplement (HDS). Use and perception of HDS has not previously been evaluated in the Hutterite population. Participants were 18 years of age and older and had to be present at the time of survey administration. Surveys were administered before and after an educational presentation at five colonies to volunteer participants. Survey data was analyzed using descriptive analysis and chi-square tests. One-hundred and six surveys were completed with 81.1 percent being female. Approximately 78 percent reported using at least one type of HDS, with an average of 2.7 (SD = 1.4) supplements per person. Women were more likely to report supplement use than men. Hutterites reported they felt HDS were safer than prescription medications. Education was effective on some aspects such as telling their doctor if they are taking HDS. Some study limitations included small sample size, possible lack of survey understanding, and the limited number of male participants. The frequency of HDS use in South Dakota Hutterites appears to be very high. Baseline knowledge on the safety and regulation of HDS reveals that education of this population is needed. Further investigation of HDS use in Hutterites is warranted.

  2. Comparison of the efficacy among multiple chemotherapeutic interventions combined with radiation therapy for patients with cervix cancer after surgery: A network meta-analysis.

    Science.gov (United States)

    Chang, Lei; Guo, Ruixia

    2017-07-25

    Cervix cancer was the second most common cancer in female. However, there was no network meta-analysis (NMA) comparing the efficacy of the multiple chemotherapeutic interventions combined with radiation therapy in patients after operation. Randomized controlled trials were retrieved from PubMed, Embase and Cochrane Library. Overall survival (OS), recurrence-free survival (RFS), incidence of recurrence and distant metastasis were the main outcomes, particularly 5-year OS and PFS were considered as primary outcomes. Furthermore, the hazard ratio (HR) or odds ratio (OR) and their 95% credible intervals (CrIs) were extracted. The surface under cumulative ranking curve (SUCRA) was also used in this NMA. A total of 39 eligible trials with 8,952 patients were included and 22 common chemotherapies were evaluated in this meta-analysis. For OS, cisplatin+fluorouracil+hydroxyurea, fluorouracil+mitomycin C, cisplatin and cisplatin+fluorouracil were better than placebo. As for RFS, cisplatin+fluorouracil, fluorouracil+mitomycin C, and cisplatin alone had the significant superiority compared with placebo. In terms of incidence of recurrence, the optimal drug combination was cisplatin+ifosfamide (0.93) based on SUCRA. Moreover, epirubicin (OR = 0.28, 95% CrI: 0.08-0.91) was the only one had the distinguished potency in reducing the occurrence of distant metastasis with a SUCRA rank probability of 0.88. We recommended cisplatin+fluorouracil+hydroxyurea and cisplatin+docetaxel for their good efficacy in long term survival. Meanwhile, the combination of multiple drugs with different mechanisms worked better.

  3. Comparison of diagnostic efficacy between CLE, tissue sampling, and CLE combined with tissue sampling for undetermined pancreaticobiliary strictures: a meta-analysis.

    Science.gov (United States)

    Gao, Ya-Dong; Qu, Ya-Wei; Liu, Hai-Feng

    2018-04-01

    The accurate diagnosis of undetermined pancreaticobiliary strictures remains challenging. Current ERCP-guided tissue sampling methods are of low sensitivity. Confocal laser endomicroscopy (CLE) is a new procedure and allows real optical biopsies that may improve the diagnosis of undetermined pancreaticobiliary strictures. The aim of this meta-analysis was to determine the diagnostic yield of CLE, tissue sampling, and CLE combined with tissue sampling for undetermined pancreaticobiliary strictures. Pubmed, Embase, and the Cochrane Library database were reviewed for relevant studies. Pooled estimates of sensitivity and specificity with 95% confidence intervals (CIs) were calculated using the random-effects meta-analysis model. The summary receiver-operating characteristic (SROC) curve was constructed, and the area under the receiver operating characteristic curve (AUC) was calculated. Twelve studies involving 591 patients were enrolled in our analysis. The overall sensitivity and the specificity estimate of CLE for discriminating benign and malignant pancreaticobiliary strictures were 87% (95%CI, 83-91%) and 76% (95%CI, 70-81%), respectively. The AUC to assess the diagnostic efficacy was 0.8705. For tissue sampling, the overall sensitivity and the specificity estimate were 64% (95%CI, 57-70%) and 94% (95%CI, 90-97%), respectively. The AUC to assess the diagnostic efficacy was 0.8040. A combination of both methods increased the sensitivity (93%; 95%CI, 88-96%) with a specificity of 82% (95%CI, 74-89%). The AUC to assess the diagnostic efficacy was 0.9377. There was no publication bias by Deeks' Funnel Plot with p = .936. Compared with tissue sampling, CLE may increase the sensitivity for the diagnosis of malignant pancreaticobiliary strictures. A combination of both can effectively diagnose malignant pancreaticobiliary strictures.

  4. A systemic review and meta-analysis of the clinical efficacy and safety of total glucosides of peony combined with methotrexate in rheumatoid arthritis.

    Science.gov (United States)

    Feng, Zhi-Tao; Xu, Juan; He, Guo-Chao; Cai, San-Jin; Li, Juan; Mei, Zhi-Gang

    2018-01-01

    To assess the efficacy and safety of the combination of total glucoside of peony (TGP) and methotrexate (MTX) for the treatment of rheumatoid arthritis (RA). Randomized controlled trial (RCT) data on the traditional Chinese active component TGP combined with MTX vs. MTX alone for the treatment of RA was collected by searching the Pubmed, Embase, Cochrane Library, CNKI, VIP Journals database, and Wanfang database up to February 2017. Study selection, data extraction, data synthesis, and data analyses were performed according to the Cochrane standards. A total of eight RCTs involving 522 participants were included in this meta-analysis. Compared with MTX alone, the use of TGP combined with MTX exhibited better therapeutic effects for the treatment of RA (P = 0.004). In addition, TGP combined with MTX caused a more significant decrease in erythrocyte sedimentation rate (ESR) (P TGP and MTX combination group (P = 0.0007). Our study demonstrates that TGP combined with MTX is more effective than MTX alone for the treatment of RA. Nevertheless, the adverse effects of the combination of TGP and MTX need to be further assessed. Due to the poor methodological quality of included trials, well-designed, multi-center, and large-scale RCTs are necessary to draw a more definitive conclusion.

  5. Combined versus single application of tranexamic acid in total knee and hip arthroplasty: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Peng Zhang, M M; Jifeng Li, M M; Xiao Wang, M M

    2017-07-01

    To compare the efficacy and safety of the combined application of both intravenous and topical tranexamic acid versus the single use of either application in patients with total knee and hip arthroplasty. Potentially relevant studies were identified from electronic databases including Medline, PubMed, Embase, ScienceDirect and the Cochrane Library. Patients undergoing primary total knee and hip arthroplasty were included in our studies, with an experimental group that received combined intravenous and topical application of tranexamic acid and a control group that received a single application of tranexamic acid or normal saline. The primary outcomes were total blood loss, hemoglobin decline and transfusion requirements. The secondary outcomes were length of stay, operation time and tranexamic acid-related adverse effects, such as superficial infection, deep vein thrombosis or pulmonary embolism. Modified Jadad scores were used to assess the quality of the included randomized controlled trials (RCTs). The data was pooled using RevMan 5.3. After testing for heterogeneity across studies, the data were aggregated using random-effects modeling when appropriate. We have registered the trial at http://www.researchregistry.com. Six RCTs that included 704 patients met the inclusion criteria. The present meta-analysis indicated significant differences existed in the total blood loss (MD = -134.65, 95% CI: -191.66 to -77.64, P tranexamic acid in total knee and hip arthroplasty was associated with significantly reduced total blood loss, postoperative hemoglobin decline, drainage volume, and transfusion requirements. Based on the limitations of current meta-analysis, well-designed, high-quality RCTs with long-term follow-up are still required. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  6. A non-parametric meta-analysis approach for combining independent microarray datasets: application using two microarray datasets pertaining to chronic allograft nephropathy

    Directory of Open Access Journals (Sweden)

    Archer Kellie J

    2008-02-01

    Full Text Available Abstract Background With the popularity of DNA microarray technology, multiple groups of researchers have studied the gene expression of similar biological conditions. Different methods have been developed to integrate the results from various microarray studies, though most of them rely on distributional assumptions, such as the t-statistic based, mixed-effects model, or Bayesian model methods. However, often the sample size for each individual microarray experiment is small. Therefore, in this paper we present a non-parametric meta-analysis approach for combining data from independent microarray studies, and illustrate its application on two independent Affymetrix GeneChip studies that compared the gene expression of biopsies from kidney transplant recipients with chronic allograft nephropathy (CAN to those with normal functioning allograft. Results The simulation study comparing the non-parametric meta-analysis approach to a commonly used t-statistic based approach shows that the non-parametric approach has better sensitivity and specificity. For the application on the two CAN studies, we identified 309 distinct genes that expressed differently in CAN. By applying Fisher's exact test to identify enriched KEGG pathways among those genes called differentially expressed, we found 6 KEGG pathways to be over-represented among the identified genes. We used the expression measurements of the identified genes as predictors to predict the class labels for 6 additional biopsy samples, and the predicted results all conformed to their pathologist diagnosed class labels. Conclusion We present a new approach for combining data from multiple independent microarray studies. This approach is non-parametric and does not rely on any distributional assumptions. The rationale behind the approach is logically intuitive and can be easily understood by researchers not having advanced training in statistics. Some of the identified genes and pathways have been

  7. Survival, recurrence and toxicity of HNSCC in comparison of a radiotherapy combination with cisplatin versus cetuximab: a meta-analysis

    International Nuclear Information System (INIS)

    Huang, Jingwen; Zhang, Jing; Shi, Changle; Liu, Lei; Wei, Yuquan

    2016-01-01

    Cisplatin-based treatment has been considered the standard treatment regimen of HNSCC. Cetuximab is an emerging target therapy that has potential therapeutic benefits over cisplatin. Nevertheless, curative effects of cisplatin-based chemoradiotherapy (CRT) versus cetuximab-based bioradiotherapy (BRT) are still controversial. Potentially eligible studies were retrieved using PubMed, Embase and Medline. Basic characteristics of patients and statistical data were collected. A meta-analysis model was established to compare CRT and BRT. Thirty-one eligible studies and 4212 patients were found. The pooled HRs with 95 % confidence intervals (CIs) for OS and PFS were 0.32 [0.09, 0.55] and 0.51 [0.22, 0.80], respectively, and both were in favor of cisplatin. However, 3-year survival and recurrence analysis of the subgroups showed no differences between the two groups (p > 0.05). In subgroup analysis, oropharyngeal primary tumors exhibited improved results by cetuximab with a pooled HR of 1.56 [1.14, 2.13] for PFS. Additionally, the HPV+ status was a significant factor in positive outcomes with cetuximab with a pooled HR of 1.12 [0.46, 2.17] for OS. Long-term use of BRT showed no significant difference compared with CRT, and both arms showed different aspects of toxicity. In subgroup analysis, taking the effects of treatment and adverse events into consideration, cetuximab plus radiation may show superior responses regarding OS and PFS in patients who have HPV+ or primary oropharyngeal HNSCC, respectively, but physicians should administer them with caution

  8. Combining evidence from multiple electronic health care databases: performances of one-stage and two-stage meta-analysis in matched case-control studies.

    Science.gov (United States)

    La Gamba, Fabiola; Corrao, Giovanni; Romio, Silvana; Sturkenboom, Miriam; Trifirò, Gianluca; Schink, Tania; de Ridder, Maria

    2017-10-01

    Clustering of patients in databases is usually ignored in one-stage meta-analysis of multi-database studies using matched case-control data. The aim of this study was to compare bias and efficiency of such a one-stage meta-analysis with a two-stage meta-analysis. First, we compared the approaches by generating matched case-control data under 5 simulated scenarios, built by varying: (1) the exposure-outcome association; (2) its variability among databases; (3) the confounding strength of one covariate on this association; (4) its variability; and (5) the (heterogeneous) confounding strength of two covariates. Second, we made the same comparison using empirical data from the ARITMO project, a multiple database study investigating the risk of ventricular arrhythmia following the use of medications with arrhythmogenic potential. In our study, we specifically investigated the effect of current use of promethazine. Bias increased for one-stage meta-analysis with increasing (1) between-database variance of exposure effect and (2) heterogeneous confounding generated by two covariates. The efficiency of one-stage meta-analysis was slightly lower than that of two-stage meta-analysis for the majority of investigated scenarios. Based on ARITMO data, there were no evident differences between one-stage (OR = 1.50, CI = [1.08; 2.08]) and two-stage (OR = 1.55, CI = [1.12; 2.16]) approaches. When the effect of interest is heterogeneous, a one-stage meta-analysis ignoring clustering gives biased estimates. Two-stage meta-analysis generates estimates at least as accurate and precise as one-stage meta-analysis. However, in a study using small databases and rare exposures and/or outcomes, a correct one-stage meta-analysis becomes essential. Copyright © 2017 John Wiley & Sons, Ltd.

  9. The Efficacy and Safety of the Combination of Total Glucosides of Peony and Leflunomide for the Treatment of Rheumatoid Arthritis: A Systemic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Zhitao Feng

    2016-01-01

    Full Text Available Objective. To evaluate the efficacy and safety of the total glucosides of peony (TGP and leflunomide (LEF for the treatment of rheumatoid arthritis (RA. Methods. Randomized controlled trials (RCTs on the efficacy and safety of the combination of TGP and LEF versus LEF alone for the treatment of RA were retrieved by searching PubMed, EMBASE, Cochrane Library, the China National Knowledge Infrastructure database, and Wanfang database. Results. Eight RCTs including 643 RA patients were included in the present meta-analysis. The quality of included studies was poor. The levels of ESR (P<0.0001, CRP (P<0.0001, and RF (P<0.0001 in RA patients who received the combination of TGP and LEF were significantly lower than RA patients who received LEF therapy alone. The pooled results suggest that the combination of TGP and LEF caused less abnormal liver function than LEF alone (P=0.02. No significant difference in the gastrointestinal discomfort was identified between the combination of TGP and LEF and LEF alone groups (P=0.18. Conclusion. The combination of TGP and LEF in treatment of RA presented the characteristics of notably decreasing the levels of laboratory indexes and higher safety in terms of liver function. However, this conclusion should be further investigated based on a larger sample size.

  10. Combination therapy of fenofibrate and ursodeoxycholic acid in patients with primary biliary cirrhosis who respond incompletely to UDCA monotherapy: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2015-05-01

    Full Text Available Yan Zhang,1,2,* Sainan Li,1,* Lei He,1 Fan Wang,1 Kan Chen,1 Jingjing Li,1 Tong Liu,1 Yuanyuan Zheng,1 Jianrong Wang,1,3 Wenxia Lu,1,3 Yuqing Zhou,1,4 Qin Yin,1,4 Yujing Xia,1 Yingqun Zhou,1 Jie Lu,1 Chuanyong Guo1 1Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 2Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 3The First Clinical Medical College of Nanjing Medical University, Nanjing, 4The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China *These authors contributed equally to this work Background: Although the effectiveness of treatment with ursodeoxycholic acid (UDCA and fenofibrate for primary biliary cirrhosis (PBC has been suggested by small trials, a systematic review to summarize the evidence has not yet been carried out.Methods: A meta-analysis of all long-term randomized controlled trials comparing the combination of UDCA and fenofibrate with UDCA monotherapy was performed via electronic searches.Results: Six trials, which included 84 patients, were assessed. Combination therapy with UDCA and fenofibrate was more effective than UDCA monotherapy in improving alkaline phosphatase (mean difference [MD]: -90.44 IU/L; 95% confidence interval [CI]: -119.95 to -60.92; P<0.00001, gamma-glutamyl transferase (MD: -61.58 IU/L; 95% CI: -122.80 to -0.35; P=0.05, immunoglobulin M (MD: -38.45 mg/dL; 95% CI: -64.38 to -12.51; P=0.004, and triglycerides (MD: -0.41 mg/dL; 95% CI: -0.82 to -0.01; P=0.05. However, their effects on pruritus (odds ratio [OR]: 0.39; 95% CI: 0.09–1.78; P=0.23, total bilirubin (MD: -0.05 mg/dL; 95% CI: -0.21 to 0.12; P=0.58, and alanine aminotransferase (MD: -3.31 IU/L; 95% CI: -14.60 to 7.97; P=0.56 did not differ significantly. This meta-analysis revealed no significant differences in the incidence of adverse events (OR: 0.21; 95% CI: 0.03–1.25; P=0.09 between patients treated with

  11. The Efficacy and Safety of the Combination of Total Glucosides of Peony and Leflunomide for the Treatment of Rheumatoid Arthritis: A Systemic Review and Meta-Analysis.

    Science.gov (United States)

    Feng, Zhitao; Xu, Juan; He, Guochao; Cao, Meiqun; Duan, Lihong; Chen, Liguo; Wu, Zhengzhi

    2016-01-01

    Objective. To evaluate the efficacy and safety of the total glucosides of peony (TGP) and leflunomide (LEF) for the treatment of rheumatoid arthritis (RA). Methods. Randomized controlled trials (RCTs) on the efficacy and safety of the combination of TGP and LEF versus LEF alone for the treatment of RA were retrieved by searching PubMed, EMBASE, Cochrane Library, the China National Knowledge Infrastructure database, and Wanfang database. Results. Eight RCTs including 643 RA patients were included in the present meta-analysis. The quality of included studies was poor. The levels of ESR (P TGP and LEF were significantly lower than RA patients who received LEF therapy alone. The pooled results suggest that the combination of TGP and LEF caused less abnormal liver function than LEF alone (P = 0.02). No significant difference in the gastrointestinal discomfort was identified between the combination of TGP and LEF and LEF alone groups (P = 0.18). Conclusion. The combination of TGP and LEF in treatment of RA presented the characteristics of notably decreasing the levels of laboratory indexes and higher safety in terms of liver function. However, this conclusion should be further investigated based on a larger sample size.

  12. Evidence of genetic heterogeneity in Alberta Hutterites with Usher syndrome type I.

    Science.gov (United States)

    Zhou, Qi; Lenger, Chaeli; Smith, Richard; Kimberling, William J; Ye, Ming; Lehmann, Ordan; MacDonald, Ian

    2012-01-01

    To identify the genetic defect in a Hutterite population from northern Alberta with Usher syndrome type I. Complete ophthalmic examinations were conducted on two boys and two girls from two related Hutterite families diagnosed with Usher syndrome type I. DNA from patients and their parents was first evaluated for a mutation in exon 10 of the protocadherin-related 15 (PCDH15) gene (c.1471delG), previously reported in southern Alberta Hutterite patients with Usher syndrome (USH1F). Single nucleotide polymorphic linkage analysis was then used to confirm another locus, and DNA was analyzed with the Usher Chip v4.0 platform. Severe hearing impairment, unintelligible speech, and retinitis pigmentosa with varying degrees of visual acuity and visual field loss established a clinical diagnosis of Usher syndrome type I. The patients did not carry the exon 10 mutation in the PCDH15 gene; however, with microarray analysis, a previously reported mutation (c.52C>T; p.Q18X) in the myosin VIIA (MYO7A) gene was found in the homozygous state in the affected siblings. The finding of a MYO7A mutation in two related Hutterite families from northern Alberta provides evidence of genetic heterogeneity in Hutterites affected by Usher syndrome type I.

  13. Meta-analysis: low-dose intake of vitamin E combined with other vitamins or minerals may decrease all-cause mortality.

    Science.gov (United States)

    Jiang, Shan; Pan, Zhenyu; Li, Hui; Li, Fenglan; Song, Yanyan; Qiu, Yu

    2014-01-01

    It has been suggested that vitamin E alone or combined with other vitamins or minerals can prevent oxidative stress and slow oxidative injury-related diseases, such as cardiovascular disease and cancer. A comprehensive search of PubMed/MEDLINE, EMBASE and the Cochrane Library was performed. Relative risk was used as an effect measure to compare the intervention and control groups. A total of 33 trials were included in the meta-analysis. Neither vitamin E intake alone (RR=1.01; 95% CI, 0.97 to 1.04; p=0.77) nor vitamin E intake combined with other agents (RR=0.97; 95% CI, 0.89 to 1.06; p=0.55) was correlated with all-cause mortality. Subgroup analyses revealed that low-dose vitamin E supplementation combined with other agents is associated with a statistically significant reduction in all-cause mortality (RR=0.92; 95% CI, 0.86 to 0.98; p=0.01), and vitamin E intake combined with other agents is associated with a statistically significant reduction in mortality rates among individuals without probable or confirmed diseases (RR=0.92; 95% CI, 0.86 to 0.99; p=0.02). Neither vitamin E intake alone nor combined with other agents is associated with a reduction in all-cause mortality. But a low dose (vitamin E combined with other agents is correlated with a reduction in all-cause mortality, and vitamin E intake combined with other agents is correlated with a reduction in the mortality rate among individuals without probable or confirmed diseases.

  14. A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Budach, W; Hehr, T; Budach, V; Belka, C; Dietz, K

    2006-01-01

    Former meta-analyses have shown a survival benefit for the addition of chemotherapy (CHX) to radiotherapy (RT) and to some extent also for the use of hyperfractionated radiation therapy (HFRT) and accelerated radiation therapy (AFRT) in locally advanced squamous cell carcinoma (SCC) of the head and neck. However, the publication of new studies and the fact that many older studies that were included in these former meta-analyses used obsolete radiation doses, CHX schedules or study designs prompted us to carry out a new analysis using strict inclusion criteria. Randomised trials testing curatively intended RT (≥60 Gy in >4 weeks/>50 Gy in <4 weeks) on SCC of the oral cavity, oropharynx, hypopharynx, and larynx published as full paper or in abstract form between 1975 and 2003 were eligible. Trials comparing RT alone with concurrent or alternating chemoradiation (5-fluorouracil (5-FU), cisplatin, carboplatin, mitomycin C) were analyzed according to the employed radiation schedule and the used CHX regimen. Studies comparing conventionally fractionated radiotherapy (CFRT) with either HFRT or AFRT without CHX were separately examined. End point of the meta-analysis was overall survival. Thirty-two trials with a total of 10 225 patients were included into the meta-analysis. An overall survival benefit of 12.0 months was observed for the addition of simultaneous CHX to either CFRT or HFRT/AFRT (p < 0.001). Separate analyses by cytostatic drug indicate a prolongation of survival of 24.0 months, 16.8 months, 6.7 months, and 4.0 months, respectively, for the simultaneous administration of 5-FU, cisplatin-based, carboplatin-based, and mitomycin C-based CHX to RT (each p < 0.01). Whereas no significant gain in overall survival was observed for AFRT in comparison to CFRT, a substantial prolongation of median survival (14.2 months, p < 0.001) was seen for HFRT compared to CFRT (both without CHX). RT combined with simultaneous 5-FU, cisplatin, carboplatin, and mitomycin C as

  15. A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck

    Directory of Open Access Journals (Sweden)

    Budach V

    2006-01-01

    Full Text Available Abstract Background Former meta-analyses have shown a survival benefit for the addition of chemotherapy (CHX to radiotherapy (RT and to some extent also for the use of hyperfractionated radiation therapy (HFRT and accelerated radiation therapy (AFRT in locally advanced squamous cell carcinoma (SCC of the head and neck. However, the publication of new studies and the fact that many older studies that were included in these former meta-analyses used obsolete radiation doses, CHX schedules or study designs prompted us to carry out a new analysis using strict inclusion criteria. Methods Randomised trials testing curatively intended RT (≥60 Gy in >4 weeks/>50 Gy in Results Thirty-two trials with a total of 10 225 patients were included into the meta-analysis. An overall survival benefit of 12.0 months was observed for the addition of simultaneous CHX to either CFRT or HFRT/AFRT (p Conclusion RT combined with simultaneous 5-FU, cisplatin, carboplatin, and mitomycin C as single drug or combinations of 5-FU with one of the other drugs results in a large survival advantage irrespective the employed radiation schedule. If radiation therapy is used as single modality, hyperfractionation leads to a significant improvement of overall survival. Accelerated radiation therapy alone, especially when given as split course radiation schedule or extremely accelerated treatments with decreased total dose, does not increase overall survival.

  16. The protein kinase C (PKC) inhibitors combined with chemotherapy in the treatment of advanced non-small cell lung cancer: meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Zhang, L L; Cao, F F; Wang, Y; Meng, F L; Zhang, Y; Zhong, D S; Zhou, Q H

    2015-05-01

    The application of newer signaling pathway-targeted agents has become an important addition to chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC). In this study, we evaluated the efficacy and toxicities of PKC inhibitors combined with chemotherapy versus chemotherapy alone for patients with advanced NSCLC systematically. Literature retrieval, trials selection and assessment, data collection, and statistic analysis were performed according to the Cochrane Handbook 5.1.0. The outcome measures were tumor response rate, disease control rate, progression-free survival (PFS), overall survival (OS), and adverse effects. Five randomized controlled trials, comprising totally 1,005 patients, were included in this study. Meta-analysis showed significantly decreased response rate (RR 0.79; 95 % CI 0.64-0.99) and disease control rate (RR 0.90; 95 % CI 0.82-0.99) in PKC inhibitors-chemotherapy groups versus chemotherapy groups. There was no significant difference between the two treatment groups regarding progression-free survival (PFS, HR 1.05; 95 % CI 0.91-1.22) and overall survival (OS, HR 1.00; 95 % CI 0.86-1.16). The risk of grade 3/4 neutropenia, leucopenia, and thrombosis/embolism increased significantly in PKC inhibitors combination groups as compared with chemotherapy alone groups. The use of PKC inhibitors in addition to chemotherapy was not a valid alternative for patients with advanced NSCLC.

  17. Curative efficacy and safety of traditional Chinese medicine xuebijing injections combined with ulinastatin for treating sepsis in the Chinese population: A meta-analysis.

    Science.gov (United States)

    Xiao, Shi-Hui; Luo, Liang; Liu, Xiang-Hong; Zhou, Yu-Ming; Liu, Hong-Ming; Huang, Zhen-Fei

    2018-06-01

    Sepsis is a clinically critical disease. However, it is still controversial whether the combined use of traditional Chinese medicine Xuebijing injections (XBJI) and western medicine can enhance curative efficacy and ensure safety compared with western medicine alone. Thus, this research consisted of a systematic review of the curative efficacy and safety of traditional Chinese medicine XBJI combined with ulinastatin for treating sepsis in the Chinese population. A total of 8 databases were retrieved: 4 foreign databases, namely, PubMed, The Cochrane Library, Embase, and Web of Science; and 4 Chinese databases, namely, Sino Med, China National Knowledge Infrastructure (CNKI), VIP, and Wangfang Data. The time span of retrieval began from the establishment of each database and ended on August 1, 2017. Published randomized controlled trials about the combined use of traditional Chinese medicine XBJI and western medicine were included, regardless of language. Stata12.0 software was used for statistical analysis. Finally, 16 papers involving 1335 cases were included. The result of meta-analysis showed that compared with the single use of ulinastatin, traditional Chinese medicine XBJI combined with ulinastatin could reduce the time of mechanical ventilation, shorten the length of intensive care unit (ICU) stay, improve the 28-day survival rate, and decrease the occurrence rate of multiple organ dysfunction syndrome, case fatality rate, procalcitonin (PCT) content, APACKEII score, tumor necrosis factor (TNF)-α level, and interleukin (IL)-6 level. On the basis of the common basic therapeutic regimen, the combined use of traditional Chinese medicine XBJI and ulinastatin was compared with the use of ulinastatin alone for treating sepsis in the Chinese population. It was found that the number of adverse events of combination therapy is not significantly increased, and its clinical safety is well within the permitted range. However, considering the limitations of this

  18. Efficacy and safety of statins and exercise combination therapy compared to statin monotherapy in patients with dyslipidaemia: A systematic review and meta-analysis.

    Science.gov (United States)

    Gui, Ya-Jun; Liao, Cai-Xiu; Liu, Qiong; Guo, Yuan; Yang, Tao; Chen, Jing-Yuan; Wang, Ya-Ting; Hu, Jia-Hui; Xu, Dan-Yan

    2017-06-01

    Background Statin treatment in association with physical exercise can substantially reduce mortality in dyslipidaemic individuals. However, the available data to compare the efficacy and safety of statins and exercise combination therapy with statin monotherapy are limited. Design Systematic review and meta-analysis. Methods We systematically searched PubMed, Embase and the Cochrane Library from database inception until December 2016. We included randomised and non-randomised studies that compared the efficacy and safety of statins and exercise combination therapy with statin monotherapy in patients with dyslipidaemia. Standardised mean differences were calculated and pooled by means of fixed effects models. The risk of bias and heterogeneity among trials was also assessed. Seven articles were assessed in terms of the efficacy of therapy and 13 from the viewpoint of therapeutic safety. Results In terms of efficacy, statins and exercise combination decreased the incidence of diabetes mellitus, improved insulin sensitivity and inflammation, but caused no change in lipid profile compared to statins alone. In terms of safety, statins and exercise combination increased peak oxygen uptake (standardised mean difference 1.01, 95% confidence interval 0.46 to 1.57) compared to statins alone. In contrast to statin-induced myopathy, chronic exercise training prior to statin treatment could counteract statin-induced adverse effects in skeletal muscle. Conclusion Statins and exercise combination therapy is more effective than statin monotherapy in terms of insulin sensitivity, inflammation and exercise capacity. The small number of studies warrants the need for more randomised controlled trials evaluating the efficacy and safety of combination therapy.

  19. Meta-analysis with R

    CERN Document Server

    Schwarzer, Guido; Rücker, Gerta

    2015-01-01

    This book provides a comprehensive introduction to performing meta-analysis using the statistical software R. It is intended for quantitative researchers and students in the medical and social sciences who wish to learn how to perform meta-analysis with R. As such, the book introduces the key concepts and models used in meta-analysis. It also includes chapters on the following advanced topics: publication bias and small study effects; missing data; multivariate meta-analysis, network meta-analysis; and meta-analysis of diagnostic studies.  .

  20. Combined use of electroconvulsive therapy and antipsychotics (both clozapine and non-clozapine in treatment resistant schizophrenia: A comparative meta-analysis

    Directory of Open Access Journals (Sweden)

    Saeed Ahmed

    2017-11-01

    Full Text Available Aim: To assess the relative efficacies of clozapine plus Electroconvulsive Therapy (ECT compared against non-clozapine typical and atypical antipsychotics plus ECT for the treatment of “Treatment Resistant Schizophrenia” (TRS. Primarily to assess if clozapine delivers a significant improvement over other antipsychotics when combined with ECT. Design: Major electronic databases were searched between 1990 and March 2017 for trials measuring the effects of either clozapine augmented ECT, other antipsychotic-augmented ECT, or both. After the systematic review of the data, a random-effects meta-analysis was conducted measuring the relative effect sizes of the different treatment regimens. Subjects: 1179 patients in 23 studies reporting the usage of ECT augmentation with antipsychotics. A total of 95 patients were tested with clozapine, and ECT (9 studies and 1084 patients were tested with non-clozapine antipsychotics (14 studies such as flupenthixol, chlorpromazine, risperidone, sulpiride, olanzapine, and loxapine with concurrent ECT treatment considered for systematic review. Of these, 13 studies reported pre and post-treatment scores were included in the meta-analysis. Main outcome measures: The main outcome measure was the presence and degree of both positive and negative psychotic symptoms, as measured by either of two standardized clinician administered tests, the Brief Psychiatric Rating Scale (BPRS, and the Positive and Negative Symptom Scale (PANSS. Results: The comparison of the different antipsychotics established the supremacy of ECT-augmented clozapine treatment against other typical and atypical antipsychotics. The Forest Plot revealed that the overall standard mean difference was 0.891 for non-clozapine studies and 1.504 for clozapine studies, at a 95% interval. Furthermore, the heterogeneity plots showed that while clozapine studies showed no significant heterogeneity, non-clozapine studies showed an I2 statistic value at 42

  1. Optimal duration of combined psychotherapy and pharmacotherapy for patients with moderate and severe depression: A meta-analysis

    DEFF Research Database (Denmark)

    Møldrup, Claus; Østergaard, Svetlana

    2011-01-01

    Background: To investigate the most effective duration of combined psychotherapy and pharmacotherapy for achieving remission and preventing relapse in depressive patients compared to pharmacotherapy alone. Methods: A systematic review of English articles using PubMed, EMBASE, Web of Science...... demonstrated a higher risk for relapse compared to those receiving combined treatment. Limitations: we restricted our search to only English language publications. Studies investigating relapse or recurrence rates are often of small size. Conclusion: Pharmacotherapy enhanced with psychotherapy is associated...

  2. Comparison of palbociclib in combination with letrozole or fulvestrant with endocrine therapies for advanced/metastatic breast cancer: network meta-analysis.

    Science.gov (United States)

    Chirila, Costel; Mitra, Debanjali; Colosia, Ann; Ling, Caroline; Odom, Dawn; Iyer, Shrividya; Kaye, James A

    2017-08-01

    Palbociclib is the first cyclin-dependent kinase 4/6 inhibitor approved in the United States for HR+/HER2- advanced/metastatic breast cancer, in combination with letrozole as initial endocrine-based therapy in postmenopausal women or with fulvestrant in women with disease progression following endocrine therapy. We compared progression-free survival (PFS) and discontinuations due to adverse events for palbociclib combinations against other endocrine therapies using a mixed-treatment comparison meta-analysis of randomized, controlled trials. A systematic literature review identified relevant trials. Separate analyses were conducted for each palbociclib combination using a Bayesian approach. Treatment rankings were established using the surface under the cumulative ranking curve (SUCRA). Sixty-five unique studies met inclusion criteria. Palbociclib plus letrozole had the highest SUCRA value (99.9%) and was associated with significantly longer PFS than all comparators in treatment-naïve patients (hazard ratios [HRs] ranged from 0.41 to 0.58). Palbociclib plus fulvestrant had the second highest SUCRA value (93.9%) and, in previously treated patients, yielded significantly longer PFS than most comparators (HRs ranged from 0.26 to 0.46); the exception was everolimus plus exemestane, with similar PFS (HR, 1.04; 95% credible interval [CrI], 0.58-1.76). Palbociclib plus fulvestrant was associated with significantly lower odds of discontinuation due to adverse events than everolimus plus exemestane (odds ratio, 0.14; 95% CrI, 0.05-0.39). The results suggest that the two palbociclib combinations yielded significantly greater PFS than endocrine therapy in treatment-naïve and previously treated patients with advanced/metastatic breast cancer. Palbociclib plus fulvestrant was associated with significantly less toxicity than everolimus plus exemestane.

  3. Manual therapy, exercise therapy or combined treatment in the management of adult neck pain - A systematic review and meta-analysis.

    Science.gov (United States)

    Fredin, Ken; Lorås, Håvard

    2017-10-01

    Neck pain is a common and often disabling musculoskeletal condition. Two therapies frequently prescribed for its management are manual therapy (MT) and exercise therapy (ET), and combining these treatment approaches are common. To assess whether or not combined treatment consisting of MT and ET is more effective than either therapy alone in relieving pain and improving function in adult patients with grade I-II neck pain. Systematic review with meta-analysis. A systematic search on EMBASE, MEDLINE, AMED, CENTRAL and PEDro were performed until June 2017. Randomized controlled trials with adult grade I-II neck pain patients were included if they investigated the combined effect of MT and ET to the same ET or MT alone, and reported pain intensity or disability on numerical scales. Quality of life was assessed as a secondary outcome. Quality of the included trials was assessed with the PEDro scale, and the quality of evidence was assessed with GRADE. 1169 articles were screened, and 7 studies were included, all of which investigated the addition of ET to MT. Only very small and non-significant between group differences was found on pain intensity at rest, neck disability, and quality of life at immediate post-treatment, 6 months, and 12 months follow-up. The quality of evidence was moderate for pain-at-rest outcomes and moderate too low for neck disability and quality of life outcomes. Combined treatment consisting of MT and ET does not seem to be more effective in reducing neck pain intensity at rest, neck disability or improving quality of life in adult patients with grade I-II neck pain, than ET alone. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis.

    Science.gov (United States)

    Peng, Le; Zhang, Chao; Zhou, Lan; Zuo, Hong-Xia; He, Xiao-Kuo; Niu, Yu-Ming

    2018-04-01

    To investigate the effectiveness of traditional manual acupuncture combined with rehabilitation therapy versus rehabilitation therapy alone for shoulder hand syndrome after stroke. PubMed, EMBASE, the Cochrane Library, Chinese Biomedicine Database, China National Knowledge Infrastructure, VIP Information Database, Wan Fang Database and reference lists of the eligible studies were searched up to July 2017 for relevant studies. Randomized controlled trials that compared the combined effects of traditional manual acupuncture and rehabilitation therapy to rehabilitation therapy alone for shoulder hand syndrome after stroke were included. Two reviewers independently screened the searched records, extracted the data and assessed risk of bias of the included studies. The treatment effect sizes were pooled in a meta-analysis using RevMan 5.3 software. A total of 20 studies involving 1918 participants were included in this study. Compared to rehabilitation therapy alone, the combined therapy significantly reduced pain on the visual analogue scale and improved limb movement on the Fugl-Meyer Assessment scale and the performance of activities of daily living (ADL) on the Barthel Index scale or Modified Barthel Index scale. Of these, the visual analogue scale score changes were significantly higher (mean difference = 1.49, 95% confidence interval = 1.15-1.82, P < 0.00001) favoring the combined therapy after treatment, with severe heterogeneity ( I 2  = 71%, P = 0.0005). Current evidence suggests that traditional manual acupuncture integrated with rehabilitation therapy is more effective in alleviating pain, improving limb movement and ADL. However, considering the relatively low quality of available evidence, further rigorously designed and large-scale randomized controlled trials are needed to confirm the results.

  5. The role of solifenacin, as monotherapy or combination with tamsulosin in ureteral stent-related symptoms: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Jue; Zhang, Xiaobei; Zhang, Tiande; Mu, Jianjun; Bai, Bing; Lei, Yi

    2017-11-01

    Ureteral stenting is associated with various morbidity and reduced quality of life. We systematically evaluated the efficacy and safety of solifenacin as monotherapy, or combined therapy with tamsulosin versus control or tamsulosin monotherapy in stent-related symptoms (SRSs). Randomized controlled trials evaluating solifenacin or its combination with tamsulosin for the treatment of SRSs were identified via a comprehensive search of Pubmed, Embase, Ovid, The Cochrane Library and relevant sources up to February 2017. Ureteral stent symptom questionnaire (USSQ) and drug-related complications were pooled for meta-analysis. Mean difference and risk difference were calculated as appropriate for each outcome to determine the cumulative effect size. There were 10 studies involving 1786 participants finally eligible in the quantitative analysis. Solifenacin monotherapy significantly reduced the total score of USSQ [MD -14.90; 95% CI (-25.19, -4.60); P = 0.005], as well as indexes of urinary symptoms, body pain, general health, sexual performance, and hematuria (P = 0.02, P = 0.009, P = 0.004, P = 0.02, P = 0.02, respectively), but the differences were insignificant when compared with tamsulosin except improved sexual performance (P = 0.004). Combined therapy of solifenacin and tamsulosin showed no beneficial effects in all indexes of USSQ over solifenacin monotherapy. Only slightly higher incidence of dry mouth (P = 0.02) was found with solifenacin versus control. The result demonstrates the safety and efficacy of solifenacin in reducing SRSs, but no significant advantage was found over tamsulosin. In addition, combination of solifenacin and tamsulosin did not show beneficial effects over solifenacin monotherapy. More high quality trials are warranted to further address this issue, however.

  6. Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis.

    Science.gov (United States)

    Tang, Kai; Si, Jun-Kang; Guo, Da-Dong; Cui, Yan; Du, Yu-Xiang; Pan, Xue-Mei; Bi, Hong-Sheng

    2015-01-01

    To compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV). A systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis. Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All Pcompare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.

  7. Combined application of eicosapentaenoic acid and docosahexaenoic acid on depression in women: a meta-analysis of double-blind randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Yang JR

    2015-08-01

    Full Text Available Jia-run Yang, Dong Han, Zheng-xue Qiao, Xue Tian, Dong Qi, Xiao-hui QiuDepartment of Medical Psychology, Public Health Institute of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of ChinaObjectives: Previous randomized controlled trials (RCTs suggest that depression can be effectively treated by omega-3 polyunsaturated fatty acids (PUFAs. Therefore, we conducted this meta-analysis to systematically evaluate the clinical applicability of the combination of docosahexaenoic acid (DHA and eicosapentaenoic acid (EPA, which are the two major bioactive types of PUFAs, in depressed women.Methods: RCTs that compared the combination of DHA and EPA to placebo for short-course treatment of depression in women were systematically reviewed up to March 2015. Outcome measurement was the standardized difference in means in clinical measure of depression severity. Random effect model was performed. Meta-regression analysis was performed to assess the effects of baseline depression scores.Results: Data were obtained from eight RCTs. In these RCTs, 182 patients received placebo and 185 patients received DHA and EPA. The pooled standardized difference in mean was 0.65 with 95% CI = [0.18, 1.12]. There was no relation between the efficacy and the baseline depression scores. The sensitivity analysis found that the combination of EPA and DHA as monotherapy yielded a standardized difference in means of 0.65 (95% CI =0.41, 0.90 without heterogeneity.Discussion: These results indicate a beneficial effect of the combination of EPA and DHA on depressed mood in women compared with placebo. The clinical applicability of EPA and DHA showed greater promise and should be further explored.Keywords: depression, omega-3 polyunsaturated fatty acids, PUFAs, docosahexaenoic acid, DHA, eicosapentaenoic acid, EPA

  8. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis

    NARCIS (Netherlands)

    Langebeek, Nienke; Gisolf, Elizabeth H.; Reiss, Peter; Vervoort, Sigrid C.; Hafsteinsdóttir, Thóra B.; Richter, Clemens; Sprangers, Mirjam A. G.; Nieuwkerk, Pythia T.

    2014-01-01

    Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of

  9. Combined oral contraceptives, thrombophilia and the risk of venous thromboembolism : a systematic review and meta-analysis

    NARCIS (Netherlands)

    van Vlijmen, E. F. W.; Wiewel-Verschueren, S.; Monster, T. B. M.; Meijer, K.

    Background Combined oral contraceptives (COCs) are associated with an increased risk of venous thromboembolism (VTE), which is shown to be more pronounced in women with hereditary thrombophilia. Currently, WHO recommendations state that COC-use in women with hereditary thrombophilias (antithrombin

  10. Combined effects of aerobic exercise and diet on lipids and lipoproteins in overweight and obese adults: a meta-analysis

    Science.gov (United States)

    This study used the aggregate data meta-analytic approach to determine the combined effects of aerobic exercise and diet on lipids and lipoproteins in overweight and obese adults. Twelve studies representing 859 men and women (443 intervention, 416 control) were included. Using random-effects models...

  11. Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma

    Directory of Open Access Journals (Sweden)

    Nan Jiang

    2018-02-01

    Full Text Available AIM: To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma. METHODS: We performed a systematic search of the related literature in the Cochrane Library, PubMed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction (IOPR% from baseline to end-point, the percentage of number of glaucoma medications reduction from pre- to post-operation, and the secondary efficacy evaluations were performed by odds ratio (OR and 95% confidence interval (CI for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using RevMan software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi2 test and the I2 measure. RESULTS: Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification. CONCLUSION: Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate

  12. Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma.

    Science.gov (United States)

    Jiang, Nan; Zhao, Gui-Qiu; Lin, Jing; Hu, Li-Ting; Che, Cheng-Ye; Wang, Qian; Xu, Qiang; Li, Cui; Zhang, Jie

    2018-01-01

    To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma. We performed a systematic search of the related literature in the Cochrane Library, PubMed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction (IOPR%) from baseline to end-point, the percentage of number of glaucoma medications reduction from pre- to post-operation, and the secondary efficacy evaluations were performed by odds ratio (OR) and 95% confidence interval (CI) for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using RevMan software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi 2 test and the I 2 measure. Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification. Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse

  13. Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis.

    Science.gov (United States)

    Hudson, Joanna L; Bundy, Chris; Coventry, Peter A; Dickens, Chris

    2014-04-01

    Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated. Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r=±0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also. Associations between cognitive illness representations and poor emotional health were in the expected direction - negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. a meta-analysis

    Indian Academy of Sciences (India)

    Chrissa G. Tsiara

    2018-03-13

    Mar 13, 2018 ... a meta-analysis of case–control studies was conducted. Univariate and ...... recent hepatitis C virus: potential benefit for ribavirin use in. HCV/HIV ... C/G polymorphism in breast pathologies and in HIV-infected patients.

  15. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis

    OpenAIRE

    Langebeek, Nienke; Gisolf, Elizabeth H; Reiss, Peter; Vervoort, Sigrid C; Hafsteinsdóttir, Thóra B; Richter, Clemens; Sprangers, Mirjam AG; Nieuwkerk, Pythia T

    2014-01-01

    Background Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adher...

  16. A systematic review and meta-analysis comparing combined intravenous and topical tranexamic acid with intravenous administration alone in THA.

    Directory of Open Access Journals (Sweden)

    Yangbai Sun

    Full Text Available To compare the effectiveness and safety of combined intravenous and topical tranexamic acid with intravenous use alone in THA.The electronic databases MEDLINE, EMBASE, BIOSIS, Cochrane central, and further adapted for Google and Google Scholar internet, last updated on Dec 30, 2016, were searched. Evaluated outcomes included total blood loss, transfusion rate, maximum postoperative Hb drop, and incidence of thromboembolic complications. The standard mean difference (SMD or the relative risk (RR was calculated for continuous or dichotomous data respectively. The quality of the trial was assessed, and meta-analyses were performed with the Cochrane Collaboration's RevMan 5.0 software.Five RCTs with 457 patients were included. Combined TXA administration reduced blood loss (SMD, 1.39; 95%CI, 0.55 to 2.23; P<0.00001, I2 = 94%, hemoglobin decline (SMD, 0.84; 95%CI, 0.13 to 1.54; P = 0.01, I2 = 83% and the need for transfusion (RR, 2.58; 95%CI, 1.59 to 4.18; P = 0.65, I2 = 0% without increasing the rate of thromboembolic complications significantly (RR, 0.83; 95%CI, 0.27 to 2.54; P = 0.81, I2 = 0%.The present study has emphasized that combined TXA administration can effectively reduce blood loss, hemoglobin decline and the need for transfusion without increasing the rate of thromboembolic complications.

  17. Xuebijing Injection Combined with Antibiotics for the Treatment of Spontaneous Bacterial Peritonitis in Liver Cirrhosis: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Dan Han

    2018-01-01

    Full Text Available Background and Aim. Spontaneous bacterial peritonitis (SBP is one of the most common complications of liver cirrhosis. Antibiotics are the main treatment regimen of SBP. Traditional Chinese medicine Xuebijing injection has been used in such patients. Our study aimed to overview the efficacy of Xuebijing injection combined with antibiotics for the treatment of SBP. Method. We searched the PubMed, Embase, China National Knowledge Infrastructure, VIP, and Wanfang databases. The search items included “Xuebijing”, “peritonitis”, “liver cirrhosis”, and “random” to identify all relevant randomized controlled trials (RCTs. The Cochrane risk of bias tool was used to assess the study quality. The odd ratios (ORs with 95% confidence intervals (CIs were calculated by using a random-effect model. Heterogeneity was also calculated. Results. A total of 9 RCTs were included. The study quality was unsatisfied. The overall (OR = 2.95, 95% CI = 1.97–4.42, p<0.00001 and complete (OR = 2.18, 95% CI = 1.57–3.04, p<0.00001 responses were significantly higher in the Xuebijing injection combined with antibiotics group than the antibiotics alone group. The incidence of cirrhosis related complications, including hepatic encephalopathy and hepatorenal syndrome, was lower in the Xuebijing injection combined with antibiotics group than the antibiotics alone group. No significant heterogeneity was observed among studies. Conclusion. Additional use of Xuebijing injection may improve the efficacy of antibiotics for the treatment of SBP in liver cirrhosis. However, due to a low level of current evidence, we did not establish any recommendation regarding the use of Xuebijing injection for the treatment of SBP.

  18. Usefulness of {sup 18}F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: A meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Tang Shuang [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Huang Gang, E-mail: huang2802@163.com [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Liu Jianjun [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Liu Tao [Department of Orthopedics, Soochow University, Suzhou (China); Treven, Lyndal [Faculty of Public Health, University of Sydney, Sydney (Australia); Song Saoli; Zhang Chenpeng; Pan Lingling [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Zhang Ting [Department of Anesthesiology, Renji Hospital, Shanghai (China)

    2011-04-15

    The aim was to evaluate the diagnostic value of {sup 18}F-fluorodeoxyglucose-positron emission tomography ({sup 18}F-FDG PET), combined {sup 18}F-fluorodeoxyglucose-positron emission tomography/computed tomography ({sup 18}F-FDG PET/CT) and endoscopic ultrasonography (EUS) in diagnosing patients with pancreatic carcinoma. MEDLINE, EMBASE, Cochrane library and some other databases, from January 1966 to April 2009, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of {sup 18}F-FDG PET, PET/CT and EUS for patients with pancreatic cancer were collected. Methodological quality was assessed. The statistic software called 'Meta-Disc 1.4' was used for data analysis. Results: 51 studies were included in this meta-analysis. The pooled sensitivity estimate for combined PET/CT (90.1%) was significantly higher than PET (88.4%) and EUS (81.2%). The pooled specificity estimate for EUS (93.2%) was significantly higher than PET (83.1%) and PET/CT (80.1%). The pooled DOR estimate for EUS (49.774) was significantly higher than PET (32.778) and PET/CT (27.105). SROC curves for PET/CT and EUS showed a little better diagnostic accuracy than PET alone. For PET alone, when interpreted the results with knowledge of other imaging tests, its sensitivity (89.4%) and specificity (80.1%) were closer to PET/CT. For EUS, its diagnostic value decreased in differentiating pancreatic cancer for patients with chronic pancreatitis. In conclusion, PET/CT was a high sensitive and EUS was a high specific modality in diagnosing patients with pancreatic cancer. PET/CT and EUS could play different roles during different conditions in diagnosing pancreatic carcinoma.

  19. A meta-analysis of combination therapy versus single-agent therapy in anthracycline- and taxane-pretreated metastatic breast cancer: results from nine randomized Phase III trials

    Directory of Open Access Journals (Sweden)

    Xu L

    2016-07-01

    Full Text Available Liang Xu,1,2,* Xiaobo Wu,3,* Chun Hu,1,2 Zhiying Zhang,4 Le Zhang,1,2 Shujing Liang,1,2 Yingchun Xu,5 Fengchun Zhang1,2 1Department of Oncology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 2Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 3Prevention and Cure Center of Breast Disease, Third Hospital of Nanchang, Nanchang, 4Graduate School, Xuzhou Medical College, Xuzhou, 5Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Nowadays, the philosophy of treating metastatic breast cancer (MBC is slowly evolving. Especially for the anthracycline- and taxane-pretreated MBC patients, no standard therapy exists in this setting. Whether to choose doublet agents or single agent as salvage treatment remains fiercely debated. Thus, we conducted a meta-analysis to resolve this problem. Databases including PubMed, EMBASE, and Cochrane library were searched for Phase III randomized clinical trials (published before August 2015 comparing the efficacy and adverse effects between the combination therapy and single-agent therapy in anthracycline- and taxane-pretreated MBC patients. The primary end point was the overall survival (OS, and the secondary end points were the progression-free survival (PFS, overall response rate (ORR, and grade 3 or 4 toxicities. The pooled hazard ratio (HR and pooled risk ratio (RR were used to evaluate the efficacy. Analyses were also performed to estimate the side effects and safety of both groups. In all, nine eligible randomized clinical trials were included in this meta-analysis. Improvements were proven in the doublet agents group on OS (HR 0.90, 95% confidence interval [CI] 0.84–0.96, P=0.002, PFS (HR 0.81, 95% CI 0.76–0.88, P<0.001, and ORR (RR 1.72, 95% CI 1.34–2.21, P<0.001. Notably, subgroup analysis

  20. Efficacy and Safety of Metronidazole Monotherapy versus Vancomycin Monotherapy or Combination Therapy in Patients with Clostridium difficile Infection: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Rui Li

    Full Text Available Clostridium difficile infection (CDI has become a global epidemiological problem for both hospitalized patients and outpatients. The most commonly used drugs to treat CDI are metronidazole and vancomycin. The aim of this study was to compare the efficacy and safety of metronidazole monotherapy with vancomycin monotherapy and combination therapy in CDI patients.A comprehensive search without publication status or other restrictions was conducted. Studies comparing metronidazole monotherapy with vancomycin monotherapy or combination therapy in patients with CDI were considered eligible. Meta-analysis was performed using the Mantel-Haenszel fixed-effects model, and odds ratios (ORs with 95% confidence intervals (95% CIs were calculated and reported.Of the 1910 records identified, seventeen studies from thirteen articles (n = 2501 patients were included. No statistically significant difference in the rate of clinical cure was found between metronidazole and vancomycin for mild CDI (OR = 0.67, 95% CI (0.45, 1.00, p = 0.05 or between either monotherapy and combination therapy for CDI (OR = 1.07, 95% CI (0.58, 1.96, p = 0.83; however, the rate of clinical cure was lower for metronidazole than for vancomycin for severe CDI (OR = 0.46, 95% CI (0.26, 0.80, p = 0.006. No statistically significant difference in the rate of CDI recurrence was found between metronidazole and vancomycin for mild CDI (OR = 0.99, 95% CI (0.40, 2.45, p = 0.98 or severe CDI (OR = 0.98, 95% CI (0.63, 1.53, p = 0.94 or between either monotherapy and combination therapy for CDI (OR = 0.91, 95% CI (0.66, 1.26, p = 0.56. In addition, there was no significant difference in the rate of adverse events (AEs between metronidazole and vancomycin (OR = 1.18, 95% CI (0.80, 1.74, p = 0.41. In contrast, the rate of AEs was significantly lower for either monotherapy than for combination therapy (OR = 0.30, 95% CI (0.17, 0.51, p < 0.0001.Metronidazole and vancomycin are equally effective for the

  1. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Kwee, Thomas C.; Kwee, Robert M.

    2009-01-01

    The aim of this study was to systematically review and meta-analyze published data on the diagnostic performance of combined 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of primary tumors in patients with cancer of unknown primary (CUP). A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Methodological quality of the included studies was assessed. Reported detection rates, sensitivities and specificities were meta-analyzed. Subgroup analyses were performed if results of individual studies were heterogeneous. The 11 included studies, comprising a total sample size of 433 patients with CUP, had moderate methodological quality. Overall primary tumor detection rate, pooled sensitivity and specificity of FDG-PET/CT were 37%, 84% (95% CI 78-88%) and 84% (95% CI 78-89%), respectively. Sensitivity was heterogeneous across studies (P = 0.0001), whereas specificity was homogeneous across studies (P = 0.2114). Completeness of diagnostic workup before FDG-PET/CT, location of metastases of unknown primary, administration of CT contrast agents, type of FDG-PET/CT images evaluated and way of FDG-PET/CT review did not significantly influence diagnostic performance. In conclusion, FDG-PET/CT can be a useful method for unknown primary tumor detection. Future studies are required to prove the assumed advantage of FDG-PET/CT over FDG-PET alone and to further explore causes of heterogeneity. (orig.)

  2. Pedometer Readings and Self-Reported Walking Distances in a Rural Hutterite Population

    Science.gov (United States)

    Samra, Haifa Abou; Beare, Tianna; Specker, Bonny

    2008-01-01

    Purpose: This study assessed the accuracy with which a rural population reported daily walking distances using a 7-day activity recall questionnaire obtained quarterly compared to pedometer readings. Methods: Study participants were 48 Hutterite men and women aged 11-66 years. Findings: Pedometer-miles quartiles were associated with self-reported…

  3. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis.

    Science.gov (United States)

    Langebeek, Nienke; Gisolf, Elizabeth H; Reiss, Peter; Vervoort, Sigrid C; Hafsteinsdóttir, Thóra B; Richter, Clemens; Sprangers, Mirjam A G; Nieuwkerk, Pythia T

    2014-08-21

    Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the

  4. A process for assessing the feasibility of a network meta-analysis: a case study of everolimus in combination with hormonal therapy versus chemotherapy for advanced breast cancer.

    Science.gov (United States)

    Cope, Shannon; Zhang, Jie; Saletan, Stephen; Smiechowski, Brielan; Jansen, Jeroen P; Schmid, Peter

    2014-06-05

    The aim of this study is to outline a general process for assessing the feasibility of performing a valid network meta-analysis (NMA) of randomized controlled trials (RCTs) to synthesize direct and indirect evidence for alternative treatments for a specific disease population. Several steps to assess the feasibility of an NMA are proposed based on existing recommendations. Next, a case study is used to illustrate this NMA feasibility assessment process in order to compare everolimus in combination with hormonal therapy to alternative chemotherapies in terms of progression-free survival for women with advanced breast cancer. A general process for assessing the feasibility of an NMA is outlined that incorporates explicit steps to visualize the heterogeneity in terms of treatment and outcome characteristics (Part A) as well as the study and patient characteristics (Part B). Additionally, steps are performed to illustrate differences within and across different types of direct comparisons in terms of baseline risk (Part C) and observed treatment effects (Part D) since there is a risk that the treatment effect modifiers identified may not explain the observed heterogeneity or inconsistency in the results due to unexpected, unreported or unmeasured differences. Depending on the data available, alternative approaches are suggested: list assumptions, perform a meta-regression analysis, subgroup analysis, sensitivity analyses, or summarize why an NMA is not feasible. The process outlined to assess the feasibility of an NMA provides a stepwise framework that will help to ensure that the underlying assumptions are systematically explored and that the risks (and benefits) of pooling and indirectly comparing treatment effects from RCTs for a particular research question are transparent.

  5. Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Shao-Bo; Zhang, Yi-Bao; Wang, Sheng-Hong; Zhang, Hua; Liu, Peng; Zhang, Wei; Ma, Jing-Lin; Wang, Jing

    2017-04-01

    To compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture. We searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated. Nine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group. LIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  6. Which are the best Chinese herbal injections combined with XELOX regimen for gastric cancer?: A PRISMA-compliant network meta-analysis.

    Science.gov (United States)

    Zhang, Dan; Wu, Jiarui; Wang, Kaihuan; Duan, Xiaojiao; Liu, Shi; Zhang, Bing

    2018-03-01

    The optimal Chinese herbal injections (CHIs) combined with XELOX regimen for patients with gastric cancer remains elusive. The aim of our network meta-analysis (NMA) is to explore the best options among different CHIs for gastric cancer. PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure Database (CNKI), Wan-fang Database, Cqvip Database (VIP), China Biology Medicine disc (CBMdisc) were searched to identify RCTs which focused on CHIs against gastric cancer. The quality assessment of included randomized controlled trials (RCTs) was conducted by the Cochrane risk of bias tool. Standard pair-wise and Bayesian NMAs were performed to compare the efficacy and safety of different CHIs combined with the XELOX regimen via Stata 13.0 and WinBUGS1.4 software. A total of 2316 records were searched, the network of evidence included 26 eligible RCTs involving 13 types of CHIs and 2154 patients. The results suggested that Shenqifuzheng+ XELOX, Huachansu+ XELOX, Kangai+ XELOX, Javanica oil emulsion+ XELOX, Aidi injection+ XELOX might be the optimal treatment for gastric cancer in improving the performance status than using XELOX regimen single, with odds ratios (OR) and 95% confidence intervals (CIs) of 2.74 (1.24, 6.17), 8.27 (1.74, 42.43), 4.28 (1.80, 10.48), 5.14 (1.87, 16.28), 0.20 (0.090, 0.44). At the aspects of ADRs (adverse reactions), Compound Kushen+ XELOX, Lentinan+ XELOX, Xiaoaiping injection+ XELOX could obviously relieve leukopenia than only receiving XELOX regimen, and their ORs and 95% CIs were 5.62 (1.41, 36.24), 8.16 (2.25, 29.43), 5.69 (1.85, 15.77). Furthermore, Disodium cantharidinate and vitamin B6+ XELOX, Shenqifuzheng+ XELOX, Kangai+ XELOX, Lentinan+ XELOX could obviously relieve the nausea and vomiting than receiving the XELOX regimen alone, with ORs and 95% CIs of 5.29 (1.30, 23.96), 2.50 (1.16, 5.26), 2.42 (1.06, 5.63), 9.04 (3.24, 26.73). Nevertheless, CHIs combined with XELOX regimen did not confer higher better clinical

  7. Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis

    Science.gov (United States)

    Zhou, Xinyu; Cipriani, Andrea; Zhang, Yuqing; Cuijpers, Pim; Hetrick, Sarah E; Weisz, John R; Pu, Juncai; Giovane, Cinzia Del; Furukawa, Toshiaki A; Barth, Jürgen; Coghill, David; Leucht, Stefan; Yang, Lining; Ravindran, Arun V; Xie, Peng

    2017-01-01

    Introduction Depressive disorder is common in children and adolescents, with important consequences and serious impairments in terms of personal and social functioning. While both pharmacological and psychological interventions have been shown to be effective, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank in a network meta-analysis (NMA) the commonly used psychological, pharmacological and combined interventions for depressive disorder in children and adolescents. Methods and analysis We will update the literature search of two previous NMAs for the identification of trials of antidepressant and psychotherapy alone for depressive disorder in children and adolescents. For identification of trials of combination interventions, seven databases (PubMed, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS) will be searched from date of inception. We will also search ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and check relevant reports on the US Food and Drug Administration website for unpublished data. Building on our previous findings in the field, we will include any commonly prescribed oral antidepressants and any manualised or structured psychotherapies, as well as their combinations. Randomised controlled trials assessing any active intervention against active comparator or pill placebo/psychological controls in acute treatment for depressive disorder in children and adolescents will be included. The primary outcomes will be efficacy (mean change in depressive symptoms), and acceptability of treatment (dropout rate due to any cause). The secondary outcomes will be remission rate, tolerability of treatment (dropouts for adverse events), as well as suicide-related outcomes (suicidal behaviour or ideation). We will perform Bayesian NMAs for all relative outcome

  8. Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis.

    Science.gov (United States)

    Zhou, Xinyu; Cipriani, Andrea; Zhang, Yuqing; Cuijpers, Pim; Hetrick, Sarah E; Weisz, John R; Pu, Juncai; Giovane, Cinzia Del; Furukawa, Toshiaki A; Barth, Jürgen; Coghill, David; Leucht, Stefan; Yang, Lining; Ravindran, Arun V; Xie, Peng

    2017-08-11

    Depressive disorder is common in children and adolescents, with important consequences and serious impairments in terms of personal and social functioning. While both pharmacological and psychological interventions have been shown to be effective, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank in a network meta-analysis (NMA) the commonly used psychological, pharmacological and combined interventions for depressive disorder in children and adolescents. We will update the literature search of two previous NMAs for the identification of trials of antidepressant and psychotherapy alone for depressive disorder in children and adolescents. For identification of trials of combination interventions, seven databases (PubMed, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS) will be searched from date of inception. We will also search ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and check relevant reports on the US Food and Drug Administration website for unpublished data. Building on our previous findings in the field, we will include any commonly prescribed oral antidepressants and any manualised or structured psychotherapies, as well as their combinations. Randomised controlled trials assessing any active intervention against active comparator or pill placebo/psychological controls in acute treatment for depressive disorder in children and adolescents will be included. The primary outcomes will be efficacy (mean change in depressive symptoms), and acceptability of treatment (dropout rate due to any cause). The secondary outcomes will be remission rate, tolerability of treatment (dropouts for adverse events), as well as suicide-related outcomes (suicidal behaviour or ideation). We will perform Bayesian NMAs for all relative outcome measures. Subgroup analyses and

  9. Combining risk estimates from observational studies with different exposure cutpoints: a meta-analysis on body mass index and diabetes type 2.

    NARCIS (Netherlands)

    Hartemink, Nienke; Boshuizen, Hendriek C; Nagelkerke, Nico J D; Jacobs, Monique A M; Houwelingen, Hans C van

    2006-01-01

    Studies on a dose-response relation often report separate relative risks for several risk classes compared with a referent class. When performing a meta-analysis of such studies, one has to convert these relative risks into an overall relative risk for a continuous effect. Apart from taking the

  10. Clinical Efficacy of Jinshuibao Capsules Combined with Angiotensin Receptor Blockers in Patients with Early Diabetic Nephropathy: A Meta-Analysis of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Qiang Lu

    2018-01-01

    Full Text Available Background. Jinshuibao capsules (JSB have been widely used to treat early diabetic nephropathy (DN, but the specific effects are still inconsistent. A meta-analysis of randomized controlled trials (RCTs was conducted to evaluate the clinical efficacy of JSB for early DN. Methods. Four international databases and four Chinese databases were searched from publication dates to March 1, 2018. The RCTs reporting the results of JSB’s specific effects were included, and comparisons were between JSB combined with Angiotensin Receptor Blockers (ARBs as experimental intervention and ARBs as the control. Included studies’ quality was evaluated and the extracted data were analyzed with RevMan 5.3 software. Results. Twenty-six RCTs including 2198 early DN participants were adopted in the meta-analysis. The results showed that, compared with the ARBs alone, JSB could remarkably improve the ORR (OR = 3.84; 95% CI: 2.37~6.24; P<0.00001 and decrease 24 h UTP (MD = −93.32; 95% CI: −128.60 ~-58.04; P<0.00001, UAER (MD = −24.02; 95% CI: −30.93 ~-17.11; P<0.00001, BUN (MD = −0.26; 95%: −0.44 ~-0.08; P=0.005, Scr (MD = −9.07; 95% CI: −14.26 ~-3.88; P=0.0006, ACR (MD = −17.55; 95% CI: −22.81 ~-12.29; P<0.00001, Cys-C (MD = −0.60; 95% CI: −0.88 ~-0.32; P<0.00001, SBP (MD = −3.08; 95% CI: −4.65 ~-1.52; P=0.0001, DBP (MD = −2.09; 95% CI: −4.00 ~-0.19; P=0.03, and TG (MD = −0.36; 95% CI: −0.50 ~-0.21; P<0.00001. However, it showed no significant differences in TC (MD = −0.32; 95% CI: −0.69~0.04; P=0.08, FBG (MD = 0.04; 95% CI: −0.39~0.47; P=0.87, HbA1c (MD = −0.26; 95% CI: −0.59~0.06; P=0.11, and β2-MG (MD = −15.61; 95% CI: −32.95~1.73; P=0.08. Conclusions. This study indicates that JSB is an effective accessory therapeutic medicine for patients with early DN. It contributes to decreasing blood pressure and the content of triglyceride and improving the renal function of early DN patients. However, there is still a

  11. Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures.

    Science.gov (United States)

    Cui, Xueliang; Chen, Hui; Rui, Yunfeng; Niu, Yang; Li, He

    2018-01-01

    Objectives Two-stage open reduction and internal fixation (ORIF) and limited internal fixation combined with external fixation (LIFEF) are two widely used methods to treat Pilon injury. However, which method is superior to the other remains controversial. This meta-analysis was performed to quantitatively compare two-stage ORIF and LIFEF and clarify which method is better with respect to postoperative complications in the treatment of tibial Pilon fractures. Methods We conducted a meta-analysis to quantitatively compare the postoperative complications between two-stage ORIF and LIFEF. Eight studies involving 360 fractures in 359 patients were included in the meta-analysis. Results The two-stage ORIF group had a significantly lower risk of superficial infection, nonunion, and bone healing problems than the LIFEF group. However, no significant differences in deep infection, delayed union, malunion, arthritis symptoms, or chronic osteomyelitis were found between the two groups. Conclusion Two-stage ORIF was associated with a lower risk of postoperative complications with respect to superficial infection, nonunion, and bone healing problems than LIFEF for tibial Pilon fractures. Level of evidence 2.

  12. Teaching meta-analysis using MetaLight

    Directory of Open Access Journals (Sweden)

    Thomas James

    2012-10-01

    Full Text Available Abstract Background Meta-analysis is a statistical method for combining the results of primary studies. It is often used in systematic reviews and is increasingly a method and topic that appears in student dissertations. MetaLight is a freely available software application that runs simple meta-analyses and contains specific functionality to facilitate the teaching and learning of meta-analysis. While there are many courses and resources for meta-analysis available and numerous software applications to run meta-analyses, there are few pieces of software which are aimed specifically at helping those teaching and learning meta-analysis. Valuable teaching time can be spent learning the mechanics of a new software application, rather than on the principles and practices of meta-analysis. Findings We discuss ways in which the MetaLight tool can be used to present some of the main issues involved in undertaking and interpreting a meta-analysis. Conclusions While there are many software tools available for conducting meta-analysis, in the context of a teaching programme such software can require expenditure both in terms of money and in terms of the time it takes to learn how to use it. MetaLight was developed specifically as a tool to facilitate the teaching and learning of meta-analysis and we have presented here some of the ways it might be used in a training situation.

  13. Use of meta-analysis to combine candidate gene association studies: application to study the relationship between the ESR PvuII polymorphism and sow litter size

    Directory of Open Access Journals (Sweden)

    Alfonso Leopoldo

    2005-07-01

    Full Text Available Abstract This article investigates the application of meta-analysis on livestock candidate gene effects. The PvuII polymorphism of the ESR gene is used as an example. The association among ESR PvuII alleles with the number of piglets born alive and total born in the first (NBA1, TNB1 and later parities (NBA, TNB is reviewed by conducting a meta-analysis of 15 published studies including 9329 sows. Under a fixed effects model, litter size values were significantly lower in the "AA" genotype groups when compared with "AB" and "BB" homozygotes. Under the random effects model, the results were similar although differences between "AA" and "AB" genotype groups were not clearly significant for NBA and TNB. Nevertheless, the most noticeable result was the high and significant heterogeneity estimated among studies. This heterogeneity could be assigned to error sampling, genotype by environment interaction, linkage or epistasis, as referred to in the literature, but also to the hypothesis of population admixture/stratification. It is concluded that meta-analysis can be considered as a helpful analytical tool to synthesise and discuss livestock candidate gene effects. The main difficulty found was the insufficient information on the standard errors of the estimated genotype effects in several publications. Consequently, the convenience of publishing the standard errors or the concrete P-values instead of the test significance level should be recommended to guarantee the quality of candidate gene effect meta-analyses.

  14. Efficacy and Safety of rh-Endostatin Combined with Chemotherapy 
versus Chemotherapy Alone for Advanced NSCLC: A Meta-analysis Review

    Directory of Open Access Journals (Sweden)

    Jinzhong ZHANG

    2011-05-01

    Full Text Available Background and objective In recent years, there has been a large number of studies and reports about the efficacy and safety of recombinant human endostatin (rh-endostatin, an anti-angiogenic drug, in treatment of advanced lung cancer. Authentic assessment of rh-endostatin treatment in lung cancer is important. The aim of this study is to assess the clinical efficacy and safety of rh-endostatin combined with chemotherapy in the treatment of patients with non-small cell lung cancer (NSCLC. Methods Cochrane systematic review methods were used in the data selection, and data were selected from the Cochrane Library, EMBASE, Medline, SCI, CBM, CNKI, and etc electronic database to get all clinical controlled trials. The retrieval time was March 2010. The objects of these randomized controlled trials were advanced NSCLC patients and in the experimental group was rh-endostatin combination chemotherapy, in the control group was chemotherapy alone to compare the efficacy of two groups. The quality of included trials were evaluated by two reviewers independently. The software RevMan 5.0 was used for meta-analyses. Results Fifteen trials with 1,326 patients were included according to the including criterion. All trials were randomized controlled trials, and two trials were adequate in reporting randomization. Thirteen trials didn’t mention the blinding methods. Meta analysis indicated that the NPE arm (Vinorelbine+cisplatin+rh-endostatin had a different response rate compared with NP (Vinorelbine+cisplatin arm (OR=2.16, 95%CI: 1.57-2.99. The incidences of severe leukopenia (OR=0.94, 95%CI: 0.66-1.32 and severe thrombocytopenia (OR=1.00, 95%CI: 0.64-1.57 and nausea and vomiting (OR=0.85, 95%CI: 0.61-1.20 were similar in the NPE arm compared with those in the NP arm. The NPE plus radiotherapy (RT arm had a similar response rate compared with NP plus RT arm (OR=2.39, 95%CI: 0.99-5.79. The incidences of leukopenia (OR=0.83, 95%CI: 0.35-1.94 and

  15. Combined oral contraceptives and/or antiandrogens versus insulin sensitizers for polycystic ovary syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Luque-Ramírez, Manuel; Nattero-Chávez, Lía; Ortiz Flores, Andrés E; Escobar-Morreale, Héctor F

    2017-12-27

    Androgen excess is a key pathogenetic mechanism in polycystic ovary syndrome (PCOS), although hyperinsulinism also contributes to androgen secretion. Therapeutic approaches for adult patients not seeking fertility include combined oral contraceptives (COC), antiandrogens (AA) and/or insulin sensitizers, although these practices are supported by limited high-quality evidence. We aimed to assess the efficacy and safety of these common treatments for PCOS by conducting a meta-analysis of RCTs with the following review questions: Which is the more appropriate therapeutic approach for hyperandrogenic symptoms, hyperandrogenemia, and ovulatory dysfunction in adult women with PCOS not seeking fertility; What is the impact on classic cardiometabolic risk factors of the more common treatments used in those women; Does the combination of the antiandrogenic therapy plus metformin have any impact on efficacy or cardiometabolic profile? We searched PubMed and EMBASE for articles published up to 16 September 2017. After deleting duplicates, the abstracts of 1522 articles were analysed. We subsequently excluded 1446 articles leaving 76 studies for full-text assessment of eligibility. Of them, 43 articles were excluded. Hence, 33 studies and 1521 women were included in the quantitative synthesis and in the meta-analyses. Meta-analyses calculated mean differences (MD), standardized mean differences (SMD), odds ratio (OR) and 95% CIs. Heterogeneity and inconsistency across studies was assessed by χ2 test and Higgins's I2 statistics. Quality and risk of bias of individual studies were assessed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. We then used the approach recommended by the Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) group to indicate the global quality of evidence for a selection of primary outcomes. Regarding efficacy, the MD in hirsutism score between COC and/or AA and metformin were not significant

  16. An overview of meta-analysis for clinicians.

    Science.gov (United States)

    Lee, Young Ho

    2018-03-01

    The number of medical studies being published is increasing exponentially, and clinicians must routinely process large amounts of new information. Moreover, the results of individual studies are often insufficient to provide confident answers, as their results are not consistently reproducible. A meta-analysis is a statistical method for combining the results of different studies on the same topic and it may resolve conflicts among studies. Meta-analysis is being used increasingly and plays an important role in medical research. This review introduces the basic concepts, steps, advantages, and caveats of meta-analysis, to help clinicians understand it in clinical practice and research. A major advantage of a meta-analysis is that it produces a precise estimate of the effect size, with considerably increased statistical power, which is important when the power of the primary study is limited because of a small sample size. A meta-analysis may yield conclusive results when individual studies are inconclusive. Furthermore, meta-analyses investigate the source of variation and different effects among subgroups. In summary, a meta-analysis is an objective, quantitative method that provides less biased estimates on a specific topic. Understanding how to conduct a meta-analysis aids clinicians in the process of making clinical decisions.

  17. An overview of meta-analysis for clinicians

    Science.gov (United States)

    Lee, Young Ho

    2018-01-01

    The number of medical studies being published is increasing exponentially, and clinicians must routinely process large amounts of new information. Moreover, the results of individual studies are often insufficient to provide confident answers, as their results are not consistently reproducible. A meta-analysis is a statistical method for combining the results of different studies on the same topic and it may resolve conflicts among studies. Meta-analysis is being used increasingly and plays an important role in medical research. This review introduces the basic concepts, steps, advantages, and caveats of meta-analysis, to help clinicians understand it in clinical practice and research. A major advantage of a meta-analysis is that it produces a precise estimate of the effect size, with considerably increased statistical power, which is important when the power of the primary study is limited because of a small sample size. A meta-analysis may yield conclusive results when individual studies are inconclusive. Furthermore, meta-analyses investigate the source of variation and different effects among subgroups. In summary, a meta-analysis is an objective, quantitative method that provides less biased estimates on a specific topic. Understanding how to conduct a meta-analysis aids clinicians in the process of making clinical decisions. PMID:29277096

  18. The Safety and Efficacy of Laparoscopic Common Bile Duct Exploration Combined with Cholecystectomy for the Management of Cholecysto-choledocholithiasis: An Up-to-date Meta-analysis.

    Science.gov (United States)

    Pan, Long; Chen, Mingyu; Ji, Lin; Zheng, Longbo; Yan, Peijian; Fang, Jing; Zhang, Bin; Cai, Xiujun

    2018-03-12

    The aim of this study was to compare the efficacy and safety of the laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) with preoperative endoscopic sphincterotomy (pre-EST) and LC for concomitant gallstones and common bile duct (CBD) stones. It remains controversial whether LCBDE+LC is better than pre-EST+LC for gallstones and CBD stones. A specific search of online databases was performed from January 2006 to October 2017. Relative outcomes of perioperative safety and postoperative efficacy were synthesized. Single-arm meta-analysis and cumulative meta-analysis were also conducted. A total of 13 studies involving 1757 (872 vs 885) patients were included for analysis in our study. The CBD stones clearance rate [94.1% vs 90.1%; odds ratio (OR) 1.56, P = 0.012] was significantly higher in patients who underwent LCBDE+LC than pre-EST+LC, while perioperative complications (7.6% vs 12.0%; OR 0.67, P = 0.015), conversion to other procedure (4.1% vs 7.1%; OR 0.64, P = 0.025), retained stones rate (1.2% vs 7.9%; OR 0.34, P = 0.004), lithiasis recurrence rate (1.8% vs 5.6%, OR 0.32, P = 0.005), operative time [112.28 vs 132.03 minutes; weighted mean difference (WMD) -18.08, P = 0.002], length of hospital stay (4.94 vs 6.62 days; WMD -1.63, P = 0.023), and total charges [standardized mean difference (SMD) -2.76, P = 0.002] were significantly lower in LCBDE+LC. The mortality (0.6% vs 1.1%; OR 0.32, P = 0.117) was similar between the 2 groups. The cumulative meta-analyses indicated the effect sizes of CBD stones clearance rate, perioperative complications, and conversion to other procedure have already stabilized between 2 groups. The updated meta-analysis first confirms that LCBDE+LC is superior to pre-EST+LC both in perioperative safety and short- and long-term postoperative efficacy, which should be considered as optimal treatment choice for cholecysto-choledocholithiasis.

  19. Cognitive-Behavioural Analysis System of Psychotherapy (CBASP), a drug, or their combination: differential therapeutics for persistent depressive disorder: a study protocol of an individual participant data network meta-analysis

    Science.gov (United States)

    Schramm, Elisabeth; Weitz, Erica S; Salanti, Georgia; Efthimiou, Orestis; Michalak, Johannes; Watanabe, Norio; Keller, Martin B; Kocsis, James H; Klein, Daniel N; Cuijpers, Pim

    2016-01-01

    Introduction Despite important advances in psychological and pharmacological treatments of persistent depressive disorders in the past decades, their responses remain typically slow and poor, and differential responses among different modalities of treatments or their combinations are not well understood. Cognitive-Behavioural Analysis System of Psychotherapy (CBASP) is the only psychotherapy that has been specifically designed for chronic depression and has been examined in an increasing number of trials against medications, alone or in combination. When several treatment alternatives are available for a certain condition, network meta-analysis (NMA) provides a powerful tool to examine their relative efficacy by combining all direct and indirect comparisons. Individual participant data (IPD) meta-analysis enables exploration of impacts of individual characteristics that lead to a differentiated approach matching treatments to specific subgroups of patients. Methods and analysis We will search for all randomised controlled trials that compared CBASP, pharmacotherapy or their combination, in the treatment of patients with persistent depressive disorder, in Cochrane CENTRAL, PUBMED, SCOPUS and PsycINFO, supplemented by personal contacts. Individual participant data will be sought from the principal investigators of all the identified trials. Our primary outcomes are depression severity as measured on a continuous observer-rated scale for depression, and dropouts for any reason as a proxy measure of overall treatment acceptability. We will conduct a one-step IPD-NMA to compare CBASP, medications and their combinations, and also carry out a meta-regression to identify their prognostic factors and effect moderators. The model will be fitted in OpenBUGS, using vague priors for all location parameters. For the heterogeneity we will use a half-normal prior on the SD. Ethics and dissemination This study requires no ethical approval. We will publish the findings in a peer

  20. Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Hyun Jung Kim

    Full Text Available There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH/lower urinary tract symptoms (LUTS.The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis.We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS, maximal urinary flow rate (Qmax, post-voided residual volume (PVR, and quality of life (QoL.In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls. The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08. The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 - -0.17. The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 - -0.07, 0.00 (95% CI: -0.08-0.08, and 0.56 (95% CI: 0.23-0.89, respectively. There was no significant difference in the number of acute urinary retention (AUR events or PVR.Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/ LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.

  1. Live Attenuated Versus Inactivated Influenza Vaccine in Hutterite Children: A Cluster Randomized Blinded Trial.

    Science.gov (United States)

    Loeb, Mark; Russell, Margaret L; Manning, Vanessa; Fonseca, Kevin; Earn, David J D; Horsman, Gregory; Chokani, Khami; Vooght, Mark; Babiuk, Lorne; Schwartz, Lisa; Neupane, Binod; Singh, Pardeep; Walter, Stephen D; Pullenayegum, Eleanor

    2016-11-01

    Whether vaccinating children with intranasal live attenuated influenza vaccine (LAIV) is more effective than inactivated influenza vaccine (IIV) in providing both direct protection in vaccinated persons and herd protection in unvaccinated persons is uncertain. Hutterite colonies, where members live in close-knit, small rural communities in which influenza virus infection regularly occurs, offer an opportunity to address this question. To determine whether vaccinating children and adolescents with LAIV provides better community protection than IIV. A cluster randomized blinded trial conducted between October 2012 and May 2015 over 3 influenza seasons. (ClinicalTrials.gov: NCT01653015). 52 Hutterite colonies in Alberta and Saskatchewan, Canada. 1186 Canadian children and adolescents aged 36 months to 15 years who received the study vaccine and 3425 community members who did not. Children were randomly assigned according to community in a blinded manner to receive standard dosing of either trivalent LAIV or trivalent IIV. The primary outcome was reverse transcriptase polymerase chain reaction-confirmed influenza A or B virus in all participants (vaccinated children and persons who did not receive the study vaccine). Mean vaccine coverage among children in the LAIV group was 76.9% versus 72.3% in the IIV group. Influenza virus infection occurred at a rate of 5.3% (295 of 5560 person-years) in the LAIV group versus 5.2% (304 of 5810 person-years) in the IIV group. The hazard ratio comparing LAIV with IIV for influenza A or B virus was 1.03 (95% CI, 0.85 to 1.24). The study was conducted in Hutterite communities, which may limit generalizability. Immunizing children with LAIV does not provide better community protection against influenza than IIV. The Canadian Institutes for Health Research.

  2. Low twinning rate and seasonal effects on twinning in a fertile population, the Hutterites

    Science.gov (United States)

    Nonaka, K.; Miura, T.; Peter, K.

    1993-09-01

    This paper analyzes from the mid 18th century to 1987 the birth records of the “Dariusleut,” one of the three subgroups of the Hutterite population. The aim of this study is to describe several aspects of the twinning rate in a fertile population. The overall rate of twinning was 0.90%:103 twins among all 11492 maternities. The rate peaked at the 7th birth order and at the maternal age of 40 years and over. Until the mid 19th century when the Hutterites lived in Russia, the twinning rate was higher (1.5%), and it decreased during the migration period in the second half of the 19th century (0.7%). After the group had settled in the USA and Canada, the population maintained a twinning rate of 1.0% until 1965. After 1965 the rate decreased to 0.7%, partly due to a decline in fertility among women aged 30 years and over. There was a significant seasonal variation: the twinning rate decreased to 0.5% in May July compared to 1.2% for the other three seasons during the years up to 1965 ( P<0.01), while more recent mothers did not show such a seasonal variation. The incidence of twin births in this population seems to have been influenced by environmental factors, which would change their effect seasonally and secularly.

  3. Systematic review and network meta-analysis of combination and monotherapy treatments in disease-modifying antirheumatic drug-experienced patients with rheumatoid arthritis: analysis of American College of Rheumatology criteria scores 20, 50, and 70

    Science.gov (United States)

    Orme, Michelle E; MacGilchrist, Katherine S; Mitchell, Stephen; Spurden, Dean; Bird, Alex

    2012-01-01

    Background Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with suboptimal response or intolerance to conventional DMARDs. The objective of this systematic review and meta-analysis was to compare the relative efficacy of EU-licensed bDMARD combination therapy or monotherapy for patients intolerant of or contraindicated to continued methotrexate. Methods Comprehensive, structured literature searches were conducted in Medline, Embase, and the Cochrane Library, as well as hand-searching of conference proceedings and reference lists. Phase II or III randomized controlled trials reporting American College of Rheumatology (ACR) criteria scores of 20, 50, and 70 between 12 and 30 weeks’ follow-up and enrolling adult patients meeting ACR classification criteria for rheumatoid arthritis previously treated with and with an inadequate response to conventional DMARDs were eligible. To estimate the relative efficacy of treatments whilst preserving the randomized comparisons within each trial, a Bayesian network meta-analysis was conducted in WinBUGS using fixed and random-effects, logit-link models fitted to the binomial ACR 20/50/70 trial data. Results The systematic review identified 10,625 citations, and after a review of 2450 full-text papers, there were 29 and 14 eligible studies for the combination and monotherapy meta-analyses, respectively. In the combination analysis, all licensed bDMARD combinations had significantly higher odds of ACR 20/50/70 compared to DMARDs alone, except for the rituximab comparison, which did not reach significance for the ACR 70 outcome (based on the 95% credible interval). The etanercept combination was significantly better than the tumor necrosis factor-α inhibitors adalimumab and infliximab in improving ACR 20/50/70 outcomes, with no significant differences between the etanercept combination and certolizumab pegol or tocilizumab. Licensed-dose etanercept, adalimumab

  4. A network meta-analysis to compare simeprevir with boceprevir and telaprevir in combination with peginterferon-α and ribavirin in patients infected with genotype 1 Hepatitis C virus.

    Science.gov (United States)

    Taieb, Vanessa; Pacou, Maud; Ho, Sophia; Pettré, Ségolène; Van Sanden, Suzy; Pisini, Marta; Ustianowski, Andrew; Mehnert, Angelika

    2015-01-01

    To conduct a network meta-analysis (NMA) to assess the relative efficacy and safety of simeprevir, a second generation oral protease inhibitor (PI), compared to telaprevir and boceprevir in combination with pegylated interferon-α and ribavirin (PR) in patients with chronic hepatitis C. A systematic literature review and NMA of randomized controlled trials involving anti-virals added to PR were conducted. Electronic database searches and hand searches were conducted to identify relevant publications. Outcomes of interest included sustained virologic response (SVR), incidence of adverse events (AEs), and discontinuation due to AEs. Networks were based on treatment-, dose-, and duration-specific nodes. Sub-group analyses were conducted to investigate heterogeneity, based on Metavir scores, sub-genotypes 1a/1b, and prior response. A total of 15 publications were considered for the base case of the meta-analysis. Simeprevir was associated with higher SVR rates than PR alone. Compared to telaprevir and boceprevir, SVR rates tended to be higher for simeprevir, with odds ratios ranging from 1.27 [0.81-2.00] to 2.61 [1.44-4.74] in treatment-naïve and from 1.04 [0.78-1.38] to 1.74 [0.84-3.61] in treatment-experienced patients, respectively. In terms of safety, the risks of anemia and discontinuations due to AEs were lower for simeprevir compared to PR alone, telaprevir, and boceprevir. The risk of rash was lower for simeprevir compared to telaprevir, and similar compared to PR alone and boceprevir. This NMA in genotype 1 HCV patients suggests a similar or better efficacy and tolerability profile for simeprevir compared to telaprevir and boceprevir.

  5. Hydropower externalities: a meta analysis

    NARCIS (Netherlands)

    Mattmann, M.; Logar, I.; Brouwer, R.

    2016-01-01

    This paper presents a meta-analysis of existing research related to the economic valuation of the external effects of hydropower. A database consisting of 81 observations derived from 29 studies valuing the non-market impacts of hydropower electricity generation is constructed with the main aim to

  6. Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys.

    Science.gov (United States)

    Semlyen, Joanna; King, Michael; Varney, Justin; Hagger-Johnson, Gareth

    2016-03-24

    Previous studies have indicated increased risk of mental disorder symptoms, suicide and substance misuse in lesbian, gay and bisexual (LGB) adults, compared to heterosexual adults. Our aims were to determine an estimate of the association between sexual orientation identity and poor mental health and wellbeing among adults from 12 population surveys in the UK, and to consider whether effects differed for specific subgroups of the population. Individual data were pooled from the British Cohort Study 2012, Health Survey for England 2011, 2012 and 2013, Scottish Health Survey 2008 to 2013, Longitudinal Study of Young People in England 2009/10 and Understanding Society 2011/12. Individual participant meta-analysis was used to pool estimates from each study, allowing for between-study variation. Of 94,818 participants, 1.1 % identified as lesbian/gay, 0.9 % as bisexual, 0.8 % as 'other' and 97.2 % as heterosexual. Adjusting for a range of covariates, adults who identified as lesbian/gay had higher prevalence of common mental disorder when compared to heterosexuals, but the association was different in different age groups: apparent for those under 35 (OR = 1.78, 95 % CI 1.40, 2.26), weaker at age 35-54.9 (OR = 1.42, 95 % CI 1.10, 1.84), but strongest at age 55+ (OR = 2.06, 95 % CI 1.29, 3.31). These effects were stronger for bisexual adults, similar for those identifying as 'other', and similar for 'low wellbeing'. In the UK, LGB adults have higher prevalence of poor mental health and low wellbeing when compared to heterosexuals, particularly younger and older LGB adults. Sexual orientation identity should be measured routinely in all health studies and in administrative data in the UK in order to influence national and local policy development and service delivery. These results reiterate the need for local government, NHS providers and public health policy makers to consider how to address inequalities in mental health among these minority groups.

  7. Comparison of prophylactic effect of UGIB and effects on platelet function between PPIs and H2RAs combined with DAPT: systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Yi Z

    2017-03-01

    inhibitors, histamine-2 receptor antagonists, dual-antiplatelet therapy, upper gastrointestinal bleeding, platelet function, meta-analysis

  8. Abiraterone acetate/androgen deprivation therapy combination versus docetaxel/androgen deprivation therapy combination in advanced hormone-sensitive prostate cancer: a network meta-analysis on safety and efficacy.

    Science.gov (United States)

    Kassem, Loay; Shohdy, Kyrillus S; Abdel-Rahman, Omar

    2018-05-01

    A major, yet precisely studied, shift has occurred in the treatment of advanced hormone-sensitive prostate cancer (HSPC) by the addition of docetaxel to androgen deprivation therapy (ADT) in the first line. Recently, two landmark trials showed that abiraterone acetate (AA) can be an effective alternative along with ADT in the same setting. We implemented a network meta-analysis to compare the safety and efficacy of the two combinations. PubMed database, ASCO and ESMO meeting library databases of all results published until June 2017 were searched using the keywords: "prostate cancer" AND "docetaxel" OR "abiraterone acetate". Efficacy endpoints including progression-free survival (PFS) and overall survival (OS), and safety endpoints (including treatment related deaths and selected adverse events) were assessed. Twenty relevant studies were retrieved and assessed for eligibility. Of those trials, eight were found potentially eligible. Inconsistent reporting of efficacy outcomes limited our analysis to M1 HSPC. The pooled hazard ratios (HRs) of OS and PFS of the direct comparison of abiraterone acetate plus ADT versus ADT were 0.63 (95% CI: 0.545-0.717) and 0.38 (95% CI: 0.34-0.43), respectively. Meanwhile, in the trials of docetaxel plus ADT the pooled HRs of OS and PFS were 0.75 (95% CI: 0.65-0.86) and 0.634 (95% CI: 0.57-0.70), respectively. The indirect comparison showed that the HRs of OS and PFS in DOC + ADT in comparison to AA + ADT were 1.2 (95% CI: 0.98-1.46) and 1.65 (1.40-1.94), respectively. The pooled RR of treatment-related mortality in docetaxel + ADT versus AA + ADT was 1.438 (95% CI: 0.508-4.075). Patients with metastatic HSPC (mHSPC) who received abiraterone acetate with ADT had better PFS and less toxicity compared to those receiving docetaxel with ADT. A trend towards superior OS and fewer treatment-related deaths was also observed, but was statistically non-significant. In view of lacking clear OS advantage, the choice between

  9. Causal Meta-Analysis : Methodology and Applications

    NARCIS (Netherlands)

    Bax, L.J.

    2009-01-01

    Meta-analysis is a statistical method to summarize research data from multiple studies in a quantitative manner. This dissertation addresses a number of methodological topics in causal meta-analysis and reports the development and validation of meta-analysis software. In the first (methodological)

  10. Meta-analysis in plant pathology: synthesizing research results.

    Science.gov (United States)

    Rosenberg, M S; Garrett, K A; Su, Z; Bowden, R L

    2004-09-01

    ABSTRACT Meta-analysis is a set of statistical procedures for synthesizing research results from a number of different studies. An estimate of a statistical effect, such as the difference in disease severity for plants with or without a management treatment, is collected from each study along with a measure of the variance of the estimate of the effect. Combining results from different studies will generally result in increased statistical power so that it is easier to detect small effects. Combining results from different studies may also make it possible to compare the size of the effect as a function of other predictor variables such as geographic region or pathogen species. We present a review of the basic methodology for meta-analysis. We also present an example of meta-analysis of the relationship between disease severity and yield loss for foliar wheat diseases, based on data collected from a decade of fungicide and nematicide test results.

  11. Genetic variability of HLA in the Dariusleut Hutterites. A comparative genetic analysis of the Hutterities, the Amish, and other selected Caucasian populations.

    OpenAIRE

    Morgan, K; Holmes, T M; Schlaut, J; Marchuk, L; Kovithavongs, T; Pazderka, F; Dossetor, J B

    1980-01-01

    There are three endogamous subdivisions of the Hutterite population, a North American religious isolate. These individuals live on communal farms, and residence is strictly patrilocal. We report on the distributions of HLA-A and B alleles and haplotypes in 203 married women from one subdivision--the Dariusleut--in Alberta, Canada. We demonstrate that there is significant linkage disequilbrium among a large fraction of the distinct haplotypes in the Dariusleut Hutterite data; there is a restri...

  12. Protocol: Transmission and prevention of influenza in Hutterites: Zoonotic transmission of influenza A: swine & swine workers

    Directory of Open Access Journals (Sweden)

    Loeb Mark

    2009-11-01

    Full Text Available Abstract Background Among swine, reassortment of influenza virus genes from birds, pigs, and humans could generate influenza viruses with pandemic potential. Humans with acute infection might also be a source of infection for swine production units. This article describes the study design and methods being used to assess influenza A transmission between swine workers and pigs. We hypothesize that transmission of swine influenza viruses to humans, transmission of human influenza viruses to swine, and reassortment of human and swine influenza A viruses is occurring. The project is part of a Team Grant; all Team Grant studies include active surveillance for influenza among Hutterite swine farmers in Alberta, Canada. This project also includes non-Hutterite swine farms that are experiencing swine respiratory illness. Methods/Design Nurses conduct active surveillance for influenza-like-illness (ILI, visiting participating communally owned and operated Hutterite swine farms twice weekly. Nasopharyngeal swabs and acute and convalescent sera are obtained from persons with any two such symptoms. Swabs are tested for influenza A and B by a real time RT-PCR (reverse transcriptase polymerase chain reaction at the Alberta Provincial Laboratory for Public Health (ProvLab. Test-positive participants are advised that they have influenza. The occurrence of test-positive swine workers triggers sampling (swabbing, acute and convalescent serology of the swine herd by veterinarians. Specimens obtained from swine are couriered to St. Jude Children's Research Hospital, Memphis, TN for testing. Veterinarians and herd owners are notified if animal specimens are test-positive for influenza. If swine ILI occurs, veterinarians obtain samples from the pigs; test-positives from the animals trigger nurses to obtain specimens (swabbing, acute and convalescent serology from the swine workers. ProvLab cultures influenza virus from human specimens, freezes these cultures and

  13. Rethinking Meta-Analysis: Applications for Air Pollution Data and Beyond

    Science.gov (United States)

    Goodman, Julie E; Petito Boyce, Catherine; Sax, Sonja N; Beyer, Leslie A; Prueitt, Robyn L

    2015-01-01

    Meta-analyses offer a rigorous and transparent systematic framework for synthesizing data that can be used for a wide range of research areas, study designs, and data types. Both the outcome of meta-analyses and the meta-analysis process itself can yield useful insights for answering scientific questions and making policy decisions. Development of the National Ambient Air Quality Standards illustrates many potential applications of meta-analysis. These applications demonstrate the strengths and limitations of meta-analysis, issues that arise in various data realms, how meta-analysis design choices can influence interpretation of results, and how meta-analysis can be used to address bias and heterogeneity. Reviewing available data from a meta-analysis perspective can provide a useful framework and impetus for identifying and refining strategies for future research. Moreover, increased pervasiveness of a meta-analysis mindset—focusing on how the pieces of the research puzzle fit together—would benefit scientific research and data syntheses regardless of whether or not a quantitative meta-analysis is undertaken. While an individual meta-analysis can only synthesize studies addressing the same research question, the results of separate meta-analyses can be combined to address a question encompassing multiple data types. This observation applies to any scientific or policy area where information from a variety of disciplines must be considered to address a broader research question. PMID:25969128

  14. Quality of Life in Autism across the Lifespan: A Meta-Analysis

    Science.gov (United States)

    van Heijst, Barbara F. C.; Geurts, Hilde M.

    2015-01-01

    Autism is a lifelong neurodevelopmental disorder, with a known impact on quality of life. Yet the developmental trajectory of quality of life is not well understood. First, the effect of age on quality of life was studied with a meta-analysis. Our meta-analysis included 10 studies (published between 2004 and 2012) with a combined sample size of…

  15. Multivariate Meta-Analysis Using Individual Participant Data

    Science.gov (United States)

    Riley, R. D.; Price, M. J.; Jackson, D.; Wardle, M.; Gueyffier, F.; Wang, J.; Staessen, J. A.; White, I. R.

    2015-01-01

    When combining results across related studies, a multivariate meta-analysis allows the joint synthesis of correlated effect estimates from multiple outcomes. Joint synthesis can improve efficiency over separate univariate syntheses, may reduce selective outcome reporting biases, and enables joint inferences across the outcomes. A common issue is…

  16. Comprehensive School Reform and Achievement: A Meta-Analysis

    Science.gov (United States)

    Borman, Geoffrey D.; Hewes, Gina M.; Overman, Laura T.; Brown, Shelly

    2003-01-01

    This meta-analysis reviews research on the achievement effects of comprehensive school reform (CSR) and summarizes the specific effects of 29 widely implemented models. There are limitations on the overall quantity and quality of the research base, but the overall effects of CSR appear promising. The combined quantity, quality, and statistical…

  17. Hydropower externalities: A meta-analysis

    International Nuclear Information System (INIS)

    Mattmann, Matteo; Logar, Ivana; Brouwer, Roy

    2016-01-01

    This paper presents a meta-analysis of existing research related to the economic valuation of the external effects of hydropower. A database consisting of 81 observations derived from 29 studies valuing the non-market impacts of hydropower electricity generation is constructed with the main aim to quantify and explain the economic values for positive and negative hydropower externalities. Different meta-regression model specifications are used to test the robustness of significant determinants of non-market values, including different types of hydropower impacts. The explanatory and predictive power of the estimated models is relatively high. Whilst controlling for sample and study characteristics, we find significant evidence for public aversion towards deteriorations of landscape, vegetation and wildlife caused by hydropower projects. There is however only weak evidence of willingness to pay for mitigating these effects. The main positive externality of hydropower generation, the avoidance of greenhouse gas emission, positively influences welfare estimates when combined with the share of hydropower in national energy production. Sensitivity to scope is detected, but not linked to specific externalities or non-market valuation methods. - Highlights: • A global meta-analysis of valuation studies of hydropower externalities is presented. • Positive and negative externalities are distinguished. • Welfare losses due to environmental deteriorations outweigh gains of GHG reductions. • There is only weak evidence of public WTP for mitigating negative externalities. • The non-market values of hydropower externalities are sensitive to scope.

  18. Gametocyte carriage in uncomplicated Plasmodium falciparum malaria following treatment with artemisinin combination therapy: a systematic review and meta-analysis of individual patient data

    NARCIS (Netherlands)

    Abdulla, Salim; Achan, Jane; Adam, Ishag; Alemayehu, Bereket H.; Allan, Richard; Allen, Elizabeth N.; Anvikar, Anupkumar R.; Arinaitwe, Emmanuel; Ashley, Elizabeth A.; Asih, Puji Budi Setia; Awab, Ghulam Rahim; Barnes, Karen I.; Bassat, Quique; Baudin, Elisabeth; Bjorkman, Anders; Bompart, Francois; Bonnet, Maryline; Borrmann, Steffen; Bousema, Teun; Carrara, Verena I.; Cenci, Fabio; Checchi, Francesco; Cot, Michel; Dahal, Prabin; d'Alessandro, Umberto; Deloron, Philippe; Djimde, Abdoulaye; Dondorp, Arjen; Dorsey, Grant; Doumbo, Ogobara K.; Drakeley, Chris J.; Duparc, Stephan; Espie, Emmanuelle; Faiz, Abul; Falade, Catherine O.; Fanello, Caterina; Faucher, Jean-Francois; Faye, Babacar; Filler, Scott; Fofana, Bakary; Fogg, Carole; Gansane, Adama; Gaye, Oumar; Genton, Blaise; Gething, Peter W.; Gonzalez, Raquel; Grandesso, Francesco; Greenwood, Brian; Grivoyannis, Anastasia; Guerin, Philippe J.; Hamed, Kamal; Hatz, Christoph; Hay, Simon I.; Hodel, Eva Maria; Humphreys, Georgina S.; Hwang, Jimee; Janssens, Bart; Jima, Daddi; Juma, Elizabeth; Kachur, S. Patrick; Kager, Piet; Kamya, Moses R.; Kapulu, Melissa; Karema, Corine; Kayentao, Kassoum; Kiechel, Jean R.; Kofoed, Poul-Erik; Lameyre, Valerie; Lee, Sue J.; Lell, Bertrand; Lima, Nines; Marsh, Kevin; Martensson, Andreas; Massougbodji, Achille; Mayxay, Mayfong; McGready, Rose; Menan, Herve; Menendez, Clara; Mens, Petra; Meremikwu, Martin; Mockenhaupt, Frank P.; Moreira, Clarissa; Nabasumba, Carolyn; Nambozi, Michael; Ndiaye, Jean-Louis; Newton, Paul N.; Ngasala, Billy E.; Nosten, Francois; Nsanzabana, Christian; Offianan, Andre Toure; Oguike, Mary; Ogutu, Bernhards R.; Olliaro, Piero; Omar, Sabah A.; Osorio, Lyda; Owusu-Agyei, Seth; Penali, Louis K.; Pene, Mbaye; Peshu, Judy; Piola, Patrice; Premji, Zul; Price, Ric N.; Ramharter, Michael; Rombo, Lars; Roper, Cally; Rosenthal, Philip J.; Sagara, Issaka; Sawa, Patrick; Schallig, Henk D. F. H.; Schramm, Birgit; Shekalaghe, Seif A.; Sibley, Carol H.; Sirima, Sodiomon; Smithuis, Frank; Sow, Doudou; Staedke, Sarah G.; Stepniewska, Kasia; Sutanto, Inge; Sutherland, Colin J.; Swarthout, Todd D.; Syafruddin, Din; Sylla, Khadime; Talisuna, Ambrose O.; Taylor, Walter R.; Temu, Emmanuel A.; ter Kuile, Feiko; Tinto, Halidou; Tjitra, Emiliana; Ursing, Johan; Valecha, Neena; van den Broek, Ingrid; van Herp, Michel; van Vugt, Michele; Ward, Stephen A.; White, Nicholas J.; Winstanley, Peter A.; Woodrow, Charles J.; Yeka, Adoke; Zwang, Julien

    2016-01-01

    Background: Gametocytes are responsible for transmission of malaria from human to mosquito. Artemisinin combination therapy (ACT) reduces post-treatment gametocyte carriage, dependent upon host, parasite and pharmacodynamic factors. The gametocytocidal properties of antimalarial drugs are important

  19. Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: Systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    M.A. Martínez-Vázquez

    2012-04-01

    Conclusions: Antispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations.

  20. Anticonvulsants or Antidepressants in Combination Pharmacotherapy for Treatment of Neuropathic Pain in Cancer Patients: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Guan, Jia; Tanaka, Shiro; Kawakami, Koji

    2016-08-01

    To investigate the efficacy of anticonvulsants or antidepressants in combination pharmacotherapy for treatment of neuropathic pain in cancer patients. We systematically searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the metaRegister of Controlled Trials for randomized controlled trials that compared anticonvulsants or antidepressants in combination pharmacotherapy (experimental group) with treatments without anticonvulsants or antidepressants (control group) for neuropathic pain in cancer patients. Risk of bias was evaluated in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was a mean difference (MD) in change in global pain analyzed by a random-effects model. Eight trials met the inclusion criteria with a total of 1359 participants of whom 698 received an experimental intervention. The MD in change in global pain suggested a favorable association with anticonvulsants or antidepressants in combination pharmacotherapy compared with control groups (MD, -0.41; 95% confidence interval, -0.70 to -0.12) with no heterogeneity across trials (I=0%). The MD in change estimated in all sensitivity analyses ranged from -0.36 to -0.47, suggesting that these effects were consistent across different study designs and statistical assumptions. Anticonvulsants or antidepressants in combination pharmacotherapy reduce neuropathic pain in cancer patients compared with treatments without anticonvulsants or antidepressants. Limited evidence precludes a recommendation on specific adjuvants in combination pharmacotherapy.

  1. Prognosis of Combining Remaining Teeth and Implants in Double-Crown-Retained Removable Dental Prostheses: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Lian, Meifei; Zhao, Kai; Feng, Yunzhi; Yao, Qian

    The reliability of combining natural teeth and implants in one removable prosthesis is controversial. This systematic review was conducted to evaluate the prognosis of combined tooth/implant-supported double-crown-retained removable dental prostheses (DCR-RDPs) and to compare them with solely implant-supported prostheses with a minimum observation period of 3 years. Electronic database (PubMed, Embase, Central, and SCI) and manual searches up to August 2016 were conducted to identify human clinical studies on tooth/implant-supported DCR-RDPs. Literature selection and data extraction were accomplished by two independent reviewers. Meta-analyses of survival and complication rates were performed separately for combined tooth/implant-supported and solely implant-supported DCRRDPs. Among the initially identified 366 articles, 17 were included in a quantitative analysis. The estimated overall cumulative survival rate (CSR) for implants in combined tooth/implant-supported DCRRDPs was 98.72% (95% confidence interval [95% CI]: 96.98% to 99.82%), and that for implants in solely implant-supported DCR-RDPs was 98.83% (95% CI: 97.45% to 99.75%). The summary CSR for abutment teeth was 92.96% (95% CI: 85.38% to 98.12%). Double-crown-retained dentures with both abutment types showed high CSRs, most of which were approximately 100%. Regarding prosthetic maintenance treatment, the estimated incidence for patients treated with combined tooth/implant-supported RDPs was 0.164 (95% CI: 0.089 to 0.305) per patient per year (T/P/Y) and that for patients restored with solely implant-supported RDPs was 0.260 (95% CI: 0.149 to 0.454) T/P/Y. Based on four studies with combined tooth/implant-supported DCR-RDPs, no intrusion phenomena were encountered. Subject to the limitations of the present review, combining remaining teeth and implants in DCR-RDPs is a reliable and predictable treatment modality for partially edentulous patients. Comparable high survival rates and minor biologic or

  2. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis

    NARCIS (Netherlands)

    van Galen, Katy A.; Nellen, Jeannine F.; Nieuwkerk, Pythia T.

    2014-01-01

    Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched

  3. Electronic medication monitoring-informed counseling to improve adherence to combination anti-retroviral therapy and virologic treatment outcomes: a meta-analysis

    NARCIS (Netherlands)

    Langebeek, Nienke; Nieuwkerk, Pythia

    2015-01-01

    Adherence to combination anti-retroviral therapy for HIV infection is a primary determinant of treatment success, but is often suboptimal. Previous studies have suggested that electronic medication monitoring-informed counseling is among the most effective adherence intervention components. Our

  4. Empirical mono- versus combination antibiotic therapy in adult intensive care patients with severe sepsis – A systematic review with meta-analysis and trial sequential analysis

    DEFF Research Database (Denmark)

    Sjövall, Karl Fredrik Lennart; Perner, Anders; Hylander Møller, Morten

    2017-01-01

    assessment and trial sequential analysis (TSA). We included randomised clinical trials (RCT) assessing empirical mono-antibiotic therapy versus a combination of two or more antibiotics in adult ICU patients with severe sepsis. We exclusively assessed patient-important outcomes, including mortality. Two...... reviewers independently evaluated studies for inclusion, extracted data, and assessed risk of bias. Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated and the risk of random errors was assessed by TSA. Results Thirteen RCTs (n = 2633) were included; all were judged as having high risk...... of bias. Carbapenems were the most frequently used mono-antibiotic (8 of 13 trials). There was no difference in mortality (RR 1.11, 95% CI 0.95–1.29; p = 0.19) or in any other patient-important outcomes between mono- vs. combination therapy. In TSA of mortality, the Z-curve reached the futility area...

  5. Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk--a meta-analysis

    DEFF Research Database (Denmark)

    Vestergaard, P; Jørgensen, Niklas R; Mosekilde, L

    2007-01-01

    AIM: The effects of parathyroid hormone (PTH) alone or in combination with antiresorptive therapy on changes in bone mineral density (BMD) and fracture risk were studied. MATERIALS AND METHODS: Randomised placebo controlled trials were retrieved from the PubMed, Web of Science or Embase databases......, nausea and discomfort at the injection sites. Only limited data are currently available on fracture risk reduction with PTH plus antiresorptive therapies. CONCLUSION: Although the number of studies on non-vertebral fractures is limited, our pooled analysis revealed that PTH alone or in combination...... are necessary. No studies comparing PTH, PTH plus antiresorptive drugs and antiresorptive drug versus placebo in a factorial design are available; consequently, we were unable to draw any conclusions on the superiority of PTH plus antiresorptive drug versus antiresorptive drug or PTH alone with respect to BMD...

  6. Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis

    OpenAIRE

    Zhang, Shaobo; Zhang, Yibao; Wang, Shenghong; Zhang, Hua; Liu, Peng; Zhang, Wei; Ma, Jing-Lin; Wang, Jing

    2017-01-01

    Purpose: To compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture. Methods: We searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the ...

  7. The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis.

    Science.gov (United States)

    Antoniak, Anneka Elizabeth; Greig, Carolyn A

    2017-07-20

    In older adults, there is a blunted responsiveness to resistance training and reduced muscle hypertrophy compared with younger adults. There is evidence that both exercise training and vitamin D supplementation may benefit musculoskeletal health in older adults, and it is plausible that in combination their effects may be additive. The aim of this systematic review was to evaluate the effectiveness of combined resistance exercise training and vitamin D 3 supplementation on musculoskeletal health in older adults. A comprehensive search of electronic databases, including Science Direct, Medline, PubMed, Google Scholar and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL accessed by Wiley Science) was conducted. Eligible studies were randomised controlled trials including men and women (aged ≥65 years or mean age ≥65 years); enlisting resistance exercise training and vitamin D 3 supplementation; including outcomes of muscle strength, function, muscle power, body composition, serum vitamin D/calcium status or quality of life comparing results with a control group. The review was informed by a preregistered protocol (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015020157). Seven studies including a total of 792 participants were identified. Studies were categorised into two groups; group 1 compared vitamin D 3 supplementation and exercise training versus exercise alone (describing the additive effect of vitamin D 3 supplementation when combined with resistance exercise training) and group 2 compared vitamin D 3 supplementation and exercise training versus vitamin D 3 supplementation alone (describing the additive effect of resistance exercise training when combined with vitamin D 3 supplementation).Meta-analyses for group 1 found muscle strength of the lower limb to be significantly improved within the intervention group (0.98, 95% CI 0.73 to 1.24, pexercise and vitamin D 3 supplementation for the improvement of muscle strength in

  8. Meta-analysis in microbiology

    Directory of Open Access Journals (Sweden)

    N Pabalan

    2014-01-01

    Full Text Available The use of meta-analysis in microbiology may facilitate decision-making that impacts public health policy. Directed at clinicians and researchers in microbiology, this review outlines the steps in performing this statistical technique, addresses its biases and describes its value in this discipline. The survey to estimate extent of the use of meta-analyses in microbiology shows the remarkable growth in the use of this research methodology, from a minimal Asian output to a level comparable with those of Europe and North America in the last 7 years.

  9. Combined diagnostic performance of coronary computed tomography angiography and computed tomography derived fractional flow reserve for the evaluation of myocardial ischemia: A meta-analysis.

    Science.gov (United States)

    Tan, Xiao Wei; Zheng, Qishi; Shi, Luming; Gao, Fei; Allen, John Carson; Coenen, Adriaan; Baumann, Stefan; Schoepf, U Joseph; Kassab, Ghassan S; Lim, Soo Teik; Wong, Aaron Sung Lung; Tan, Jack Wei Chieh; Yeo, Khung Keong; Chin, Chee Tang; Ho, Kay Woon; Tan, Swee Yaw; Chua, Terrance Siang Jin; Chan, Edwin Shih Yen; Tan, Ru San; Zhong, Liang

    2017-06-01

    To evaluate the combined diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography derived fractional flow reserve (FFRct) in patients with suspected or known coronary artery disease (CAD). PubMed, The Cochrane library, Embase and OpenGray were searched to identify studies comparing diagnostic accuracy of CCTA and FFRct. Diagnostic test measurements of FFRct were either extracted directly from the published papers or calculated from provided information. Bivariate models were conducted to synthesize the diagnostic performance of combined CCTA and FFRct at both "per-vessel" and "per-patient" levels. 7 articles were included for analysis. The combined diagnostic outcomes from "both positive" strategy, i.e. a subject was considered as "positive" only when both CCTA and FFRct were "positive", demonstrated relative high specificity (per-vessel: 0.91; per-patient: 0.81), high positive likelihood ratio (LR+, per-vessel: 7.93; per-patient: 4.26), high negative likelihood ratio (LR-, per-vessel: 0.30; per patient: 0.24) and high accuracy (per-vessel: 0.91; per-patient: 0.81) while "either positive" strategy, i.e. a subject was considered as "positive" when either CCTA or FFRct was "positive", demonstrated relative high sensitivity (per-vessel: 0.97; per-patient: 0.98), low LR+ (per-vessel: 1.50; per-patient: 1.17), low LR- (per-vessel: 0.07; per-patient: 0.09) and low accuracy (per-vessel: 0.57; per-patient: 0.54). "Both positive" strategy showed better diagnostic performance to rule in patients with non-significant stenosis compared to "either positive" strategy, as it efficiently reduces the proportion of testing false positive subjects. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Lamivudine plus adefovir combination therapy versus entecavir monotherapy for lamivudine-resistant chronic hepatitis B: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Hu Peng

    2011-08-01

    Full Text Available Abstract Background Chronic hepatitis B virus (HBV infection represents a serious global health problem and resistance to lamivudine (LAM has become a serious clinical challenge. Previous rescue therapy for the treatment of chronic LAM-resistant hepatitis B infected patients included switching to entecavir (ETV and adding adefovir (ADV or tenofovir (TFV. At present, switching to ETV is not recommended for rescue therapy for LAM-resistant chronic hepatitis B (CHB. The aim of this report was to determine whether add-on ADV was a superior rescue strategy in the treatment of CHB patients with LAM resistance. Methods We searched Medline/PubMed, EMBASE, Web of Knowledge, and the Cochrane Library. Relative risks (RRs of virologic response, virologic breakthrough, normalization of serum alanine aminotransferase (ALT levels and HBeAg seroconversion rates were studied. Factors predicting virologic response, standardized mean differences (SMD in HBV DNA levels and safety were reviewed. Results Six eligible trials (451 patients in total were included in the analysis. The rate of virologic breakthrough in the ETV group was higher than that in the LAM plus ADV group. There were no statistical differences in virologic response, ALT normalization and HBeAg seroconversion in either group 48 weeks post treatment. LAM plus ADV combination therapy produced faster and greater HBV DNA reduction rates 24 weeks post therapy compared to ETV monotherapy. HBV DNA baseline levels and the initial virologic response (IVR were predictive of the virologic response. Additionally, combination therapy or monotherapy were both well tolerated. Conclusions LAM plus ADV combination therapy was more effective and produced longer-lasting effects than switching to ETV monotherapy in treating CHB patients with LAM resistance. However, considering the practical benefits and limitations of ADV, individualized therapy will be needed in patients with prior history of LAM resistant infections.

  11. Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome.

    Science.gov (United States)

    Wewege, Michael A; Thom, Jeanette M; Rye, Kerry-Anne; Parmenter, Belinda J

    2018-05-03

    Exercise is beneficial to individuals with metabolic syndrome (MetS). An understudied group, who represent the majority of the MetS population, are individuals who have not developed diabetes. This review examined aerobic, resistance and combined (aerobic + resistance) exercise for cardiovascular risk factors in MetS without diabetes. Eight electronic databases were searched up to September 2017 for randomised controlled trials >4 weeks in duration that compared an exercise intervention to the non-exercise control in MetS without diabetes. MetS criteria, cardiorespiratory fitness and cardiovascular risk factors were meta-analysed in a random effects model. Eleven studies with 16 interventions were included (12 aerobic, 4 resistance). Aerobic exercise significantly improved waist circumference -3.4 cm (p exercise possibly due to limited data. Sub-analyses suggested that aerobic exercise progressed to vigorous intensity, and conducted 3 days/week for ≥12 weeks offered larger and more widespread improvements. Aerobic exercise following current guidelines offers widespread benefits to individuals with MetS without diabetes. More studies on resistance/combined exercise programs in MetS are required to improve the quality of evidence. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. Combining Whole-Brain Radiotherapy with Gefitinib/Erlotinib for Brain Metastases from Non-Small-Cell Lung Cancer: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Mao-hua Zheng

    2016-01-01

    Full Text Available Background. To comprehensively assess the efficacy and safety of whole-brain radiotherapy (WBRT combined with gefitinib/erlotinib for treatment of brain metastases (BM from non-small-cell lung cancer (NSCLC. Methods. Databases including PubMed, EMBASE.com, Web of Science, and Cochrane Library were searched from inception to April 12, 2015. Studies on randomized controlled trials (RCTs and case-control trials comparing WBRT combined with gefitinib/erlotinib versus WBRT alone for BM from NSCLC were included. Literature selection, data extraction, and quality assessment were performed independently by two trained reviewers. RevMan 5.3 software was used to analyze data. Results. A total of 7 trials involving 622 patients were included. Compared with WBRT alone or WBRT plus chemotherapy, WBRT plus gefitinib/erlotinib could significantly improve response rate (OR = 2.16, 95% CI: 1.35–3.47; P=0.001, remission rate of central nervous system (OR = 6.06, 95% CI: 2.57–14.29; P<0.0001, disease control rate (OR = 3.34, 95% CI: 1.84–6.07; P<0.0001, overall survival (HR = 0.72, 95% CI: 0.58–0.89; P=0.002, and 1-year survival rate (OR = 2.43, 95% CI: 1.51–3.91; P=0.0002. In adverse events (III-IV, statistically significant differences were not found, except for rash (OR = 7.96, 95% CI: 2.02–31.34; P=0.003 and myelosuppression (OR = 0.19, 95% CI: 0.07–0.51; P=0.0010. Conclusions. WBRT plus gefitinib/erlotinib was superior to WBRT alone and well tolerated in patients with BM from NSCLC.

  13. MetaEasy: A Meta-Analysis Add-In for Microsoft Excel

    Directory of Open Access Journals (Sweden)

    Evangelos Kontopantelis

    2009-04-01

    Full Text Available Meta-analysis is a statistical methodology that combines or integrates the results ofseveral independent clinical trials considered by the analyst to be `combinable' (Huque1988. However, completeness and user-friendliness are uncommon both in specialisedmeta-analysis software packages and in mainstream statistical packages that have to relyon user-written commands. We implemented the meta-analysis methodology in an Mi-crosoft Excel add-in which is freely available and incorporates more meta-analysis models(including the iterative maximum likelihood and prole likelihood than are usually avail-able, while paying particular attention to the user-friendliness of the package.

  14. Efficacy and safety of gemcitabine-fluorouracil combination therapy in the management of advanced pancreatic cancer: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Qin Li

    Full Text Available Gemcitabine (GEM is the standard first-line chemotherapy that provides limited clinical benefits for patients with locally advanced/metastatic pancreatic adenocarcinoma (LA/MPC. However, the fluorouracil derivatives (CAP and S-1 show promising efficacy in these patients. This study compared the efficacy and safety of GEM with GEM plus fluorouracil drugs in the treatment of LA/MPC.Pubmed, EMBASE and Cochrane Library databases were searched for relevant randomized controlled trials published on or before January 2014. The Cochrane Collaboration's tool was used to assess the risk of bias in randomized trials. The primary end point was overall survival (OS; the secondary end points were one-year survival rate, objective response rate (ORR and toxicity rates (TRs.A total of 8 randomized controlled trials involving 2,126 patients were included in the systematic evaluation. The results showed that OS was significantly improved (HR 0.83, P<0.01; HR 0.87, P = 0.03; HR 0.80, P = 0.01; respectively and ORR was significantly increased (OR 0.51, P<0.01; OR 0.66, P = 0.03; OR 0.35, P<0.01; respectively in the GEM+5-FU/CAP/S-1, GEM+CAP and GEM+S-1 groups compared to the GEM alone group. In addition, the one-year survival rate was significantly increased (OR 0.78 P = 0.01; OR 0.47, P = 0.04; respectively in the GEM+5-FU/CAP/S-1 and GEM+S-1 groups compared to the GEM alone group. The frequency of grade 3/4 TRs were higher in GEM+5-FU/CAP/S-1 group, the significant increase of grade 3/4 neutropenia, thrombocytopenia and diarrhea were observed.GEM combined with fluorouracil drugs significantly improved OS and increased one-year survival rate and ORR compared to GEM alone in LA/MPC patients. GEM combined with fluorouracil drugs may be considered as an acceptable alternative treatment for LA/MPC patients.

  15. Combined metformin-clomiphene in clomiphene-resistant polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Abu Hashim, Hatem; Foda, Osama; Ghayaty, Essam

    2015-09-01

    Our objective was to compare the effectiveness of metformin plus clomiphene citrate vs. gonadotrophins, laparoscopic ovarian diathermy, aromatase inhibitors, N-acetyl-cysteine and other insulin sensitizers+clomiphene for improving fertility outcomes in women with clomiphene-resistant polycystic ovary syndrome. PubMed, SCOPUS and CENTRAL databases were searched until April 2014 with the key words: PCOS, polycystic ovary syndrome, metformin, clomiphene citrate, ovulation induction and pregnancy. The search was limited to articles conducted with humans and published in English. The PRISMA statement was followed. Twelve randomized controlled trials (n = 1411 women) were included. Ovulation and clinical pregnancy rates per woman randomized. Compared with gonadotrophins, the metformin+clomiphene combination resulted in significantly fewer ovulations (odds ratio 0.25; 95% confidence interval 0.15-0.41; p < 0.00001, 3 trials, I(2) = 85%, n = 323) and pregnancies (odds ratio 0.45; 95% confidence interval 0.27-0.75; p = 0.002, 3 trials, I(2) = 0%, n = 323). No significant differences were found when metformin+clomiphene was compared with laparoscopic ovarian diathermy (odds ratio 0.88; 95% confidence interval 0.53-1.47; p = 0.62, 1 trial, n = 282; odds ratio 0.96; 95% confidence interval 0.60-1.54; p = 0.88, 2 trials, I(2) = 0%, n = 332, for ovulation and pregnancy rates, respectively). Likewise, no differences were observed in comparison with aromatase inhibitors (odds ratio 0.88; 95% confidence interval 0.58-1.34; p = 0.55, 3 trials, I(2) = 3%, n = 409; odds ratio 0.85; 95% confidence interval 0.53-1.36; p = 0.50, 2 trials, n = 309, for ovulation and pregnancy rates, respectively). There is evidence for the superiority of gonadotrophins, but the metformin+clomiphene combination is mainly relevant for clomiphene-resistant polycystic ovary syndrome patients and, if not effective, a next step could be gonadotrophins. More attempts with metformin+clomiphene are only relevant

  16. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    van Galen, Katy A; Nellen, Jeannine F; Nieuwkerk, Pythia T

    2014-01-01

    Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03-1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00-2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.

  17. Electronic medication monitoring-informed counselling to improve adherence to combination antiretroviral therapy and virologic treatment outcomes: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Nienke eLangebeek

    2015-05-01

    Full Text Available Background: Adherence to combination antiretroviral therapy (cART for HIV infection is a primary determinant of treatment success, but is often suboptimal. Previous studies have suggested that electronic medication monitoring-informed counselling is among the most effective adherence intervention components. Our objective was to review available evidence about the effectiveness of monitoring-informed counselling and to aggregate findings into quantitative estimates of the effect of such intervention on medication adherence and virologic treatment outcomes.Methods: We searched PubMed for papers reporting on randomized controlled trials (RCTs comparing intervention groups receiving monitoring-informed counselling as one of the intervention components versus control groups not receiving such counselling for their effect on medication adherence and viral load concentrations. The standardized mean difference (SMD in adherence and the odds ratio (OR of undetectable HIV RNA in intervention versus control groups were the common effect sizes. Random-effect models with inverse variance weights were used to aggregate findings into pooled effect estimates with 95% confidence limits. Results: A total of 13 studies were included. Adherence was significantly higher in intervention groups than in control groups (SMD 0.51, 95% CI 0.31 to 0.71. Patients in intervention groups were significantly more likely to have undetectable HIV RNA concentrations than patients in control groups (OR 1.35, 95% CI 1.12 to 1.63. However, in studies in which monitoring-informed counselling was the only intervention component, the difference in adherence and virologic response between intervention and control groups was not statistically significant.Conclusion: Electronic monitoring-informed counselling improved adherence and virologic response compared with control groups not receiving such counselling in studies in which it was one out of multiple intervention components, but not

  18. Electronic medication monitoring-informed counseling to improve adherence to combination anti-retroviral therapy and virologic treatment outcomes: a meta-analysis.

    Science.gov (United States)

    Langebeek, Nienke; Nieuwkerk, Pythia

    2015-01-01

    Adherence to combination anti-retroviral therapy for HIV infection is a primary determinant of treatment success, but is often suboptimal. Previous studies have suggested that electronic medication monitoring-informed counseling is among the most effective adherence intervention components. Our objective was to review available evidence about the effectiveness of monitoring-informed counseling and to aggregate findings into quantitative estimates of the effect of such intervention on medication adherence and virologic treatment outcomes. We searched PubMed for papers reporting on randomized controlled trials comparing intervention groups receiving monitoring-informed counseling as one of the intervention components versus control groups not receiving such counseling for their effect on medication adherence and viral load concentrations. The standardized mean difference (SMD) in adherence and the odds ratio (OR) of undetectable HIV RNA in intervention versus control groups were the common effect sizes. Random-effect models with inverse variance weights were used to aggregate findings into pooled effect estimates with 95% confidence limits (CI). A total of 13 studies were included. Adherence was significantly higher in intervention groups than in control groups (SMD 0.51, 95% CI 0.31-0.71). Patients in intervention groups were significantly more likely to have undetectable HIV RNA concentrations than patients in control groups (OR 1.35, 95% CI 1.12-1.63). However, in studies in which monitoring-informed counseling was the only intervention component, the difference in adherence and virologic response between intervention and control groups was not statistically significant. Electronic monitoring-informed counseling improved adherence and virologic response compared with control groups not receiving such counseling in studies in which it was one out of multiple intervention components, but not in studies where it was the only intervention component.

  19. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events : A meta-analysis

    NARCIS (Netherlands)

    van Melle, JP; de Jonge, P; Spijkerman, TA; Tijssen, JGP; Ormel, J; van Veldhuisen, DJ; van den Brink, RHS; van den Berg, MP

    2004-01-01

    Objective: To assess the association of depression following myocardial infarction (MI) and cardiovascular prognosis. Methods: The authors performed a meta-analysis of references derived from MEDLINE, EMBASE, and PSYCINFO (1975-2003) combined with crossreferencing without language restrictions. The

  20. Effect of Influenza Vaccination of Children on Infection Rate in Hutterite Communities: Follow-Up Study of a Randomized Trial.

    Directory of Open Access Journals (Sweden)

    Biao Wang

    Full Text Available An earlier cluster randomized controlled trial (RCT of Hutterite colonies had shown that if more than 80% of children and adolescents were immunized with influenza vaccine there was a statistically significant reduction in laboratory-confirmed influenza among all unimmunized community members. We assessed the impact of this intervention for two additional influenza seasonal periods.Follow-up data for two influenza seasonal periods of a cluster randomized trial involving 1053 Canadian children and adolescents aged 36 months to 15 years in Season 2 and 1014 in Season 3 who received the study vaccine, and 2805 community members in Season 2 and 2840 in Season 3 who did not receive the study vaccine. Follow-up for Season 2 began November 18, 2009 and ended April 25, 2010 while Season 3 extended from December 6, 2010 and ended May 27, 2011. Children were randomly assigned in a blinded manner according to community membership to receive either inactivated trivalent influenza vaccine or hepatitis A. The primary outcome was confirmed influenza A and B infection using RT-PCR assay. Due to the outbreak of 2009 H1N1 pandemic, data in Season 2 were excluded for analysis.For an analysis of the combined Season 1 and Season 3 data, among non-recipients (i.e., participants who did not receive study vaccines, 66 of the 2794 (2.4% participants in the influenza vaccine colonies and 121 of the 2301 (5.3% participants in the hepatitis A colonies had influenza confirmed by RT-PCR, for a protective effectiveness of 60% (95% CI, 6% to 83%; P = 0.04; among all study participants (i.e., including both those who received study vaccine and those who did not, 125 of the 3806 (3.3% in the influenza vaccine colonies and 239 of the 3243 (7.4% in the hepatitis A colonies had influenza confirmed by RT-PCR, for a protective effectiveness of 63% (95% CI, 5% to 85%; P = 0.04.Immunizing children and adolescents with inactivated influenza vaccine can offer a protective effect among

  1. OHBM 2017: Practical intensity based meta-analysis

    OpenAIRE

    Maumet, Camille

    2017-01-01

    "Practical intensity-based meta-analysis" slides from my talk in the OHBM 2017 educational talk on Neuroimaging meta-analysis.http://www.humanbrainmapping.org/files/2017/ED Courses/Neuroimaging Meta-Analysis.pdf

  2. Meta-Analysis in Stata Using Gllamm

    Science.gov (United States)

    Bagos, Pantelis G.

    2015-01-01

    There are several user-written programs for performing meta-analysis in Stata (Stata Statistical Software: College Station, TX: Stata Corp LP). These include metan, metareg, mvmeta, and glst. However, there are several cases for which these programs do not suffice. For instance, there is no software for performing univariate meta-analysis with…

  3. Trial Sequential Methods for Meta-Analysis

    Science.gov (United States)

    Kulinskaya, Elena; Wood, John

    2014-01-01

    Statistical methods for sequential meta-analysis have applications also for the design of new trials. Existing methods are based on group sequential methods developed for single trials and start with the calculation of a required information size. This works satisfactorily within the framework of fixed effects meta-analysis, but conceptual…

  4. Statistical Power in Meta-Analysis

    Science.gov (United States)

    Liu, Jin

    2015-01-01

    Statistical power is important in a meta-analysis study, although few studies have examined the performance of simulated power in meta-analysis. The purpose of this study is to inform researchers about statistical power estimation on two sample mean difference test under different situations: (1) the discrepancy between the analytical power and…

  5. Bayesian Meta-Analysis of Coefficient Alpha

    Science.gov (United States)

    Brannick, Michael T.; Zhang, Nanhua

    2013-01-01

    The current paper describes and illustrates a Bayesian approach to the meta-analysis of coefficient alpha. Alpha is the most commonly used estimate of the reliability or consistency (freedom from measurement error) for educational and psychological measures. The conventional approach to meta-analysis uses inverse variance weights to combine…

  6. Online open neuroimaging mass meta-analysis

    DEFF Research Database (Denmark)

    Nielsen, Finn Årup; Kempton, Matthew J.; Williams, Steven C. R.

    We describe a system for meta-analysis where a wiki stores numerical data in a simple format and a web service performs the numerical computation. We initially apply the system on multiple meta-analyses of structural neuroimaging data results. The described system allows for mass meta-analysis, e...

  7. Comparing the Effects of Combined Oral Contraceptives Containing Progestins With Low Androgenic and Antiandrogenic Activities on the Hypothalamic-Pituitary-Gonadal Axis in Patients With Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Amiri, Mina; Ramezani Tehrani, Fahimeh; Nahidi, Fatemeh; Kabir, Ali; Azizi, Fereidoun

    2018-04-25

    Different products of combined oral contraceptives (COCs) can improve clinical and biochemical findings in patients with polycystic ovary syndrome (PCOS) through suppression of the hypothalamic-pituitary-gonadal (HPG) axis. This systematic review and meta-analysis aimed to compare the effects of COCs containing progestins with low androgenic and antiandrogenic activities on the HPG axis in patients with PCOS. We searched PubMed, Scopus, Google Scholar, ScienceDirect, and Web of Science databases (1980-2017) to identify randomized controlled trials or nonrandomized studies investigating the effect of COCs containing progestins with low androgenic and antiandrogenic activities, including the products containing desogestrel, cyproterone acetate, and drospirenone, on the HPG axis in patients with PCOS. In this meta-analysis, fixed and random effect models were used. Outcomes of interest were weighted mean differences (WMD) of hormonal parameters, including the follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH-to-FSH ratio, estradiol, total testosterone, and sex hormone-binding globulin. Potential sources of heterogeneity were investigated using meta-regression and subgroup analyses. Subgroup analyses were performed based on the used progestin compound and treatment duration. We assessed quality of included studies and their risk of bias using Cochrane guidelines. Publication bias was assessed using Egger test and funnel plot. COC use was significantly associated with a decrease in gonadotropin levels, including FSH and LH. Use of products containing cyproterone acetate was associated with a decrease in FSH levels after 3 months (WMD=-0.48; 95% CI -0.81 to -0.15), 6 months (WMD=-2.33; 95% CI -3.48 to -1.18), and 12 months (WMD=-4.70; 95% CI -4.98 to -4.42) and a decrease in LH levels after 3 months (WMD=-3.57; 95% CI -5.14 to -1.99), 6 months (WMD=-5.68; 95% CI -9.57 to -1.80), and 12 months (WMD=-11.60; 95% CI -17.60 to -5.60). Use of COCs containing

  8. Combination of ranibizumab with photodynamic therapy vs ranibizumab monotherapy in the treatment of age-related macular degeneration:a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Jun-Kang Si

    2014-06-01

    Full Text Available AIM:To compare the efficacy and safety of combination of ranibizumab with photodynamic therapy (PDT vs ranibizumab monotherapy in the treatment of age-related macular degeneration (AMD.METHODS:The Cochrane Central Register of Controlled Trials (CENTRAL in the Cochrane Library, Pubmed, and Embase were searched. There were no language or data restrictions in the search for trials. Only randomized controlled trials (RCTs were included. Methodological quality of the literatures was evaluated according to the Jadad Score. RevMan 5.2.6 software was used to do the meta-analysis.RESULTS:Seven studies were included in our systematic review, among which four of them were included in quantitative analysis. The result shows that the ranibizumab monotherapy group had a better mean best corrected visual acuity (BCVA change vs baseline at month 12 compared with that of the combination treatment group, and the statistical difference was significant (WMD, -2.61; 95% CI, -5.08 to -0.13; P=0.04. However, after the removal of one study, the difference between the two groups showed no significant difference (WMD, -2.29; 95% CI, -4.81 to 0.23; P=0.07. Meanwhile, no significant central retinal thickness (CRT reduction was found in the combination treatment group and the ranibizumab monotherapy group at 12 months follow-up. Nevertheless, the combination group tended to have a greater reduction in CRT (WMD, -4.13μm; 95%CI, -25.88 to 17.63, P=0.71. The proportion of patients gaining more than 3 lines at month 12 in the ranibizumab group was higher than in the combination group and there was a significant difference (RR, 0.72; 95% CI, 0.54 to 0.95; P=0.02. Whereas there was no significant difference for the proportion of patients gaining more than 0 line at month 12 between the two groups (RR, 0.93; 95% CI, 0.76 to 1.15; P=0.52. The general tendency shows a reduction in ranibizumab retreatment number in the combination treatment group compared with the ranibizumab

  9. Astragalus-containing Traditional Chinese Medicine, with and without prescription based on syndrome differentiation, combined with chemotherapy for advanced non-small-cell lung cancer: a systemic review and meta-analysis.

    Science.gov (United States)

    Wang, S F; Wang, Q; Jiao, L J; Huang, Y L; Garfield, D; Zhang, J; Xu, L

    2016-06-01

    Traditional Chinese Medicine (tcm) is used in China as part of the treatment for non-small-cell lung cancer (nsclc) and often includes prescription of herbal therapy based on syndrome differentiation. Studies of various Astragalus-based Chinese medicines combined with platinum-based chemotherapy in the treatment of lung cancer are popular in East Asia, particularly in China. The aim of the present study was to perform a systematic review and meta-analysis comparing platinum-based chemotherapy alone with platinum-based chemotherapy plus Astragalus-based Chinese botanicals, with and without prescription based on syndrome differentiation, as first-line treatment for advanced nsclc. We searched the Chinese Biomedical Literature database, the China National Knowledge Internet, the VIP Chinese Science and Technology Periodicals Database, PubMed, embase, the Cochrane databases, and abstracts presented at meetings of the American Society of Clinical Oncology, the World Conference on Lung Cancer, the European Society for Medical Oncology, and the Chinese Society of Clinical Oncology for all eligible studies. Endpoints were overall survival; 1-year, 2-year, and 3-year survival rates; performance status; overall response rate; and grade 3 or 4 adverse events. Subgroup analyses based on herbal formulae individualized using syndrome differentiation or on oral or injection patent medicines were performed using the Stata software application (version 11.0: StataCorp LP, College Station, TX, U.S.A.) and a fixed-effects or random-effects model in case of heterogeneity. Results are expressed as a hazard ratio (hr) or relative risk (rr), with corresponding 95% confidence intervals (cis). Seventeen randomized studies with scores on the Jadad quality scale of 2 or more, representing 1552 patients, met the inclusion criteria. Compared with platinum-based chemotherapy alone, the addition of Astragalus-based tcm to chemotherapy was associated with significantly increased overall survival

  10. Conducting Meta-Analysis Using SAS

    CERN Document Server

    Arthur, Winfried; Huffcutt, Allen I; Arthur, Winfred

    2001-01-01

    Conducting Meta-Analysis Using SAS reviews the meta-analysis statistical procedure and shows the reader how to conduct one using SAS. It presents and illustrates the use of the PROC MEANS procedure in SAS to perform the data computations called for by the two most commonly used meta-analytic procedures, the Hunter & Schmidt and Glassian approaches. This book serves as both an operational guide and user's manual by describing and explaining the meta-analysis procedures and then presenting the appropriate SAS program code for computing the pertinent statistics. The practical, step-by-step instru

  11. Meta-analysis: Problems with Russian Publications.

    Science.gov (United States)

    Verbitskaya, E V

    2015-01-01

    Meta-analysis is a powerful tool to identify Evidence Based medical technologies (interventions) for use in every day practice. Meta-analysis uses statistical approaches to combine results from multiple studies in an effort to increase power (over individual studies), improve estimates of the size of the effect and/or to resolve uncertainty when reports disagree. Meta-analysis is a quantitative, formal study design used to systematically assess previous research studies to derive conclusions from this research. Meta-analysis may provide more precise estimate of the effect of treatment or risk factor for a disease, or other outcomes, than any individual study contributing to the pooled analysis.We have quite a substantial number of Russian medical publications, but not so many Meta-Analyses published in Russian. Russian publications are cited in English language papers not so often. A total of 90% of clinical studies included in published Meta-Analyses incorporate only English language papers. International studies or papers with Russian co-authors are published in English language. The main question is: what is the problem with inclusion of Russian medical publications in Meta-Analysis? The main reasons for this are the following: 1) It is difficult to find Russian papers, difficult to work with them and to work with Russian journals:a. There are single Russian Biomedical Journals, which are translated into English and are included in databases (PubMed, Scopus and other), despite the fact that all of them have English language abstracts.b. The majority the meta-analyses authors use in their work different citation management software such as the Mendeley, Reference Manager, ProCite, EndNote, and others. These citation management systems allow scientists to organize their own literature databases with internet searches and have adds-on for the Office programs what makes process of literature citation very convenient. The Internet sites of the majority of

  12. Physical Readiness Training: A Meta-Analysis

    National Research Council Canada - National Science Library

    Vickers, Jr, Ross R

    2007-01-01

    .... This meta-analysis of available PRT studies (k = 3) indicated that (a) Fitness gains in the PRT program were equal to the gains in traditional fitness programs, and (b) the injury rate (i.e., hazard ratio...

  13. Exercise and Bone Density: Meta-Analysis

    National Research Council Canada - National Science Library

    Kelley, George A; Sharpe-Kelley, Kristi

    2007-01-01

    .... Since no meta-analysis had existed using individual patient data (IPD) to examine the effects of exercise on BMD, our second two-year period of funding was devoted to examining the feasibility...

  14. "Nobody Told Me They Didn't Speak English!": Teacher Language Views and Student Linguistic Repertoires in Hutterite Colony Schools in Canada

    Science.gov (United States)

    Sterzuk, Andrea; Nelson, Cynthia A.

    2016-01-01

    This article presents a qualitative study of five monolingual teachers' understandings of the linguistic repertoires of their multilingual students. These teachers deliver the Saskatchewan provincial curricula in English to Hutterite colony students who are users of three languages: (a) spoken Hutterisch as a home and community language, (b)…

  15. Meta-analysis: Effect of Monotherapy and Combination Therapy with Sucralfate and Acid Secretion Inhibitor%硫糖铝与抑酸剂联用与单用比较的Meta分析

    Institute of Scientific and Technical Information of China (English)

    蔡宏文; 徐慧敏; 何亚男; 戴海斌; 俞凌燕; 颜小锋

    2012-01-01

    OBJECTIVE To evaluate the efficacy and safety of combined sucralfate and acid secretion inhibitor. METHODS The Cochrane Central Register of Controlled Trials (Issue 4,2011),MEDLINE,EMbase,CBM and CNKI (from their inception to November 2011) were searched for relevant studies. Two reviewers independently retrieved randomized controlled trials (RCTs) according to the inclusion and exclusion criteria,assessed the methodological quality of included trials,and extracted data. Meta-analysis was performed by RevMan 4.2 soft. RESULTS Seven RCTs involving 595 patients were ultimately identified. The results of meta-analyses showed combination therapy was not superior to monotherapy in symptom improvement [OR 1.6,95%CI (0.87,2.93),P=0.13],endoscopic healing [OR 1.36,95%CI (0.87,2.12),P=0.17] and adverse events [OR 1.36,95%CI (0.64,2.90),P=0.42]. CONCLUSION Combination therapy with sucralfate and acid secretion inhibitor provides no superior in efficacy and safety than monotherapy.%目的 系统评价硫糖铝与抑酸剂联用的有效性和安全性.方法 计算机检索Cochrane图书馆临床对照试验资料库(2011年第4期)、MEDLINE、EMbase、中国生物医学文献数据库和中国期刊全文数据库(从建库至2011年11月).由两位研究者按纳入与排除标准选择随机对照研究评价质量及提取资料后,采用RevMan 4.2软件对数据进行Meta分析.结果 初检出11篇文献,经筛选最终纳入7篇文献共7个随机对照研究,包括595例患者.Meta分析结果显示,硫糖铝与抑酸剂联用与单药相比,临床症状有效率[OR 1.6,95%CI(0.87,2.93),P=0.13]、胃镜治愈率[OR 1.36,95%CI(0.87,2.12),P=0.17]、不良反应发生率[OR 1.36,95%CI(0.64,2.90),P=0.42],均无统计学差异.结论 现有研究结果表明,硫糖铝与抑酸剂联用与单药相比,未能显著增加疗效和减少不良反应,不优于两者单用.

  16. MADAM - An open source meta-analysis toolbox for R and Bioconductor

    Directory of Open Access Journals (Sweden)

    Graber Armin

    2010-03-01

    Full Text Available Abstract Background Meta-analysis is a major theme in biomedical research. In the present paper we introduce a package for R and Bioconductor that provides useful tools for performing this type of work. One idea behind the development of MADAM was that many meta-analysis methods, which are available in R, are not able to use the capacities of parallel computing yet. In this first version, we implemented one meta-analysis method in such a parallel manner. Additionally, we provide tools for combining the results from a set of methods in an ensemble approach. Functionality for visualization of results is also provided. Results The presented package enables the carrying out of meta-analysis either by providing functions directly or by wrapping them to existing implementations. Overall, five different meta-analysis methods are now usable through MADAM, along with another three methods for combining the corresponding results. Visualizing the results is eased by three included functions. For developing and testing meta-analysis methods, a mock up data generator is integrated. Conclusions The use of MADAM enables a user to focus on one package, in turn enabling them to work with the same data types across a set of methods. By making use of the snow package, MADAM can be made compatible with an existing parallel computing infrastructure. MADAM is open source and freely available within CRAN http://cran.r-project.org.

  17. Meniscal allograft transplantation: a meta-analysis

    Directory of Open Access Journals (Sweden)

    De Bruycker Manolito

    2017-01-01

    Full Text Available Purpose: This meta-analysis evaluates the mid- to long-term survival outcome of MAT (meniscal allograft transplantation. Potential prognosticators, with particular focus on chondral status and age of the patient at the time of transplantation, were also analysed. Study design: Meta-analysis. Methods: An online database search was performed using following search string: “meniscal allograft transplantation” and “outcome”. A total of 65 articles were analysed for a total of 3157 performed MAT with a mean follow-up of 5.4 years. Subjective and clinical data was analysed. Results: The subjective and objective results of 2977 patients (3157 allografts were analysed; 70% were male, 30% were female. Thirty-eight percent received an isolated MAT. All other patients underwent at least one concomitant procedure. Lysholm, Knee injury and Osteoarthritis Outcome (KOOS, International Knee Documentation Committee (IKDC and Visual Analogue Scale (VAS scores were analysed. All scores showed a good patient satisfaction at long-term follow-up. The mean overall survival rate was 80.9%. Complication rates were comparable to standard meniscal repair surgery. There was a degenerative evolution in osteoarthritis with at least one grade in 1760 radiographically analysed patients. Concomitant procedures seem to have no effect on the outcome. Age at transplantation is a negative prognosticator. The body mass index (BMI of the patient shows a slightly negative correlation with the outcome of MAT. Conclusions: MAT is a viable solution for the younger patient with chronic pain in the meniscectomised knee joint. The complications are not severe and comparable to meniscal repair. The overall failure rate at final follow-up is acceptable and the allograft heals well in most cases, but MAT cannot be seen as a definitive solution for post-meniscectomy pain. The correct approach to the chronic painful total meniscectomised knee joint thus requires consideration of all

  18. Drivers of wetland conversion: a global meta-analysis.

    Science.gov (United States)

    van Asselen, Sanneke; Verburg, Peter H; Vermaat, Jan E; Janse, Jan H

    2013-01-01

    Meta-analysis of case studies has become an important tool for synthesizing case study findings in land change. Meta-analyses of deforestation, urbanization, desertification and change in shifting cultivation systems have been published. This present study adds to this literature, with an analysis of the proximate causes and underlying forces of wetland conversion at a global scale using two complementary approaches of systematic review. Firstly, a meta-analysis of 105 case-study papers describing wetland conversion was performed, showing that different combinations of multiple-factor proximate causes, and underlying forces, drive wetland conversion. Agricultural development has been the main proximate cause of wetland conversion, and economic growth and population density are the most frequently identified underlying forces. Secondly, to add a more quantitative component to the study, a logistic meta-regression analysis was performed to estimate the likelihood of wetland conversion worldwide, using globally-consistent biophysical and socioeconomic location factor maps. Significant factors explaining wetland conversion, in order of importance, are market influence, total wetland area (lower conversion probability), mean annual temperature and cropland or built-up area. The regression analyses results support the outcomes of the meta-analysis of the processes of conversion mentioned in the individual case studies. In other meta-analyses of land change, similar factors (e.g., agricultural development, population growth, market/economic factors) are also identified as important causes of various types of land change (e.g., deforestation, desertification). Meta-analysis helps to identify commonalities across the various local case studies and identify which variables may lead to individual cases to behave differently. The meta-regression provides maps indicating the likelihood of wetland conversion worldwide based on the location factors that have determined historic

  19. MetaGenyo: a web tool for meta-analysis of genetic association studies.

    Science.gov (United States)

    Martorell-Marugan, Jordi; Toro-Dominguez, Daniel; Alarcon-Riquelme, Marta E; Carmona-Saez, Pedro

    2017-12-16

    Genetic association studies (GAS) aims to evaluate the association between genetic variants and phenotypes. In the last few years, the number of this type of study has increased exponentially, but the results are not always reproducible due to experimental designs, low sample sizes and other methodological errors. In this field, meta-analysis techniques are becoming very popular tools to combine results across studies to increase statistical power and to resolve discrepancies in genetic association studies. A meta-analysis summarizes research findings, increases statistical power and enables the identification of genuine associations between genotypes and phenotypes. Meta-analysis techniques are increasingly used in GAS, but it is also increasing the amount of published meta-analysis containing different errors. Although there are several software packages that implement meta-analysis, none of them are specifically designed for genetic association studies and in most cases their use requires advanced programming or scripting expertise. We have developed MetaGenyo, a web tool for meta-analysis in GAS. MetaGenyo implements a complete and comprehensive workflow that can be executed in an easy-to-use environment without programming knowledge. MetaGenyo has been developed to guide users through the main steps of a GAS meta-analysis, covering Hardy-Weinberg test, statistical association for different genetic models, analysis of heterogeneity, testing for publication bias, subgroup analysis and robustness testing of the results. MetaGenyo is a useful tool to conduct comprehensive genetic association meta-analysis. The application is freely available at http://bioinfo.genyo.es/metagenyo/ .

  20. Meta-Analyst: software for meta-analysis of binary, continuous and diagnostic data

    Directory of Open Access Journals (Sweden)

    Schmid Christopher H

    2009-12-01

    Full Text Available Abstract Background Meta-analysis is increasingly used as a key source of evidence synthesis to inform clinical practice. The theory and statistical foundations of meta-analysis continually evolve, providing solutions to many new and challenging problems. In practice, most meta-analyses are performed in general statistical packages or dedicated meta-analysis programs. Results Herein, we introduce Meta-Analyst, a novel, powerful, intuitive, and free meta-analysis program for the meta-analysis of a variety of problems. Meta-Analyst is implemented in C# atop of the Microsoft .NET framework, and features a graphical user interface. The software performs several meta-analysis and meta-regression models for binary and continuous outcomes, as well as analyses for diagnostic and prognostic test studies in the frequentist and Bayesian frameworks. Moreover, Meta-Analyst includes a flexible tool to edit and customize generated meta-analysis graphs (e.g., forest plots and provides output in many formats (images, Adobe PDF, Microsoft Word-ready RTF. The software architecture employed allows for rapid changes to be made to either the Graphical User Interface (GUI or to the analytic modules. We verified the numerical precision of Meta-Analyst by comparing its output with that from standard meta-analysis routines in Stata over a large database of 11,803 meta-analyses of binary outcome data, and 6,881 meta-analyses of continuous outcome data from the Cochrane Library of Systematic Reviews. Results from analyses of diagnostic and prognostic test studies have been verified in a limited number of meta-analyses versus MetaDisc and MetaTest. Bayesian statistical analyses use the OpenBUGS calculation engine (and are thus as accurate as the standalone OpenBUGS software. Conclusion We have developed and validated a new program for conducting meta-analyses that combines the advantages of existing software for this task.

  1. Mass meta-analysis in Talairach space

    DEFF Research Database (Denmark)

    Nielsen, Finn Årup

    2004-01-01

    We provide a method for mass meta-analysis in a neuroinformatics database containing stereotaxic Talairach coordinates from neuroimaging experiments. Database labels are used to group the individual experiments, e.g., according to cognitive function, and the consistent pattern of the experiments...... of experiments, and the distances to the null hypotheses are used to sort the voxels across groups of experiments. This allows for mass meta-analysis, with the construction of a list with the most prominent associations between brain areas and group labels. Furthermore, the method can be used for functional...

  2. Dyadic Interracial Interactions: A Meta-Analysis

    Science.gov (United States)

    Toosi, Negin R.; Babbitt, Laura G.; Ambady, Nalini; Sommers, Samuel R.

    2012-01-01

    This meta-analysis examined over 40 years of research on interracial interactions by exploring 4 types of outcomes: explicit attitudes toward interaction partners, participants' self-reports of their own emotional state, nonverbal or observed behavior, and objective measures of performance. Data were collected from 108 samples (N = 12,463)…

  3. Meta-analysis in clinical trials revisited.

    Science.gov (United States)

    DerSimonian, Rebecca; Laird, Nan

    2015-11-01

    In this paper, we revisit a 1986 article we published in this Journal, Meta-Analysis in Clinical Trials, where we introduced a random-effects model to summarize the evidence about treatment efficacy from a number of related clinical trials. Because of its simplicity and ease of implementation, our approach has been widely used (with more than 12,000 citations to date) and the "DerSimonian and Laird method" is now often referred to as the 'standard approach' or a 'popular' method for meta-analysis in medical and clinical research. The method is especially useful for providing an overall effect estimate and for characterizing the heterogeneity of effects across a series of studies. Here, we review the background that led to the original 1986 article, briefly describe the random-effects approach for meta-analysis, explore its use in various settings and trends over time and recommend a refinement to the method using a robust variance estimator for testing overall effect. We conclude with a discussion of repurposing the method for Big Data meta-analysis and Genome Wide Association Studies for studying the importance of genetic variants in complex diseases. Published by Elsevier Inc.

  4. A Bayesian Nonparametric Meta-Analysis Model

    Science.gov (United States)

    Karabatsos, George; Talbott, Elizabeth; Walker, Stephen G.

    2015-01-01

    In a meta-analysis, it is important to specify a model that adequately describes the effect-size distribution of the underlying population of studies. The conventional normal fixed-effect and normal random-effects models assume a normal effect-size population distribution, conditionally on parameters and covariates. For estimating the mean overall…

  5. Wind power externalities: A meta-analysis

    NARCIS (Netherlands)

    Mattmann, M.; Logar, I.; Brouwer, R.

    2016-01-01

    This study presents the first quantitative meta-analysis of the non-market valuation literature on the external effects associated with wind power production. A data set of 60 observations drawn from 32 studies is constructed. The relative economic values of different types of externalities as well

  6. Meta-Analysis of Coefficient Alpha

    Science.gov (United States)

    Rodriguez, Michael C.; Maeda, Yukiko

    2006-01-01

    The meta-analysis of coefficient alpha across many studies is becoming more common in psychology by a methodology labeled reliability generalization. Existing reliability generalization studies have not used the sampling distribution of coefficient alpha for precision weighting and other common meta-analytic procedures. A framework is provided for…

  7. Meta-Analysis at Middle Age: A Personal History

    Science.gov (United States)

    Glass, Gene V.

    2015-01-01

    The 40-year history of meta-analysis is traced from the vantage point of one of its originators. Research syntheses leading to the first examples of meta-analysis are identified. Early meta-analyses of the literature on psychotherapy outcomes and school class size are recounted. The influence on the development of meta-analysis of several…

  8. Meta-Analysis of Effect Sizes Reported at Multiple Time Points Using General Linear Mixed Model

    Science.gov (United States)

    Musekiwa, Alfred; Manda, Samuel O. M.; Mwambi, Henry G.; Chen, Ding-Geng

    2016-01-01

    Meta-analysis of longitudinal studies combines effect sizes measured at pre-determined time points. The most common approach involves performing separate univariate meta-analyses at individual time points. This simplistic approach ignores dependence between longitudinal effect sizes, which might result in less precise parameter estimates. In this paper, we show how to conduct a meta-analysis of longitudinal effect sizes where we contrast different covariance structures for dependence between effect sizes, both within and between studies. We propose new combinations of covariance structures for the dependence between effect size and utilize a practical example involving meta-analysis of 17 trials comparing postoperative treatments for a type of cancer, where survival is measured at 6, 12, 18 and 24 months post randomization. Although the results from this particular data set show the benefit of accounting for within-study serial correlation between effect sizes, simulations are required to confirm these results. PMID:27798661

  9. Efficacy of Anti-HER2 Agents in Combination With Adjuvant or Neoadjuvant Chemotherapy for Early and Locally Advanced HER2-Positive Breast Cancer Patients: A Network Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Márcio Debiasi

    2018-05-01

    Full Text Available BackgroundSeveral (neoadjuvant treatments for patients with HER2-positive breast cancer have been compared in different randomized clinical trials. Since it is not feasible to conduct adequate pairwise comparative trials of all these therapeutic options, network meta-analysis offers an opportunity for more detailed inference for evidence-based therapy.MethodsPhase II/III randomized clinical trials comparing two or more different (neoadjuvant treatments for HER2-positive breast cancer patients were included. Relative treatment effects were pooled in two separate network meta-analyses for overall survival (OS and disease-free survival (DFS.Results17 clinical trials met our eligibility criteria. Two different networks of trials were created based on the availability of the outcomes: OS network (15 trials: 37,837 patients; and DFS network (17 trials: 40,992 patients. Two studies—the ExteNET and the NeoSphere trials—were included only in this DFS network because OS data have not yet been reported. The concept of the dual anti-HER2 blockade proved to be the best option in terms of OS and DFS. Chemotherapy (CT plus trastuzumab (T and lapatinib (L and CT + T + Pertuzumab (P are probably the best treatment options in terms of OS, with 62.47% and 22.06%, respectively. In the DFS network, CT + T + Neratinib (N was the best treatment option with 50.55%, followed by CT + T + P (26.59% and CT + T + L (20.62%.ConclusionThis network meta-analysis suggests that dual anti-HER2 blockade with trastuzumab plus either lapatinib or pertuzumab are probably the best treatment options in the (neoadjuvant setting for HER2-positive breast cancer patients in terms of OS gain. Mature OS results are still expected for the Aphinity trial and for the sequential use of trastuzumab followed by neratinib, the treatment that showed the best performance in terms of DFS in our analysis.

  10. Internal fixation of mandibular angle fractures: a meta-analysis.

    Science.gov (United States)

    Regev, Eran; Shiff, Jacob S; Kiss, Alex; Fialkov, Jeffrey A

    2010-06-01

    The degree of rigidity of internal fixation required for the treatment of mandibular angle fractures has long been at the center of debate in the literature. A statistical comparison between rigid fixation and monocortical fixation has been difficult because of multiple terms, definitions, and technical variations. The purpose of this study was to use the meta-analysis tool to combine information from multiple studies and to compare complication rates for different fixation methods. An English language literature search was conducted for articles on mandibular angle fractures. Information was collected on four variables of interest: compression/noncompression technique, monocortical/bicortical screws, number of plates, and location of plates. Five outcome rates were analyzed: infection, reoperation, hardware removal, malunion, and nonunion. Meta-analyses were run using Comprehensive Meta Analysis, version 2.2.03. Twenty-four studies with relevant data on the variables and outcomes of interest met the inclusion criteria. Significantly higher rates of infection, reoperation, and hardware removal were found for compression compared with noncompression, two plates compared with one plate, and for plates located on both the inferior and superior borders as compared with superior or inferior only. There were also significantly higher infection rates for bicortical screws compared with monocortical screws and higher malunion rates for compression compared with noncompression plating techniques. The results of this meta-analysis found lower complication rates with the use of noncompression, monocortical, and single-plate fixation, supporting the trend toward a single, superiorly placed, monocortical miniplate for fixation of mandibular angle fractures.

  11. Meta-analysis of randomized clinical trials in the era of individual patient data sharing.

    Science.gov (United States)

    Kawahara, Takuya; Fukuda, Musashi; Oba, Koji; Sakamoto, Junichi; Buyse, Marc

    2018-06-01

    Individual patient data (IPD) meta-analysis is considered to be a gold standard when the results of several randomized trials are combined. Recent initiatives on sharing IPD from clinical trials offer unprecedented opportunities for using such data in IPD meta-analyses. First, we discuss the evidence generated and the benefits obtained by a long-established prospective IPD meta-analysis in early breast cancer. Next, we discuss a data-sharing system that has been adopted by several pharmaceutical sponsors. We review a number of retrospective IPD meta-analyses that have already been proposed using this data-sharing system. Finally, we discuss the role of data sharing in IPD meta-analysis in the future. Treatment effects can be more reliably estimated in both types of IPD meta-analyses than with summary statistics extracted from published papers. Specifically, with rich covariate information available on each patient, prognostic and predictive factors can be identified or confirmed. Also, when several endpoints are available, surrogate endpoints can be assessed statistically. Although there are difficulties in conducting, analyzing, and interpreting retrospective IPD meta-analysis utilizing the currently available data-sharing systems, data sharing will play an important role in IPD meta-analysis in the future.

  12. The potential for meta-analysis to support decision analysis in ecology.

    Science.gov (United States)

    Mengersen, Kerrie; MacNeil, M Aaron; Caley, M Julian

    2015-06-01

    Meta-analysis and decision analysis are underpinned by well-developed methods that are commonly applied to a variety of problems and disciplines. While these two fields have been closely linked in some disciplines such as medicine, comparatively little attention has been paid to the potential benefits of linking them in ecology, despite reasonable expectations that benefits would be derived from doing so. Meta-analysis combines information from multiple studies to provide more accurate parameter estimates and to reduce the uncertainty surrounding them. Decision analysis involves selecting among alternative choices using statistical information that helps to shed light on the uncertainties involved. By linking meta-analysis to decision analysis, improved decisions can be made, with quantification of the costs and benefits of alternate decisions supported by a greater density of information. Here, we briefly review concepts of both meta-analysis and decision analysis, illustrating the natural linkage between them and the benefits from explicitly linking one to the other. We discuss some examples in which this linkage has been exploited in the medical arena and how improvements in precision and reduction of structural uncertainty inherent in a meta-analysis can provide substantive improvements to decision analysis outcomes by reducing uncertainty in expected loss and maximising information from across studies. We then argue that these significant benefits could be translated to ecology, in particular to the problem of making optimal ecological decisions in the face of uncertainty. Copyright © 2013 John Wiley & Sons, Ltd.

  13. Meta-analysis of SNPs involved in variance heterogeneity using Levene's test for equal variances

    Science.gov (United States)

    Deng, Wei Q; Asma, Senay; Paré, Guillaume

    2014-01-01

    Meta-analysis is a commonly used approach to increase the sample size for genome-wide association searches when individual studies are otherwise underpowered. Here, we present a meta-analysis procedure to estimate the heterogeneity of the quantitative trait variance attributable to genetic variants using Levene's test without needing to exchange individual-level data. The meta-analysis of Levene's test offers the opportunity to combine the considerable sample size of a genome-wide meta-analysis to identify the genetic basis of phenotypic variability and to prioritize single-nucleotide polymorphisms (SNPs) for gene–gene and gene–environment interactions. The use of Levene's test has several advantages, including robustness to departure from the normality assumption, freedom from the influence of the main effects of SNPs, and no assumption of an additive genetic model. We conducted a meta-analysis of the log-transformed body mass index of 5892 individuals and identified a variant with a highly suggestive Levene's test P-value of 4.28E-06 near the NEGR1 locus known to be associated with extreme obesity. PMID:23921533

  14. Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data

    OpenAIRE

    Virtanen, M.; Jokela, M.; Madsen, I. E.; Magnusson Hanson, L. L.; Lallukka, T.; Nyberg, S. T.; Alfredsson, L.; Batty, D.; Bjorner, J. B.; Borritz, M.; Burr, H.; Dragano, N.; Erbel, R.; Ferrie, J. E.; Heikkilä, K.

    2018-01-01

    Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identi...

  15. Systematic review with meta-analysis

    DEFF Research Database (Denmark)

    Roda, G; Narula, N; Pinotti, R

    2017-01-01

    and meta-analysis of epidemiological studies reporting on extension of ulcerative colitis to determine frequency of disease extension in patients with limited ulcerative colitis at diagnosis. METHODS: We performed a systematic literature search to identify studies on disease extension of ulcerative colitis...... (UC) and predictors of disease progression. RESULTS: Overall, 41 studies were eligible for systematic review but only 30 for meta-analysis. The overall pooled frequency of UC extension was 22.8% with colonic extension being 17.8% at 5 years and 31% at 10 years. Extension was 17.8% (95% CI 11...... in patients from North America (37.8%) than from Europe (19.6%) (Pmeta-analysis, approximately one quarter of patients with limited UC extend over time with most extension occurring during the first 10 years. Rate of extension depends on age at diagnosis and geographic origin...

  16. A Global Meta-Analysis of the Value of Ecosystem Services Provided by Lakes.

    Science.gov (United States)

    Reynaud, Arnaud; Lanzanova, Denis

    2017-07-01

    This study presents the first meta-analysis on the economic value of ecosystem services delivered by lakes. A worldwide data set of 699 observations drawn from 133 studies combines information reported in primary studies with geospatial data. The meta-analysis explores antagonisms and synergies between ecosystem services. This is the first meta-analysis to incorporate simultaneously external geospatial data and ecosystem service interactions. We first show that it is possible to reliably predict the value of ecosystem services provided by lakes based on their physical and geographic characteristics. Second, we demonstrate that interactions between ecosystem services appear to be significant for explaining lake ecosystem service values. Third, we provide an estimation of the average value of ecosystem services provided by lakes: between 106 and 140 USD$2010 per respondent per year for non-hedonic price studies and between 169 and 403 USD$2010 per property per year for hedonic price studies.

  17. Grain yield increase in cereal variety mixtures: A meta-analysis of field trials

    DEFF Research Database (Denmark)

    Kiær, Lars Pødenphant; Skovgaard, Ib; Østergård, Hanne

    2009-01-01

    on grain yield. To investigate the prevalence and preconditions for positive mixing effects, reported grain yields of variety mixtures and pure variety stands were obtained from previously published variety trials, converted into relative mixing effects and combined using meta-analysis. Furthermore...... as meeting the criteria for inclusion in the meta-analysis; on the other hand, nearly 200 studies were discarded. The accepted studies reported results on both winter and spring types of each crop species. Relative mixing effects ranged from 30% to 100% with an overall meta-estimate of at least 2.7% (p

  18. Multivariate meta-analysis: Potential and promise

    Science.gov (United States)

    Jackson, Dan; Riley, Richard; White, Ian R

    2011-01-01

    The multivariate random effects model is a generalization of the standard univariate model. Multivariate meta-analysis is becoming more commonly used and the techniques and related computer software, although continually under development, are now in place. In order to raise awareness of the multivariate methods, and discuss their advantages and disadvantages, we organized a one day ‘Multivariate meta-analysis’ event at the Royal Statistical Society. In addition to disseminating the most recent developments, we also received an abundance of comments, concerns, insights, critiques and encouragement. This article provides a balanced account of the day's discourse. By giving others the opportunity to respond to our assessment, we hope to ensure that the various view points and opinions are aired before multivariate meta-analysis simply becomes another widely used de facto method without any proper consideration of it by the medical statistics community. We describe the areas of application that multivariate meta-analysis has found, the methods available, the difficulties typically encountered and the arguments for and against the multivariate methods, using four representative but contrasting examples. We conclude that the multivariate methods can be useful, and in particular can provide estimates with better statistical properties, but also that these benefits come at the price of making more assumptions which do not result in better inference in every case. Although there is evidence that multivariate meta-analysis has considerable potential, it must be even more carefully applied than its univariate counterpart in practice. Copyright © 2011 John Wiley & Sons, Ltd. PMID:21268052

  19. Using Meta-Analysis to Inform the Design of Subsequent Studies of Diagnostic Test Accuracy

    Science.gov (United States)

    Hinchliffe, Sally R.; Crowther, Michael J.; Phillips, Robert S.; Sutton, Alex J.

    2013-01-01

    An individual diagnostic accuracy study rarely provides enough information to make conclusive recommendations about the accuracy of a diagnostic test; particularly when the study is small. Meta-analysis methods provide a way of combining information from multiple studies, reducing uncertainty in the result and hopefully providing substantial…

  20. The universality of childhood emotional abuse: A meta-analysis of worldwide prevalence

    NARCIS (Netherlands)

    Stoltenborgh, M.; Bakermans-Kranenburg, M.J.; Alink, L.R.A.; van IJzendoorn, M.H.

    2012-01-01

    This comprehensive meta-analysis combined prevalence figures of child emotional abuse reported in 29 studies, including 46 independent samples with a total of 7,082,279 participants. The overall estimated prevalence was 3/1,000 for studies using informants and 363/1,000 for studies using self-report

  1. Novel non-HLA-susceptible regions determined by meta-analysis of ...

    Indian Academy of Sciences (India)

    We identified novel non-HLA-susceptible regions for ankylosing spondylitis (AS) by applying the genome-search-meta-analysis (GSMA) method to combine the previous four AS genomewide scan studies including 479 families with 1175 affected individuals. Three original genomescans were mainly analysed for Caucasian ...

  2. Examining Psychokinesis: The Interaction of Human Intention with Random Number Generators--A Meta-Analysis

    Science.gov (United States)

    Bosch, Holger; Steinkamp, Fiona; Boller, Emil

    2006-01-01

    Seance-room and other large-scale psychokinetic phenomena have fascinated humankind for decades. Experimental research has reduced these phenomena to attempts to influence (a) the fall of dice and, later, (b) the output of random number generators (RNGs). The meta-analysis combined 380 studies that assessed whether RNG output correlated with human…

  3. Medicinal plants with promising antileishmanial activity in Iran: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Masoud Soosaraei

    2017-09-01

    Conclusion: The most Iranian plants used as anti-leishmanial activity were Artemisia species, Allium sativum, Achilleamille folium, Peganum harmala and Thymus vulgaris. The present systematic and meta-analysis review provide valuable information about natural products with anti-Leishmania activity, which would be examined in the future experimental and clinical trials and herbal combination therapy.

  4. A meta-analysis of the association between mental disorders and juvenile recidivism

    NARCIS (Netherlands)

    Wibbelink, C.J.M.; Hoeve, M.; Stams, G.J.J.M.; Oort, F.J.

    To investigate the association between mental disorders and recidivism in juveniles, a three-level meta-analysis of 20 manuscripts (17 independent studies, N = 5737 juveniles) was conducted. The study focused on internalizing disorders, externalizing disorders, and comorbid disorders (combinations

  5. Meta-Analysis of Explicit Memory Studies in Populations with Intellectual Disability

    Science.gov (United States)

    Lifshitz, Hefziba; Shtein, Sarit; Weiss, Izhak; Vakil, Eli

    2011-01-01

    This meta-analysis combines the effect size (ES) of 40 explicit memory experiments in populations with intellectual disability (ID). Eight meta-analyses were performed, as well as contrast tests between ES. The explicit memory of participants with ID was inferior to that of participants with typical development (TD). Relatively preserved explicit…

  6. A Review and Meta-Analysis of Country-of-Origin Research

    NARCIS (Netherlands)

    Verlegh, P.W.J.; Steenkamp, J.E.B.M.

    1999-01-01

    Despite a large body of research, country-of-origin effects are still poorly understood. Combining the strengths of a narrative review with those of a quantitative meta-analysis, our study seeks to establish a firm grounding for country-of-origin research. We review previous country-of-origin

  7. The Effect of Educational Leadership on Students' Achievement: A Meta-Analysis Study

    Science.gov (United States)

    Karadag, Engin; Bektas, Fatih; Çogaltay, Nazim; Yalçin, Mikail

    2015-01-01

    In this meta-analysis study, different leadership styles were combined, and the relationship between educational leadership and student achievement was analyzed. In the literature review, 57 research articles/dissertations, independent from one another, were brought together, and 28,964 study subjects were included in the sample group. The results…

  8. Multiple Sclerosis Increases Fracture Risk: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Guixian Dong

    2015-01-01

    Full Text Available Purpose. The association between multiple sclerosis (MS and fracture risk has been reported, but results of previous studies remain controversial and ambiguous. To assess the association between MS and fracture risk, a meta-analysis was performed. Method. Based on comprehensive searches of the PubMed, Embase, and Web of Science, we identified outcome data from all articles estimating the association between MS and fracture risk. The pooled risk ratios (RRs with 95% confidence intervals (CIs were calculated. Results. A significant association between MS and fracture risk was found. This result remained statistically significant when the adjusted RRs were combined. Subgroup analysis stratified by the site of fracture suggested significant associations between MS and tibia fracture risk, femur fracture risk, hip fracture risk, pelvis fracture risk, vertebrae fracture risk, and humerus fracture risk. In the subgroup analysis by gender, female MS patients had increased fracture risk. When stratified by history of drug use, use of antidepressants, hypnotics/anxiolytics, anticonvulsants, and glucocorticoids increased the risk of fracture risk in MS patients. Conclusions. This meta-analysis demonstrated that MS was significantly associated with fracture risk.

  9. Multivariate meta-analysis: a robust approach based on the theory of U-statistic.

    Science.gov (United States)

    Ma, Yan; Mazumdar, Madhu

    2011-10-30

    Meta-analysis is the methodology for combining findings from similar research studies asking the same question. When the question of interest involves multiple outcomes, multivariate meta-analysis is used to synthesize the outcomes simultaneously taking into account the correlation between the outcomes. Likelihood-based approaches, in particular restricted maximum likelihood (REML) method, are commonly utilized in this context. REML assumes a multivariate normal distribution for the random-effects model. This assumption is difficult to verify, especially for meta-analysis with small number of component studies. The use of REML also requires iterative estimation between parameters, needing moderately high computation time, especially when the dimension of outcomes is large. A multivariate method of moments (MMM) is available and is shown to perform equally well to REML. However, there is a lack of information on the performance of these two methods when the true data distribution is far from normality. In this paper, we propose a new nonparametric and non-iterative method for multivariate meta-analysis on the basis of the theory of U-statistic and compare the properties of these three procedures under both normal and skewed data through simulation studies. It is shown that the effect on estimates from REML because of non-normal data distribution is marginal and that the estimates from MMM and U-statistic-based approaches are very similar. Therefore, we conclude that for performing multivariate meta-analysis, the U-statistic estimation procedure is a viable alternative to REML and MMM. Easy implementation of all three methods are illustrated by their application to data from two published meta-analysis from the fields of hip fracture and periodontal disease. We discuss ideas for future research based on U-statistic for testing significance of between-study heterogeneity and for extending the work to meta-regression setting. Copyright © 2011 John Wiley & Sons, Ltd.

  10. Online Open Neuroimaging Mass Meta-Analysis with a Wiki

    DEFF Research Database (Denmark)

    Nielsen, Finn Arup; Kempton, Matthew J.; Williams, Steven C. R.

    2015-01-01

    We describe a system for meta-analysis where a wiki stores numerical data in a simple comma-separated values format and a web service performs the numerical statistical computation. We initially apply the system on multiple meta-analyses of structural neuroimaging data results. The described system...... allows for mass meta-analysis, e.g., meta-analysis across multiple brain regions and multiple mental disorders providing an overview of important relationships and their uncertainties in a collaborative environment....

  11. Global meta-analysis of transcriptomics studies.

    Directory of Open Access Journals (Sweden)

    José Caldas

    Full Text Available Transcriptomics meta-analysis aims at re-using existing data to derive novel biological hypotheses, and is motivated by the public availability of a large number of independent studies. Current methods are based on breaking down studies into multiple comparisons between phenotypes (e.g. disease vs. healthy, based on the studies' experimental designs, followed by computing the overlap between the resulting differential expression signatures. While useful, in this methodology each study yields multiple independent phenotype comparisons, and connections are established not between studies, but rather between subsets of the studies corresponding to phenotype comparisons. We propose a rank-based statistical meta-analysis framework that establishes global connections between transcriptomics studies without breaking down studies into sets of phenotype comparisons. By using a rank product method, our framework extracts global features from each study, corresponding to genes that are consistently among the most expressed or differentially expressed genes in that study. Those features are then statistically modelled via a term-frequency inverse-document frequency (TF-IDF model, which is then used for connecting studies. Our framework is fast and parameter-free; when applied to large collections of Homo sapiens and Streptococcus pneumoniae transcriptomics studies, it performs better than similarity-based approaches in retrieving related studies, using a Medical Subject Headings gold standard. Finally, we highlight via case studies how the framework can be used to derive novel biological hypotheses regarding related studies and the genes that drive those connections. Our proposed statistical framework shows that it is possible to perform a meta-analysis of transcriptomics studies with arbitrary experimental designs by deriving global expression features rather than decomposing studies into multiple phenotype comparisons.

  12. Teaching tools in Evidence Based Practice: evaluation of reusable learning objects (RLOs for learning about Meta-analysis

    Directory of Open Access Journals (Sweden)

    Wharrad Heather

    2011-05-01

    Full Text Available Abstract Background All healthcare students are taught the principles of evidence based practice on their courses. The ability to understand the procedures used in systematically reviewing evidence reported in studies, such as meta-analysis, are an important element of evidence based practice. Meta-analysis is a difficult statistical concept for healthcare students to understand yet it is an important technique used in systematic reviews to pool data from studies to look at combined effectiveness of treatments. In other areas of the healthcare curricula, by supplementing lectures, workbooks and workshops with pedagogically designed, multimedia learning objects (known as reusable learning objects or RLOs we have shown an improvement in students' perceived understanding in subjects they found difficult. In this study we describe the development and evaluation of two RLOs on meta-analysis. The RLOs supplement associated lectures and aim to improve students' understanding of meta-analysis in healthcare students. Methods Following a quality controlled design process two RLOs were developed and delivered to two cohorts of students, a Master in Public Health course and Postgraduate diploma in nursing course. Students' understanding of five key concepts of Meta-analysis were measured before and after a lecture and again after RLO use. RLOs were also evaluated for their educational value, learning support, media attributes and usability using closed and open questions. Results Students rated their understanding of meta-analysis as improved after a lecture and further improved after completing the RLOs (Wilcoxon paired test, p Conclusions Meta-analysis RLOs that are openly accessible and unrestricted by usernames and passwords provide flexible support for students who find the process of meta-analysis difficult.

  13. Meta-analysis a structural equation modeling approach

    CERN Document Server

    Cheung, Mike W-L

    2015-01-01

    Presents a novel approach to conducting meta-analysis using structural equation modeling. Structural equation modeling (SEM) and meta-analysis are two powerful statistical methods in the educational, social, behavioral, and medical sciences. They are often treated as two unrelated topics in the literature. This book presents a unified framework on analyzing meta-analytic data within the SEM framework, and illustrates how to conduct meta-analysis using the metaSEM package in the R statistical environment. Meta-Analysis: A Structural Equation Modeling Approach begins by introducing the impo

  14. Systematic review and meta-analysis

    DEFF Research Database (Denmark)

    Lo, B; Prosberg, M V; Gluud, L L

    2018-01-01

    BACKGROUND: The Inflammatory Bowel Disease Disability Index (IBD-DI) has recently been developed for patients with Crohn's disease (CD) and ulcerative colitis (UC). AIM: To assess the severity of disability and associated factors using the IBD-DI, and review the validity of the IBD-DI as a tool. ...... review and meta-analysis found a significant association between disease activity, treatment received and disability; although significant heterogeneity was found. The IBD-DI is reliable and valid, but further studies are needed to measure its interpretability....

  15. Systematic review with meta-analysis

    DEFF Research Database (Denmark)

    Kimer, N; Krag, A; Møller, Søren

    2014-01-01

    BACKGROUND: Rifaximin is recommended for prevention of hepatic encephalopathy (HE). The effects of rifaximin on overt and minimal HE are debated. AIM: To perform a systematic review and meta-analysis of randomised controlled trials (RCTs) on rifaximin for HE. METHODS: We performed electronic...... and manual searches, gathered information from the U.S. Food and Drug Administration Home Page, and obtained unpublished information on trial design and outcome measures from authors and pharmaceutical companies. Meta-analyses were performed and results presented as risk ratios (RR) with 95% confidence...

  16. Bayesian meta-analysis models for microarray data: a comparative study

    Directory of Open Access Journals (Sweden)

    Song Joon J

    2007-03-01

    Full Text Available Abstract Background With the growing abundance of microarray data, statistical methods are increasingly needed to integrate results across studies. Two common approaches for meta-analysis of microarrays include either combining gene expression measures across studies or combining summaries such as p-values, probabilities or ranks. Here, we compare two Bayesian meta-analysis models that are analogous to these methods. Results Two Bayesian meta-analysis models for microarray data have recently been introduced. The first model combines standardized gene expression measures across studies into an overall mean, accounting for inter-study variability, while the second combines probabilities of differential expression without combining expression values. Both models produce the gene-specific posterior probability of differential expression, which is the basis for inference. Since the standardized expression integration model includes inter-study variability, it may improve accuracy of results versus the probability integration model. However, due to the small number of studies typical in microarray meta-analyses, the variability between studies is challenging to estimate. The probability integration model eliminates the need to model variability between studies, and thus its implementation is more straightforward. We found in simulations of two and five studies that combining probabilities outperformed combining standardized gene expression measures for three comparison values: the percent of true discovered genes in meta-analysis versus individual studies; the percent of true genes omitted in meta-analysis versus separate studies, and the number of true discovered genes for fixed levels of Bayesian false discovery. We identified similar results when pooling two independent studies of Bacillus subtilis. We assumed that each study was produced from the same microarray platform with only two conditions: a treatment and control, and that the data sets

  17. Time perspective and environmental engagement: a meta-analysis.

    Science.gov (United States)

    Milfont, Taciano L; Wilson, Jessie; Diniz, Pollyane

    2012-01-01

    Environmental issues entail both a social conflict (private vs. public interests) and a temporal conflict (short- vs. long-term interests). This paper focuses on the role temporal concerns play in influencing environmental engagement by quantitatively integrating results of studies that assessed the associations between time perspective and proenvironmental attitudes and behaviors. The meta-analysis included a total of 19 independent samples and 6,301 participants from seven countries (Australia, Brazil, Germany, Mexico, New Zealand, Norway, and the United States). Results showed that the associations between time perspective and proenvironmental behaviors were higher than those for proenvironmental attitudes. Supporting predictions, the associations between future time perspective and proenvironmental behaviors were strong and nontrivial compared to those for the combined past-present time perspective. The findings indicate that future time perspective seems to play an important role in influencing individuals' attitudes and behaviors towards the environment. Implications of the findings for theory and practice are discussed.

  18. Spatial Bayesian latent factor regression modeling of coordinate-based meta-analysis data.

    Science.gov (United States)

    Montagna, Silvia; Wager, Tor; Barrett, Lisa Feldman; Johnson, Timothy D; Nichols, Thomas E

    2018-03-01

    Now over 20 years old, functional MRI (fMRI) has a large and growing literature that is best synthesised with meta-analytic tools. As most authors do not share image data, only the peak activation coordinates (foci) reported in the article are available for Coordinate-Based Meta-Analysis (CBMA). Neuroimaging meta-analysis is used to (i) identify areas of consistent activation; and (ii) build a predictive model of task type or cognitive process for new studies (reverse inference). To simultaneously address these aims, we propose a Bayesian point process hierarchical model for CBMA. We model the foci from each study as a doubly stochastic Poisson process, where the study-specific log intensity function is characterized as a linear combination of a high-dimensional basis set. A sparse representation of the intensities is guaranteed through latent factor modeling of the basis coefficients. Within our framework, it is also possible to account for the effect of study-level covariates (meta-regression), significantly expanding the capabilities of the current neuroimaging meta-analysis methods available. We apply our methodology to synthetic data and neuroimaging meta-analysis datasets. © 2017, The International Biometric Society.

  19. Visualizing the flow of evidence in network meta-analysis and characterizing mixed treatment comparisons.

    Science.gov (United States)

    König, Jochem; Krahn, Ulrike; Binder, Harald

    2013-12-30

    Network meta-analysis techniques allow for pooling evidence from different studies with only partially overlapping designs for getting a broader basis for decision support. The results are network-based effect estimates that take indirect evidence into account for all pairs of treatments. The results critically depend on homogeneity and consistency assumptions, which are sometimes difficult to investigate. To support such evaluation, we propose a display of the flow of evidence and introduce new measures that characterize the structure of a mixed treatment comparison. Specifically, a linear fixed effects model for network meta-analysis is considered, where the network estimates for two treatments are linear combinations of direct effect estimates comparing these or other treatments. The linear coefficients can be seen as the generalization of weights known from classical meta-analysis. We summarize properties of these coefficients and display them as a weighted directed acyclic graph, representing the flow of evidence. Furthermore, measures are introduced that quantify the direct evidence proportion, the mean path length, and the minimal parallelism of mixed treatment comparisons. The graphical display and the measures are illustrated for two published network meta-analyses. In these applications, the proposed methods are seen to render transparent the process of data pooling in mixed treatment comparisons. They can be expected to be more generally useful for guiding and facilitating the validity assessment in network meta-analysis. Copyright © 2013 John Wiley & Sons, Ltd.

  20. A Western Dietary Pattern Increases Prostate Cancer Risk: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Fabiani, Roberto; Minelli, Liliana; Bertarelli, Gaia; Bacci, Silvia

    2016-10-12

    Dietary patterns were recently applied to examine the relationship between eating habits and prostate cancer (PC) risk. While the associations between PC risk with the glycemic index and Mediterranean score have been reviewed, no meta-analysis is currently available on dietary patterns defined by "a posteriori" methods. A literature search was carried out (PubMed, Web of Science) to identify studies reporting the relationship between dietary patterns and PC risk. Relevant dietary patterns were selected and the risks estimated were calculated by a random-effect model. Multivariable-adjusted odds ratios (ORs), for a first-percentile increase in dietary pattern score, were combined by a dose-response meta-analysis. Twelve observational studies were included in the meta-analysis which identified a "Healthy pattern" and a "Western pattern". The Healthy pattern was not related to PC risk (OR = 0.96; 95% confidence interval (CI): 0.88-1.04) while the Western pattern significantly increased it (OR = 1.34; 95% CI: 1.08-1.65). In addition, the "Carbohydrate pattern", which was analyzed in four articles, was positively associated with a higher PC risk (OR = 1.64; 95% CI: 1.35-2.00). A significant linear trend between the Western ( p = 0.011) pattern, the Carbohydrate ( p = 0.005) pattern, and the increment of PC risk was observed. The small number of studies included in the meta-analysis suggests that further investigation is necessary to support these findings.

  1. Spatial Bayesian Latent Factor Regression Modeling of Coordinate-based Meta-analysis Data

    Science.gov (United States)

    Montagna, Silvia; Wager, Tor; Barrett, Lisa Feldman; Johnson, Timothy D.; Nichols, Thomas E.

    2017-01-01

    Summary Now over 20 years old, functional MRI (fMRI) has a large and growing literature that is best synthesised with meta-analytic tools. As most authors do not share image data, only the peak activation coordinates (foci) reported in the paper are available for Coordinate-Based Meta-Analysis (CBMA). Neuroimaging meta-analysis is used to 1) identify areas of consistent activation; and 2) build a predictive model of task type or cognitive process for new studies (reverse inference). To simultaneously address these aims, we propose a Bayesian point process hierarchical model for CBMA. We model the foci from each study as a doubly stochastic Poisson process, where the study-specific log intensity function is characterised as a linear combination of a high-dimensional basis set. A sparse representation of the intensities is guaranteed through latent factor modeling of the basis coefficients. Within our framework, it is also possible to account for the effect of study-level covariates (meta-regression), significantly expanding the capabilities of the current neuroimaging meta-analysis methods available. We apply our methodology to synthetic data and neuroimaging meta-analysis datasets. PMID:28498564

  2. Systematic reviews with meta-analysis: Why, when, and how?

    NARCIS (Netherlands)

    Crocetti, E.

    2016-01-01

    Systematic reviews with meta-analysis represent the gold standard for conducting reliable and transparent reviews of the literature. The purpose of this article is threefold: (a) to address why and when it is worthwhile to conduct a systematic review with meta-analysis, covering advantages of this

  3. Meta-analysis in a nutshell: Techniques and general findings

    DEFF Research Database (Denmark)

    Paldam, Martin

    2015-01-01

    The purpose of this article is to introduce the technique and main findings of meta-analysis to the reader, who is unfamiliar with the field and has the usual objections. A meta-analysis is a quantitative survey of a literature reporting estimates of the same parameter. The funnel showing...

  4. Comparing Active Pediatric Obesity Treatments Using Meta-Analysis

    Science.gov (United States)

    Gilles, Allyson; Cassano, Michael; Shepherd, Elizabeth J.; Higgins, Diana; Hecker, Jeffrey E.; Nangle, Douglas W.

    2008-01-01

    The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways:…

  5. Meta-analysis in epidemiology | Yach | South African Medical Journal

    African Journals Online (AJOL)

    Meta-analysis is the structured and systematic qualitative and quantitative integration of the results of several independent studies (Le. the epidemiology of results). As in any epidemiological study, a meta-analysis needs to start with clearly stated aims and objectives. Attention needs to be paid to selection bias in selecting ...

  6. Psychotherapy for chronic major depression and dysthymia: A meta analysis

    NARCIS (Netherlands)

    Cuijpers, P.; van Straten, A.; Schuurmans, J.; van Oppen, P.C.; Hollon, S.D.; Andersson, G.

    2010-01-01

    Although several studies have examined the effects of psychotherapy on chronic depression and dysthymia, no meta-analysis has been conducted to integrate results of these studies. We conducted a meta-analysis of 16 randomized trials examining the effects of psychotherapy on chronic depression and

  7. Psychotherapy for chronic major depression and dysthymia: A meta analysis.

    NARCIS (Netherlands)

    Cuijpers, P.; Straten, van A.; Schuurmans, J.; Oppen, van P.C.; Hollon, S.D.; Andersson, G.

    2009-01-01

    Abstract Although several studies have examined the effects of psychotherapy on chronic depression and dysthymia, no meta-analysis has been conducted to integrate results of these studies. We conducted a meta-analysis of 16 randomized trials examining the effects of psychotherapy on chronic

  8. Psychotherapy for chronic major depression and dysthymia: A meta analysis.

    NARCIS (Netherlands)

    Cuijpers, P.; van Straten, A.; Schuurmans, J.; van Oppen, P.C.; Hollon, S.D.; Andersson, G.

    2009-01-01

    Although several studies have examined the effects of psychotherapy on chronic depression and dysthymia, no meta-analysis has been conducted to integrate results of these studies. We conducted a meta-analysis of 16 randomized trials examining the effects of psychotherapy on chronic depression and

  9. META-ANALYSIS: THE WAY FORWARD IN MEDICAL DISCOVERY

    African Journals Online (AJOL)

    data, and (6) report the results. Define the Research Question. A meta-analysis begins with a question. Common questions addressed in meta-analyses are whether one. META-ANALYSIS: THE WAY FORWARD IN MEDICAL DISCOVERY. Akinyemi J.O. MSc (Medical Statistics), B Tech (Comp. Sc.) Correspondence:.

  10. Physical Activity and Cognitive Development: A Meta-Analysis.

    Science.gov (United States)

    Jackson, William M; Davis, Nicholas; Sands, Stephen A; Whittington, Robert A; Sun, Lena S

    2016-10-01

    inclusion. From these 18 studies, 8 were independently selected by 2 authors for inclusion in the final analysis; there were no selection discrepancies between authors with regard to the studies to be included. In all, 770 subjects were included, 339 in the control group and 431 in the intervention group. All 8 studies contained a measure of inhibitory control; no other domain of executive function was measured frequently enough to perform meta-analysis, so only measures of inhibitory control were pooled and analyzed. A Cohen d effect size was calculated for each measure using the method of Morris for controlled pre-post control measurement studies. The studies were then combined in a random effects model using Comprehensive Meta Analysis software (Biostat, Englewood, NJ) for Windows (Microsoft, Redmond, WA). All studies showed a positive effect of regular exercise with improvements in measures of inhibitory control, but none were statistically significant for this measure. When pooled, the model revealed a combined Cohen d effect size of 0.2 (95% confidence interval, 0.03-0.37; P=0.021), indicating a small improvement of inhibitory control with long-term physical activity. Heterogeneity was very low (I=0). Many studies used different neuropsychological tests to assess inhibitory control, which may have introduced unforeseen confounders. Other domains of executive functions were not measured frequently enough to perform meta-analysis. Despite attempts to gather unpublished data, positive results were observed in all of the included studies, raising the possibility of publication bias. Increased regular physical activity is associated with a small and measurable, improvement in neuropsychological tests of executive functions, specifically inhibitory control. Executive functions play an important role in complex behavior, and may contribute to academic and career achievement as well as success in social interaction. This finding provides support for the important interaction

  11. Network meta-analysis: an introduction for pharmacists.

    Science.gov (United States)

    Xu, Yina; Amiche, Mohamed Amine; Tadrous, Mina

    2018-05-21

    Network meta-analysis is a new tool used to summarize and compare studies for multiple interventions, irrespective of whether these interventions have been directly evaluated against each other. Network meta-analysis is quickly becoming the standard in conducting therapeutic reviews and clinical guideline development. However, little guidance is available to help pharmacists review network meta-analysis studies in their practice. Major institutions such as the Cochrane Collaboration, Agency for Healthcare Research and Quality, Canadian Agency for Drugs and Technologies in Health, and National Institute for Health and Care Excellence Decision Support Unit have endorsed utilizing network meta-analysis to establish therapeutic evidence and inform decision making. Our objective is to introduce this novel technique to pharmacy practitioners, and highlight key assumptions behind network meta-analysis studies.

  12. The prevalence of food allergy: a meta-analysis.

    Science.gov (United States)

    Rona, Roberto J; Keil, Thomas; Summers, Colin; Gislason, David; Zuidmeer, Laurian; Sodergren, Eva; Sigurdardottir, Sigurveig T; Lindner, Titia; Goldhahn, Klaus; Dahlstrom, Jorgen; McBride, Doreen; Madsen, Charlotte

    2007-09-01

    There is uncertainty about the prevalence of food allergy in communities. To assess the prevalence of food allergy by performing a meta-analysis according to the method of assessment used. The foods assessed were cow's milk, hen's egg, peanut, fish, shellfish, and an overall estimate of food allergy. We summarized the information in 5 categories: self-reported symptoms, specific IgE positive, specific skin prick test positive, symptoms combined with sensitization, and food challenge studies. We systematically searched MEDLINE and EMBASE for publications since 1990. The meta-analysis included only original studies. They were stratified by age groups: infant/preschool, school children, and adults. A total of 934 articles were identified, but only 51 were considered appropriate for inclusion. The prevalence of self-reported food allergy was very high compared with objective measures. There was marked heterogeneity between studies regardless of type of assessment or food item considered, and in most analyses this persisted after age stratification. Self-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for any food. There is a marked heterogeneity in the prevalence of food allergy that could be a result of differences in study design or methodology, or differences between populations. We recommend that measurements be made by using standardized methods, if possible food challenge. We need to be cautious in estimates of prevalence based only on self-reported food allergy.

  13. Sequential Stereotype Priming: A Meta-Analysis.

    Science.gov (United States)

    Kidder, Ciara K; White, Katherine R; Hinojos, Michelle R; Sandoval, Mayra; Crites, Stephen L

    2017-08-01

    Psychological interest in stereotype measurement has spanned nearly a century, with researchers adopting implicit measures in the 1980s to complement explicit measures. One of the most frequently used implicit measures of stereotypes is the sequential priming paradigm. The current meta-analysis examines stereotype priming, focusing specifically on this paradigm. To contribute to ongoing discussions regarding methodological rigor in social psychology, one primary goal was to identify methodological moderators of the stereotype priming effect-whether priming is due to a relation between the prime and target stimuli, the prime and target response, participant task, stereotype dimension, stimulus onset asynchrony (SOA), and stimuli type. Data from 39 studies yielded 87 individual effect sizes from 5,497 participants. Analyses revealed that stereotype priming is significantly moderated by the presence of prime-response relations, participant task, stereotype dimension, target stimulus type, SOA, and prime repetition. These results carry both practical and theoretical implications for future research on stereotype priming.

  14. Automatic imitation: A meta-analysis.

    Science.gov (United States)

    Cracco, Emiel; Bardi, Lara; Desmet, Charlotte; Genschow, Oliver; Rigoni, Davide; De Coster, Lize; Radkova, Ina; Deschrijver, Eliane; Brass, Marcel

    2018-05-01

    Automatic imitation is the finding that movement execution is facilitated by compatible and impeded by incompatible observed movements. In the past 15 years, automatic imitation has been studied to understand the relation between perception and action in social interaction. Although research on this topic started in cognitive science, interest quickly spread to related disciplines such as social psychology, clinical psychology, and neuroscience. However, important theoretical questions have remained unanswered. Therefore, in the present meta-analysis, we evaluated seven key questions on automatic imitation. The results, based on 161 studies containing 226 experiments, revealed an overall effect size of g z = 0.95, 95% CI [0.88, 1.02]. Moderator analyses identified automatic imitation as a flexible, largely automatic process that is driven by movement and effector compatibility, but is also influenced by spatial compatibility. Automatic imitation was found to be stronger for forced choice tasks than for simple response tasks, for human agents than for nonhuman agents, and for goalless actions than for goal-directed actions. However, it was not modulated by more subtle factors such as animacy beliefs, motion profiles, or visual perspective. Finally, there was no evidence for a relation between automatic imitation and either empathy or autism. Among other things, these findings point toward actor-imitator similarity as a crucial modulator of automatic imitation and challenge the view that imitative tendencies are an indicator of social functioning. The current meta-analysis has important theoretical implications and sheds light on longstanding controversies in the literature on automatic imitation and related domains. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  15. Early Start DENVER Model: A Meta - analysis

    Directory of Open Access Journals (Sweden)

    Jane P. Canoy

    2015-11-01

    Full Text Available Each child with Autism Spectrum Disorder has different symptoms, skills and types of impairment or disorder with other children. This is why the word “spectrum” is included in this disorder. Eapen, Crncec, and Walter, 2013 claimed that there was an emerging evidence that early interventions gives the greatest capacity of child’s development during their first years of life as “brain plasticity” are high during this period. With this, the only intervention program model for children as young as 18 months that has been validated in a randomized clinical trial is “Early Start Denver Model” (ESDM. This study aimed to determine the effectiveness of the outcome of “Early Start Denver Model” (ESDM towards young children with Autism Spectrum Disorders. This study made use of meta-analysis method. In this study, the researcher utilized studies related to “Early Start Denver Model (ESDM” which is published in a refereed journal which are all available online. There were five studies included which totals 149 children exposed to ESDM. To examine the “pooled effects” of ESDM in a variety of outcomes, a meta-analytic procedure was performed after the extraction of data of the concrete outcomes. Comprehensive Meta Analysis Version 3.3.070 was used to analyze the data.  The effectiveness of the outcome of “Early Start Denver Model” towards young children with Autism Spectrum Disorders (ASD highly depends on the intensity of intervention and the younger child age. This study would provide the basis in effectively implementing an early intervention to children with autism such as the “Early Start Denver Model” (ESDM that would show great outcome effects to those children that has “Autism Spectrum Disorder”.

  16. A resampling-based meta-analysis for detection of differential gene expression in breast cancer

    International Nuclear Information System (INIS)

    Gur-Dedeoglu, Bala; Konu, Ozlen; Kir, Serkan; Ozturk, Ahmet Rasit; Bozkurt, Betul; Ergul, Gulusan; Yulug, Isik G

    2008-01-01

    Accuracy in the diagnosis of breast cancer and classification of cancer subtypes has improved over the years with the development of well-established immunohistopathological criteria. More recently, diagnostic gene-sets at the mRNA expression level have been tested as better predictors of disease state. However, breast cancer is heterogeneous in nature; thus extraction of differentially expressed gene-sets that stably distinguish normal tissue from various pathologies poses challenges. Meta-analysis of high-throughput expression data using a collection of statistical methodologies leads to the identification of robust tumor gene expression signatures. A resampling-based meta-analysis strategy, which involves the use of resampling and application of distribution statistics in combination to assess the degree of significance in differential expression between sample classes, was developed. Two independent microarray datasets that contain normal breast, invasive ductal carcinoma (IDC), and invasive lobular carcinoma (ILC) samples were used for the meta-analysis. Expression of the genes, selected from the gene list for classification of normal breast samples and breast tumors encompassing both the ILC and IDC subtypes were tested on 10 independent primary IDC samples and matched non-tumor controls by real-time qRT-PCR. Other existing breast cancer microarray datasets were used in support of the resampling-based meta-analysis. The two independent microarray studies were found to be comparable, although differing in their experimental methodologies (Pearson correlation coefficient, R = 0.9389 and R = 0.8465 for ductal and lobular samples, respectively). The resampling-based meta-analysis has led to the identification of a highly stable set of genes for classification of normal breast samples and breast tumors encompassing both the ILC and IDC subtypes. The expression results of the selected genes obtained through real-time qRT-PCR supported the meta-analysis results. The

  17. A resampling-based meta-analysis for detection of differential gene expression in breast cancer

    Directory of Open Access Journals (Sweden)

    Ergul Gulusan

    2008-12-01

    Full Text Available Abstract Background Accuracy in the diagnosis of breast cancer and classification of cancer subtypes has improved over the years with the development of well-established immunohistopathological criteria. More recently, diagnostic gene-sets at the mRNA expression level have been tested as better predictors of disease state. However, breast cancer is heterogeneous in nature; thus extraction of differentially expressed gene-sets that stably distinguish normal tissue from various pathologies poses challenges. Meta-analysis of high-throughput expression data using a collection of statistical methodologies leads to the identification of robust tumor gene expression signatures. Methods A resampling-based meta-analysis strategy, which involves the use of resampling and application of distribution statistics in combination to assess the degree of significance in differential expression between sample classes, was developed. Two independent microarray datasets that contain normal breast, invasive ductal carcinoma (IDC, and invasive lobular carcinoma (ILC samples were used for the meta-analysis. Expression of the genes, selected from the gene list for classification of normal breast samples and breast tumors encompassing both the ILC and IDC subtypes were tested on 10 independent primary IDC samples and matched non-tumor controls by real-time qRT-PCR. Other existing breast cancer microarray datasets were used in support of the resampling-based meta-analysis. Results The two independent microarray studies were found to be comparable, although differing in their experimental methodologies (Pearson correlation coefficient, R = 0.9389 and R = 0.8465 for ductal and lobular samples, respectively. The resampling-based meta-analysis has led to the identification of a highly stable set of genes for classification of normal breast samples and breast tumors encompassing both the ILC and IDC subtypes. The expression results of the selected genes obtained through real

  18. Visual Task Demands and the Auditory Mismatch Negativity: An Empirical Study and a Meta-Analysis.

    Science.gov (United States)

    Wiens, Stefan; Szychowska, Malina; Nilsson, Mats E

    2016-01-01

    Because the auditory system is particularly useful in monitoring the environment, previous research has examined whether task-irrelevant, auditory distracters are processed even if subjects focus their attention on visual stimuli. This research suggests that attentionally demanding visual tasks decrease the auditory mismatch negativity (MMN) to simultaneously presented auditory distractors. Because a recent behavioral study found that high visual perceptual load decreased detection sensitivity of simultaneous tones, we used a similar task (n = 28) to determine if high visual perceptual load would reduce the auditory MMN. Results suggested that perceptual load did not decrease the MMN. At face value, these nonsignificant findings may suggest that effects of perceptual load on the MMN are smaller than those of other demanding visual tasks. If so, effect sizes should differ systematically between the present and previous studies. We conducted a selective meta-analysis of published studies in which the MMN was derived from the EEG, the visual task demands were continuous and varied between high and low within the same task, and the task-irrelevant tones were presented in a typical oddball paradigm simultaneously with the visual stimuli. Because the meta-analysis suggested that the present (null) findings did not differ systematically from previous findings, the available evidence was combined. Results of this meta-analysis confirmed that demanding visual tasks reduce the MMN to auditory distracters. However, because the meta-analysis was based on small studies and because of the risk for publication biases, future studies should be preregistered with large samples (n > 150) to provide confirmatory evidence for the results of the present meta-analysis. These future studies should also use control conditions that reduce confounding effects of neural adaptation, and use load manipulations that are defined independently from their effects on the MMN.

  19. Likelihood ratio meta-analysis: New motivation and approach for an old method.

    Science.gov (United States)

    Dormuth, Colin R; Filion, Kristian B; Platt, Robert W

    2016-03-01

    A 95% confidence interval (CI) in an updated meta-analysis may not have the expected 95% coverage. If a meta-analysis is simply updated with additional data, then the resulting 95% CI will be wrong because it will not have accounted for the fact that the earlier meta-analysis failed or succeeded to exclude the null. This situation can be avoided by using the likelihood ratio (LR) as a measure of evidence that does not depend on type-1 error. We show how an LR-based approach, first advanced by Goodman, can be used in a meta-analysis to pool data from separate studies to quantitatively assess where the total evidence points. The method works by estimating the log-likelihood ratio (LogLR) function from each study. Those functions are then summed to obtain a combined function, which is then used to retrieve the total effect estimate, and a corresponding 'intrinsic' confidence interval. Using as illustrations the CAPRIE trial of clopidogrel versus aspirin in the prevention of ischemic events, and our own meta-analysis of higher potency statins and the risk of acute kidney injury, we show that the LR-based method yields the same point estimate as the traditional analysis, but with an intrinsic confidence interval that is appropriately wider than the traditional 95% CI. The LR-based method can be used to conduct both fixed effect and random effects meta-analyses, it can be applied to old and new meta-analyses alike, and results can be presented in a format that is familiar to a meta-analytic audience. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Visual Task Demands and the Auditory Mismatch Negativity: An Empirical Study and a Meta-Analysis

    Science.gov (United States)

    Wiens, Stefan; Szychowska, Malina; Nilsson, Mats E.

    2016-01-01

    Because the auditory system is particularly useful in monitoring the environment, previous research has examined whether task-irrelevant, auditory distracters are processed even if subjects focus their attention on visual stimuli. This research suggests that attentionally demanding visual tasks decrease the auditory mismatch negativity (MMN) to simultaneously presented auditory distractors. Because a recent behavioral study found that high visual perceptual load decreased detection sensitivity of simultaneous tones, we used a similar task (n = 28) to determine if high visual perceptual load would reduce the auditory MMN. Results suggested that perceptual load did not decrease the MMN. At face value, these nonsignificant findings may suggest that effects of perceptual load on the MMN are smaller than those of other demanding visual tasks. If so, effect sizes should differ systematically between the present and previous studies. We conducted a selective meta-analysis of published studies in which the MMN was derived from the EEG, the visual task demands were continuous and varied between high and low within the same task, and the task-irrelevant tones were presented in a typical oddball paradigm simultaneously with the visual stimuli. Because the meta-analysis suggested that the present (null) findings did not differ systematically from previous findings, the available evidence was combined. Results of this meta-analysis confirmed that demanding visual tasks reduce the MMN to auditory distracters. However, because the meta-analysis was based on small studies and because of the risk for publication biases, future studies should be preregistered with large samples (n > 150) to provide confirmatory evidence for the results of the present meta-analysis. These future studies should also use control conditions that reduce confounding effects of neural adaptation, and use load manipulations that are defined independently from their effects on the MMN. PMID:26741815

  1. GWAMA: software for genome-wide association meta-analysis

    Directory of Open Access Journals (Sweden)

    Mägi Reedik

    2010-05-01

    Full Text Available Abstract Background Despite the recent success of genome-wide association studies in identifying novel loci contributing effects to complex human traits, such as type 2 diabetes and obesity, much of the genetic component of variation in these phenotypes remains unexplained. One way to improving power to detect further novel loci is through meta-analysis of studies from the same population, increasing the sample size over any individual study. Although statistical software analysis packages incorporate routines for meta-analysis, they are ill equipped to meet the challenges of the scale and complexity of data generated in genome-wide association studies. Results We have developed flexible, open-source software for the meta-analysis of genome-wide association studies. The software incorporates a variety of error trapping facilities, and provides a range of meta-analysis summary statistics. The software is distributed with scripts that allow simple formatting of files containing the results of each association study and generate graphical summaries of genome-wide meta-analysis results. Conclusions The GWAMA (Genome-Wide Association Meta-Analysis software has been developed to perform meta-analysis of summary statistics generated from genome-wide association studies of dichotomous phenotypes or quantitative traits. Software with source files, documentation and example data files are freely available online at http://www.well.ox.ac.uk/GWAMA.

  2. A Systematic Review and Meta-analysis of the Association Between Giardia lamblia and Endemic Pediatric Diarrhea in Developing Countries

    Science.gov (United States)

    Muhsen, Khitam; Levine, Myron M.

    2012-01-01

    We performed a systematic literature review and meta-analysis examining the association between diarrhea in young children in nonindustrialized settings and Giardia lamblia infection. Eligible were case/control and longitudinal studies that defined the outcome as acute or persistent (>14 days) diarrhea, adjusted for confounders and lasting for at least 1 year. Data on G. lamblia detection (mainly in stools) from diarrhea patients and controls without diarrhea were abstracted. Random effects model meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Twelve nonindustrialized-setting acute pediatric diarrhea studies met the meta-analysis inclusion criteria. Random-effects model meta-analysis of combined results (9774 acute diarrhea cases and 8766 controls) yielded a pooled OR of 0.60 (95% CI, .38–.94; P = .03), indicating that G. lamblia was not associated with acute diarrhea. However, limited data suggest that initial Giardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a pooled OR of 3.18 (95% CI, 1.50–6.76; P diarrhea in children in developing countries. PMID:23169940

  3. Ischiofemoral impingement syndrome: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Adam D.; Subhawong, Ty K.; Jose, Jean; Tresley, Jonathan; Clifford, Paul D. [Jackson Memorial Hospital, Department of Diagnostic Radiology, Section of Musculoskeletal Imaging, Miami, FL (United States)

    2015-06-01

    The aims of this article are to review the imaging characteristics of ischiofemoral impingement (IFI), summarize measurement thresholds for radiologic diagnosis based on a meta-analysis of the literature and raise awareness among radiologists and clinicians of this entity. A PubMed search restricted to the English language containing the keywords ''ischiofemoral impingement'' and ''quadratus femoris MRI'' was performed, and citations in these articles were also used to identify a total of 27 studies discussing ischiofemoral impingement. After excluding case reports and non-representative studies, there were five remaining articles including 193 hip MRIs of IFI in 154 subjects (133 female, 21 male) and 135 asymptomatic control hip MRIs from 74 subjects (55 female, 19 male). Additionally, we performed a retrospective database search of pelvic and hip MRI reports from our institution including the terms ''quadratus femoris'' or ''ischiofemoral impingement'' from a 9-year period and 24 hip MRIs from 21 patients (18 female, 3 male) with IFI with 5 asymptomatic contralateral control hip MRIs identified. In all, 217 hip MRIs of IFI and 140 control cases were included. A meta-analysis of these hip MRIs was conducted to determine optimal thresholds of the ischiofemoral space (IFS) and quadratus femoris space (QFS) for identifying IFI. Cases of IFI showed significantly smaller IFS and QFS compared to controls (14.91 ± 4.8 versus 26.01 ± 7.98 and 9.57 ± 3.7 versus 15.97 ± 6.07, measured in mm, respectively, p < 0.0001 for both). Pooled analysis revealed that for IFS, using a cutoff of ≤15 mm yielded a sensitivity of 76.9 %, specificity of 81.0 % and overall accuracy of 78.3 %. For QFS, a cutoff of ≤ 10.0 mm resulted in 78.7 % sensitivity, 74.1 % specificity and 77.1 % overall accuracy. IFI is a potential cause of hip pain that can be accurately diagnosed with MRI in conjunction with

  4. Determining The Factors Affecting Fruit Hardness of Different Peach Types with Meta Analysis

    Directory of Open Access Journals (Sweden)

    Hande Küçükönder

    2014-09-01

    Full Text Available The aim of this study is to determine the factor effective in determining the hardness of Caterina, Suidring, Royal Glory and Tirrenia peach types using meta analysis. In the study, the impact force (Fi and the contact time (tc were detected and the impulse values (I that are expressed as independent variable in the area under the curve were calculated in the measurements performed using the technique of a low-mass lateral impactor multiplicated with peach. Using the theory of elasticity, the independent variables were determined as Fmax (maximum impact force, contact time (tmax, Fmax/tmax, 1/tmax, 1/tmax2,5, Fmax/tmax 1.25 and Fmax2.5 parameters. The correlation coefficient values showing the relationship between these parameters and the dependent variable Magness-Taylor force (MT were calculated and were combined with meta-analysis by using the Hunter-Schmid and Fisher’s Z methods. The Cohen’s classification criterion was used in evaluating the resulting mean effect size (combined correlation value and in determining its direction. As a result of the meta-analysis, the mean effect size according to Hunter-Schmid method was found 0.436 (0.371-0.497 positively directed in 95% confidence interval, while it was found 0.468 (0.390-0.545 according to Fisher’s Z method. The effect sizes in both methods were determined “mid-level” according to the Cohen’s classification. When the significance level of the studies was analyzed with the Z test, all of the ones that taken into the meta analysis has been found statistically significant. As a result of the meta analysis in this study evaluating the relationship of peach types with the fruit hardness, the mean effect size has been found to reach “strong level”. Consequently, “maximum shock acceleration” was found to be a more effective factor comparing to the other factors in determining the the fruit hardness according to the results of meta analysis applied in both methods.

  5. Regression and local control rates after radiotherapy for jugulotympanic paragangliomas: Systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Hulsteijn, Leonie T. van; Corssmit, Eleonora P.M.; Coremans, Ida E.M.; Smit, Johannes W.A.; Jansen, Jeroen C.; Dekkers, Olaf M.

    2013-01-01

    The primary treatment goal of radiotherapy for paragangliomas of the head and neck region (HNPGLs) is local control of the tumor, i.e. stabilization of tumor volume. Interestingly, regression of tumor volume has also been reported. Up to the present, no meta-analysis has been performed giving an overview of regression rates after radiotherapy in HNPGLs. The main objective was to perform a systematic review and meta-analysis to assess regression of tumor volume in HNPGL-patients after radiotherapy. A second outcome was local tumor control. Design of the study is systematic review and meta-analysis. PubMed, EMBASE, Web of Science, COCHRANE and Academic Search Premier and references of key articles were searched in March 2012 to identify potentially relevant studies. Considering the indolent course of HNPGLs, only studies with ⩾12 months follow-up were eligible. Main outcomes were the pooled proportions of regression and local control after radiotherapy as initial, combined (i.e. directly post-operatively or post-embolization) or salvage treatment (i.e. after initial treatment has failed) for HNPGLs. A meta-analysis was performed with an exact likelihood approach using a logistic regression with a random effect at the study level. Pooled proportions with 95% confidence intervals (CI) were reported. Fifteen studies were included, concerning a total of 283 jugulotympanic HNPGLs in 276 patients. Pooled regression proportions for initial, combined and salvage treatment were respectively 21%, 33% and 52% in radiosurgery studies and 4%, 0% and 64% in external beam radiotherapy studies. Pooled local control proportions for radiotherapy as initial, combined and salvage treatment ranged from 79% to 100%. Radiotherapy for jugulotympanic paragangliomas results in excellent local tumor control and therefore is a valuable treatment for these types of tumors. The effects of radiotherapy on regression of tumor volume remain ambiguous, although the data suggest that regression can

  6. Meta-analysis of the relationship between psychosocial indexes with mental health

    Directory of Open Access Journals (Sweden)

    Ayaub Faizy

    2015-09-01

    Full Text Available Background: The expansion of studies that done in the demand of effective factors such as social factors on mental health provides the ground work for the combination of these studies. So, this meta-analysis was implemented to determine the summary effect size of the relationship between social indexes and mental health measures Material and Methods: The method used in this study is a Meta-Analysis. To achieve above aim used of quantitative findings from 46 studies, that computed 77 effect sizes from these. The studies that were used in this study collected from databases such as magiran, noormags, Scientific Information Database and proceeding articles that published in the Seminars of college student’s Mental Health. After reviewing the inclusion and exclusion criteria, the correlation effect sizes in selected studies were analyzed with the CMA2 software. In this study, were calculated both random and fixed models, that selected random model, according to the results of the heterogeneity analysis of the Q and I2 factors. Results: The results showed that the combinational effect size of the studies obtained 0.139, after eliminated 10 effect sizes. The combined effect size of studies was calculated low based on Cohen's criteria. Also, the results of heterogeneity analysis indicated that there are moderating variables in the studies. The evidence of this meta-analysis associated with prior theoretical and empirical foundations, indicates the relationship between social support and mental health. Conclusion: According to the results of this meta-analysis for successful mental health programs due to cultural and social issues will be necessary.

  7. A systematic review of the effectiveness of CBT/ERP group therapy of OCD: A meta-analysis

    DEFF Research Database (Denmark)

    Jónsson, Hjalti; Hougaard, Esben; Bennedsen, Birgit

    , as well as reviewers of the literature have focused on within single treatments effect sizes rather between group effect sizes. OBJECTIVES To make a systematic review, and by methods of meta analysis compute a pooled within effect size of studies of group CBT of OCD and compare these to previously.......05 and 1.25 respectively, with an overall combined pooled within effect size across the categories at 1.18. Finally a between effect sizes of the four studies comparing group therapy to waitlist control group was reported at.1.12 CONCLUSION The reported within effect sizes in this meta-analysis (range 1...

  8. Genome-wide association study and meta-analysis find that over 40 loci affect risk of type 1 diabetes

    DEFF Research Database (Denmark)

    Barrett, Jeffrey C; Clayton, David G; Concannon, Patrick

    2009-01-01

    Type 1 diabetes (T1D) is a common autoimmune disorder that arises from the action of multiple genetic and environmental risk factors. We report the findings of a genome-wide association study of T1D, combined in a meta-analysis with two previously published studies. The total sample set included 7......,514 cases and 9,045 reference samples. Forty-one distinct genomic locations provided evidence for association with T1D in the meta-analysis (P

  9. Moyer's method of mixed dentition analysis: a meta-analysis ...

    African Journals Online (AJOL)

    The applicability of tables derived from the data Moyer used to other ethnic groups has ... This implies that Moyer's method of prediction may have population variations. ... Key Words: meta-analysis, mixed dentition analysis, Moyer's method

  10. A Meta-Analysis of the Relations among Training Criteria

    National Research Council Canada - National Science Library

    Alliger, George

    1998-01-01

    .... Meta-analysis results among criteria using this framework include the finding of substantial reliabilities across training criteria and reasonable convergence among subdivisions of criteria within a larger level...

  11. Meta-analysis: Coeliac disease and hypertransaminasaemia.

    Science.gov (United States)

    Sainsbury, A; Sanders, D S; Ford, A C

    2011-07-01

    There may be a positive association between coeliac disease and serum hypertransaminasaemia but evidence is conflicting. To conduct a systematic review and meta-analysis to determine the prevalence of coeliac disease in adults presenting with cryptogenic serum hypertransaminasaemia and the prevalence of hypertransaminasaemia in patients with newly diagnosed coeliac disease. MEDLINE and EMBASE were searched up to August 2010. Case series and case-control studies recruiting adults with either cryptogenic hypertransaminasaemia that applied serological tests for coeliac disease and/or distal duodenal biopsy to participants or newly diagnosed biopsy-proven coeliac disease that assessed serum transaminases were eligible. The pooled prevalence of coeliac disease in individuals presenting with abnormal serum transaminases and the pooled prevalence of hypertransaminasaemia in newly diagnosed coeliac disease were calculated with 95% confidence intervals (CI). Eleven eligible studies were identified. Pooled prevalences of positive coeliac serology and biopsy-proven coeliac disease in cryptogenic hypertransaminasaemia were 6% (95% CI 3% to 10%) and 4% (95% CI 1% to 7%) respectively. Pooled prevalence of abnormal serum transaminases in newly diagnosed coeliac disease was 27% (95% CI 13% to 44%). Exclusion of gluten led to normalisation of serum transaminase levels in 63% to 90% of patients within 1 year. Undetected coeliac disease is a potential cause for cryptogenic hypertransaminasaemia in 3% to 4% of cases. More than 20% of individuals with newly diagnosed coeliac disease may have abnormal serum transaminases and these normalise on a gluten-free diet in the majority of cases. © 2011 Blackwell Publishing Ltd.

  12. Systematic review with meta-analysis: diagnostic performance of the combination of pepsinogen, gastrin-17 and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis.

    Science.gov (United States)

    Zagari, R M; Rabitti, S; Greenwood, D C; Eusebi, L H; Vestito, A; Bazzoli, F

    2017-10-01

    The combination of pepsinogen, gastrin-17 and anti-H. pylori antibodies serological assays (panel test) is a non-invasive tool for the diagnosis of atrophic gastritis. However, the diagnostic reliability of this test is still uncertain. To assess the diagnostic performance of the serum panel test for the diagnosis of atrophic gastritis. Medline via PubMed, Embase, Scopus, Cochrane Library databases and abstracts of international conferences proceedings were searched from January 1995 to December 2016 using the primary keywords "pepsinogens," "gastrin," "atrophic gastritis," "gastric precancerous lesions." Studies were included if they assessed the accuracy of the serum panel test for the diagnosis of atrophic gastritis using histology according to the updated Sydney System as reference standard. Twenty studies with a total of 4241 subjects assessed the performance of serum panel test for the diagnosis of atrophic gastritis regardless of the site in the stomach. The summary sensitivity was 74.7% (95% confidence interval (CI), 62.0-84.3) and the specificity was 95.6% (95%CI, 92.6-97.4). With a prevalence of atrophic gastritis of 27% (median prevalence across the studies), the negative predictive value was 91%. Few studies with small sample size assessed the performance of the test in detecting the site of atrophic gastritis. The combination of pepsinogen, gastrin-17 and anti-H. pylori antibodies serological assays appears to be a reliable tool for the diagnosis of atrophic gastritis. This test may be used for screening subjects or populations at high risk of gastric cancer for atrophic gastritis; however, a cost-effectiveness analysis is needed. © 2017 John Wiley & Sons Ltd.

  13. The Neural Correlates of Moral Thinking: A Meta-Analysis

    OpenAIRE

    Douglas J. Bryant; Wang F; Kelley Deardeuff; Emily Zoccoli; Chang S. Nam

    2016-01-01

    We conducted a meta-analysis to evaluate current research that aims to map the neural correlates of two typical conditions of moral judgment: right-wrong moral judgments and decision-making in moral dilemmas. Utilizing the activation likelihood estimation (ALE) method, we conducted a meta-analysis using neuroimaging data obtained from twenty-one previous studies that measured responses in one or the other of these conditions. We found that across the studies (n = 400), distinct neural circuit...

  14. [Development of an Excel spreadsheet for meta-analysis of indirect and mixed treatment comparisons].

    Science.gov (United States)

    Tobías, Aurelio; Catalá-López, Ferrán; Roqué, Marta

    2014-01-01

    Meta-analyses in clinical research usually aimed to evaluate treatment efficacy and safety in direct comparison with a unique comparator. Indirect comparisons, using the Bucher's method, can summarize primary data when information from direct comparisons is limited or nonexistent. Mixed comparisons allow combining estimates from direct and indirect comparisons, increasing statistical power. There is a need for simple applications for meta-analysis of indirect and mixed comparisons. These can easily be conducted using a Microsoft Office Excel spreadsheet. We developed a spreadsheet for indirect and mixed effects comparisons of friendly use for clinical researchers interested in systematic reviews, but non-familiarized with the use of more advanced statistical packages. The use of the proposed Excel spreadsheet for indirect and mixed comparisons can be of great use in clinical epidemiology to extend the knowledge provided by traditional meta-analysis when evidence from direct comparisons is limited or nonexistent.

  15. Multivariate Methods for Meta-Analysis of Genetic Association Studies.

    Science.gov (United States)

    Dimou, Niki L; Pantavou, Katerina G; Braliou, Georgia G; Bagos, Pantelis G

    2018-01-01

    Multivariate meta-analysis of genetic association studies and genome-wide association studies has received a remarkable attention as it improves the precision of the analysis. Here, we review, summarize and present in a unified framework methods for multivariate meta-analysis of genetic association studies and genome-wide association studies. Starting with the statistical methods used for robust analysis and genetic model selection, we present in brief univariate methods for meta-analysis and we then scrutinize multivariate methodologies. Multivariate models of meta-analysis for a single gene-disease association studies, including models for haplotype association studies, multiple linked polymorphisms and multiple outcomes are discussed. The popular Mendelian randomization approach and special cases of meta-analysis addressing issues such as the assumption of the mode of inheritance, deviation from Hardy-Weinberg Equilibrium and gene-environment interactions are also presented. All available methods are enriched with practical applications and methodologies that could be developed in the future are discussed. Links for all available software implementing multivariate meta-analysis methods are also provided.

  16. Methodology Series Module 6: Systematic Reviews and Meta-analysis.

    Science.gov (United States)

    Setia, Maninder Singh

    2016-01-01

    Systematic reviews and meta-analysis have become an important of biomedical literature, and they provide the "highest level of evidence" for various clinical questions. There are a lot of studies - sometimes with contradictory conclusions - on a particular topic in literature. Hence, as a clinician, which results will you believe? What will you tell your patient? Which drug is better? A systematic review or a meta-analysis may help us answer these questions. In addition, it may also help us understand the quality of the articles in literature or the type of studies that have been conducted and published (example, randomized trials or observational studies). The first step it to identify a research question for systematic review or meta-analysis. The next step is to identify the articles that will be included in the study. This will be done by searching various databases; it is important that the researcher should search for articles in more than one database. It will also be useful to form a group of researchers and statisticians that have expertise in conducting systematic reviews and meta-analysis before initiating them. We strongly encourage the readers to register their proposed review/meta-analysis with PROSPERO. Finally, these studies should be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist.

  17. Meta-analysis of Huangqi injection for the adjunctive therapy of aplastic anemia

    Science.gov (United States)

    Zhu, Changtai; Gao, Yulu; Jiang, Ting; Hao, Cao; Gao, Zongshuai; Sun, Yongning

    2015-01-01

    Aplastic anemia therapy remains difficult, due to lack of effective treatment regimens. In recent years, Huangqi injection for the adjunctive therapy of aplastic anemia has been reported in many clinical trials. Considering that Huangqi injection may be a novel approach to aplastic anemia treatment, we conducted a meta-analysis of clinical controlled trials to assess the clinical value of Huangqi injection in the treatment of aplastic anemia. We searched the Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Full-text Database (VIP), Wanfang Database, PubMed and EMBASE database to collect the data about the trials of Huangqi injection combined with androgens for treating aplastic anemia. A total of ten studies involving 720 patients with aplastic anemia were included in this study. The meta-analysis showed significant increases in the pool effectiveness rate, white blood cells (WBC), haematoglobin (Hb), platelets (PLT), and reticulocytes (Ret) between the experimental group versus the control group. No severe side effects were found in this study. However, the lower Jadad scores and asymmetric funnel plot degrades the validity of the meta-analysis as the clinical evidence. Therefore, Huangqi injection may significantly enhance the efficacy of androgens for aplastic anemia, suggesting that the novel approach of Chinese traditional medicine combined with Western medicine is promising. The exact outcome required confirmation with rigorously well-designed multi-center trials. PMID:26379817

  18. Systematic Review and Meta-Analysis of Randomized Controlled Trials of Xingnaojing Treatment for Stroke

    Directory of Open Access Journals (Sweden)

    Weijun Peng

    2014-01-01

    Full Text Available Objective. Xingnaojing injection (XNJ is a well-known traditional Chinese patent medicine (TCPM for stroke. The aim of this study is to assess the efficacy of XNJ for stroke including ischemic stroke, intracerebral hemorrhage (ICH, and subarachnoid hemorrhage (SAH. Methods. An extensive search was performed within using eight databases up to November 2013. Randomized controlled trials (RCTs on XNJ for treatment of stroke were collected. Study selection, data extraction, quality assessment, and meta-analysis were conducted according to the Cochrane standards, and RevMan5.0 was used for meta-analysis. Results. This review included 13 RCTs and a total of 1,514 subjects. The overall methodological quality was poor. The meta-analysis showed that XNJ combined with conventional treatment was more effective for total efficacy, neurological deficit improvement, and reduction of TNF-α levels compared with those of conventional treatment alone. Three trials reported adverse events, of these one trial reported mild impairment of kidney and liver function, whereas the other two studies failed to report specific adverse events. Conclusion. Despite the limitations of this review, we suggest that XNJ in combination with conventional medicines might be beneficial for the treatment of stroke. Currently there are various methodological problems in the studies. Therefore, high-quality, large-scale RCTs are urgently needed.

  19. Genome-wide meta-analysis in alopecia areata resolves HLA associations and reveals two new susceptibility loci

    NARCIS (Netherlands)

    Betz, Regina C; Petukhova, Lynn; Ripke, Stephan; Huang, Hailiang; Menelaou, Androniki; Redler, Silke; Becker, Tim; Heilmann, Stefanie; Yamany, Tarek; Duvic, Madeliene; Hordinsky, Maria; Norris, David; Price, Vera H; Mackay-Wiggan, Julian; de Jong, Annemieke; DeStefano, Gina M; Moebus, Susanne; Böhm, Markus; Blume-Peytavi, Ulrike; Wolff, Hans; Lutz, Gerhard; Kruse, Roland; Bian, Li; Amos, Christopher I; Lee, Annette; Gregersen, Peter K; Blaumeiser, Bettina; Altshuler, David; Clynes, Raphael; de Bakker, Paul I W; Nöthen, Markus M; Daly, Mark J; Christiano, Angela M

    2015-01-01

    Alopecia areata (AA) is a prevalent autoimmune disease with 10 known susceptibility loci. Here we perform the first meta-analysis of research on AA by combining data from two genome-wide association studies (GWAS), and replication with supplemented ImmunoChip data for a total of 3,253 cases and

  20. Meta-analysis of five genome-wide association studies identifies multiple new loci associated with testicular germ cell tumor

    DEFF Research Database (Denmark)

    Wang, Zhaoming; McGlynn, Katherine A.; Rajpert-De Meyts, Ewa

    2017-01-01

    The international Testicular Cancer Consortium (TECAC) combined five published genome-wide association studies of testicular germ cell tumor (TGCT; 3,558 cases and 13,970 controls) to identify new susceptibility loci. We conducted a fixed-effects meta-analysis, including, to our knowledge, the fi...

  1. Small and inconsistent effects of whole body vibration on athletic performance : a systematic review and meta-analysis

    NARCIS (Netherlands)

    Hortobagyi, Tibor; Lesinski, Melanie; Fernandez-del-Olmo, Miguel; Granacher, Urs

    We quantified the acute and chronic effects of whole body vibration on athletic performance or its proxy measures in competitive and/or elite athletes. Systematic literature review and meta-analysis. Whole body vibration combined with exercise had an overall 0.3 % acute effect on maximal voluntary

  2. A meta-analysis of the effectiveness of individually oriented Cognitive Behavior Therapy (CBT) for severe agressive behavior in adolescents

    NARCIS (Netherlands)

    Hoogsteder, L.M; Stams, G.J.J.M.; Figge, M.A.; Changoe, K.; van Horn, J.; Hendriks, J.; Wissink, I.B.

    2015-01-01

    This meta-analysis, including six studies (13 effect sizes) and 164 adolescents, examined the effectiveness of individually oriented treatment (which means that the intervention contained at least an individual component, possibly in combination with group and/or family therapy) with CBT-elements

  3. A meta-analysis of the effectiveness of individually oriented Cognitive Behavioral Treatment (CBT) for severe agressive behavior in adolescents

    NARCIS (Netherlands)

    Hoogsteder, L.M.; Stams, G.J.J.M.; Figge, M.A.; Changoe, K.; van Horn, J.E.; Hendriks, J.; Wissink, I.B.

    2015-01-01

    This meta-analysis, including six studies (13 effect sizes) and 164 adolescents, examined the effectiveness of individually oriented treatment (which means that the intervention contained at least an individual component, possibly in combination with group and/or family therapy) with CBT-elements

  4. Role of the Fc gamma receptor IIA polymorphism in the antiphospholipid syndrome - an international meta-analysis

    NARCIS (Netherlands)

    Karassa, FB; Bijl, M; Davies, KA; Kallenberg, CGM; Khamashta, MA; Manger, K; Michel, M; Piette, JC; Salmon, JE; Song, YW; Tsuchiya, N; Yoo, DH; Ioannidis, JPA

    Objective. To assess the impact of the FcgammaRIIA-R/H131 polymorphism on the risk for antiphospholipid syndrome (APS), both primary and secondary to systemic lupus erythematosus (SLE). Methods. This international meta-analysis combined data from 9 research teams. FcgammaRIIA-R/H131 genotypes were

  5. Standardizing effect size from linear regression models with log-transformed variables for meta-analysis.

    Science.gov (United States)

    Rodríguez-Barranco, Miguel; Tobías, Aurelio; Redondo, Daniel; Molina-Portillo, Elena; Sánchez, María José

    2017-03-17

    Meta-analysis is very useful to summarize the effect of a treatment or a risk factor for a given disease. Often studies report results based on log-transformed variables in order to achieve the principal assumptions of a linear regression model. If this is the case for some, but not all studies, the effects need to be homogenized. We derived a set of formulae to transform absolute changes into relative ones, and vice versa, to allow including all results in a meta-analysis. We applied our procedure to all possible combinations of log-transformed independent or dependent variables. We also evaluated it in a simulation based on two variables either normally or asymmetrically distributed. In all the scenarios, and based on different change criteria, the effect size estimated by the derived set of formulae was equivalent to the real effect size. To avoid biased estimates of the effect, this procedure should be used with caution in the case of independent variables with asymmetric distributions that significantly differ from the normal distribution. We illustrate an application of this procedure by an application to a meta-analysis on the potential effects on neurodevelopment in children exposed to arsenic and manganese. The procedure proposed has been shown to be valid and capable of expressing the effect size of a linear regression model based on different change criteria in the variables. Homogenizing the results from different studies beforehand allows them to be combined in a meta-analysis, independently of whether the transformations had been performed on the dependent and/or independent variables.

  6. Methotrexate for the Treatment of Pediatric Crohn's Disease: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Colman, Ruben J; Lawton, Rachel C; Dubinsky, Marla C; Rubin, David T

    2018-04-23

    Methotrexate (MTX) is an immunomodulator used for the treatment of pediatric inflammatory bowel disease (IBD). There are currently no RCTs that assess the treatment efficacy of methotrexate within the pediatric IBD patient population. This systematic review and meta-analysis assesses the efficacy of MTX therapy among the existing pediatric literature. A systematic literature search was performed using MEDLINE and the Cochrane library from inception until March 2016. Synonyms for 'pediatric', 'methotrexate' and 'IBD' were utilized as both free text and MESH search terms. The studies included contained clinical remission (CR) rates for MTX treatment of pediatric IBD patients 18 yrs old, as mono- or combination therapy. Case studies with <10 patients were excluded. Quality assessment was performed with the Newcastle-Ottawa Scale. Meta-analysis calculated pooled CR rates. A random-effects meta-analysis with forest plots was performed using R. Fourteen (11 monotherapy, 1 combination therapy, 2 both; n = 886 patients) observational studies were eligible out of 202 studies. No interventional studies were identified. The pooled achieved CR rate for pediatric CD patients on monotherapy within 3-6 months was 57.7% (95% CI 48.2-66.6%), (P =0.22; I2 = 29.8%). The CR was 37.1% (95% CI 29.5-45.5%), (P = 0.20; I2 = 37.4%) for maintenance therapy at 12 months. Sub-analysis could not identify CR differences between MTX administration types, thiopurine exposure. This meta-analysis demonstrated that, over 50% of pediatric Crohn's disease patients induced with methotrexate achieved clinical remission, while 12-month remission rate was only 37%. Prospective controlled interventional trials should assess treatment efficacy among patient subgroups. 10.1093/ibd/izy078_video1izy078.video15774883936001.

  7. Rofecoxib for dysmenorrhoea: meta-analysis using individual patient data

    Directory of Open Access Journals (Sweden)

    McQuay Henry J

    2004-07-01

    Full Text Available Abstract Background Individual patient meta-analysis to determine the analgesic efficacy and adverse effects of single-dose rofecoxib in primary dysmenorrhoea. Methods Individual patient information was available from three randomised, double blind, placebo and active controlled trials of rofecoxib. Data were combined through meta-analysis. Number-needed-to-treat (NNT for at least 50% pain relief and the proportion of patients who had taken rescue medication over 12 hours were calculated. Information was collected on adverse effects. Results For single-dose rofecoxib 50 mg compared with placebo, the NNTs (with 95% CI for at least 50% pain relief were 3.2 (2.4 to 4.5 at six, 3.1 (2.4 to 9.0 at eight, and 3.7 (2.8 to 5.6 at 12 hours. For naproxen sodium 550 mg they were 3.1 (2.4 to 4.4 at six, 3.0 (2.3 to 4.2 at eight, and 3.8 (2.7 to 6.1 at 12 hours. The proportion of patients who needed rescue medication within 12 hours was 27% with rofecoxib 50 mg, 29% with naproxen sodium 550 mg, and 50% with placebo. In the single-dose trial, the proportion of patients reporting any adverse effect was 8% (4/49 with rofecoxib 50 mg, 12% (6/49 with ibuprofen 400 mg, and 6% (3/49 with placebo. In the other two multiple dose trials, the proportion of patients reporting any adverse effect was 23% (42/179 with rofecoxib 50 mg, 24% (45/181 with naproxen sodium 550 mg, and 18% (33/178 with placebo. Conclusions Single dose rofecoxib 50 mg provided similar pain relief to naproxen sodium 550 mg over 12 hours. The duration of analgesia with rofecoxib 50 mg was similar to that of naproxen sodium 550 mg. Adverse effects were uncommon suggesting safety in short-term use of rofecoxib and naproxen sodium. Future research should include restriction on daily life and absence from work or school as outcomes.

  8. Optical Coherence Tomography in Alzheimer's Disease: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Gianluca Coppola

    Full Text Available Alzheimer's disease (AD is a neurodegenerative disorder, which is likely to start as mild cognitive impairment (MCI several years before the its full-blown clinical manifestation. Optical coherence tomography (OCT has been used to detect a loss in peripapillary retina nerve fiber layer (RNFL and a reduction in macular thickness and volume of people affected by MCI or AD. Here, we performed an aggregate meta-analysis combining results from different studies.Data sources were case-control studies published between January 2001 and August 2014 (identified through PubMed and Google Scholar databases that examined the RNFL thickness by means of OCT in AD and MCI patients compared with cognitively healthy controls.11 studies were identified, including 380 patients with AD, 68 with MCI and 293 healthy controls (HC. The studies suggest that the mean RNFL thickness is reduced in MCI (weighted mean differences in μm, WMD = -13.39, 95% CI: -17.34 to -9.45, p = 0.031 and, even more so, in AD (WMD = -15.95, 95% CI: -21.65 to -10.21, p<0.0001 patients compared to HC. RNFL in the 4 quadrants were all significantly thinner in AD superior (superior WMD = -24.0, 95% CI: -34.9 to -13.1, p<0.0001; inferior WMD = -20.8, 95% CI: -32.0 to -9.7, p<0.0001; nasal WMD = -14.7, 95% CI: -23.9 to -5.5, p<0.0001; and temporal WMD = -10.7, 95% CI: -19.9 to -1.4, p<0.0001; the same significant reduction in quadrant RNFL was observed in MCI patients compared with HC (Inferior WMD = -20.22, 95% CI: -30.41 to -10.03, p = 0.0001; nasal WMD = -7.4, 95% CI: -10.08 to -4.7, p = 0.0000; and temporal WMD = -6.88, 95% CI: -12.62 to -1.13, p = 0.01, with the exception of superior quadrant (WMD = -19.45, 95% CI: -40.23 to 1.32, p = 0.06.Results from the meta-analysis support the important role of OCT for RNFL analysis in monitoring the progression of AD and in assessing the effectiveness of purported AD treatments.

  9. The Flynn Effect: A Meta-analysis

    Science.gov (United States)

    Trahan, Lisa; Stuebing, Karla K.; Hiscock, Merril K.; Fletcher, Jack M.

    2014-01-01

    The “Flynn effect” refers to the observed rise in IQ scores over time, resulting in norms obsolescence. Although the Flynn effect is widely accepted, most approaches to estimating it have relied upon “scorecard” approaches that make estimates of its magnitude and error of measurement controversial and prevent determination of factors that moderate the Flynn effect across different IQ tests. We conducted a meta-analysis to determine the magnitude of the Flynn effect with a higher degree of precision, to determine the error of measurement, and to assess the impact of several moderator variables on the mean effect size. Across 285 studies (N = 14,031) since 1951 with administrations of two intelligence tests with different normative bases, the meta-analytic mean was 2.31, 95% CI [1.99, 2.64], standard score points per decade. The mean effect size for 53 comparisons (N = 3,951) (excluding three atypical studies that inflate the estimates) involving modern (since 1972) Stanford-Binet and Wechsler IQ tests (2.93, 95% CI [2.3, 3.5], IQ points per decade) was comparable to previous estimates of about 3 points per decade, but not consistent with the hypothesis that the Flynn effect is diminishing. For modern tests, study sample (larger increases for validation research samples vs. test standardization samples) and order of administration explained unique variance in the Flynn effect, but age and ability level were not significant moderators. These results supported previous estimates of the Flynn effect and its robustness across different age groups, measures, samples, and levels of performance. PMID:24979188

  10. Abreaction for conversion disorder: systematic review with meta-analysis.

    Science.gov (United States)

    Poole, Norman A; Wuerz, Axel; Agrawal, Niruj

    2010-08-01

    The value of drug interviews in the treatment of conversion disorder is at present unknown. To review all the available papers published in English that report on the use of drug interviews for treating conversion/dissociative disorder. Databases (including EMBASE, MEDLINE and PsycINFO) were searched from 1920 to 2009. Selected publications had to report on the use of drug interviews in people diagnosed with a conversion/dissociative disorder. Qualitative and quantitative data were extracted. Predictors of a positive response were ascertained using meta-analytic techniques. Fifty-five papers meeting inclusion criteria were identified. No studies compared the intervention with a suitable control group. However, two studies reported high response rates when drug interview was used in individuals with treatment-resistant conversion disorder. In the meta-analysis, the use of suggestion and occurrence of emotional catharsis during the interview were positively associated with recovery. Combining two medications and comorbid psychiatric disorder were negatively associated with recovery. The evidence for effectiveness of drug interviews is of poor quality but it may be of benefit in the treatment of acute and treatment-resistant conversion disorder. A proactive approach during the interview, making suggestions the individual will respond, could influence outcome. Comorbid psychiatric disorder should be treated conventionally. Experimental studies to determine efficacy are required.

  11. Toxoplasmosis and epilepsy--systematic review and meta analysis.

    Science.gov (United States)

    Ngoungou, Edgard B; Bhalla, Devender; Nzoghe, Amandine; Dardé, Marie-Laure; Preux, Pierre-Marie

    2015-02-01

    Toxoplasmosis is an important, widespread, parasitic infection caused by Toxoplasma gondii. The chronic infection in immunocompetent patients, usually considered as asymptomatic, is now suspected to be a risk factor for various neurological disorders, including epilepsy. We aimed to conduct a systematic review and meta-analysis of the available literature to estimate the risk of epilepsy due to toxoplasmosis. A systematic literature search was conducted of several databases and journals to identify studies published in English or French, without date restriction, which looked at toxoplasmosis (as exposure) and epilepsy (as disease) and met certain other inclusion criteria. The search was based on keywords and suitable combinations in English and French. Fixed and random effects models were used to determine odds ratios, and statistical significance was set at 5.0%. Six studies were identified, with an estimated total of 2888 subjects, of whom 1280 had epilepsy (477 positive for toxoplasmosis) and 1608 did not (503 positive for toxoplasmosis). The common odds ratio (calculated) by random effects model was 2.25 (95% CI 1.27-3.9), p = 0.005. Despite the limited number of studies, and a lack of high-quality data, toxoplasmosis should continue to be regarded as an epilepsy risk factor. More and better studies are needed to determine the real impact of this parasite on the occurrence of epilepsy.

  12. Survival after radiotherapy in gastric cancer: Systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Valentini, Vincenzo; Cellini, Francesco; Minsky, Bruce D.; Mattiucci, Gian Carlo; Balducci, Mario; D'Agostino, Giuseppe; D'Angelo, Elisa; Dinapoli, Nicola; Nicolotti, Nicola; Valentini, Chiara; La Torre, Giuseppe

    2009-01-01

    Background and purpose: A systematic review and meta-analysis was performed to assess the impact of radiotherapy on both 3- and 5-year survival in patients with resectable gastric cancer. Methods: Randomized Clinical Trials (RCTs) in which radiotherapy, (preoperative, postoperative and/or intraoperative), was compared with surgery alone or surgery plus chemotherapy in resectable gastric cancer were identified by searching web-based databases and supplemented by manual examination of reference lists. Meta-analysis was performed using Risk Ratios (RRs). Random or fixed effects models were used to combine data. The methodological quality was evaluated by Chalmers' score. Results: Radiotherapy had a significant impact on 5-year survival. Using an intent to treat (ITT) and a Per Protocol (PP) analysis, the overall 5-year RR was 1.26 (95% CI: 1.08-1.48; NNT = 17) and 1.31 (95% CI: 1.04-1.66; NNT = 13), respectively. Although the quality of the studies was variable, the data were consistent and no clear publication bias was found. Conclusion: This meta-analysis showed a statistically significant 5-year survival benefit with the addition of radiotherapy in patients with resectable gastric cancer. Radiotherapy remains a standard component in the treatment of resectable gastric cancer and new RCTs need to address the impact of new conformal radiotherapy technologies.

  13. Classifying oxidative stress by F2-isoprostane levels across human diseases: A meta-analysis.

    Science.gov (United States)

    van 't Erve, Thomas J; Kadiiska, Maria B; London, Stephanie J; Mason, Ronald P

    2017-08-01

    The notion that oxidative stress plays a role in virtually every human disease and environmental exposure has become ingrained in everyday knowledge. However, mounting evidence regarding the lack of specificity of biomarkers traditionally used as indicators of oxidative stress in human disease and exposures now necessitates re-evaluation. To prioritize these re-evaluations, published literature was comprehensively analyzed in a meta-analysis to quantitatively classify the levels of systemic oxidative damage across human disease and in response to environmental exposures. In this meta-analysis, the F 2 -isoprostane, 8-iso-PGF 2α , was specifically chosen as the representative marker of oxidative damage. To combine published values across measurement methods and specimens, the standardized mean differences (Hedges' g) in 8-iso-PGF 2α levels between affected and control populations were calculated. The meta-analysis resulted in a classification of oxidative damage levels as measured by 8-iso-PGF 2α across 50 human health outcomes and exposures from 242 distinct publications. Relatively small increases in 8-iso-PGF 2α levels (ganalysis of published data. This analysis provides knowledge on the true involvement of oxidative damage across human health outcomes as well as utilizes past research to prioritize those conditions requiring further scrutiny on the mechanisms of biomarker generation. Copyright © 2017. Published by Elsevier B.V.

  14. The Effect of Hypnosis on Anxiety in Patients With Cancer: A Meta-Analysis.

    Science.gov (United States)

    Chen, Pei-Ying; Liu, Ying-Mei; Chen, Mei-Ling

    2017-06-01

    Anxiety is a common form of psychological distress in patients with cancer. One recognized nonpharmacological intervention to reduce anxiety for various populations is hypnotherapy or hypnosis. However, its effect in reducing anxiety in cancer patients has not been systematically evaluated. This meta-analysis was designed to synthesize the immediate and sustained effects of hypnosis on anxiety of cancer patients and to identify moderators for these hypnosis effects. Qualified studies including randomized controlled trials (RCT) and pre-post design studies were identified by searching seven electronic databases: Scopus, Medline Ovidsp, PubMed, PsycInfo-Ovid, Academic Search Premier, CINAHL Plus with FT-EBSCO, and SDOL. Effect size (Hedges' g) was computed for each study. Random-effect modeling was used to combine effect sizes across studies. All statistical analyses were conducted with Comprehensive Meta-Analysis, version 2 (Biostat, Inc., Englewood, NJ, USA). Our meta-analysis of 20 studies found that hypnosis had a significant immediate effect on anxiety in cancer patients (Hedges' g: 0.70-1.41, p Hypnosis delivered by a therapist was significantly more effective than self-hypnosis. Hypnosis can reduce anxiety of cancer patients, especially for pediatric cancer patients who experience procedure-related stress. We recommend therapist-delivered hypnosis should be preferred until more effective self-hypnosis strategies are developed. © 2017 Sigma Theta Tau International.

  15. Meta-analysis: Association of Helicobacter pylori infection with Parkinson's diseases.

    Science.gov (United States)

    Shen, Xiaoli; Yang, Huazhen; Wu, Yili; Zhang, Dongfeng; Jiang, Hong

    2017-10-01

    The results from observational studies on the relationship between helicobacter pylori (H. pylori) infection and Parkinson's disease remain controversial. A meta-analysis was conducted to evaluate the association between helicobacter pylori infection and Parkinson's disease. A comprehensive literature search was performed on relevant studies published from January 1983 to January 2017 in PubMed, Web of Science and EMBASE databases. The fixed or random effects model was used to pool the odds ratio with 95% confidence interval from individual studies. Publication bias was estimated by Egger's test and the funnel plot. Eight eligible studies involving 33 125 participants were included in this meta-analysis. Compared with the no helicobacter pylori infected person, the pooled odds ratio of Parkinson's disease in helicobacter pylori infected person was 1.59 (95% confidence interval: 1.37-1.85). In subgroup analyzes, the combined odds ratios were 1.96 (1.23-3.12) in Asia, 1.55 (1.32-1.82) in Europe, 1.59 (1.35-1.88) in case-control studies, 1.56 (1.01-2.39) in cross-sectional studies, 1.56 (1.32-1.85) in studies with confounders adjusted, and 1.71 (1.21-2.43) in studies with no confounder adjusted, respectively. This meta-analysis indicated that H. pylori infection might be associated with the risk of Parkinson's disease. © 2017 John Wiley & Sons Ltd.

  16. Individual Participant Data Meta-Analysis of Mechanical Workplace Risk Factors and Low Back Pain

    Science.gov (United States)

    Shannon, Harry S.; Wells, Richard P.; Walter, Stephen D.; Cole, Donald C.; Côté, Pierre; Frank, John; Hogg-Johnson, Sheilah; Langlois, Lacey E.

    2012-01-01

    Objectives. We used individual participant data from multiple studies to conduct a comprehensive meta-analysis of mechanical exposures in the workplace and low back pain. Methods. We conducted a systematic literature search and contacted an author of each study to request their individual participant data. Because outcome definitions and exposure measures were not uniform across studies, we conducted 2 substudies: (1) to identify sets of outcome definitions that could be combined in a meta-analysis and (2) to develop methods to translate mechanical exposure onto a common metric. We used generalized estimating equation regression to analyze the data. Results. The odds ratios (ORs) for posture exposures ranged from 1.1 to 2.0. Force exposure ORs ranged from 1.4 to 2.1. The magnitudes of the ORs differed according to the definition of low back pain, and heterogeneity was associated with both study-level and individual-level characteristics. Conclusions. We found small to moderate ORs for the association of mechanical exposures and low back pain, although the relationships were complex. The presence of individual-level OR modifiers in such an area can be best understood by conducting a meta-analysis of individual participant data. PMID:22390445

  17. Body mass index and risk of BPH: a meta-analysis.

    Science.gov (United States)

    Wang, S; Mao, Q; Lin, Y; Wu, J; Wang, X; Zheng, X; Xie, L

    2012-09-01

    Epidemiological studies have reported conflicting results relating obesity to BPH. A meta-analysis of cohort and case-control studies was conducted to pool the risk estimates of the association between obesity and BPH. Eligible studies were retrieved by both computer searches and review of references. We analyzed abstracted data with random effects models to obtain the summary risk estimates. Dose-response meta-analysis was performed for studies reporting categorical risk estimates for a series of exposure levels. A total of 19 studies met the inclusion criteria of the meta-analysis. Positive association with body mass index (BMI) was observed in BPH and lower urinary tract symptoms (LUTS) combined group (odds ratio=1.27, 95% confidence intervals 1.05-1.53). In subgroup analysis, BMI exhibited a positive dose-response relationship with BPH/LUTS in population-based case-control studies and a marginal positive association was observed between risk of BPH and increased BMI. However, no association between BPH/LUTS and BMI was observed in other subgroups stratified by study design, geographical region or primary outcome. The overall current literatures suggested that BMI was associated with increased risk of BPH. Further efforts should be made to confirm these findings and clarify the underlying biological mechanisms.

  18. Aromatherapy for Sexual Problems in Menopausal Women: A Systematic Review and Meta-analysis

    Science.gov (United States)

    Khadivzadeh, Talat; Najafi, Mona Najaf; Irani, Morvarid; Dizavandi, Fatemeh Rajab; Shariati, Khatereh

    2018-01-01

    Objectives The aim of the present systematic review and meta-analysis is the exploration of the potential evidence of the effectiveness of aromatherapy products on the sexual function of menopausal women. Methods From inception to December 2017, the search process was performed using the MEDLINE and Scopus databases and the Cochrane Library regarding the trials on the effectiveness of herbal-medicine aromatherapy on the sexual function of menopausal women. Results Three of the trials comprise suitable data for inclusion in the meta-analysis. According to the meta-analysis, it is possible to improve the standardized mean difference (SMD) of the sexual desire up to 0.56 in the aromatherapy group compared with the control group (SMD = 0.56; P aromatherapy with neroli oil or lavender (monopreparation) and combined-oil aromatherapy with lavender, fennel, geranium, and rose significantly improved human sexual function; however, a significant change of the serum-estrogen level was not detected. The findings of the present review should be presented cautiously because of the corresponding limitations such as the lack of a standardized tool, the lack of intention-to-treat reporting, the low study amount, and the short-term follow-up. PMID:29765928

  19. The efficacy of trimetazidine on stable angina pectoris: a meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Peng, Song; Zhao, Min; Wan, Jing; Fang, Qi; Fang, Dong; Li, Kaiyong

    2014-12-20

    This meta-analysis aimed to evaluate the efficacy of trimetazidine in combination with other anti-anginal drugs versus other anti-anginal drugs in the treatment of stable angina pectoris (SAP). Randomized controlled trials (RCTs) published in English and Chinese were retrieved from computerized databases: Embase, PubMed, and CNKI. Primary outcomes consist of clinical parameters (numbers of weekly angina attacks and nitroglycerin use) and ergometric parameters (time to 1mm ST-segment depression, and total work (in Mets) and exercise duration (in seconds) at peak exercise) in stable angina pectoris treated by trimetazidine or not. The quality of studies was evaluated using Jadad score. Data analysis of 13 studies was performed using Stata 12.0 software. Results showed that treatment of trimetazidine and other anti-anginal drugs was associated with a smaller weekly mean number of angina attacks (WMD=-0.95, 95%CI: -1.30 to -0.61, Z=5.39, Pangina pectoris. Sensitivity analysis was performed. Sub-group analysis showed that treatment duration was not a significant moderator and patients treated within 8 weeks and above 12 weeks had no difference in the outcomes addressed in this meta-analysis. No publish bias was detected. This meta-analysis confirms the efficacy of trimetazidine in the treatment of stable angina pectoris, in comparison with conventional antianginal agents, regardless of treatment duration. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Meta-analysis of Gaussian individual patient data: Two-stage or not two-stage?

    Science.gov (United States)

    Morris, Tim P; Fisher, David J; Kenward, Michael G; Carpenter, James R

    2018-04-30

    Quantitative evidence synthesis through meta-analysis is central to evidence-based medicine. For well-documented reasons, the meta-analysis of individual patient data is held in higher regard than aggregate data. With access to individual patient data, the analysis is not restricted to a "two-stage" approach (combining estimates and standard errors) but can estimate parameters of interest by fitting a single model to all of the data, a so-called "one-stage" analysis. There has been debate about the merits of one- and two-stage analysis. Arguments for one-stage analysis have typically noted that a wider range of models can be fitted and overall estimates may be more precise. The two-stage side has emphasised that the models that can be fitted in two stages are sufficient to answer the relevant questions, with less scope for mistakes because there are fewer modelling choices to be made in the two-stage approach. For Gaussian data, we consider the statistical arguments for flexibility and precision in small-sample settings. Regarding flexibility, several of the models that can be fitted only in one stage may not be of serious interest to most meta-analysis practitioners. Regarding precision, we consider fixed- and random-effects meta-analysis and see that, for a model making certain assumptions, the number of stages used to fit this model is irrelevant; the precision will be approximately equal. Meta-analysts should choose modelling assumptions carefully. Sometimes relevant models can only be fitted in one stage. Otherwise, meta-analysts are free to use whichever procedure is most convenient to fit the identified model. © 2018 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  1. LncRNA expression and implication in osteosarcoma: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Wang Y

    2017-11-01

    Full Text Available Ying Wang,1,2,* Yuelong Huang,2,* Peng Xiang,3 Wei Tian2 1Department of Molecular Orthopaedics, Beijing Institute of Traumatology and Orthopaedics, 2Department of Spinal Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, 3Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Purpose: Osteosarcoma is the most prevalent primary bone tumor in children, adolescents, and older adults, typically presenting with poor survival outcomes. In recent years, ample evidence has shown that many long noncoding RNAs (lncRNAs have been aberrantly expressed in osteosarcoma, demonstrating their potential to serve as prognostic markers. In this study, we performed a meta-analysis on four lncRNAs (TUG1, UCA1, BCAR4, and HULC to systematically evaluate their prognostic value in osteosarcoma.Materials and methods: The eligible articles were systematically searched in PubMed, Web of Science, Embase, and Elsevier ScienceDirect (up to September 22, 2017, and one meta-analysis concerning the association between lncRNA expression and the overall survival (OS of osteosarcoma patients was performed. Survival outcomes were analyzed by OS. Subgroup analyses were performed.Results: A total of 1,361 patients with osteosarcoma and 12 lncRNAs from 16 articles were included in the study. Of the listed lncRNAs, the high expression of 10 lncRNAs indicated worse survival outcomes, while only two lncRNAs were shown to positively affect patients’ OS.Conclusion: This meta-analysis indicated that the abnormally expressed lncRNAs might significantly affect the survival of osteosarcoma patients. Combined use of these lncRNAs may serve as potential novel biomarkers for the indication of clinical outcomes of osteosarcoma patients as well as the selection of adjuvant chemotherapy strategies for clinical treatment of this disease. Keywords: lncRNAs, osteosarcoma

  2. [Effectiveness of acupuncture in postoperative ileus: a systematic review and Meta-analysis].

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    Cheong, Kah Bik; Zhang, Jiping; Huang, Yong

    2016-06-01

    To conduct a systematic review and Meta-analysis of the effectiveness of acupuncture and common acupoint selection for postoperative ileus (POI). Randomized controlled trials (RCTs) comparing acupuncture and non-acupuncture treatment were identified from the databases PubMed, Cochrane, EBSCO (Academic Source Premier and MEDLINE), Ovid (including Evidence-Based Medicine Reviews), China National Knowledge Infrastructure, and Wanfang Data. The data from eligible studies were extracted and a Meta-analysis performed using a fixed-effects model. Results were expressed as relative risk (RR) for dichotomous data, and 95% CI (confidence intervals) were calculated. Each trial was evaluated using the CONSORT (Consolidated Standards of Reporting Trials) and STRICTA (STandards for Reporting Interventions in Controlled Trials of Acupuncture) guideline . The quality of the study was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Of the 69 studies screened, eight RCTs were included for review. Among these, four RCTs (with a total of 123 patients in the intervention groups and 124 patients in the control groups) met the criteria for Meta-analysis. The Meta-analysis results indicated that acupuncture combined with usual care showed a significantly higher total effective rate than the control condition (usual care) (RR 1.09, 95% CI 1.01, 1.18; P = 0.02). Zusanli (ST 36) and Shangjuxu (ST 37) were the most common acupoints selected. However, the quality of the studies was generally low, as they did not emphasize the use of blinding. The results suggested that acupuncture might be effective in improving POI; however, a definite conclusion could not be drawn because of the low quality of trials. Further large-scale, high-quality randomized clinical trials are needed to validate these findings and to develop a standardized method of treatment. We hope that the present results will lead to improved research, resulting in better

  3. A Bayesian network meta-analysis on second-line systemic therapy in advanced gastric cancer.

    Science.gov (United States)

    Zhu, Xiaofu; Ko, Yoo-Joung; Berry, Scott; Shah, Keya; Lee, Esther; Chan, Kelvin

    2017-07-01

    It is unclear which regimen is the most efficacious among the available therapies for advanced gastric cancer in the second-line setting. We performed a network meta-analysis to determine their relative benefits. We conducted a systematic review of randomized controlled trials (RCTs) through the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and American Society of Clinical Oncology abstracts up to June 2014 to identify phase III RCTs on advanced gastric cancer in the second-line setting. Overall survival (OS) data were the primary outcome of interest. Hazard ratios (HRs) were extracted from the publications on the basis of reported values or were extracted from survival curves by established methods. A Bayesian network meta-analysis was performed with WinBUGS to compare all regimens simultaneously. Eight RCTs (2439 patients) were identified and contained extractable data for quantitative analysis. Network meta-analysis showed that paclitaxel plus ramucirumab was superior to single-agent ramucirumab [OS HR 0.51, 95 % credible region (CR) 0.30-0.86], paclitaxel (OS HR 0.81, 95 % CR 0.68-0.96), docetaxel (OS HR 0.56, 95 % CR 0.33-0.94), and irinotecan (OS HR 0.71, 95 % CR 0.52-0.99). Paclitaxel plus ramucirumab also had an 89 % probability of being the best regimen among all these regimens. Single-agent ramucirumab, paclitaxel, docetaxel, and irinotecan were comparable to each other with respect to OS and were superior to best supportive care. This is the first network meta-analysis to compare all second-line regimens reported in phase III gastric cancer trials. The results suggest the paclitaxel plus ramucirumab combination is the most effective therapy and should be the reference regimen for future comparative trials.

  4. Beta-binomial model for meta-analysis of odds ratios.

    Science.gov (United States)

    Bakbergenuly, Ilyas; Kulinskaya, Elena

    2017-05-20

    In meta-analysis of odds ratios (ORs), heterogeneity between the studies is usually modelled via the additive random effects model (REM). An alternative, multiplicative REM for ORs uses overdispersion. The multiplicative factor in this overdispersion model (ODM) can be interpreted as an intra-class correlation (ICC) parameter. This model naturally arises when the probabilities of an event in one or both arms of a comparative study are themselves beta-distributed, resulting in beta-binomial distributions. We propose two new estimators of the ICC for meta-analysis in this setting. One is based on the inverted Breslow-Day test, and the other on the improved gamma approximation by Kulinskaya and Dollinger (2015, p. 26) to the distribution of Cochran's Q. The performance of these and several other estimators of ICC on bias and coverage is studied by simulation. Additionally, the Mantel-Haenszel approach to estimation of ORs is extended to the beta-binomial model, and we study performance of various ICC estimators when used in the Mantel-Haenszel or the inverse-variance method to combine ORs in meta-analysis. The results of the simulations show that the improved gamma-based estimator of ICC is superior for small sample sizes, and the Breslow-Day-based estimator is the best for n⩾100. The Mantel-Haenszel-based estimator of OR is very biased and is not recommended. The inverse-variance approach is also somewhat biased for ORs≠1, but this bias is not very large in practical settings. Developed methods and R programs, provided in the Web Appendix, make the beta-binomial model a feasible alternative to the standard REM for meta-analysis of ORs. © 2017 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd. © 2017 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  5. Food and drug cues activate similar brain regions: a meta-analysis of functional MRI studies.

    Science.gov (United States)

    Tang, D W; Fellows, L K; Small, D M; Dagher, A

    2012-06-06

    In healthy individuals, food cues can trigger hunger and feeding behavior. Likewise, smoking cues can trigger craving and relapse in smokers. Brain imaging studies report that structures involved in appetitive behaviors and reward, notably the insula, striatum, amygdala and orbital frontal cortex, tend to be activated by both visual food and smoking cues. Here, by carrying out a meta-analysis of human neuro-imaging studies, we investigate the neural network activated by: 1) food versus neutral cues (14 studies, 142 foci) 2) smoking versus neutral cues (15 studies, 176 foci) 3) smoking versus neutral cues when correlated with craving scores (7 studies, 108 foci). PubMed was used to identify cue-reactivity imaging studies that compared brain response to visual food or smoking cues to neutral cues. Fourteen articles were identified for the food meta-analysis and fifteen articles were identified for the smoking meta-analysis. Six articles were identified for the smoking cue correlated with craving analysis. Meta-analyses were carried out using activation likelihood estimation. Food cues were associated with increased blood oxygen level dependent (BOLD) response in the left amygdala, bilateral insula, bilateral orbital frontal cortex, and striatum. Smoking cues were associated with increased BOLD signal in the same areas, with the exception of the insula. However, the smoking meta-analysis of brain maps correlating cue-reactivity with subjective craving did identify the insula, suggesting that insula activation is only found when craving levels are high. The brain areas identified here are involved in learning, memory and motivation, and their cue-induced activity is an index of the incentive salience of the cues. Using meta-analytic techniques to combine a series of studies, we found that food and smoking cues activate comparable brain networks. There is significant overlap in brain regions responding to conditioned cues associated with natural and drug rewards

  6. Curcuminoids Lower Plasma Leptin Concentrations: A Meta-analysis.

    Science.gov (United States)

    Atkin, Stephen L; Katsiki, Niki; Derosa, Giuseppe; Maffioli, Pamela; Sahebkar, Amirhossein

    2017-12-01

    Curcumin is a naturally occurring polyphenol that has been suggested to improve several metabolic diseases. Leptin is an adipokine involved in metabolic status and appetite, with marked crosstalk with other systems. Available data suggest that curcumin may affect leptin levels; therefore, this meta-analysis was performed to evaluate this. A systematic review and meta-analysis were undertaken on all randomized controlled trials of curcumin studies that included the measurement of leptin. The search included PubMed-Medline, Scopus, ISI Web of Knowledge, and Google Scholar databases. Quantitative data synthesis was performed by using a random-effects model, with standardized mean difference and 95% confidence interval as summary statistics. A funnel plot, Begg's rank correlation, and Egger's weighted regression tests assessed the presence of publication bias. Four eligible articles comprising five treatment arms were selected for the meta-analysis. Meta-analysis showed a significant decrease in plasma leptin concentrations following curcumin treatment (standardized mean difference: -0.69, 95% confidence interval: -1.16, -0.23, p = 0.003; I 2  = 76.53%). There was no evidence of publication bias. This meta-analysis showed that curcumin supplementation is associated with a decrease in leptin levels that may be regarded as a potential mechanism for the metabolic effects of curcumin. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  7. meta-analysis of Serum Tumor Markers in Lung Cancer

    Directory of Open Access Journals (Sweden)

    Xianfeng LU

    2010-12-01

    Full Text Available Background and objective The detection of serum tumor markers is of great value for early diagnosis of lung cancer. The aim of this study is to summarize the clinic significance characteristics of serum markers contributing to the detection of lung cancer. Methods References about serum markers of lung cancer were estimated using meta-analysis method. 712 references which included more than 20 cases, 20 controls, the serum markers of 52 832 patients with malignancies and 32 037 patients as controls were evaluated. Results Overall the detection of 13 markers play a significant part in lung cancer diagnosis. The sensitivity of CEA, CA125, CYFRA21-1, TPA, SCCAg, DKK1, NSE, ProGRP in the patients’ serum with lung cancer were 47.50%, 50.11%, 57.00%, 50.93%, 49.00%, 69.50%, 39.73%, 51.48% and the specificity were 92.34%, 80.19%, 90.16%, 88.41%, 91.07%, 92.20%, 89.11%, 94.89%. In the combined analysis of tumor markers: the sensitivity, specificity of NSE+ProGRP were 88.90% and 72.82% in diagnosis of small cell lung cancer, respectively. In diagnosis of squamous corcinoma, the sensitivity and specificity of TSGF+SCCAg+CYFRA21-1 were 95.30% and 74.20%. The the sensitivity and specificity of CA153+Ferrtin+CEA were 91.90% and 44.00% in diagnosis of lung cancer. Conclusion Although the assay of tumor markers in serum is useful for diagnosis of early lung cancer, the sensitivity and specificity are low. Combined detection of these tumor markers could increase sensitivity and specificity.

  8. Treatments for bulimia nervosa: a network meta-analysis.

    Science.gov (United States)

    Slade, Eric; Keeney, Edna; Mavranezouli, Ifigeneia; Dias, Sofia; Fou, Linyun; Stockton, Sarah; Saxon, Leanne; Waller, Glenn; Turner, Hannah; Serpell, Lucy; Fairburn, Christopher G; Kendall, Tim

    2018-05-06

    Bulimia nervosa (BN) is a severe eating disorder that can be managed using a variety of treatments including pharmacological, psychological, and combination treatments. We aimed to compare their effectiveness and to identify the most effective for the treatment of BN in adults. A search was conducted in Embase, Medline, PsycINFO, and Central from their inception to July 2016. Studies were included if they reported on treatments for adults who fulfilled diagnostic criteria for BN. Only randomised controlled trials (RCTs) that examined available psychological, pharmacological, or combination therapies licensed in the UK were included. We conducted a network meta-analysis (NMA) of RCTs. The outcome analysed was full remission at the end of treatment. We identified 21 eligible trials with 1828 participants involving 12 treatments, including wait list. The results of the NMA suggested that individual cognitive behavioural therapy (CBT) (specific to eating disorders) was most effective in achieving remission at the end of treatment compared with wait list (OR 3.89, 95% CrI 1.19-14.02), followed by guided cognitive behavioural self-help (OR 3.81, 95% CrI 1.51-10.90). Inconsistency checks did not identify any significant inconsistency between the direct and indirect evidence. The analysis suggested that the treatments that are most likely to achieve full remission are individual CBT (specific to eating disorders) and guided cognitive behavioural self-help, although no firm conclusions could be drawn due to the limited evidence base. There is a need for further research on the maintenance of treatment effects and the mediators of treatment outcome.

  9. Formalizing the definition of meta-analysis in Molecular Ecology.

    Science.gov (United States)

    ArchMiller, Althea A; Bauer, Eric F; Koch, Rebecca E; Wijayawardena, Bhagya K; Anil, Ammu; Kottwitz, Jack J; Munsterman, Amelia S; Wilson, Alan E

    2015-08-01

    Meta-analysis, the statistical synthesis of pertinent literature to develop evidence-based conclusions, is relatively new to the field of molecular ecology, with the first meta-analysis published in the journal Molecular Ecology in 2003 (Slate & Phua 2003). The goal of this article is to formalize the definition of meta-analysis for the authors, editors, reviewers and readers of Molecular Ecology by completing a review of the meta-analyses previously published in this journal. We also provide a brief overview of the many components required for meta-analysis with a more specific discussion of the issues related to the field of molecular ecology, including the use and statistical considerations of Wright's FST and its related analogues as effect sizes in meta-analysis. We performed a literature review to identify articles published as 'meta-analyses' in Molecular Ecology, which were then evaluated by at least two reviewers. We specifically targeted Molecular Ecology publications because as a flagship journal in this field, meta-analyses published in Molecular Ecology have the potential to set the standard for meta-analyses in other journals. We found that while many of these reviewed articles were strong meta-analyses, others failed to follow standard meta-analytical techniques. One of these unsatisfactory meta-analyses was in fact a secondary analysis. Other studies attempted meta-analyses but lacked the fundamental statistics that are considered necessary for an effective and powerful meta-analysis. By drawing attention to the inconsistency of studies labelled as meta-analyses, we emphasize the importance of understanding the components of traditional meta-analyses to fully embrace the strengths of quantitative data synthesis in the field of molecular ecology. © 2015 John Wiley & Sons Ltd.

  10. Using structural equation modeling for network meta-analysis.

    Science.gov (United States)

    Tu, Yu-Kang; Wu, Yun-Chun

    2017-07-14

    Network meta-analysis overcomes the limitations of traditional pair-wise meta-analysis by incorporating all available evidence into a general statistical framework for simultaneous comparisons of several treatments. Currently, network meta-analyses are undertaken either within the Bayesian hierarchical linear models or frequentist generalized linear mixed models. Structural equation modeling (SEM) is a statistical method originally developed for modeling causal relations among observed and latent variables. As random effect is explicitly modeled as a latent variable in SEM, it is very flexible for analysts to specify complex random effect structure and to make linear and nonlinear constraints on parameters. The aim of this article is to show how to undertake a network meta-analysis within the statistical framework of SEM. We used an example dataset to demonstrate the standard fixed and random effect network meta-analysis models can be easily implemented in SEM. It contains results of 26 studies that directly compared three treatment groups A, B and C for prevention of first bleeding in patients with liver cirrhosis. We also showed that a new approach to network meta-analysis based on the technique of unrestricted weighted least squares (UWLS) method can also be undertaken using SEM. For both the fixed and random effect network meta-analysis, SEM yielded similar coefficients and confidence intervals to those reported in the previous literature. The point estimates of two UWLS models were identical to those in the fixed effect model but the confidence intervals were greater. This is consistent with results from the traditional pairwise meta-analyses. Comparing to UWLS model with common variance adjusted factor, UWLS model with unique variance adjusted factor has greater confidence intervals when the heterogeneity was larger in the pairwise comparison. The UWLS model with unique variance adjusted factor reflects the difference in heterogeneity within each comparison

  11. Occupational and environmental scleroderma. Systematic review and meta-analysis.

    Science.gov (United States)

    Rubio-Rivas, Manuel; Moreno, Rafael; Corbella, Xavier

    2017-03-01

    The etiology of systemic sclerosis (SSc) remains unknown; however, several occupational and environmental factors have been implicated. Our objective was to perform a meta-analysis of all studies published on SSc associated with occupational and environmental exposure. The review was undertaken by means of MEDLINE and SCOPUS from 1960 to 2014 and using the terms: "systemic," "scleroderma," or "systemic sclerosis/chemically induced" [MesH]. The Newcastle-Ottawa Scale was used for the qualifying assessment. The inverse variance-weighted method was performed. The meta-analysis of silica exposure included 15 case-control studies [overall OR 2.81 (95%CI 1.86-4.23; p < 0.001)] and 4 cohort studies [overall RR 17.52 (95%CI 5.98-51.37; p < 0.001)]; the meta-analysis of solvents exposure included 13 case-control studies (overall OR 2.00 [95%CI 1.32-3.02; p = 0.001); the meta-analysis of breast implants exposure included 4 case-control studies (overall OR 1.68 (95%CI 1.65-1.71; p < 0.001)) and 6 cohort studies (overall RR 2.13 (95%CI 0.86-5.27; p = 0.10)); the meta-analysis of epoxy resins exposure included 4 case-control studies (overall OR 2.97 (95%CI 2.31-3.83; p < 0.001)), the meta-analysis of pesticides exposure included 3 case-control studies (overall OR 1.02 (95%CI 0.78-1.32; p = 0.90)) and, finally, the meta-analysis of welding fumes exposure included 4 studies (overall OR 1.29 (95%CI 0.44-3.74; p = 0.64)). Not enough studies citing risks related to hair dyes have been published to perform an accurate meta-analysis. Silica and solvents were the two most likely substances related to the pathogenesis of SSc. While silica is involved in particular jobs, solvents are widespread and more people are at risk of having incidental contact with them.

  12. Trial Sequential Analysis in systematic reviews with meta-analysis

    Directory of Open Access Journals (Sweden)

    Jørn Wetterslev

    2017-03-01

    Full Text Available Abstract Background Most meta-analyses in systematic reviews, including Cochrane ones, do not have sufficient statistical power to detect or refute even large intervention effects. This is why a meta-analysis ought to be regarded as an interim analysis on its way towards a required information size. The results of the meta-analyses should relate the total number of randomised participants to the estimated required meta-analytic information size accounting for statistical diversity. When the number of participants and the corresponding number of trials in a meta-analysis are insufficient, the use of the traditional 95% confidence interval or the 5% statistical significance threshold will lead to too many false positive conclusions (type I errors and too many false negative conclusions (type II errors. Methods We developed a methodology for interpreting meta-analysis results, using generally accepted, valid evidence on how to adjust thresholds for significance in randomised clinical trials when the required sample size has not been reached. Results The Lan-DeMets trial sequential monitoring boundaries in Trial Sequential Analysis offer adjusted confidence intervals and restricted thresholds for statistical significance when the diversity-adjusted required information size and the corresponding number of required trials for the meta-analysis have not been reached. Trial Sequential Analysis provides a frequentistic approach to control both type I and type II errors. We define the required information size and the corresponding number of required trials in a meta-analysis and the diversity (D2 measure of heterogeneity. We explain the reasons for using Trial Sequential Analysis of meta-analysis when the actual information size fails to reach the required information size. We present examples drawn from traditional meta-analyses using unadjusted naïve 95% confidence intervals and 5% thresholds for statistical significance. Spurious conclusions in

  13. A meta-analysis of cerebrovascular disease and hyperhomocysteinaemia

    DEFF Research Database (Denmark)

    Nielsen, G M; Tvedegaard, K C; Andersen, Niels Trolle

    2000-01-01

    Hyperhomocysteinaemia has been identified as a risk factor for stroke and cerebrovascular disease in several studies. To evaluate the evidence we performed a meta-analysis. We found 21 studies searching Medline from 1966-July 1999 using the key words homocysteine, homocystine and cerebrovascular...... was used. The reports on 8 cross-sectional and 4 longitudinal studies gave data on the mean and standard deviations of plasma or serum homocysteine for both cases and controls, and these studies were included in the meta-analysis. The results of the 5 excluded studies all pointed to a positive relationship...

  14. The prevalence of food allergy: A meta-analysis

    DEFF Research Database (Denmark)

    Rona, Roberto J.; Keil, Thomas; Summers, Colin

    2007-01-01

    Background: There is uncertainty about the prevalence of food allergy in communities. Objective: To assess the prevalence of food allergy by performing a meta-analysis according to the method of assessment used. Methods: The foods assessed were cow's milk, hen's egg, peanut, fish, shellfish....... The meta-analysis included only original studies. They were stratified by age groups: infant/preschool, school children, and adults. Results: A total of 934 articles were identified, but only 51 were considered appropriate for inclusion. The prevalence of self-reported food allergy was very high compared...

  15. Cell-Free DNA in Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Spindler, Karen-Lise G; Boysen, Anders K; Pallisgård, Niels; Johansen, Julia S; Tabernero, Josep; Sørensen, Morten M; Jensen, Benny V; Hansen, Torben F; Sefrioui, David; Andersen, Rikke F; Brandslund, Ivan; Jakobsen, Anders

    2017-09-01

    Circulating DNA can be detected and quantified in the blood of cancer patients and used for detection of tumor-specific genetic alterations. The clinical utility has been intensively investigated for the past 10 years. The majority of reports focus on analyzing the clinical potential of tumor-specific mutations, whereas the use of total cell-free DNA (cfDNA) quantification is somehow controversial and sparsely described in the literature, but holds important clinical information in itself. The purpose of the present report was to present a systematic review and meta-analysis of the prognostic value of total cfDNA in patients with metastatic colorectal cancer (mCRC) treated with chemotherapy. In addition, we report on the overall performance of cfDNA as source for KRAS mutation detection. A systematic literature search of PubMed and Embase was performed by two independent investigators. Eligibility criteria were (a) total cfDNA analysis, (b) mCRC, and (c) prognostic value during palliative treatment. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed, and meta-analysis applied on both aggregate data extraction and individual patients' data. Ten eligible cohorts were identified, including a total of 1,076 patients. Seven studies used quantitative polymerase chain reaction methods, two BEAMing [beads, emulsification, amplification, and magnetics] technology, and one study digital droplet polymerase chain reaction. The baseline levels of cfDNA was similar in the presented studies, and all studies reported a clear prognostic value in favor of patients with lowest levels of baseline cfDNA. A meta-analysis revealed a combined estimate of favorable overall survival hazard ratio (HR) in patients with levels below the median cfDNA (HR = 2.39, 95% confidence interval 2.03-2.82, p  meta-analysis. Reliable prognostic markers could help to guide patients and treating physicians regarding the relevance and choice of

  16. Family history of diabetes and the risk of gestational diabetes mellitus in Iran: A systematic review and meta-analysis.

    Science.gov (United States)

    Moosazadeh, Mahmood; Asemi, Zatollah; Lankarani, Kamran B; Tabrizi, Reza; Maharlouei, Najmeh; Naghibzadeh-Tahami, Ahmad; Yousefzadeh, Gholamreza; Sadeghi, Reza; Khatibi, Seyed Reza; Afshari, Mahdi; Khodadost, Mahmoud; Akbari, Maryam

    2017-11-01

    Gestational diabetes is the most prevalent metabolic disorder being firstly diagnosed during pregnancy. The relationship between the family history of diabetes and the gestational diabetes mellitus (GDM) has been investigated in several primary studies with a number of contradictions in the results. Hence, the purpose of the present study is to determine the relationship between the GDM and the family history of diabetes using the meta-analysis method. All published papers in main national and international databases were systematically searched with some specific keywords to find the related studies between 2000 and 2016. We calculated the odds ratio (OR) with 95% confidence interval (CI) in analysis for each study using a random-effect and Mantel-Haenzel method. We also determined heterogeneity among these 33 articles and their publication bias. We entered 33 relevant studies of 2516 articles into the meta-analysis process including 2697 women with family history of diabetes mellitus as well as 29134 women without. Of them, 954 and 4372 subjects developed GDM respectively. Combining the results of the primary studies using the meta-analysis method, the overall odds ratio of family history for developing GDM was estimated as of 3.46 (95% CI: 2.80-4.27). This meta-analysis study revealed that the family history of diabetes is an important risk factor for the gestational diabetes mellitus. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  17. Serum Uric Acid Levels and Diabetic Peripheral Neuropathy in Type 2 Diabetes: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Yu, Shuai; Chen, Ying; Hou, Xu; Xu, Donghua; Che, Kui; Li, Changgui; Yan, Shengli; Wang, Yangang; Wang, Bin

    2016-03-01

    Previous studies suggested a possible association between serum uric acid levels and peripheral neuropathy in patients with type 2 diabetes, but no definite evidence was available. A systematic review and meta-analysis of relevant studies were performed to comprehensively estimate the association. Pubmed, Web of Science, Embase, and China Biology Medicine (CBM) databases were searched for eligible studies. Study-specific data were combined using random-effect or fixed-effect models of meta-analysis according to between-study heterogeneity. Twelve studies were finally included into the meta-analysis, which involved a total of 1388 type 2 diabetic patients with peripheral neuropathy and 4746 patients without peripheral neuropathy. Meta-analysis showed that there were obvious increased serum uric acid levels in diabetic patients with peripheral neuropathy (weighted mean difference [WMD] = 50.03 μmol/L, 95% confidence interval [95%CI] 22.14-77.93, P = 0.0004). Hyperuricemia was also significantly associated with increased risk of peripheral neuropathy in patients with type 2 diabetes (risk ratio [RR] = 2.83, 95%CI 2.13-3.76, P peripheral neuropathy in type 2 diabetic patients (RR = 1.95, 95%CI 1.23-3.11, P = 0.005). Type 2 diabetic patients with peripheral neuropathy have obvious increased serum uric acid levels, and hyperuricemia is associated with increased risk of peripheral neuropathy. Further prospective cohort studies are needed to validate the impact of serum uric acid levels on peripheral neuropathy risk.

  18. A systematic review and meta-analysis of the effectiveness of nudging to increase fruit and vegetable choice.

    Science.gov (United States)

    Broers, Valérie J V; De Breucker, Céline; Van den Broucke, Stephan; Luminet, Olivier

    2017-10-01

    Nudging refers to interventions that organize the choice architecture in order to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. As a strategy to encourage healthy behaviour, nudging can serve as a complement to health education. However, the empirical evidence regarding the effectiveness of nudging as a way to influence food choice remains contradictory. To address this issue, a systematic review and meta-analysis was conducted to test the effects of nudging to encourage people to select more fruit and vegetables. A systematic literature search was performed on PubMed, Medline, PsycInfo, Cochrane library, Scopus and Google Scholar. After quality assessment, 20 articles (23 studies) were retained for narrative synthesis. Twelve articles (14 studies) contained enough information to calculate effect-sizes for meta-analysis using Comprehensive Meta-analysis software. The meta-analysis shows that nudging interventions that aim to increase fruit and/or vegetable choice/sales/servings have a moderately significant effect (d = 0.30), with the largest effect for altering placement (d = 0.39) and combined nudges (d = 0.28). The results of this review provide an indication of the effectiveness of nudging on fruit and vegetable choice in terms of actual effect-sizes, while also highlighting the problems that must be addressed before more definitive conclusions can be drawn. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  19. Urban-rural differences in childhood and adolescent obesity in the United States: a systematic review and meta-analysis.

    Science.gov (United States)

    Johnson, James Allen; Johnson, Asal Mohamadi

    2015-06-01

    A systematic literature review and subsequent meta-analysis were performed to investigate differences in childhood obesity between urban and rural areas in the United States. A search of published studies comparing childhood obesity in urban and rural settings was undertaken by probing PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for articles that met predetermined inclusion criteria. A subsequent meta-analysis was conducted to determine the combined effect size and significance of differences in childhood obesity between urban and rural areas. Ten studies were identified for systematic review, five of which contributed to the meta-analysis. All but one study suggested that residence in rural areas was associated with higher prevalence or increased odds of childhood obesity, compared to children living in urban areas. A meta-analysis of 74,168 pooled participants ages 2-19 found that rural children have 26% greater odds of obesity, compared to urban children (odds ratio=1.26; 95% confidence interval, 1.21-1.32). Obesity rates are higher among rural children than urban children in the United States. To ensure successful targeted interventions and effective resource allocation, practitioners and policy makers alike should be cognizant of this disparity in childhood obesity.

  20. Improved score statistics for meta-analysis in single-variant and gene-level association studies.

    Science.gov (United States)

    Yang, Jingjing; Chen, Sai; Abecasis, Gonçalo

    2018-06-01

    Meta-analysis is now an essential tool for genetic association studies, allowing them to combine large studies and greatly accelerating the pace of genetic discovery. Although the standard meta-analysis methods perform equivalently as the more cumbersome joint analysis under ideal settings, they result in substantial power loss under unbalanced settings with various case-control ratios. Here, we investigate the power loss problem by the standard meta-analysis methods for unbalanced studies, and further propose novel meta-analysis methods performing equivalently to the joint analysis under both balanced and unbalanced settings. We derive improved meta-score-statistics that can accurately approximate the joint-score-statistics with combined individual-level data, for both linear and logistic regression models, with and without covariates. In addition, we propose a novel approach to adjust for population stratification by correcting for known population structures through minor allele frequencies. In the simulated gene-level association studies under unbalanced settings, our method recovered up to 85% power loss caused by the standard methods. We further showed the power gain of our methods in gene-level tests with 26 unbalanced studies of age-related macular degeneration . In addition, we took the meta-analysis of three unbalanced studies of type 2 diabetes as an example to discuss the challenges of meta-analyzing multi-ethnic samples. In summary, our improved meta-score-statistics with corrections for population stratification can be used to construct both single-variant and gene-level association studies, providing a useful framework for ensuring well-powered, convenient, cross-study analyses. © 2018 WILEY PERIODICALS, INC.

  1. Living network meta-analysis compared with pairwise meta-analysis in comparative effectiveness research: empirical study.

    Science.gov (United States)

    Nikolakopoulou, Adriani; Mavridis, Dimitris; Furukawa, Toshi A; Cipriani, Andrea; Tricco, Andrea C; Straus, Sharon E; Siontis, George C M; Egger, Matthias; Salanti, Georgia

    2018-02-28

    To examine whether the continuous updating of networks of prospectively planned randomised controlled trials (RCTs) ("living" network meta-analysis) provides strong evidence against the null hypothesis in comparative effectiveness of medical interventions earlier than the updating of conventional, pairwise meta-analysis. Empirical study of the accumulating evidence about the comparative effectiveness of clinical interventions. Database of network meta-analyses of RCTs identified through searches of Medline, Embase, and the Cochrane Database of Systematic Reviews until 14 April 2015. Network meta-analyses published after January 2012 that compared at least five treatments and included at least 20 RCTs. Clinical experts were asked to identify in each network the treatment comparison of greatest clinical interest. Comparisons were excluded for which direct and indirect evidence disagreed, based on side, or node, splitting test (Pmeta-analyses were performed for each selected comparison. Monitoring boundaries of statistical significance were constructed and the evidence against the null hypothesis was considered to be strong when the monitoring boundaries were crossed. A significance level was defined as α=5%, power of 90% (β=10%), and an anticipated treatment effect to detect equal to the final estimate from the network meta-analysis. The frequency and time to strong evidence was compared against the null hypothesis between pairwise and network meta-analyses. 49 comparisons of interest from 44 networks were included; most (n=39, 80%) were between active drugs, mainly from the specialties of cardiology, endocrinology, psychiatry, and rheumatology. 29 comparisons were informed by both direct and indirect evidence (59%), 13 by indirect evidence (27%), and 7 by direct evidence (14%). Both network and pairwise meta-analysis provided strong evidence against the null hypothesis for seven comparisons, but for an additional 10 comparisons only network meta-analysis provided

  2. Psoriasis and suicidality: A systematic review and meta-analysis.

    Science.gov (United States)

    Singh, Sanminder; Taylor, Catherine; Kornmehl, Heather; Armstrong, April W

    2017-09-01

    Psoriasis is associated with psychiatric comorbidities; however, the relationship between psoriasis and suicidality is not well understood. To perform a systematic review and meta-analysis that elucidates the relationship between psoriasis and suicidality. Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched the PubMed, EMBASE, PsycINFO, and Cochrane databases. We searched literature published between 1946 and 2017. We identified 18 studies with a total of 1,767,583 participants, of whom 330,207 had psoriasis. On the basis of random effects modeling, the pooled odds ratio (OR) for suicidal ideation among patients with psoriasis was 2.05 (95% confidence interval [CI], 1.54-2.74). Patients with psoriasis were more likely to exhibit suicidal behaviors (combined attempted and completed suicides) with a pooled OR of 1.26 (95% CI, 1.13-1.40). Subgroup analysis showed that patients with psoriasis were more likely to attempt suicides (OR, 1.32; 95% CI, 1.14-1.54) and complete suicide (OR, 1.20; 95% CI, 1.04-1.39) than those without psoriasis. More severe psoriasis and younger age were associated with greater likelihood of suicidality. There are few studies examining suicidality in conjunction with psoriasis severity. Patients with psoriasis have a significantly higher likelihood of suicidal ideation, suicide attempts, and completed suicides. Among patients with psoriasis, those who are younger and whose psoriasis is more severe are at particular risk for suicidality. Copyright © 2017. Published by Elsevier Inc.

  3. Meta Analysis of Gene Expression Data within and Across Species.

    Science.gov (United States)

    Fierro, Ana C; Vandenbussche, Filip; Engelen, Kristof; Van de Peer, Yves; Marchal, Kathleen

    2008-12-01

    Since the second half of the 1990s, a large number of genome-wide analyses have been described that study gene expression at the transcript level. To this end, two major strategies have been adopted, a first one relying on hybridization techniques such as microarrays, and a second one based on sequencing techniques such as serial analysis of gene expression (SAGE), cDNA-AFLP, and analysis based on expressed sequence tags (ESTs). Despite both types of profiling experiments becoming routine techniques in many research groups, their application remains costly and laborious. As a result, the number of conditions profiled in individual studies is still relatively small and usually varies from only two to few hundreds of samples for the largest experiments. More and more, scientific journals require the deposit of these high throughput experiments in public databases upon publication. Mining the information present in these databases offers molecular biologists the possibility to view their own small-scale analysis in the light of what is already available. However, so far, the richness of the public information remains largely unexploited. Several obstacles such as the correct association between ESTs and microarray probes with the corresponding gene transcript, the incompleteness and inconsistency in the annotation of experimental conditions, and the lack of standardized experimental protocols to generate gene expression data, all impede the successful mining of these data. Here, we review the potential and difficulties of combining publicly available expression data from respectively EST analyses and microarray experiments. With examples from literature, we show how meta-analysis of expression profiling experiments can be used to study expression behavior in a single organism or between organisms, across a wide range of experimental conditions. We also provide an overview of the methods and tools that can aid molecular biologists in exploiting these public data.

  4. Thrombophilic disorders and fetal loss: a meta-analysis.

    Science.gov (United States)

    Rey, Evelyne; Kahn, Susan R; David, Michèle; Shrier, Ian

    2003-03-15

    Our aim was to assess the strength of the controversial association between thrombophilia and fetal loss, and to examine whether it varies according to the timing or definition of fetal loss. We searched Medline and Current Contents for articles published between 1975 and 2002 and their references with terms denoting recurrent fetal and non-recurrent fetal loss combined with various thrombophilic disorders. We included in our meta-analysis case-control, cohort, and cross-sectional studies published in English, the methodological quality of which was rated as moderate or strong. Pooled odds ratios (OR) with 95% CI were generated by random effects models with Cochrane Review Manager software. We included 31 studies. Factor V Leiden was associated with early (OR 2.01, 95% CI 1.13-3.58) and late (7.83, 2.83-21.67) recurrent fetal loss, and late non-recurrent fetal loss (3.26, 1.82-5.83). Exclusion of women with other pathologies that could explain fetal loss strengthened the association between Factor V Leiden and recurrent fetal loss. Activated protein C resistance was associated with early recurrent fetal loss (3.48, 1.58-7.69), and prothrombin G20210A mutation with early recurrent (2.56, 1.04-.29) and late non-recurrent (2.30, 1.09-4.87) fetal loss. Protein S deficiency was associated with recurrent fetal loss (14.72, 0.99-218.01) and late non-recurrent fetal loss (7.39, 1.28-42.63). Methylenetetrahydrofolate mutation, protein C, and antithrombin deficiencies were not significantly associated with fetal loss. The magnitude of the association between thrombophilia and fetal loss varies, according to type of fetal loss and type of thrombophilia.

  5. Does plyometric training improve strength performance? A meta-analysis.

    Science.gov (United States)

    Sáez-Sáez de Villarreal, Eduardo; Requena, Bernardo; Newton, Robert U

    2010-09-01

    Majority of the research suggests plyometric training (PT) improves maximal strength performance as measured by 1RM, isometric MVC or slow velocity isokinetic testing. However, the effectiveness of PT depends upon various factors. A meta-analysis of 15 studies with a total of 31 effect sizes (ES) was carried out to analyse the role of various factors on the effects of PT on strength performance. The inclusion criteria for the analysis were: (a) studies using PT programs for lower limb muscles; (b) studies employing true experimental design and valid and reliable measurements; (c) studies including sufficient data to calculate ES. When subjects can adequately follow plyometric exercises, the training gains are independent of fitness level. Subjects in either good or poor physical condition, benefit equally from plyometric work, also men obtain similar strength results to women following PT. In relation to the variables of program design, training volume of less than 10 weeks and with more than 15 sessions, as well as the implementation of high-intensity programs, with more than 40 jumps per session, were the strategies that seem to maximize the probability to obtain significantly greater improvements in performance (p<0.05). In order to optimise strength enhancement, the combination of different types of plyometrics with weight-training would be recommended, rather than utilizing only one form (p<0.05). The responses identified in this analysis are essential and should be considered by the strength and conditioning professional with regard to the most appropriate dose-response trends for PT to optimise strength gains.

  6. Digital Simulation-Based Training: A Meta-Analysis

    Science.gov (United States)

    Gegenfurtner, Andreas; Quesada-Pallarès, Carla; Knogler, Maximilian

    2014-01-01

    This study examines how design characteristics in digital simulation-based learning environments moderate self-efficacy and transfer of learning. Drawing on social cognitive theory and the cognitive theory of multimedia learning, the meta-analysis psychometrically cumulated k?=?15 studies of 25 years of research with a total sample size of…

  7. Visuo-Spatial Performance in Autism: A Meta-Analysis

    Science.gov (United States)

    Muth, Anne; Hönekopp, Johannes; Falter, Christine M.

    2014-01-01

    Visuo-spatial skills are believed to be enhanced in autism spectrum disorders (ASDs). This meta-analysis tests the current state of evidence for Figure Disembedding, Block Design, Mental Rotation and Navon tasks in ASD and neurotypicals. Block Design (d = 0.32) and Figure Disembedding (d = 0.26) showed superior performance for ASD with large…

  8. Does College Teach Critical Thinking? A Meta-Analysis

    Science.gov (United States)

    Huber, Christopher R.; Kuncel, Nathan R.

    2016-01-01

    Educators view critical thinking as an essential skill, yet it remains unclear how effectively it is being taught in college. This meta-analysis synthesizes research on gains in critical thinking skills and attitudinal dispositions over various time frames in college. The results suggest that both critical thinking skills and dispositions improve…

  9. Tutoring Adolescents in Literacy: A Meta-Analysis

    Science.gov (United States)

    Jun, Seung Won; Ramirez, Gloria; Cumming, Alister

    2010-01-01

    What does research reveal about tutoring adolescents in literacy? We conducted a meta-analysis, identifying 152 published studies, of which 12 met rigorous inclusion criteria. We analyzed the 12 studies for the effects of tutoring according to the type, focus, and amount of tutoring; the number, age, and language background of students; and the…

  10. Meta-analysis of landscape conservation plan evaluations

    Science.gov (United States)

    Michaela Foster; M. Nils Peterson; Frederick Cubbage; Gerard McMahon

    2016-01-01

    The number of studies evaluating the quality and content of many types of plans have grown in recent decades. Natural resource conservation plans have been included in some of these plan evaluation studies; however, no meta-analysis of natural resource planning literature has been conducted. This focus is needed because natural resource conservation planning differs...

  11. Financial liberalization and economic growth : A meta-analysis

    NARCIS (Netherlands)

    Bumann, Silke; Hermes, Niels; Lensink, Robert

    This study provides a systematic analysis of the empirical literature on the relationship between financial liberalization and economic growth by conducting a meta-analysis, based on 441 t-statistics reported in 60 empirical studies. We focus on explaining the heterogeneity of results in our sample

  12. Contemporary management of frontal sinus mucoceles: a meta-analysis.

    Science.gov (United States)

    Courson, Andy M; Stankiewicz, James A; Lal, Devyani

    2014-02-01

    To analyze trends in the surgical management of frontal and fronto-ethmoid mucoceles through meta-analysis. Meta-analysis and case series. A systematic literature review on surgical management of frontal and fronto-ethmoid mucoceles was conducted. Studies were divided into historical (1975-2001) and contemporary (2002-2012) groups. A meta-analysis of these studies was performed. The historical and contemporary cohorts were compared (surgical approach, recurrence, and complications). To study evolution in surgical management, a senior surgeon's experience over 28 years was analyzed separately. Thirty-one studies were included for meta-analysis. The historical cohort included 425 mucoceles from 11 studies. The contemporary cohort included 542 mucoceles from 20 studies. More endoscopic techniques were used in the contemporary versus historical cohort (53.9% vs. 24.7%; P = contemporary). In the historical cohort, higher recurrence was noted in the external group (P = 0.03). Results from endoscopic and open approaches are comparable. Although endoscopic techniques are being increasingly adopted, comparison with our series shows that more cases could potentially be treated endoscopically. Frequent use of open approaches may reflect efficacy, or perhaps lack of expertise and equipment required for endoscopic management. Most contemporary authors favor endoscopic management, limiting open approaches for specific indications (unfavorable anatomy, lateral disease, and scarring). N/A. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Meta-analysis of genetic polymorphisms in xenobiotic metabolizing ...

    Indian Academy of Sciences (India)

    TAJAMUL HUSSAIN

    2018-06-12

    Jun 12, 2018 ... ity in COMT protein, thus impairing conversion of cate- chol oestrogens ... nale of the current meta-analysis is to address the ambi- guity in the .... disease association across the globe with this polymor- ..... Health Perspect. 117 ...

  14. Hypothyroidism and carpal tunnel syndrome: a meta-analysis.

    Science.gov (United States)

    Shiri, Rahman

    2014-12-01

    This study aimed to assess the magnitude of the association between hypothyroidism and carpal tunnel syndrome (CTS). Eighteen studies were included in a random-effects meta-analysis. A meta-analysis of the studies that did not control their estimates for any confounder showed an association between a thyroid disease (hypo- or hyperthyroidism) and CTS (N = 9,573, effect size [ES] = 1.32 (95% confidence interval [CI], 1.04-1.68) and between hypothyroidism and CTS (N = 64,531, ES = 2.15 [95% CI, 1.64-2.83]). When a meta-analysis limited to the studies that controlled their estimates for some potential confounders, the association between a thyroid disease and CTS disappeared (N = 4,799, ES = 1.17 [95% CI, 0.71-1.92], I(2) = 0%), and the effect size for hypothyroidism largely attenuated (N = 71,133, ES = 1.44 [95% CI, 1.27-1.63], I(2) = 0%). Moreover, there was evidence of publication bias. This meta-analysis found only a modest association between hypothyroidism and CTS. Confounding and publication bias may still account for part of the remaining excess risk. © 2014 Wiley Periodicals, Inc.

  15. [The meta-analysis of data from individual patients].

    NARCIS (Netherlands)

    Rovers, M.M.; Reitsma, J.B.

    2012-01-01

    - An IPD (Individual Participant Data) meta-analysis requires collecting original individual patient data and calculating an estimated effect based on these data.- The use of individual patient data has various advantages: the original data and the results of published analyses are verified,

  16. Meta-analysis of graduated driver licensing laws.

    Science.gov (United States)

    2015-11-01

    The objective of the present study was to assess the effectiveness of GDL programs for reducing total, injury, and fatal crashes among drivers 15 to 20 years old by conducting a meta-analysis of GDL research since 2001 that evaluated the effectivenes...

  17. The Economic Value of Mangroves: A Meta-Analysis

    Science.gov (United States)

    Marwa Salem; D. Evan Mercer

    2012-01-01

    This paper presents a synthesis of the mangrove ecosystem valuation literature through a meta-regression analysis. The main contribution of this study is that it is the first meta-analysis focusing solely on mangrove forests, whereas previous studies have included different types of wetlands. The number of studies included in the regression analysis is 44 for a total...

  18. How to do Meta-Analysis using HLM software

    OpenAIRE

    Petscher, Yaacov

    2013-01-01

    This is a step-by-step presentation of how to run a meta-analysis using HLM software. Because it's a variance known model, it is not run through the GUI, but batch mode. These slides show how to prepare the data and run the analysis.

  19. Moral development and recidivism: a meta-analysis

    NARCIS (Netherlands)

    van Vugt, E.; Gibbs, J.; Stams, G.J.; Bijleveld, C.; Hendriks, J.; van der Laan, P.

    2011-01-01

    A meta-analysis of 19 studies (N = 15,992 offenders) showed a significant inverse relation between more mature moral development and recidivism. Moderator analyses revealed a larger effect size for moral cognition (r = .20) than for moral emotion (r = .11). Effect sizes for production measures (r =

  20. The Paradox of Intragroup Conflict: A Meta-Analysis

    Science.gov (United States)

    de Wit, Frank R. C.; Greer, Lindred L.; Jehn, Karen A.

    2012-01-01

    Since the meta-analysis by De Dreu and Weingart (2003b) on the effects of intragroup conflict on group outcomes, more than 80 new empirical studies of conflict have been conducted, often investigating more complex, moderated relationships between conflict and group outcomes, as well as new types of intragroup conflict, such as process conflict. To…

  1. The Impact of Uncertainty on Investment. A Meta-Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Koetse, M.J. [Department of Spatial Economics, Vrije Universiteit Amsterdam (Netherlands); De Groot, Henri L.F. [Tinbergen Institute, Amsterdam (Netherlands); Florax, R.J.G.M. [Department of Agricultural Economics, Purdue University, West Lafayette (United States)

    2006-07-01

    In this paper we perform a meta-analysis on empirical estimates of the impact between investment and uncertainty. Since the outcomes of primary studies are largely incomparable with respect to the magnitude of the effect, our analysis focuses on the direction and statistical significance of the relationship. The standard approach in this situation is to estimate an ordered probit model on a categorical estimate, defined in terms of the direction of the effect. The estimates are transformed into marginal effects, in order to represent the changes in the probability of finding a negative significant, insignificant, and positive significant estimate. Although a meta-analysis generally does not allow for inferences on the correctness of model specifications in primary studies, our results give clear directions for model building in empirical investment research. For example, not including factor prices in investment models may seriously affect the model outcomes. Furthermore, we find that Q models produce more negative significant estimates than other models do, ceteris paribus. The outcome of a study is also affected by the type of data used in a primary study. Although it is clear that meta-analysis cannot always give decisive insights into the explanations for the variation in empirical outcomes, our meta-analysis shows that we can explain to a large extent why empirical estimates of the investment uncertainty relationship differ.

  2. Effectiveness of Conceptual Change Texts: A Meta Analysis

    Science.gov (United States)

    Armagan, Fulya Öner; Keskin, Melike Özer; Akin, Beril Salman

    2017-01-01

    The purpose of this study was to determine the overall effectiveness of conceptual change texts (CCTs) on academic achievement and to find out if effectiveness was related to some characteristics of the study. It followed up a Meta-analysis research approach. 42 published and unpublished studies, published between 1995 and 2010, and 42 experiment…

  3. The Psychological Effects of Meditation: A Meta-Analysis

    Science.gov (United States)

    Sedlmeier, Peter; Eberth, Juliane; Schwarz, Marcus; Zimmermann, Doreen; Haarig, Frederik; Jaeger, Sonia; Kunze, Sonja

    2012-01-01

    In this meta-analysis, we give a comprehensive overview of the effects of meditation on psychological variables that can be extracted from empirical studies, concentrating on the effects of meditation on nonclinical groups of adult meditators. Mostly because of methodological problems, almost 3/4 of an initially identified 595 studies had to be…

  4. A Meta-Analysis: Acoustic Measurement of Roughness and Breathiness

    Science.gov (United States)

    v. Latoszek, Ben Barsties; Maryn, Youri; Gerrits, Ellen; De Bodt, Marc

    2018-01-01

    Purpose: Over the last 5 decades, many acoustic measures have been created to measure roughness and breathiness. The aim of this study is to present a meta-analysis of correlation coefficients (r) between auditory-perceptual judgment of roughness and breathiness and various acoustic measures in both sustained vowels and continuous speech. Method:…

  5. Meta-Analysis: Application to Clinical Dentistry and Dental Education.

    Science.gov (United States)

    Cohen, Peter A.

    1992-01-01

    Meta-analysis is proposed as an effective alternative to conventional narrative review for extracting trends from research findings. This type of analysis is explained, advantages over more traditional review techniques are discussed, basic procedures and limitations are outlined, and potential applications in dental education and clinical…

  6. Creativity and Academic Achievement: A Meta-Analysis

    Science.gov (United States)

    Gajda, Aleksandra; Karwowski, Maciej; Beghetto, Ronald A.

    2017-01-01

    This article reports on a meta-analysis of 120 studies (total N = 52,578; 782 effects) examining the relationship between creativity and academic achievement in research conducted since the 1960s. Average correlation between creativity and academic achievement was r = 0.22, 95% CI [0.19, 0.24]. An analysis of moderators revealed that this…

  7. The Categorical Perception Deficit in Dyslexia: A Meta-Analysis

    Science.gov (United States)

    Noordenbos, Mark W.; Serniclaes, Willy

    2015-01-01

    Speech perception in dyslexia is characterized by a categorical perception (CP) deficit, demonstrated by weaker discrimination of acoustic differences between phonemic categories in conjunction with better discrimination of acoustic differences within phonemic categories. We performed a meta-analysis of studies that examined the reliability of the…

  8. Achievement Goals and Achievement Emotions: A Meta-Analysis

    Science.gov (United States)

    Huang, Chiungjung

    2011-01-01

    This meta-analysis synthesized 93 independent samples (N = 30,003) in 77 studies that reported in 78 articles examining correlations between achievement goals and achievement emotions. Achievement goals were meaningfully associated with different achievement emotions. The correlations of mastery and mastery approach goals with positive achievement…

  9. Effectiveness of Secondary Pregnancy Prevention Programs: A Meta-Analysis

    Science.gov (United States)

    Corcoran, Jacqueline; Pillai, Vijayan K.

    2007-01-01

    Because subsequent pregnancy in teen parents often worsens the impact of adolescent parenting; therefore, a common goal of teenage parent programs has been to reduce repeat pregnancy. To examine the impact of this goal, a meta-analysis was conducted on 16 control-comparison group studies that evaluated the effect of teenage pregnancy and parenting…

  10. Psychological treatment of generalized anxiety disorder: A meta-analysis.

    NARCIS (Netherlands)

    Cuijpers, P.; Sijbrandij, M.; Koole, S.L.; Huibers, M.J.H.; Berking, M.; Andersson, G.

    2014-01-01

    Recent years have seen a near-doubling of the number of studies examining the effects of psychotherapies for generalized anxiety disorder (GAD) in adults. The present article integrates this new evidence with the older literature through a quantitative meta-analysis. A total of 41 studies (with 2132

  11. Why Is Family Firms' Internationalization Unique? : A Meta-Analysis

    NARCIS (Netherlands)

    Arregle, Jean-Luc; Duran, Patricio; Hitt, Michael A.; van Essen, M.

    Despite its importance, there is no clear understanding of the uniqueness of family firms' internationalization. This article sheds new light on this issue with a meta-analysis of 76 studies covering 41 countries. We show that the considerable study and cross-country differences in the relationship

  12. Drivers of Wetland Conversion: a Global Meta-Analysis

    NARCIS (Netherlands)

    van Asselen, S.; Verburg, P.H.; Vermaat, J.E.; Janse, J.

    2013-01-01

    Meta-analysis of case studies has become an important tool for synthesizing case study findings in land change. Meta-analyses of deforestation, urbanization, desertification and change in shifting cultivation systems have been published. This present study adds to this literature, with an analysis

  13. A Meta-Analysis of Massage Therapy Research

    Science.gov (United States)

    Moyer, Christopher A.; Rounds, James; Hannum, James W.

    2004-01-01

    Massage therapy (MT) is an ancient form of treatment that is now gaining popularity as part of the complementary and alternative medical therapy movement. A meta-analysis was conducted of studies that used random assignment to test the effectiveness of MT. Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single…

  14. A meta-analysis of electroconvulsive therapy efficacy in depression

    NARCIS (Netherlands)

    Kho, King Han; van Vreeswijk, Michiel Floris; Simpson, Steve; Zwinderman, Aeilko H.

    2003-01-01

    Recently published controlled studies comparing electroconvulsive therapy (ECT) with other treatments for depression offer the opportunity to perform a meta-analysis of ECT in depression. Fifteen studies were identified which fulfilled the inclusion criteria. From these controlled trials, 20 effect

  15. The Relationship Between Parenting and Delinquency: A Meta-analysis

    NARCIS (Netherlands)

    Hoeve, M.; Dubas, J.S.; Eichelsheim, V.I.; Laan, P.H. van der; Smeenk, W.H.; Gerris, J.R.M.

    2009-01-01

    This meta-analysis of 161 published and unpublished manuscripts was conducted to determine whether the association between parenting and delinquency exists and what the magnitude of this linkage is. The strongest links were found for parental monitoring, psychological control, and negative aspects

  16. The relationship between parenting and delinquency: A meta-analysis

    NARCIS (Netherlands)

    Hoeve, M.; Dubas, J.S.; Eichelsheim, V.I.; van der Laan, P.H.; Smeenk, W.; Gerris, J.R.M.

    2009-01-01

    This meta-analysis of 161 published and unpublished manuscripts was conducted to determine whether the association between parenting and delinquency exists and what the magnitude of this linkage is. The strongest links were found for parental monitoring, psychological control, and negative aspects

  17. A Meta-Analysis of Attachment to Parents and Delinquency

    Science.gov (United States)

    Hoeve, Machteld; Stams, Geert Jan J. M.; van der Put, Claudia E.; Dubas, Judith Semon; van der Laan, Peter H.; Gerris, Jan R. M.

    2012-01-01

    To investigate the link between attachment to parents and delinquency, and the potential moderating effects of age and sex, 74 published and unpublished manuscripts (N = 55,537 participants) were subjected to a multilevel meta-analysis. A mean small to moderate effect size was found (r = 0.18). Poor attachment to parents was significantly linked…

  18. Lead and Conduct Problems: A Meta-Analysis

    Science.gov (United States)

    Marcus, David K.; Fulton, Jessica J.; Clarke, Erin J.

    2010-01-01

    This meta-analysis examined the association between conduct problems and lead exposure. Nineteen studies on 8,561 children and adolescents were included. The average "r" across all 19 studies was 0.19 (p less than 0.001), which is considered a medium effect size. Studies that assessed lead exposure using hair element analysis yielded…

  19. A Meta-Analysis on Unconscious Thought Effects

    NARCIS (Netherlands)

    Strick, M.A.; Dijksterhuis, A.J.; Bos, M.W.; Sjoerdsma, A.; Baaren, R.B. van; Nordgren, L.F.

    2011-01-01

    A meta-analysis was performed on the unconscious thought effect (UTE). All available published and unpublished data on unconscious thought were included. Our aims were to provide a statistically robust estimate of the effect size of the UTE, to identify significant moderators, and to

  20. Updated Meta-Analysis of Learner Control within Educational Technology

    Science.gov (United States)

    Karich, Abbey C.; Burns, Matthew K.; Maki, Kathrin E.

    2014-01-01

    Giving a student control over their learning has theoretical and intuitive appeal, but its effects are neither powerful nor consistent in the empirical literature base. This meta-analysis updated previous meta-analytic research by Niemiec, Sikorski, and Walberg by studying the overall effectiveness of providing learner control within educational…

  1. The Psychophysiology of Posttraumatic Stress Disorder: A Meta-Analysis

    Science.gov (United States)

    Pole, Nnamdi

    2007-01-01

    This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure.…

  2. The prevalence of food allergy: a meta-analysis

    NARCIS (Netherlands)

    Rona, Roberto J.; Keil, Thomas; Summers, Colin; Gislason, David; Zuidmeer, Laurian; Sodergren, Eva; Sigurdardottir, Sigurveig T.; Lindner, Titia; Goldhahn, Klaus; Dahlstrom, Jorgen; McBride, Doreen; Madsen, Charlotte

    2007-01-01

    There is uncertainty about the prevalence of food allergy in communities. To assess the prevalence of food allergy by performing a meta-analysis according to the method of assessment used. The foods assessed were cow's milk, hen's egg, peanut, fish, shellfish, and an overall estimate of food

  3. A Meta-Analysis of Advance-Organizer Studies.

    Science.gov (United States)

    Stone, Carol Leth

    Long term studies of advance organizers (AO) were analyzed with Glass's meta-analysis technique. AO's were defined as bridges from reader's previous knowledge to what is to be learned. The results were compared with predictions from Ausubel's model of assimilative learning. The results of the study indicated that advance organizers were associated…

  4. A Meta-Analysis of Advanced Organizer Studies.

    Science.gov (United States)

    Stone, Carol Leth

    1983-01-01

    Twenty-nine reports yielding 112 studies were analyzed with Glass's meta-analysis technique, and results were compared with predictions from Ausubel's model of assimilative learning. Overall, advance organizers were shown to be associated with increased learning and retention of material to be learned. (Author)

  5. Macroeconomics of natural disasters : Meta-analysis and policy options

    NARCIS (Netherlands)

    P.A.G. van Bergeijk (Peter); S. Lazzaroni (Sara)

    2013-01-01

    textabstractWe use the case of the impact of natural disasters to analyse strengths and weaknesses of meta-analysis in an emerging research field. Macroeconomists have published on this issue since 2002 (we identified 22 studies to date). The results of the studies are contradictory and

  6. Impact of Instructional Decisions on the Effectiveness of Cooperative Learning in Chemistry through Meta-Analysis

    Science.gov (United States)

    Apugliese, Andrew; Lewis, Scott E.

    2017-01-01

    Meta-analysis can provide a robust description of the impact of educational reforms and also offer an opportunity to explore the conditions where such reforms are more or less effective. This article describes a meta-analysis on the impact of cooperative learning on students' chemistry understanding. Modifiers in the meta-analysis are purposefully…

  7. ABO blood group and esophageal carcinoma risk: from a case-control study in Chinese population to meta-analysis.

    Science.gov (United States)

    Wang, Wei; Liu, Lei; Wang, Zhiwei; Lu, Xiaopeng; Wei, Min; Lin, Tianlong; Zhang, Yixin; Jiang, Songqi; Wang, Qiang; Cao, Ziang; Shi, Minxin

    2014-10-01

    The association between ABO blood group and the risk of esophageal carcinoma (EC) in previously published studies is uncertain and conflicting. The aim of the current study was to determine the correlation of ABO blood group with EC risk via a case-control study and meta-analysis. We performed a population-based case-control study of 3,595 cases and 41,788 controls in Chinese population to evaluate the association between ABO blood group and EC risk. Then, a comprehensive meta-analysis combining our original data and previously published data was conducted to clearly discern the real relationship. The strength of association was measured by odds ratios (ORs) with 95% confidence intervals (CI). In our case-control study, the risk of EC in blood group B was significantly higher than that in non-B groups (A, O, and AB) (OR = 1.15, 95% CI 1.09-1.21). Compared with non-O groups (A, B, and AB), individuals with blood group O demonstrated a reduced risk of EC (OR = 0.90, 95% CI 0.85-0.94). The meta-analysis also indicated that blood group B was associated with significantly higher EC risk (OR = 1.20, 95% CI 1.10-1.31), and people with blood group O had a decreased EC risk (OR = 0.94, 95% CI 0.90-0.99). Neither the case-control study nor the meta-analysis produced any significant association of blood group A or AB with EC risk. Results from our case-control study and the followed meta-analysis confirmed that there was an increased risk of EC in blood group B individuals, whereas a decreased risk of EC was observed in blood group O individuals.

  8. The relationship between quality of life and methods of delivery: A systematic review and meta-analysis.

    Science.gov (United States)

    Rezaei, Nazanin; Tavalaee, Zahra; Sayehmiri, Kourosh; Sharifi, Nasibeh; Daliri, Salman

    2018-04-01

    Some physical, emotional and social changes arise in mothers during the postpartum periods which can affect the quality of life (QOL) of the mother and family. Given the importance of the quality of life in the postpartum period and its influencing factors such as method of delivery, the present study aimed at investigating the relationship between the quality of life and methods of delivery in the world, using a systematic review and meta-analysis method. The present study is a systematic review and meta-analysis on the relationship between aspects of quality of life and method of delivery in the world conducted in Persian and English language articles published by the end of 2015. For this purpose, the databases of Medlib, SID, Scopus, ISI Web of Science, PubMed, Google scholar, Irandoc, Magiran and Iranmedex were searched using key words and their compounds. The results of studies were combined using the random effects model in the meta-analysis. Heterogeneity of studies was assessed using I2 index and Cochran test and data were analyzed using STATA Version 11.1 and SPSS Version 16. Based on the results of the meta-analysis of studies, the aspect of physical functioning had the highest quality of life mean score in women with vaginal delivery: 74.37 (95% CI: 67.7-81) and mental health had the highest QOL mean score in women with cesarean delivery: 65.8 (95% CI: 62.7-69). Also, based on the time elapsed since delivery, mental health had the highest mean score in less than 1 month, 2 months and 4 months' postpartum. Physical pain had the highest mean score 6 months after giving birth, and mental functioning in 8 months after giving birth. The results of the present meta-analysis showed that the mean scores for most dimensions of quality of life in women with vaginal delivery were higher than in women with cesarean delivery.

  9. ABERRANT RESTING-STATE BRAIN ACTIVITY IN POSTTRAUMATIC STRESS DISORDER: A META-ANALYSIS AND SYSTEMATIC REVIEW.

    Science.gov (United States)

    Koch, Saskia B J; van Zuiden, Mirjam; Nawijn, Laura; Frijling, Jessie L; Veltman, Dick J; Olff, Miranda

    2016-07-01

    About 10% of trauma-exposed individuals develop PTSD. Although a growing number of studies have investigated resting-state abnormalities in PTSD, inconsistent results suggest a need for a meta-analysis and a systematic review. We conducted a systematic literature search in four online databases using keywords for PTSD, functional neuroimaging, and resting-state. In total, 23 studies matched our eligibility criteria. For the meta-analysis, we included 14 whole-brain resting-state studies, reporting data on 663 participants (298 PTSD patients and 365 controls). We used the activation likelihood estimation approach to identify concurrence of whole-brain hypo- and hyperactivations in PTSD patients during rest. Seed-based studies could not be included in the quantitative meta-analysis. Therefore, a separate qualitative systematic review was conducted on nine seed-based functional connectivity studies. The meta-analysis showed consistent hyperactivity in the ventral anterior cingulate cortex and the parahippocampus/amygdala, but hypoactivity in the (posterior) insula, cerebellar pyramis and middle frontal gyrus in PTSD patients, compared to healthy controls. Partly concordant with these findings, the systematic review on seed-based functional connectivity studies showed enhanced salience network (SN) connectivity, but decreased default mode network (DMN) connectivity in PTSD. Combined, these altered resting-state connectivity and activity patterns could represent neurobiological correlates of increased salience processing and hypervigilance (SN), at the cost of awareness of internal thoughts and autobiographical memory (DMN) in PTSD. However, several discrepancies between findings of the meta-analysis and systematic review were observed, stressing the need for future studies on resting-state abnormalities in PTSD patients. © 2016 Wiley Periodicals, Inc.

  10. CrossFit Overview: Systematic Review and Meta-analysis.

    Science.gov (United States)

    Claudino, João Gustavo; Gabbett, Tim J; Bourgeois, Frank; Souza, Helton de Sá; Miranda, Rafael Chagas; Mezêncio, Bruno; Soncin, Rafael; Cardoso Filho, Carlos Alberto; Bottaro, Martim; Hernandez, Arnaldo Jose; Amadio, Alberto Carlos; Serrão, Julio Cerca

    2018-02-26

    CrossFit is recognized as one of the fastest growing high-intensity functional training modes in the world. However, scientific data regarding the practice of CrossFit is sparse. Therefore, the objective of this study is to analyze the findings of scientific literature related to CrossFit via systematic review and meta-analysis. Systematic searches of the PubMed, Web of Science, Scopus, Bireme/MedLine, and SciELO online databases were conducted for articles reporting the effects of CrossFit training. The systematic review followed the PRISMA guidelines. The Oxford Levels of Evidence was used for all included articles, and only studies that investigated the effects of CrossFit as a training program were included in the meta-analysis. For the meta-analysis, effect sizes (ESs) with 95% confidence interval (CI) were calculated and heterogeneity was assessed using a random-effects model. Thirty-one articles were included in the systematic review and four were included in the meta-analysis. However, only two studies had a high level of evidence at low risk of bias. Scientific literature related to CrossFit has reported on body composition, psycho-physiological parameters, musculoskeletal injury risk, life and health aspects, and psycho-social behavior. In the meta-analysis, significant results were not found for any variables. The current scientific literature related to CrossFit has few studies with high level of evidence at low risk of bias. However, preliminary data has suggested that CrossFit practice is associated with higher levels of sense of community, satisfaction, and motivation.

  11. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Vittorio Unfer1,

    2017-10-01

    Full Text Available Myo-inositol (MI supplementation in women with polycystic ovary syndrome (PCOS has been evaluated over the last years. Many hormonal and reproductive impairments associated with this disorder seem relieved by the supplement. The objective of the meta-analysis was to assess the effects of MI alone or combined with d-chiro-inositol (DCI on the endocrine and metabolic abnormalities of women with PCOS. Literature was retrieved from selected databases, MEDLINE, EMBASE, PubMed and Research Gate (up to November 2016. Only randomized controlled trials (RCTs investigating the effects of MI alone or combined with DdCI were reviewed. Nine RCTs involving 247 cases and 249 controls were included. Significant decreases in fasting insulin (SMD = −1.021 μU/mL, 95% CI: −1.791 to −0.251, P = 0.009 and homeostasis model assessment (HOMA index (SMD = −0.585, 95% CI: −1.145 to −0.025, P = 0.041 were identified after MI supplementation. The trial sequential analysis of insulin meta-analysis illustrates that the cumulative z-curve crossed the monitoring boundary, providing firm evidence of the intervention effect. A slight trend toward a reduction of testosterone concentration by MI with respect to controls was found (SMD = −0.49, 95% CI: −1.072 to 0.092, P = 0.099, whereas androstenedione levels remained unaffected. Throughout a subgroup’s meta-analysis, a significant increase in serum SHBG was observed only in those studies where MI was administered for at least 24 weeks (SMD = 0.425 nmol/L, 95% CI: 0.050–0.801, P = 0.026. These results highlight the beneficial effect of MI in improving the metabolic profile of women with PCOS, concomitantly reducing their hyperandrogenism.

  12. Circulating folate levels and colorectal adenoma: a case-control study and a meta-analysis.

    Science.gov (United States)

    Park, Yeong Mi; Youn, Jiyoung; Cho, Chang Ho; Kim, Sung Hi; Lee, Jung Eun

    2017-10-01

    The relationship between folate and colorectal neoplasia remains controversial. We examined the association between serum folate concentrations and colorectal adenomas in a case-control study of Korean adults and conducted a meta-analysis. Our case-control study included 113 pairs of case and control who underwent colonoscopy and provided blood samples. We used multivariable conditional logistic regression models to obtain the odds ratios and 95% confidence interval (CIs). For meta-analysis, we identified the relevant studies by searching the PubMed database up to February 2017, included our case-control study and combined the study-specific relative risks (RRs) using a random-effects model. In this case-control study, we included 58 men and 55 women with colorectal adenomas and sex and fasting status matched the controls. We did not find any significant association between the serum folate levels and colorectal adenomas in either men or women. For meta-analysis, a total of eleven studies were included in our analysis and classified into two groups; polyp clearance group (PC) for the studies that included participants who underwent endoscopies and had their polyps removed at baseline; and no polyp clearance group (NPC) for the studies that included participants whose histories of endoscopies were unknown or who underwent their first endoscopies. Four PC (1,311 cases and 1,672 non-cases) and eight NPC studies (3,501 cases and 11,347 non-cases) were included. The combined RRs (95% CIs) comparing the bottom with the top categories of circulating folate levels were 1.07 (0.97-1.18) for the NPC group but 1.45 (1.16-1.74) for the PC group. Low circulating folate levels were associated with new adenoma formation.

  13. Fruits, vegetables and breast cancer risk: a systematic review and meta-analysis of prospective studies.

    Science.gov (United States)

    Aune, D; Chan, D S M; Vieira, A R; Rosenblatt, D A Navarro; Vieira, R; Greenwood, D C; Norat, T

    2012-07-01

    Evidence for an association between fruit and vegetable intake and breast cancer risk is inconclusive. To clarify the association, we conducted a systematic review and meta-analysis of the evidence from prospective studies. We searched PubMed for prospective studies of fruit and vegetable intake and breast cancer risk until April 30, 2011. We included fifteen prospective studies that reported relative risk estimates and 95 % confidence intervals (CIs) of breast cancer associated with fruit and vegetable intake. Random effects models were used to estimate summary relative risks. The summary relative risk (RR) for the highest versus the lowest intake was 0.89 (95 % CI: 0.80-0.99, I (2) = 0 %) for fruits and vegetables combined, 0.92 (95 % CI: 0.86-0.98, I (2) = 9 %) for fruits, and 0.99 (95 % CI: 0.92-1.06, I (2) = 20 %) for vegetables. In dose-response analyses, the summary RR per 200 g/day was 0.96 (95 % CI: 0.93-1.00, I (2) = 2 %) for fruits and vegetables combined, 0.94 (95 % CI: 0.89-1.00, I (2) = 39 %) for fruits, and 1.00 (95 % CI: 0.95-1.06, I (2) = 17 %) for vegetables. In this meta-analysis of prospective studies, high intake of fruits, and fruits and vegetables combined, but not vegetables, is associated with a weak reduction in risk of breast cancer.

  14. Living network meta-analysis compared with pairwise meta-analysis in comparative effectiveness research: empirical study

    Science.gov (United States)

    Nikolakopoulou, Adriani; Mavridis, Dimitris; Furukawa, Toshi A; Cipriani, Andrea; Tricco, Andrea C; Straus, Sharon E; Siontis, George C M; Egger, Matthias

    2018-01-01

    Abstract Objective To examine whether the continuous updating of networks of prospectively planned randomised controlled trials (RCTs) (“living” network meta-analysis) provides strong evidence against the null hypothesis in comparative effectiveness of medical interventions earlier than the updating of conventional, pairwise meta-analysis. Design Empirical study of the accumulating evidence about the comparative effectiveness of clinical interventions. Data sources Database of network meta-analyses of RCTs identified through searches of Medline, Embase, and the Cochrane Database of Systematic Reviews until 14 April 2015. Eligibility criteria for study selection Network meta-analyses published after January 2012 that compared at least five treatments and included at least 20 RCTs. Clinical experts were asked to identify in each network the treatment comparison of greatest clinical interest. Comparisons were excluded for which direct and indirect evidence disagreed, based on side, or node, splitting test (Pmeta-analysis. The frequency and time to strong evidence was compared against the null hypothesis between pairwise and network meta-analyses. Results 49 comparisons of interest from 44 networks were included; most (n=39, 80%) were between active drugs, mainly from the specialties of cardiology, endocrinology, psychiatry, and rheumatology. 29 comparisons were informed by both direct and indirect evidence (59%), 13 by indirect evidence (27%), and 7 by direct evidence (14%). Both network and pairwise meta-analysis provided strong evidence against the null hypothesis for seven comparisons, but for an additional 10 comparisons only network meta-analysis provided strong evidence against the null hypothesis (P=0.002). The median time to strong evidence against the null hypothesis was 19 years with living network meta-analysis and 23 years with living pairwise meta-analysis (hazard ratio 2.78, 95% confidence interval 1.00 to 7.72, P=0.05). Studies directly comparing

  15. Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis

    OpenAIRE

    Zhu, Min; Zhou, Chengmao; Huang, Bing; Ruan, Lin; Liang, Rui

    2017-01-01

    Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone...

  16. Dipyridamole plus aspirin versus aspirin alone in the secondary prevention after TIA or stroke: a meta-analysis by risk

    OpenAIRE

    Halkes, P.H.A.; Gray, Laura J.; Bath, Philip M.W.; Diener, Hans-Christoph; Guiraud-Chaumeil, B.

    2008-01-01

    Objectives: Our aim was to study the effect of combination therapy with aspirin and dipyridamole (A+D) over aspirin alone (ASA) in secondary prevention after transient \\ud ischemic attack or minor stroke of presumed arterial origin and to perform subgroup analyses to identify patients that might benefit most from secondary prevention with A+D.\\ud Data sources: The previously published meta-analysis of individual patient data was updated with data from ESPRIT (N=2,739); trials without data on ...

  17. Occurrence of Phlebitis: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Chang, Wen P; Peng, Yu X

    Peripheral venous catheters (PVCs) are commonly used in clinical practice. However, varying degrees of phlebitis often occur in patients receiving intravenous injections. The relevant literature suggests that phlebitis occurrence is highly associated with the catheter gauge, insertion site, and catheterization duration. Nevertheless, no meta-analysis has been performed on the influence of these three factors on the occurrence of phlebitis. The objective of this study was to determine whether any significant differences exist in the occurrence of phlebitis between catheters of 20 gauge or smaller and those larger than 20 gauge, between catheters inserted in the antecubital fossa and those inserted in other locations on the upper limbs, or between catheters inserted for more than 96 hours and those inserted for 96 hours or less. Using a systematic approach, we searched for literature published between 2006 and 2017 in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Cochrane Library databases. We used Comprehensive Meta-analysis Version 2 to perform our meta-analysis. After the screening and review processes, we identified 17 studies that met our selection conditions. Among these studies, 14 contained complete data for meta-analysis. These studies involved 4,343 patients and 5,846 PVCs. Regarding the overall effect size in the meta-analysis, the results of the forest plot comparing catheters of 20 gauge or smaller and those larger than 20 gauge presented a risk ratio (RR) of 0.88 (95% confidence interval [0.67, 1.17], p = .380), indicating no statistically significant difference in the occurrence of phlebitis between catheters of the aforementioned gauges. The results of the forest plot comparing catheters inserted in the antecubital fossa and those inserted in other locations on the upper limbs presented an RR of 1.05 (95% confidence interval [0.82, 1.34], p = .696), indicating no statistically significant difference in

  18. Claustrophobia in magnetic resonance imaging: A systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Munn, Zachary; Moola, Sandeep; Lisy, Karolina; Riitano, Dagmara; Murphy, Fred

    2015-01-01

    Purpose: Anxiety and claustrophobia are common during MRI scanning. It has been estimated that 2 million scans worldwide cannot be performed annually either due to premature scan termination or refusal due to claustrophobia. The actual prevalence of claustrophobic reactions (defined here as scan terminations or refusals) reported in published studies varies significantly. Materials and methods: A systematic search was performed to identify literature on this topic. Studies were included if they assessed adults undergoing MRI and reported on claustrophobic reactions. Data on the proportion of patients who suffered a claustrophobic reaction was extracted and combined in a meta-analysis where possible. Following the search, 18 studies were retrieved that met the inclusion criteria. Results: There was significant clinical and statistical heterogeneity across the included studies, and data was only included in meta-analysis where there were comparable populations and scan. The pooled proportion for scan terminations due to claustrophobia equalled 1.18% (95% CI 0.79–1.65). Conclusion: The results of this review show that claustrophobia is an issue when undergoing MRI, with approximately 1 out of 100 or 12 out of 1000 people scanned experiencing a claustrophobic reaction requiring premature termination of the scan. Health professionals working in MRI should be prepared to encounter claustrophobic patients. - Highlights: • We reviewed all the published literature reporting on claustrophobic events during MRI. • Meta-analysis of these results shows that 1.2 people out of 100 have a claustrophobic event. • Health professionals working in MRI need to be prepared to encounter claustrophobic patients

  19. Cigarette smoking and telomere length: A systematic review of 84 studies and meta-analysis.

    Science.gov (United States)

    Astuti, Yuliana; Wardhana, Ardyan; Watkins, Johnathan; Wulaningsih, Wahyu

    2017-10-01

    Cigarette smoking is a risk factor for ageing-related disease, but its association with biological ageing, indicated by telomere length, is unclear. We systematically reviewed evidence evaluating association between smoking status and telomere length. Searches were performed in MEDLINE (Ovid) and EMBASE (Ovid) databases, combining variation of keywords "smoking" and "telomere". Data was extracted for study characteristics and estimates for association between smoking and telomere length. Quality of studies was assessed with a risk of bias score, and publication bias was assessed with a funnel plot. I 2 test was used to observe heterogeneity. Meta-analysis was carried out to compare mean difference in telomere length by smoking status, and a dose-response approach was carried out for pack-years of smoking and telomere length. A sensitivity analysis was carried out to examine sources of heterogeneity. A total of 84 studies were included in the review, and 30 among them were included in our meta-analysis. Potential bias was addressed in half of included studies, and there was little evidence of small study bias. Telomere length was shorter among ever smokers compared to never smokers (summary standard mean difference [SMD]: -0.11 (95% CI -0.16 to -0.07)). Similarly, shorter telomere length was found among smokers compared to non-smokers, and among current smokers compared to never or former smokers. Dose-response meta-analysis suggested an inverse trend between pack-years of smoking and telomere length. However, heterogeneity among some analyses was observed. Shorter telomeres among ever smokers compared to those who never smoked may imply mechanisms linking tobacco smoke exposure to ageing-related disease. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  20. Interleukin-8 for diagnosis of neonatal sepsis: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Min Zhou

    Full Text Available Neonatal sepsis (NS is a life-threatening disorder and an important cause of morbidity and mortality in neonates. Previous studies showed that interleukin 8 (IL-8 may effectively and rapidly diagnose NS.We conducted the systematic review and meta-analysis to investigate the diagnostic value of the IL-8 in NS.The literature was searched in PUBMED, EMBASE, Cochrane Library, CNKI, VIP and other Chinese Medical Databases during October 1998 to January 2014 using set search criteria. Each included study was evaluated by quality assessment of diagnostic accuracy studies tool. Two investigators independently extracted the data and study characteristics, and disagreements, if any, were resolved by consensus. Meta-disc software was used to calculate the pooled sensitivity, specificity and summary diagnostic odds ratio (SDOR, I² or Cochrane Q to test heterogeneity, and meta-regression to investigate the source of heterogeneity. Funnel plots were used to test the potential presence of publication bias. False-positive report probability (FPRP was calculated to confirm the significance of the results.Eight studies (548 neonates were included in this meta-analysis. The pooled sensitivity and specificity of IL-8 were 0.78 and 0.84, respectively, which had moderate accuracy in the diagnosis of NS. The pooled diagnostic odds ratio (DOR and area under curve (AUC was 21.64 and 0.8908 (Q*=0.8215, respectively. The diagnostic threshold analysis showed that there was no threshold effect. The meta-regression analysis showed the cut-off, QUADAS and onset time have no effect on the heterogeneity. The funnel plots showed the existence of publication bias.Meta-analysis showed IL-8 had a moderate accuracy (AUC=0.8908 for the diagnosis of NS. IL-8 is a helpful biomarker for early diagnosis of NS. However, we should combine the results with clinical symptoms and signs, laboratory and microbial results.

  1. A Healthy Dietary Pattern Reduces Lung Cancer Risk: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yanlai Sun

    2016-03-01

    Full Text Available Background: Diet and nutrients play an important role in cancer development and progress; a healthy dietary pattern has been found to be associated with several types of cancer. However, the association between a healthy eating pattern and lung cancer risk is still unclear. Objective: Therefore, we conducted a systematic review with meta-analysis to evaluate whether a healthy eating pattern might reduce lung cancer risk. Methods: We identified relevant studies from the PubMed and Embase databases up to October 2015, and the relative risks were extracted and combined by the fixed-effects model when no substantial heterogeneity was observed; otherwise, the random-effects model was employed. Subgroup and publication bias analyses were also performed. Results: Finally, eight observational studies were included in the meta-analysis. The pooled relative risk of lung cancer for the highest vs. lowest category of healthy dietary pattern was 0.81 (95% confidence interval, CI: 0.75–0.86, and no significant heterogeneity was detected. The relative risks (RRs for non-smokers, former smokers and current smokers were 0.89 (95% CI: 0.63–1.27, 0.74 (95% CI: 0.62–0.89 and 0.86 (95% CI: 0.79–0.93, respectively. The results remained stable in subgroup analyses by other confounders and sensitivity analysis. Conclusions: The results of our meta-analysis suggest that a healthy dietary pattern is associated with a lower lung cancer risk, and they provide more beneficial evidence for changing the diet pattern in the general population.

  2. Workplace interventions to improve work ability: A systematic review and meta-analysis of their effectiveness.

    Science.gov (United States)

    Oakman, Jodi; Neupane, Subas; Proper, Karin I; Kinsman, Natasha; Nygård, Clas-Håkan

    2018-03-01

    Objective Extended working lives due to an ageing population will necessitate the maintenance of work ability across the life course. This systematic review aimed to analyze whether workplace interventions positively impact work ability. Methods We searched Medline, PsycINFO, CINAHL and Embase databases using relevant terms. Work-based interventions were those focused on individuals, the workplace, or multilevel (combination). Work ability - measured using the work ability index (WAI) or the single-item work ability score (WAS) - was the outcome measure. Grading of Recommendations Assessment, Development & Evaluation (GRADE) criteria was used to assess evidence quality, and impact statements were developed to synthesize the results. Meta-analysis was undertaken where appropriate. Results We reviewed 17 randomized control trials (comprising 22 articles). Multilevel interventions (N=5) included changes to work arrangements and liaisons with supervisors, whilst individual-focused interventions (N=12) involved behavior change or exercise programs. We identified only evidence of a moderate quality for either individual or multilevel interventions aiming to improve work ability. The meta-analysis of 13 studies found a small positive significant effect for interventions on work ability [overall pooled mean 0.12, 95% confidence interval (CI) 0.03-0.21] with no heterogeneity for the effect size (Chi 2 =11.28, P=0.51; I 2 =0%). Conclusions The meta-analysis showed a small positive effect, suggesting that workplace interventions might improve work ability. However, the quality of the evidence base was only moderate, precluding any firm conclusion. Further high quality studies are require to establish the role of interventions on work ability.

  3. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials.

    Science.gov (United States)

    Bernardi, Mauro; Caraceni, Paolo; Navickis, Roberta J; Wilkes, Mahlon M

    2012-04-01

    Albumin infusion reduces the incidence of postparacentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment. Treatment alternatives to albumin, such as artificial colloids and vasoconstrictors, have been widely investigated. The aim of this meta-analysis was to determine whether morbidity and mortality differ between patients receiving albumin versus alternative treatments. The meta-analysis included randomized trials evaluating albumin infusion in patients with tense ascites. Primary endpoints were postparacentesis circulatory dysfunction, hyponatremia, and mortality. Eligible trials were sought by multiple methods, including computer searches of bibliographic and abstract databases and the Cochrane Library. Results were quantitatively combined under a fixed-effects model. Seventeen trials with 1,225 total patients were included. There was no evidence of heterogeneity or publication bias. Compared with alternative treatments, albumin reduced the incidence of postparacentesis circulatory dysfunction (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.27-0.55). Significant reductions in that complication by albumin were also shown in subgroup analyses versus each of the other volume expanders tested (e.g., dextran, gelatin, hydroxyethyl starch, and hypertonic saline). The occurrence of hyponatremia was also decreased by albumin, compared with alternative treatments (OR, 0.58; 95% CI, 0.39-0.87). In addition, mortality was lower in patients receiving albumin than alternative treatments (OR, 0.64; 95% CI, 0.41-0.98). This meta-analysis provides evidence that albumin reduces morbidity and mortality among patients with tense ascites undergoing large-volume paracentesis, as compared with alternative treatments investigated thus far. Copyright © 2011 American Association for the Study of Liver Diseases.

  4. Biomechanical Differences of Foot-Strike Patterns During Running: A Systematic Review With Meta-analysis.

    Science.gov (United States)

    Almeida, Matheus O; Davis, Irene S; Lopes, Alexandre D

    2015-10-01

    Systematic review with meta-analysis. To determine the biomechanical differences between foot-strike patterns used when running. Strike patterns during running have received attention in the recent literature due to their potential mechanical differences and associated injury risks. Electronic databases (MEDLINE, Embase, LILACS, SciELO, and SPORTDiscus) were searched through July 2014. Studies (cross-sectional, case-control, prospective, and retrospective) comparing the biomechanical characteristics of foot-strike patterns during running in distance runners at least 18 years of age were included in this review. Two independent reviewers evaluated the risk of bias. A meta-analysis with a random-effects model was used to combine the data from the included studies. Sixteen studies were included in the final analysis. In the meta-analyses of kinematic variables, significant differences between forefoot and rearfoot strikers were found for foot and knee angle at initial contact and knee flexion range of motion. A forefoot-strike pattern resulted in a plantar-flexed ankle position and a more flexed knee position, compared to a dorsiflexed ankle position and a more extended knee position for the rearfoot strikers, at initial contact with the ground. In the comparison of rearfoot and midfoot strikers, midfoot strikers demonstrated greater ankle dorsiflexion range of motion and decreased knee flexion range of motion compared to rearfoot strikers. For kinetic variables, the meta-analysis revealed that rearfoot strikers had higher vertical loading rates compared to forefoot strikers. There are differences in kinematic and kinetic characteristics between foot-strike patterns when running. Clinicians should be aware of these characteristics to help in the management of running injuries and advice on training.

  5. The association between Selenium and Prostate Cancer: a Systematic Review and Meta-Analysis

    Science.gov (United States)

    Sayehmiri, Kourosh; Azami, Milad; Mohammadi, Younes; Soleymani, Ali; Tardeh, Zainab

    2018-06-25

    Background: Evidence of relationship between selenium and prostate cancer has been inconsistent. The present metaanalysis was conducted to determine relationship between selenium and prostate cancer. Methods: A systematic review and meta-analysis was carried out using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We searched PubMed, Scopus, Web of Science, ScienceDirect, Embase, CINAHL, Cochrane Library, EBSCO and Google scholar search engines and the reference lists of the retrieved papers for relevant data, without any limitation regarding language or time until 2016. Heterogeneity among studies was evaluated using Q test and I2 Index. Finally, a random effects model was used for combining results using STATA software version 11.1. P<0.05 was considered significant. Results: Thirty-eight studies including 36,419 cases and 105,293 controls were included in the final analysis. The pooled relative risk (RR) of relation between selenium and prostate cancer was 0.86 (95% Confidence Interval [CI]:0.78-0.94). Sub-group analyses based on case-control, cohort, and RCT studies gave values of 0.89 (95% CI: 0.80-1.00), 0.77 (95% CI: 0.52-1.14) and 0.90 (95% CI: 0.74-1.09), respectively. RRs based on serum, plasma and nail samples were 0.69 (95% CI: 0.51-0.95), 0.85 (95% CI: 0.61-1.17), 0.66 (95% CI: 0.41-1.05), respectively. According to 10 studies, investigated the relation between advanced prostate cancer and selenium in which the RR was 0.67 (95% CI: 0.52-0.87). Conclusions: This meta-analysis indicated that selenium most probably has a protective role against development of prostate cancer and its progression to advanced stages. Therefore, selenium supplementation can be proposed for prevention of prostate cancer. Creative Commons Attribution License

  6. Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Mohamed Amgad

    Full Text Available Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research.To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue.We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed.Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during

  7. A Healthy Dietary Pattern Reduces Lung Cancer Risk: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Sun, Yanlai; Li, Zhenxiang; Li, Jianning; Li, Zengjun; Han, Jianjun

    2016-03-04

    Diet and nutrients play an important role in cancer development and progress; a healthy dietary pattern has been found to be associated with several types of cancer. However, the association between a healthy eating pattern and lung cancer risk is still unclear. Therefore, we conducted a systematic review with meta-analysis to evaluate whether a healthy eating pattern might reduce lung cancer risk. We identified relevant studies from the PubMed and Embase databases up to October 2015, and the relative risks were extracted and combined by the fixed-effects model when no substantial heterogeneity was observed; otherwise, the random-effects model was employed. Subgroup and publication bias analyses were also performed. Finally, eight observational studies were included in the meta-analysis. The pooled relative risk of lung cancer for the highest vs. lowest category of healthy dietary pattern was 0.81 (95% confidence interval, CI: 0.75-0.86), and no significant heterogeneity was detected. The relative risks (RRs) for non-smokers, former smokers and current smokers were 0.89 (95% CI: 0.63-1.27), 0.74 (95% CI: 0.62-0.89) and 0.86 (95% CI: 0.79-0.93), respectively. The results remained stable in subgroup analyses by other confounders and sensitivity analysis. The results of our meta-analysis suggest that a healthy dietary pattern is associated with a lower lung cancer risk, and they provide more beneficial evidence for changing the diet pattern in the general population.

  8. Association between LRP1 C766T polymorphism and Alzheimer's disease susceptibility: a meta-analysis.

    Science.gov (United States)

    Wang, Yun; Liu, Shengyuan; Wang, Jingjing; Zhang, Jie; Hua, Yaqiong; Li, Hua; Tan, Huibiao; Kuai, Bin; Wang, Biao; Sheng, Sitong

    2017-08-16

    Low density lipoprotein receptor-related protein 1 (LRP1) C766T polymorphism (rs1799986) has been extensively investigated for Alzheimer's disease (AD) susceptibility. However, results in different studies have been contradictory. Therefore, we conducted a meta-analysis containing 6455 AD cases and 6304 controls from 26 independent case-control studies to determine whether there was an association between the LRP1 C766T polymorphism and AD susceptibility. The combined analysis showed that there was no significant association between LRP1 C766T polymorphism and AD susceptibility (TT + CT versus CC: OR = 0.920, 95% CI = 0.817-1.037, P = 0.172). In subgroup analysis, significant decreased AD susceptibility was found among Asian population in allele model (T versus C: OR = 0.786, 95% CI = 0.635-0.974, P = 0.028) and dominant model (TT + CT versus CC: OR = 0.800, 95% CI = 0.647-0.990, P = 0.040). Moreover, T allele of LRP1 C766T was statistically associated with late onset of AD (LOAD) (T versus C: OR = 0.858, 95% CI = 0.748-0.985, P = 0.029; TT + CT versus CC: OR = 0.871, 95% CI = 0.763-0.994, P = 0.040). In conclusion, our meta-analysis suggested that LRP1 C766T polymorphism was associated with lower risk of AD in Asian, and could reduce LOAD risk especially. Considering some limitations of our meta-analysis, further large-scale studies should be done to reach a more comprehensive understanding.

  9. Tooth erosion and eating disorders: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Ana Paula Hermont

    Full Text Available BACKGROUND: Eating disorders are associated with the highest rates of morbidity and mortality of any mental disorders among adolescents. The failure to recognize their early signs can compromise a patient's recovery and long-term prognosis. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders. OBJECTIVES: The aim of this systematic review and meta-analysis was to search for scientific evidence regarding the following clinical question: Do eating disorders increase the risk of tooth erosion? METHODS: An electronic search addressing eating disorders and tooth erosion was conducted in eight databases. Two independent reviewers selected studies, abstracted information and assessed its quality. Data were abstracted for meta-analysis comparing tooth erosion in control patients (without eating disorders vs. patients with eating disorders; and patients with eating disorder risk behavior vs. patients without such risk behavior. Combined odds ratios (ORs and a 95% confidence interval (CI were obtained. RESULTS: Twenty-three papers were included in the qualitative synthesis and assessed by a modified version of the Newcastle-Ottawa Scale. Fourteen papers were included in the meta-analysis. Patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1-37.5. Patients with eating disorders who self-induced vomiting had more risk of tooth erosion than those patients who did not self-induce vomiting (OR = 19.6, 95%CI = 5.6-68.8. Patients with risk behavior of eating disorder had more risk of tooth erosion than patients without such risk behavior (Summary OR = 11.6, 95%CI = 3.2-41.7. CONCLUSION: The scientific evidence suggests a causal relationship between tooth erosion and eating disorders and purging practices. Nevertheless, there is a lack of scientific evidence to fulfill the basic criteria of causation between the risk behavior for eating disorders and tooth erosion.

  10. Potential diagnostic value of serum p53 antibody for detecting colorectal cancer: A meta-analysis.

    Science.gov (United States)

    Meng, Rongqin; Wang, Yang; He, Liang; He, Yuanqing; Du, Zedong

    2018-04-01

    Numerous studies have assessed the diagnostic value of serum p53 (s-p53) antibody in patients with colorectal cancer (CRC); however, results remain controversial. The present study aimed to comprehensively and quantitatively summarize the potential diagnostic value of s-p53 antibody in CRC. The present study utilized databases, including PubMed and EmBase, systematically regarding s-p53 antibody diagnosis in CRC, accessed on and prior to 31 July 2016. The quality of all the included studies was assessed using quality assessment of studies of diagnostic accuracy (QUADAS). The result of pooled sensitivity, pooled specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were analyzed and compared with overall accuracy measures using diagnostic odds ratios (DORs) and area under the curve (AUC) analysis. Publication bias and heterogeneity were also assessed. A total of 11 trials that enrolled a combined 3,392 participants were included in the meta-analysis. Approximately 72.73% (8/11) of the included studies were of high quality (QUADAS score >7), and all were retrospective case-control studies. The pooled sensitivity was 0.19 [95% confidence interval (CI), 0.18-0.21] and pooled specificity was 0.93 (95% CI, 0.92-0.94). Results also demonstrated a PLR of 4.56 (95% CI, 3.27-6.34), NLR of 0.78 (95% CI, 0.71-0.85) and DOR of 6.70 (95% CI, 4.59-9.76). The symmetrical summary receiver operating characteristic curve was 0.73. Furthermore, no evidence of publication bias or heterogeneity was observed in the meta-analysis. Meta-analysis data indicated that s-p53 antibody possesses potential diagnostic value for CRC. However, discrimination power was somewhat limited due to the low sensitivity.

  11. Systematic review and meta-analysis: tools for the information age.

    Science.gov (United States)

    Weatherall, Mark

    2017-11-01

    The amount of available biomedical information is vast and growing. Natural limitations of the way clinicians and researchers approach this treasure trove of information comprise difficulties locating the information, and once located, cognitive biases may lead to inappropriate use of the information. Systematic reviews and meta-analyses represent important tools in the information age to improve knowledge and action. Systematic reviews represent a census approach to identifying literature to avoid non-response bias. They are a necessary prelude to producing combined quantitative summaries of associations or treatment effects. Meta-analysis comprises the arithmetical techniques for producing combined summaries from individual study reports. Careful, thoughtful and rigorous use of these tools is likely to enhance knowledge and action. Use of standard guidelines, such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, or embedding these activities within collaborative groups such as the Cochrane Collaboration, are likely to lead to more useful systematic review and meta-analysis reporting. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. The relationship between job satisfaction and health: a meta-analysis.

    Science.gov (United States)

    Faragher, E B; Cass, M; Cooper, C L

    2005-02-01

    A vast number of published studies have suggested a link between job satisfaction levels and health. The sizes of the relationships reported vary widely. Narrative overviews of this relationship have been published, but no systematic meta-analysis review has been conducted. A systematic review and meta-analysis of 485 studies with a combined sample size of 267 995 individuals was conducted, evaluating the research evidence linking self-report measures of job satisfaction to measures of physical and mental wellbeing. The overall correlation combined across all health measures was r = 0.312 (0.370 after Schmidt-Hunter adjustment). Job satisfaction was most strongly associated with mental/psychological problems; strongest relationships were found for burnout (corrected r = 0.478), self-esteem(r = 0.429), depression (r = 0.428), and anxiety(r = 0.420). The correlation with subjective physical illness was more modest (r = 0.287). Correlations in excess of 0.3 are rare in this context. The relationships found suggest that job satisfaction level is an important factor influencing the health of workers. Organisations should include the development of stress management policies to identify and eradicate work practices that cause most job dissatisfaction as part of any exercise aimed at improving employee health. Occupational health clinicians should consider counselling employees diagnosed as having psychological problems to critically evaluate their work-and help them to explore ways of gaining greater satisfaction from this important aspect of their life.

  13. Genome-Wide Meta-Analysis of Longitudinal Alcohol Consumption Across Youth and Early Adulthood.

    Science.gov (United States)

    Adkins, Daniel E; Clark, Shaunna L; Copeland, William E; Kennedy, Martin; Conway, Kevin; Angold, Adrian; Maes, Hermine; Liu, Youfang; Kumar, Gaurav; Erkanli, Alaattin; Patkar, Ashwin A; Silberg, Judy; Brown, Tyson H; Fergusson, David M; Horwood, L John; Eaves, Lindon; van den Oord, Edwin J C G; Sullivan, Patrick F; Costello, E J

    2015-08-01

    The public health burden of alcohol is unevenly distributed across the life course, with levels of use, abuse, and dependence increasing across adolescence and peaking in early adulthood. Here, we leverage this temporal patterning to search for common genetic variants predicting developmental trajectories of alcohol consumption. Comparable psychiatric evaluations measuring alcohol consumption were collected in three longitudinal community samples (N=2,126, obs=12,166). Consumption-repeated measurements spanning adolescence and early adulthood were analyzed using linear mixed models, estimating individual consumption trajectories, which were then tested for association with Illumina 660W-Quad genotype data (866,099 SNPs after imputation and QC). Association results were combined across samples using standard meta-analysis methods. Four meta-analysis associations satisfied our pre-determined genome-wide significance criterion (FDR<0.1) and six others met our 'suggestive' criterion (FDR<0.2). Genome-wide significant associations were highly biological plausible, including associations within GABA transporter 1, SLC6A1 (solute carrier family 6, member 1), and exonic hits in LOC100129340 (mitofusin-1-like). Pathway analyses elaborated single marker results, indicating significant enriched associations to intuitive biological mechanisms, including neurotransmission, xenobiotic pharmacodynamics, and nuclear hormone receptors (NHR). These findings underscore the value of combining longitudinal behavioral data and genome-wide genotype information in order to study developmental patterns and improve statistical power in genomic studies.

  14. Family-Based Interventions in Preventing Children and Adolescents from Using Tobacco: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Thomas, Roger E; Baker, Philip R A; Thomas, Bennett C

    2016-07-01

    Tobacco is the main preventable cause of death and disease worldwide. Adolescent smoking is increasing in many countries with poorer countries following the earlier experiences of affluent countries. Preventing adolescents from starting smoking is crucial to decreasing tobacco-related illness. To assess effectiveness of family-based interventions alone and combined with school-based interventions to prevent children and adolescents from initiating tobacco use. Fourteen bibliographic databases and the Internet, journals hand-searched, and experts consulted. Randomized controlled trials (RCTs) with children or adolescents and families, interventions to prevent starting tobacco use, and follow-up ≥6 months. Abstracts/titles independently assessed and data independently entered by 2 authors. Risk of bias was assessed with the Cochrane Risk-of-Bias tool. Twenty-seven RCTs were included. Nine trials of never-smokers compared with a control provided data for meta-analysis. Family intervention trials had significantly fewer students who started smoking. Meta-analysis of 2 RCTs of combined family and school interventions compared with school only, showed additional significant benefit. The common feature of effective high-intensity interventions was encouraging authoritative parenting. Only 14 RCTs provided data for meta-analysis (approximately a third of participants). Of the 13 RCTs that did not provide data for meta-analysis 8 compared a family intervention with no intervention and 1 reported significant effects, and 5 compared a family combined with school intervention with a school intervention only and none reported additional significant effects. There is moderate-quality evidence that family-based interventions prevent children and adolescents from starting to smoke. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  15. Meta-Analysis of Social Cognition in Mild Cognitive Impairment.

    Science.gov (United States)

    Bora, Emre; Yener, Görsev G

    2017-07-01

    Social cognitive abilities are impaired in Alzheimer disease and other dementias. Recent studies suggested that social cognitive abilities might be also impaired in mild cognitive impairment (MCI). Current meta-analysis aimed to summarize available evidence for deficits in theory of mind (ToM) and emotion recognition in MCI. In this meta-analysis of 17 studies, facial emotion recognition and ToM performances of 513 individuals with MCI and 693 healthy controls were compared. Mild cognitive impairment was associated with significant impairments falling in the medium effect sizes range in ToM ( d = 0.63) and facial emotion recognition ( d = 0.58). Among individual emotions, recognition of fear and sadness were particularly impaired. There were no significant between-group differences in recognition of disgust, happiness, and surprise. Social cognitive deficits were more severe in multidomain MCI. There is a need for longitudinal studies investigating the potential role of social cognitive impairment in predicting conversion to dementia.

  16. Efficacy of escitalopram compared to citalopram: a meta-analysis.

    Science.gov (United States)

    Montgomery, Stuart; Hansen, Thomas; Kasper, Siegfried

    2011-03-01

    The aim of this review was to assess the clinical relevance of the relative antidepressant efficacy of escitalopram and citalopram by meta-analysis. Studies in major depressive disorder (MDD) with both escitalopram and citalopram treatment arms were identified. Adult patients had to meet DSM-IV criteria for MDD. The primary outcome measure was the treatment difference in Montgomery-Asberg Depression Rating Scale (MADRS) total score at week 8 (or last assessment if escitalopram, n=995; citalopram, n=1014). Escitalopram was significantly more effective than citalopram in overall treatment effect, with an estimated mean treatment difference of 1.7 points at week 8 (or last assessment if escitalopram. In this meta-analysis, the statistically significant superior efficacy of escitalopram compared to citalopram was shown to be clinically relevant.

  17. Immunotherapy in advanced melanoma: a network meta-analysis.

    Science.gov (United States)

    Pyo, Jung-Soo; Kang, Guhyun

    2017-05-01

    The aim of this study was to compare the effects of various immunotherapeutic agents and chemotherapy for unresected or metastatic melanomas. We performed a network meta-analysis using a Bayesian statistical model to compare objective response rate (ORR) of various immunotherapies from 12 randomized controlled studies. The estimated ORRs of immunotherapy and chemotherapy were 0.224 and 0.108, respectively. The ORRs of immunotherapy in untreated and pretreated patients were 0.279 and 0.176, respectively. In network meta-analysis, the odds ratios for ORR of nivolumab (1 mg/kg)/ipilmumab (3 mg/kg), pembrolizumab 10 mg/kg and nivolumab 3 mg/kg were 8.54, 5.39 and 4.35, respectively, compared with chemotherapy alone. Our data showed that various immunotherapies had higher ORRs rather than chemotherapy alone.

  18. Dividend Policy and Corporate Value (A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Tifani Titah Dwi Tyastari

    2017-07-01

    Full Text Available This study aimed to understand the effect of dividend policy on corporate value, as well as to examine and analyze the variation of result study on corporate value in Indonesia.Dividend Signaling Model was the grand theory used to explain the effect of dividend policy on corporate value. This study used meta-analysis approach with the sample were 70 researches in Indonesia, both the published and unpublished in 2007-2015. The result of this study, meta-analysis strengthens the findings of the previous study which stated that the dividend policy could increase the corporate value. The differences of the previous studies were due to the presence of moderation effect from the measurement model of corporate value and dividend corporate.

  19. Road safety effects of roundabouts: A meta-analysis.

    Science.gov (United States)

    Elvik, Rune

    2017-02-01

    This paper presents a meta-analysis of the road safety effects of converting junctions to roundabouts. 44 studies containing a total of 154 estimates of effect were included. Based on a meta-regression analysis, converting junctions to roundabouts is associated with a reduction of fatal accidents of about 65% and a reduction of injury accidents of about 40%. The mean effect on property-damage-only accidents is ambiguous. Summary estimates of effect are robust for fatal and injury accidents, but vary depending on the model of meta-analysis and the treatment of outlying data points for property-damage-only accidents. A trim-and-fill analysis suggests a weak tendency for publication bias, with modest influence on summary estimates of effect. It is concluded that roundabouts are very effective in reducing traffic fatalities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. A meta-analysis of echocardiographic measurements of the left heart for the development of normative reference ranges in a large international cohort

    DEFF Research Database (Denmark)

    Møgelvang, Rasmus

    2014-01-01

    , from multiple studies around the world. METHODS AND RESULTS: The Echocardiographic Normal Ranges Meta-Analysis of the Left heart (EchoNoRMAL) collaboration was established and population-based data sets of echocardiographic measurements combined to perform an individual person data meta-analysis. Data...... from 43 studies were received, representing 51 222 subjects, of which 22 404 adults aged 18-80 years were without clinical cardiovascular or renal disease, hypertension or diabetes. Quantile regression or an appropriate parametric regression method will be used to derive reference values at the 5th...

  1. Does Orthognathic Surgery Cause or Cure Temporomandibular Disorders? A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Al-Moraissi, Essam Ahmed; Wolford, Larry M; Perez, Daniel; Laskin, Daniel M; Ellis, Edward

    2017-09-01

    There is still controversy about whether orthognathic surgery negatively or positively affects temporomandibular disorders (TMDs). The purpose of this study was to determine whether orthognathic surgery has a beneficial or deleterious effect on pre-existing TMDs. A systematic review and meta-analysis were conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 major databases to locate all pertinent articles published from 1980 to March 2016. All subjects in the various studies were stratified a priori into 9 categories based on subdiagnoses of TMDs. The predictor variables were those patients with pre-existing TMDs who underwent orthognathic surgery in various subgroups. The outcome variables were maximal mouth opening and signs and symptoms of a TMD before and after orthognathic surgery based on the type of osteotomy. The meta-analysis was performed using Comprehensive Meta-Analysis software (Biostat, Englewood, NJ). A total of 5,029 patients enrolled in 29 studies were included in this meta-analysis. There was a significant reduction in TMDs in patients with a retrognathic mandible after bilateral sagittal split osteotomy (BSSO) (P = .014), but no significant difference after bimaxillary surgery (BSSO and Le Fort I osteotomy) (P = .336). There was a significant difference in patients with prognathism after isolated BSSO or intraoral vertical ramus osteotomy and after combined BSSO and Le Fort I osteotomy (P = .001), but no significant difference after BSSO (P = .424) or bimaxillary surgery (intraoral vertical ramus osteotomy and Le Fort I osteotomy) (P = .728). Orthognathic surgery caused a decrease in TMD symptoms for many patients who had symptoms before surgery, but it created symptoms in a smaller group of patients who were asymptomatic before surgery. The presence of presurgical TMD symptoms or the type of jaw deformity did not identify which patients' TMDs would improve, remain the

  2. Quick, “Imputation-free” meta-analysis with proxy-SNPs

    Directory of Open Access Journals (Sweden)

    Meesters Christian

    2012-09-01

    Full Text Available Abstract Background Meta-analysis (MA is widely used to pool genome-wide association studies (GWASes in order to a increase the power to detect strong or weak genotype effects or b as a result verification method. As a consequence of differing SNP panels among genotyping chips, imputation is the method of choice within GWAS consortia to avoid losing too many SNPs in a MA. YAMAS (Yet Another Meta Analysis Software, however, enables cross-GWAS conclusions prior to finished and polished imputation runs, which eventually are time-consuming. Results Here we present a fast method to avoid forfeiting SNPs present in only a subset of studies, without relying on imputation. This is accomplished by using reference linkage disequilibrium data from 1,000 Genomes/HapMap projects to find proxy-SNPs together with in-phase alleles for SNPs missing in at least one study. MA is conducted by combining association effect estimates of a SNP and those of its proxy-SNPs. Our algorithm is implemented in the MA software YAMAS. Association results from GWAS analysis applications can be used as input files for MA, tremendously speeding up MA compared to the conventional imputation approach. We show that our proxy algorithm is well-powered and yields valuable ad hoc results, possibly providing an incentive for follow-up studies. We propose our method as a quick screening step prior to imputation-based MA, as well as an additional main approach for studies without available reference data matching the ethnicities of study participants. As a proof of principle, we analyzed six dbGaP Type II Diabetes GWAS and found that the proxy algorithm clearly outperforms naïve MA on the p-value level: for 17 out of 23 we observe an improvement on the p-value level by a factor of more than two, and a maximum improvement by a factor of 2127. Conclusions YAMAS is an efficient and fast meta-analysis program which offers various methods, including conventional MA as well as inserting proxy

  3. A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder.

    Directory of Open Access Journals (Sweden)

    Juleen Lam

    Full Text Available Exposure to ambient air pollution is widespread and may be detrimental to human brain development and a potential risk factor for Autism Spectrum Disorder (ASD. We conducted a systematic review of the human evidence on the relationship between ASD and exposure to all airborne pollutants, including particulate matter air pollutants and others (e.g. pesticides and metals.To answer the question: "is developmental exposure to air pollution associated with ASD?"We conducted a comprehensive search of the literature, identified relevant studies using inclusion/exclusion criteria pre-specified in our protocol (registered in PROSPERO, CRD # 42015017890, evaluated the potential risk of bias for each included study and identified an appropriate subset of studies to combine in a meta-analysis. We then rated the overall quality and strength of the evidence collectively across all air pollutants.Of 1,158 total references identified, 23 human studies met our inclusion criteria (17 case-control, 4 ecological, 2 cohort. Risk of bias was generally low across studies for most domains; study limitations were related to potential confounding and accuracy of exposure assessment methods. We rated the quality of the body of evidence across all air pollutants as "moderate." From our meta-analysis, we found statistically significant summary odds ratios (ORs of 1.07 (95% CI: 1.06, 1.08 per 10-μg/m3 increase in PM10 exposure (n = 6 studies and 2.32 (95% CI: 2.15, 2.51 per 10-μg/m3 increase in PM2.5 exposure (n = 3 studies. For pollutants not included in a meta-analysis, we collectively evaluated evidence from each study in rating the strength and quality of overall evidence considering factors such as inconsistency, imprecision, and evidence of dose-response. All included studies generally showed increased risk of ASD with increasing exposure to air pollution, although not consistently across all chemical components.After considering strengths and limitations of the body

  4. The effects of fennel on menstrual bleeding: A systematic review and meta-analysis.

    Science.gov (United States)

    Abdollahi, Nafiseh Ghassab; Mirghafourvand, Mojgan; Mollazadeh, Sanaz

    2018-03-02

    Introduction Fennel has many medicinal properties and is used in the treatment of dysmenorrhea. Given the widespread use of herbal medicine among women for menstrual problems and considering the fact that there has been no study to date about the effect of fennel on menstrual bleeding and duration of menstrual bleeding through systematic review, the present study was conducted to determine the effect of fennel on the amount (primary outcome) and duration of menstrual bleeding and its side-effects (secondary outcomes). Materials All articles, including Persian and English, with no time limit were searched for in the following databases: Medline (through PubMed), Scopus, EMBASE (through Ovid), Cochrane Library, Web of Sciences, Google Scholar, ProQuest, Clininaltrial.gov, SID, Magiran, Irandoc, and Iranmedex, using MeSH terms, including menstrual bleeding, menstruation, severity of bleeding, hypermenorrhea, menorrhagia, fennel, fennelin, Foeniculum vulgare, dysmenorrhea, and painful menstruation, which were searched separately or in combination. Two authors separately reviewed articles to determine the inclusion criteria, and any disagreement was resolved by reaching consensus with a third person. Results A total of 7993 articles were identified through searching the databases, of which 7327 were excluded as duplicates and 666 were screened for inclusion. Six hundread and forty six were excluded by title and abstract based on not being relevant to the review and being conducted on animals. Eventually, six articles were included in the study and four articles entered into the meta-analysis. The results from meta-analysis showed that using fennel caused a significant increase in mean menstrual bleeding in the first cycle after treatment in the intervention group compared to the control (Std. mean difference: 0.46; 95 % CI: 0.18-0.73; p = 0.001; I2 = 9 %). However, it had no significant effect on menstrual bleeding in the second cycle after treatment (Mean

  5. [Composite prevention strategy for shoulder dystocia: meta-analysis].

    Science.gov (United States)

    Wang, Shaowei; Zhao, Xiaodong; Chu, Defa; Li, Min; Liang, Lin; Zhang, Junrong

    2015-01-01

    To investigate the composite prevention strategy for shoulder dystocia. The published articles of randomized controlled trial (RCT) of comparison about the prevention of shoulder dystocia were searched in PubMed, EMBASE, EBSCO databases and Cochrane Library, and these studies were screened under inclusion and exclusion criteria. The quality of included studies were evaluated. And the Meta-analysis using statistic software RevMan 5.1 was completed. Totally 16 articles, all English published with no one Chinese article being searched out, were included in this analysis, published from 1993 to 2009. ( 1)To the gestational diabetes mellitus (GDM) patients, reviewed from 2 articles, it was found that the incidence of shoulder dystocia was reduced significantly by prenatal intervention versus usual care (OR = 0.40, 95% CI:0.21- 0.75, P = 0.004). (2)To the GDM patients with intensive prenatal intervention, reviewed form 5 articles, it was found that the incidence of shoulder dystocia was reduced significantly by intensive intervention(diet control combined with insulin if necessary)versus less intensive intervention (only diet control), OR = 0.29 (95%CI:0.11-0.73, P = 0.009). (3) To the non-GDM patients with suspected macrosomia, reviewed from 4 articles, it was found that the incidence of shoulder dystocia was not reduced by early artificial induction of parturition (OR = 0.85, 95%CI:0.41-1.75, P = 0.660). (4)To the GDM patients, reviewed form 2 articles, it was found that the incidence of shoulder dystocia was reduced marginal significantly by artificial induction of parturition in 38-39 gestational weeks compared with all spontaneous parturition patients (OR = 0.18, 95%CI:0.03-0.97, P = 0.050) and significantly reduced when compared with those spontaneous parturition patients after 40 gestational weeks (OR = 0.13, 95%CI: 0.02-0.75, P = 0.020). (5)To the GDM patients with suspected macrosomia, reviewed from only one article, it was found that the incidence of shoulder

  6. Caffeine ingestion enhances Wingate performance: a meta-analysis.

    Science.gov (United States)

    Grgic, Jozo

    2018-03-01

    The positive effects of caffeine ingestion on aerobic performance are well-established; however, recent findings are suggesting that caffeine ingestion might also enhance components of anaerobic performance. A commonly used test of anaerobic performance and power output is the 30-second Wingate test. Several studies explored the effects of caffeine ingestion on Wingate performance, with equivocal findings. To elucidate this topic, this paper aims to determine the effects of caffeine ingestion on Wingate performance using meta-analytic statistical techniques. Following a search through PubMed/MEDLINE, Scopus, and SportDiscus ® , 16 studies were found meeting the inclusion criteria (pooled number of participants = 246). Random-effects meta-analysis of standardized mean differences (SMD) for peak power output and mean power output was performed. Study quality was assessed using the modified version of the PEDro checklist. Results of the meta-analysis indicated a significant difference (p = .005) between the placebo and caffeine trials on mean power output with SMD values of small magnitude (0.18; 95% confidence interval: 0.05, 0.31; +3%). The meta-analysis performed for peak power output indicated a significant difference (p = .006) between the placebo and caffeine trials (SMD = 0.27; 95% confidence interval: 0.08, 0.47 [moderate magnitude]; +4%). The results from the PEDro checklist indicated that, in general, studies are of good and excellent methodological quality. This meta-analysis adds on to the current body of evidence showing that caffeine ingestion can also enhance components of anaerobic performance. The results presented herein may be helpful for developing more efficient evidence-based recommendations regarding caffeine supplementation.

  7. Computer use and carpal tunnel syndrome: A meta-analysis.

    Science.gov (United States)

    Shiri, Rahman; Falah-Hassani, Kobra

    2015-02-15

    Studies have reported contradictory results on the role of keyboard or mouse use in carpal tunnel syndrome (CTS). This meta-analysis aimed to assess whether computer use causes CTS. Literature searches were conducted in several databases until May 2014. Twelve studies qualified for a random-effects meta-analysis. Heterogeneity and publication bias were assessed. In a meta-analysis of six studies (N=4964) that compared computer workers with the general population or other occupational populations, computer/typewriter use (pooled odds ratio (OR)=0.72, 95% confidence interval (CI) 0.58-0.90), computer/typewriter use ≥1 vs. computer/typewriter use ≥4 vs. computer/typewriter use (pooled OR=1.34, 95% CI 1.08-1.65), mouse use (OR=1.93, 95% CI 1.43-2.61), frequent computer use (OR=1.89, 95% CI 1.15-3.09), frequent mouse use (OR=1.84, 95% CI 1.18-2.87) and with years of computer work (OR=1.92, 95% CI 1.17-3.17 for long vs. short). There was no evidence of publication bias for both types of studies. Studies that compared computer workers with the general population or several occupational groups did not control their estimates for occupational risk factors. Thus, office workers with no or little computer use are a more appropriate comparison group than the general population or several occupational groups. This meta-analysis suggests that excessive computer use, particularly mouse usage might be a minor occupational risk factor for CTS. Further prospective studies among office workers with objectively assessed keyboard and mouse use, and CTS symptoms or signs confirmed by a nerve conduction study are needed. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Visuo-Spatial Performance in Autism: A Meta-analysis

    OpenAIRE

    Muth, Anne; Honekopp, Johannes; Falter, Christine

    2014-01-01

    Visuo-spatial skills are believed to be enhanced in autism spectrum disorders (ASDs). This meta-analysis tests the current state of evidence for Figure Disembedding, Block Design, Mental Rotation and Navon tasks in ASD and neurotypicals. Block Design (d = 0.32) and Figure Disembedding (d = 0.26) showed superior performance for ASD with large heterogeneity that is unaccounted for. No clear differences were found for Mental Rotation. ASD samples showed a stronger local processing preference for...

  9. Complementary and alternative exercise for fibromyalgia: a meta-analysis

    OpenAIRE

    Mist, Scott; Firestone,Kari; Jones,Kim Dupree

    2013-01-01

    Scott David Mist, Kari Firestone, Kim Dupree Jones Fibromyalgia Research and Treatment Group, School of Nursing, Oregon Health and Science University, Portland, OR, USA Abstract: Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events....

  10. Musicians have better memory than nonmusicians: A meta-analysis

    OpenAIRE

    Talamini, Francesca; Altoè, Gianmarco; Carretti, Barbara; Grassi, Massimo

    2017-01-01

    Background Several studies have found that musicians perform better than nonmusicians in memory tasks, but this is not always the case, and the strength of this apparent advantage is unknown. Here, we conducted a meta-analysis with the aim of clarifying whether musicians perform better than nonmusicians in memory tasks. Methods Education Source; PEP (WEB)—Psychoanalytic Electronic Publishing; Psychology and Behavioral Science (EBSCO); PsycINFO (Ovid); PubMed; ScienceDirect—AllBooks Content (E...

  11. Induced abortion rate in Iran: a meta-analysis.

    Science.gov (United States)

    Motaghi, Zahra; Poorolajal, Jalal; Keramat, Afsaneh; Shariati, Mohammad; Yunesian, Masud; Masoumi, Seyyedeh Zahra

    2013-10-01

    About 44 million induced abortions take place worldwide annually, of which 50% are unsafe. The results of studies investigated the induced abortion rate in Iran are inconsistent. The aim of this meta-analysis was to estimate the incidence rate of induced abortion in Iran. National and international electronic databases, as well as conference databases until July 2012 were searched. Reference lists of articles were screened and the studies' authors were contacted for additional unpublished studies. Cross-sectional studies addressing induced abortion in Iran were included in this meta-analysis. The primary outcome of interest was the induced abortion rate (the number of abortions per 1000 women aged 15-44 years in a year) or the ratio (the number of abortions per 100 live births in a year). The secondary outcome of interest was the prevalence of unintended pregnancies (the number of mistimed, unplanned, or unwanted pregnancies per total pregnancies). Data were analyzed using random effect models. Of 603 retrieved studies, using search strategy, 10 studies involving 102,394 participants were eventually included in the meta-analysis. The induced abortion rate and ratio were estimated as 8.9 per 1000 women aged 15-44 years (95% CI: 5.46, 12.33) and 5.34 per 100 live births (95% CI: 3.61, 7.07), respectively. The prevalence of unintended pregnancy was estimated as 27.94 per 100 pregnant women (95% CI: 23.46, 32.42). The results of this meta-analysis helped a better understanding of the incidence of induced abortion in Iran compared to the other developing countries in Asia. However, additional sources of data on abortion other than medical records and survey studies are needed to estimate the true rate of unsafe abortion in Iran.

  12. Does Daylight Saving Save Energy? A Meta-Analysis

    OpenAIRE

    Havránek, Tomáš; Herman, Dominik; Irsova, Zuzana

    2016-01-01

    The original rationale for adopting daylight saving time (DST) was energy savings. Modern research studies, however, question the magnitude and even direction of the effect of DST on energy consumption. Representing the first meta-analysis in this literature, we collect 162 estimates from 44 studies and find that the mean reported estimate indicates modest energy savings: 0.34% during the days when DST applies. The literature is not affected by publication bias, but the results vary systemati...

  13. Thyroid Cytology in India: Contemporary Review and Meta-analysis.

    Science.gov (United States)

    Agarwal, Shipra; Jain, Deepali

    2017-11-01

    Fine-needle aspiration cytology (FNAC) is a screening test for triaging thyroid nodules, aiding in subsequent clinical management. However, the advantages have been overshadowed by the multiplicity of reporting systems and a wide range of nomenclature used. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was formulated in 2007, to give the world a uniform thyroid cytology reporting system, facilitating easy interpretation by the clinicians. Here, we review the status of thyroid FNAC in India in terms of various reporting systems used including a meta-analysis of the previously published data. An extensive literature search was performed using internet search engines. The reports with detailed classification system used in thyroid cytology were included. The meta-analysis of published data was compared with the implied risk of malignancy by TBSRTC. More than 50 studies were retrieved and evaluated. TBSRTC is currently the most widely used reporting system with different studies showing good efficacy and interobserver concordance. Ancillary techniques have, as of now, limited applicability and acceptability in thyroid cytology in India. Twenty-eight published articles met the criteria for inclusion in the meta-analysis. When compared with TBSRTC recommendations, the meta-analysis showed a higher risk of malignancy for categories I and III. Thyroid FNAC is practiced all over India. TBSRTC has found widespread acceptance, with most institutions using this system for routine thyroid cytology reporting. However, reasons for a high malignancy risk for categories I and III need to be looked into. Various possible contributing factors are discussed in the review.

  14. Testicular cancer in twins: a meta-analysis.

    Science.gov (United States)

    Neale, R E; Carrière, P; Murphy, M F G; Baade, P D

    2008-01-15

    In a meta-analysis of testicular cancer in twins, twins had a 30% increased risk (estimate 1.31, 95% CI 1.1-1.6), providing indirect support for the hypothesis that in utero hormone variations influence risk of testicular cancer. The summary-estimate for dizygotic twins was 1.3 (1.0-1.7) and for monozygotic or same sex twins 1.4 (1.2-1.8).

  15. Meta-analysis in applied ecology.

    Science.gov (United States)

    Stewart, Gavin

    2010-02-23

    This overview examines research synthesis in applied ecology and conservation. Vote counting and pooling unweighted averages are widespread despite the superiority of syntheses based on weighted combination of effects. Such analyses allow exploration of methodological uncertainty in addition to consistency of effects across species, space and time, but exploring heterogeneity remains controversial. Meta-analyses are required to generalize in ecology, and to inform evidence-based decision-making, but the more sophisticated statistical techniques and registers of research used in other disciplines must be employed in ecology to fully realize their benefits.

  16. Dietary patterns and colorectal cancer risk: a meta-analysis.

    Science.gov (United States)

    Feng, Yu-Liang; Shu, Long; Zheng, Pei-Fen; Zhang, Xiao-Yan; Si, Cai-Juan; Yu, Xiao-Long; Gao, Wei; Zhang, Lun

    2017-05-01

    The analysis of dietary patterns has recently drawn considerable attention as a method of investigating the association between the overall whole diet and the risk of colorectal cancer. However, the results have yielded conflicting findings. Here, we carried out a meta-analysis to identify the association between dietary patterns and the risk of colorectal cancer. A total of 40 studies fulfilled the inclusion criteria and were included in this meta-analysis. The highest category of 'healthy' dietary pattern compared with the lowest category was apparently associated with a decreased risk for colorectal cancer [odds ratio (OR)=0.75; confidence interval (CI): 0.68-0.83; Pcolorectal cancer was shown for the highest compared with the lowest category of a 'western-style' dietary pattern (OR=1.40; CI: 1.26-1.56; Pcolorectal cancer in the highest compared with the lowest category of 'alcohol-consumption' pattern (OR=1.44; CI: 1.13-1.82; P=0.003). The results of this meta-analysis indicate that a 'healthy' dietary pattern may decrease the risk of colorectal cancer, whereas 'western-style' and 'alcohol-consumption' patterns may increase the risk of colorectal cancer.

  17. Dietary patterns and depression risk: A meta-analysis.

    Science.gov (United States)

    Li, Ye; Lv, Mei-Rong; Wei, Yan-Jin; Sun, Ling; Zhang, Ji-Xiang; Zhang, Huai-Guo; Li, Bin

    2017-07-01

    Although some studies have reported potential associations of dietary patterns with depression risk, a consistent perspective hasn't been estimated to date. Therefore, we conducted this meta-analysis to evaluate the relation between dietary patterns and the risk of depression. A literature research was conducted searching MEDLINE and EMBASE databases up to September 2016. In total, 21 studies from ten countries met the inclusion criteria and were included in the present meta-analysis. A dietary pattern characterized by a high intakes of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression. A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression. The results of this meta-analysis suggest that healthy pattern may decrease the risk of depression, whereas western-style may increase the risk of depression. However, more randomized controlled trails and cohort studies are urgently required to confirm this findings. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  18. Neurological Soft Signs in Schizophrenia: A Meta-analysis

    Science.gov (United States)

    Chan, Raymond C. K.; Xu, Ting; Heinrichs, R. Walter; Yu, Yue; Wang, Ya

    2010-01-01

    Background: Neurological soft signs (NSS) are hypothesized as candidate endophenotypes for schizophrenia, but their prevalence and relations with clinical and demographic data are unknown. The authors undertook a quantification (meta-analysis) of the published literature on NSS in patients with schizophrenia and healthy controls. A systematic search was conducted for published articles reporting NSS and related data using standard measures in schizophrenia and healthy comparison groups. Method: A systematic search was conducted for published articles reporting data on the prevalence of NSS in schizophrenia using standard clinical rating scales and healthy comparison groups. Meta-analyses were performed using the Comprehensive Meta-analysis software package. Effect sizes (Cohen d) indexing the difference between schizophrenic patients and the healthy controls were calculated on the basis of reported statistics. Potential moderator variables evaluated included age of patient samples, level of education, sample sex proportions, medication doses, and negative and positive symptoms. Results: A total of 33 articles met inclusion criteria for the meta-analysis. A large and reliable group difference (Cohen d) indicated that, on average, a majority of patients (73%) perform outside the range of healthy subjects on aggregate NSS measures. Cognitive performance and positive and negative symptoms share 2%–10% of their variance with NSS. Conclusions: NSS occur in a majority of the schizophrenia patient population and are largely distinct from symptomatic and cognitive features of the illness. PMID:19377058

  19. Radiosurgery of Glomus Jugulare Tumors: A Meta-Analysis

    International Nuclear Information System (INIS)

    Guss, Zachary D.; Batra, Sachin; Limb, Charles J.; Li, Gordon; Sughrue, Michael E.; Redmond, Kristin; Rigamonti, Daniele; Parsa, Andrew T.; Chang, Steven; Kleinberg, Lawrence; Lim, Michael

    2011-01-01

    Purpose: During the past two decades, radiosurgery has arisen as a promising approach to the management of glomus jugulare. In the present study, we report on a systematic review and meta-analysis of the available published data on the radiosurgical management of glomus jugulare tumors. Methods and Materials: To identify eligible studies, systematic searches of all glomus jugulare tumors treated with radiosurgery were conducted in major scientific publication databases. The data search yielded 19 studies, which were included in the meta-analysis. The data from 335 glomus jugulare patients were extracted. The fixed effects pooled proportions were calculated from the data when Cochrane's statistic was statistically insignificant and the inconsistency among studies was 36 months. In these studies, 95% of patients achieved clinical control and 96% achieved tumor control. The gamma knife, linear accelerator, and CyberKnife technologies all exhibited high rates of tumor and clinical control. Conclusions: The present study reports the results of a meta-analysis for the radiosurgical management of glomus jugulare. Because of its high effectiveness, we suggest considering radiosurgery for the primary management of glomus jugulare tumors.

  20. Memory and Obstructive Sleep Apnea: A Meta-Analysis

    Science.gov (United States)

    Wallace, Anna; Bucks, Romola S.

    2013-01-01

    Study Objectives: To examine episodic memory performance in individuals with obstructive sleep apnea (OSA). Design Meta-analysis was used to synthesize results from individual studies examining the impact of OSA on episodic memory performance. The performance of individuals with OSA was compared to healthy controls or normative data. Participants Forty-two studies were included, comprising 2,294 adults with untreated OSA and 1,364 healthy controls. Studies that recorded information about participants at baseline prior to treatment interventions were included in the analysis. Measurements Participants were assessed with tasks that included a measure of episodic memory: immediate recall, delayed recall, learning, and/or recognition memory. Results: The results of the meta-analyses provide evidence that individuals with OSA are significantly impaired when compared to healthy controls on verbal episodic memory (immediate recall, delayed recall, learning, and recognition) and visuo-spatial episodic memory (immediate and delayed recall), but not visual immediate recall or visuo-spatial learning. When patients were compared to norms, negative effects of OSA were found only in verbal immediate and delayed recall. Conclusions: This meta-analysis contributes to understanding of the nature of episodic memory deficits in individuals with OSA. Impairments to episodic memory are likely to affect the daily functioning of individuals with OSA. Citation Wallace A; Bucks RS. Memory and obstructive sleep apnea: a meta-analysis. SLEEP 2013;36(2):203-220. PMID:23372268

  1. The paradox of intragroup conflict: a meta-analysis.

    Science.gov (United States)

    de Wit, Frank R C; Greer, Lindred L; Jehn, Karen A

    2012-03-01

    Since the meta-analysis by De Dreu and Weingart (2003b) on the effects of intragroup conflict on group outcomes, more than 80 new empirical studies of conflict have been conducted, often investigating more complex, moderated relationships between conflict and group outcomes, as well as new types of intragroup conflict, such as process conflict. To explore the trends in this new body of literature, we conducted a meta-analysis of 116 empirical studies of intragroup conflict (n = 8,880 groups) and its relationship with group outcomes. To address the heterogeneity across the studies included in the meta-analysis, we also investigated a number of moderating variables. Stable negative relationships were found between relationship and process conflict and group outcomes. In contrast to the results of De Dreu and Weingart, we did not find a strong and negative association between task conflict and group performance. Analyses of main effects as well as moderator analyses revealed a more complex picture. Task conflict and group performance were more positively related among studies where the association between task and relationship conflict was relatively weak, in studies conducted among top management teams rather than non-top management teams, and in studies where performance was measured in terms of financial performance or decision quality rather than overall performance.

  2. A comparison of national guidelines for network meta-analysis.

    Science.gov (United States)

    Laws, Andrew; Kendall, Robyn; Hawkins, Neil

    2014-07-01

    Within technology appraisals, it is necessary to compare the complete set of treatments that may be used in the patient group under consideration. Randomized controlled trials are a key source of evidence for these comparisons. The techniques of network meta-analysis allow the networks of trial evidence to be evaluated to obtain estimates of comparative efficacy between sets of treatments. These techniques may be the only source of estimates of comparative effectiveness if trials directly comparing the treatments of interest have not been conducted, and may provide useful additional evidence if both direct and indirect comparisons exist. We examined both published and draft guidelines from reimbursement and health technology appraisal bodies, and considered their recommendations using appropriate methodology for the conduct of indirect comparisons and the assessments of their validity. Guidelines from 33 countries were reviewed. Of these, guidelines from 9 countries-Australia, Belgium, Canada, France, Germany, Scotland, Spain, South Africa, and the United Kingdom (England and Wales)-included detailed recommendations on the conduct of network meta-analysis. The recommendations were summarized. No two recommendations from the multiple national guidelines are mutually exclusive. It is possible to perform one network meta-analysis for submission to multiple national jurisdictions. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Autogenic training: a meta-analysis of clinical outcome studies.

    Science.gov (United States)

    Stetter, Friedhelm; Kupper, Sirko

    2002-03-01

    Autogenic training (AT) is a self-relaxation procedure by which a psychophysiological determined relaxation response is elicited. A meta-analysis was performed to evaluate the clinical effectiveness of AT. Seventy-three controlled outcome studies were found (published 1952-99). Sixty studies (35 randomized controlled trials [RCT]) qualified for inclusion in the meta-analysis. Medium-to-large effect sizes (ES) occurred for pre-post comparisons of disease-specific AT-effects, with the RCTs showing larger ES. When AT was compared to real control conditions, medium ES were found. Comparisons of AT versus other psychological treatment mostly resulted in no effects or small negative ES. This pattern of results was stable at follow-up. Unspecific AT-effects (i.e., effects on mood, cognitive performance, quality of life, and physiological variables) tended to be even larger than main effects. Separate meta-analyses for different disorders revealed a significant reduction of the heterogeneity of ES. Positive effects (medium range) of AT and of AT versus control in the meta-analysis of at least 3 studies were found for tension headache/migraine, mild-to-moderate essential hypertension, coronary heart disease, asthma bronchiale, somatoform pain disorder (unspecified type), Raynaud's disease, anxiety disorders, mild-to-moderate depression/dysthymia, and functional sleep disorders.

  4. Inference for binomial probability based on dependent Bernoulli random variables with applications to meta-analysis and group level studies.

    Science.gov (United States)

    Bakbergenuly, Ilyas; Kulinskaya, Elena; Morgenthaler, Stephan

    2016-07-01

    We study bias arising as a result of nonlinear transformations of random variables in random or mixed effects models and its effect on inference in group-level studies or in meta-analysis. The findings are illustrated on the example of overdispersed binomial distributions, where we demonstrate considerable biases arising from standard log-odds and arcsine transformations of the estimated probability p̂, both for single-group studies and in combining results from several groups or studies in meta-analysis. Our simulations confirm that these biases are linear in ρ, for small values of ρ, the intracluster correlation coefficient. These biases do not depend on the sample sizes or the number of studies K in a meta-analysis and result in abysmal coverage of the combined effect for large K. We also propose bias-correction for the arcsine transformation. Our simulations demonstrate that this bias-correction works well for small values of the intraclass correlation. The methods are applied to two examples of meta-analyses of prevalence. © 2016 The Authors. Biometrical Journal Published by Wiley-VCH Verlag GmbH & Co. KGaA.

  5. Prognostic value of C-reactive protein levels in patients with bone neoplasms: A meta-analysis.

    Science.gov (United States)

    Li, Wenyi; Luo, Xujun; Liu, Zhongyue; Chen, Yanqiao; Li, Zhihong

    2018-01-01

    The aim of this study was to conduct a meta-analysis of retrospective studies that investigated the association of preoperative C-reactive protein (CRP) levels with the overall survival (OS) of patients with bone neoplasms. A detailed literature search was performed in the Cochrane Library, Web of Science, Embase and PubMed databases up to August 28, 2017, for related research publications written in English. We extracted the data from these studies and combined the hazard ratios (HR) and 95% confidence intervals (CIs) to assess the correlation between CRP levels and OS in patients with bone neoplasms. Five studies with a total of 816 participants from several countries were enrolled in this current meta-analysis. In a pooled analysis of all the publications, increased serum CRP levels had an adverse prognostic effect on the overall survival of patients with bone neoplasms. However, the combined data showed no significant relationship between the level of CRP and OS in Asian patients (HR = 1.73; 95% CI: 0.86-3.49; P = 0.125). Similar trends were observed in patients with bone neoplasms when stratified by ethnicity, histology, metastasis and study sample size. The results of this meta-analysis suggest that increased CRP expression indicates a poorer prognosis in patients with bone neoplasms. More prospective studies are needed to confirm the prognostic significance of CRP levels in patients with bone neoplasms.

  6. Long-Term Memory: A Review and Meta-Analysis of Studies of Declarative and Procedural Memory in Specific Language Impairment

    Science.gov (United States)

    Lum, Jarrad A. G.; Conti-Ramsden, Gina

    2013-01-01

    This review examined the status of long-term memory systems in specific language impairment (SLI)--declarative memory and aspects of procedural memory in particular. Studies included in the review were identified following a systematic search of the literature and findings combined using meta-analysis. This review showed that individuals with SLI…

  7. Adoptive immunotherapy with interleukin-2 & induced killer cells in non-small cell lung cancer: A systematic review & meta-analysis

    Directory of Open Access Journals (Sweden)

    Denghai Mi

    2016-01-01

    Interpretation & conclusions: The meta-analysis showed that IL-2 or induced killer cells combination therapy was efficacious in treating NSCLC and improved overall survival. Further analysis of trials having adequate information and data need to be done to confirm these findings.

  8. GACT: a Genome build and Allele definition Conversion Tool for SNP imputation and meta-analysis in genetic association studies.

    Science.gov (United States)

    Sulovari, Arvis; Li, Dawei

    2014-07-19

    Genome-wide association studies (GWAS) have successfully identified genes associated with complex human diseases. Although much of the heritability remains unexplained, combining single nucleotide polymorphism (SNP) genotypes from multiple studies for meta-analysis will increase the statistical power to identify new disease-associated variants. Meta-analysis requires same allele definition (nomenclature) and genome build among individual studies. Similarly, imputation, commonly-used prior to meta-analysis, requires the same consistency. However, the genotypes from various GWAS are generated using different genotyping platforms, arrays or SNP-calling approaches, resulting in use of different genome builds and allele definitions. Incorrect assumptions of identical allele definition among combined GWAS lead to a large portion of discarded genotypes or incorrect association findings. There is no published tool that predicts and converts among all major allele definitions. In this study, we have developed a tool, GACT, which stands for Genome build and Allele definition Conversion Tool, that predicts and inter-converts between any of the common SNP allele definitions and between the major genome builds. In addition, we assessed several factors that may affect imputation quality, and our results indicated that inclusion of singletons in the reference had detrimental effects while ambiguous SNPs had no measurable effect. Unexpectedly, exclusion of genotypes with missing rate > 0.001 (40% of study SNPs) showed no significant decrease of imputation quality (even significantly higher when compared to the imputation with singletons in the reference), especially for rare SNPs. GACT is a new, powerful, and user-friendly tool with both command-line and interactive online versions that can accurately predict, and convert between any of the common allele definitions and between genome builds for genome-wide meta-analysis and imputation of genotypes from SNP-arrays or deep

  9. Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma

    International Nuclear Information System (INIS)

    Robinson, John W.; Moritz, Sabine; Fung, Tak

    2002-01-01

    Purpose: The results of a 1997 meta-analysis of the rates of erectile function after external beam radiotherapy (EBRT) and radical prostatectomy have been widely used in patient and professional education materials and as a reference against which new findings are compared. With a number of recent publications, it is now possible to update this analysis and compare brachytherapy with or without EBRT with EBRT alone, standard and nerve-sparing radical prostatectomy, and cryotherapy. Methods: A comprehensive literature review and subsequent meta-analysis of the rates of erectile dysfunction associated with the treatments of localized prostate carcinoma was conducted. A simple logistic regression analysis was used to combine the data from the 54 articles that met the selection criteria. Results: The predicted probability of maintaining erectile function after brachytherapy was 0.76, after brachytherapy plus EBRT 0.60, after EBRT 0.55, after nerve-sparing radical prostatectomy 0.34, after standard radical prostatectomy 0.25, and after cryotherapy 0.13. When only studies reporting ≥2 years follow-up were considered, the only significant change was a decline in the probability for nerve-sparing radical prostatectomy. No brachytherapy studies had a follow-up of ≥2 years. When the probabilities were adjusted for age, the spread between the RT methods and surgical approaches was greater. Conclusion: The differences in the probability of maintaining erectile function after different treatments of localized prostate cancer are significant

  10. Effect of Sling Exercise Training on Balance in Patients with Stroke: A Meta-Analysis.

    Science.gov (United States)

    Chen, Lianghua; Chen, Junqi; Peng, Qiyuan; Chen, Jingjie; Zou, Yucong; Liu, Gang

    2016-01-01

    This study aims to evaluate the effect of sling exercise training (SET) on balance in patients with stroke. PubMed, Cochrane Library, Ovid LWW, CBM, CNKI, WanFang, and VIP databases were searched for randomized controlled trials of the effect of SET on balance in patients with stroke. The study design and participants were subjected to metrological analysis. Berg balance Scale (BBS), Barthel index score (BI), and Fugl-Meyer Assessment (FMA) were used as independent parameters for evaluating balance function, activities of daily living(ADL) and motor function after stroke respectively, and were subjected to meta-analysis by RevMan5.3 software. Nine studies with 460 participants were analyzed. Results of meta-analysis showed that the SET treatment combined with conventional rehabilitation was superior to conventional rehabilitation treatments, with increased degrees of BBS (WMD = 3.81, 95% CI [0.15, 7.48], P = 0.04), BI (WMD = 12.98, 95% CI [8.39, 17.56], P risk of bias. Therefore, more multi-center and large-sampled randomized controlled trials are needed to confirm its clinical applications.

  11. Garlic consumption and colorectal cancer risk in man: a systematic review and meta-analysis.

    Science.gov (United States)

    Chiavarini, Manuela; Minelli, Liliana; Fabiani, Roberto

    2016-02-01

    Colorectal cancer shows large incidence variations worldwide that have been attributed to different dietary factors. We conducted a meta-analysis on the relationship between garlic consumption and colorectal cancer risk. We systematically reviewed publications obtained by searching ISI Web of Knowledge, MEDLINE and EMBASE literature databases. We extracted the risk estimate of the highest and the lowest reported categories of intake from each study and conducted meta-analysis using a random-effects model. The pooled analysis of all fourteen studies, seven cohort and seven case-control, indicated that garlic consumption was not associated with colorectal cancer risk (OR=0·93; 95 % CI 0·82, 1·06, P=0·281; I 2=83·6 %, P≤0·001). Separate analyses on the basis of cancer sites and sex also revealed no statistically significant effects on cancer risk. However, when separately analysed on the basis of study type, we found that garlic was associated with an approximately 37 % reduction in colorectal cancer risk in the case-control studies (combined risk estimate=0·63, 95 % CI 0·48, 0·82, P=0·001; I 2=75·6 %, P≤0·001). Our results suggest that consumption of garlic is not associated with a reduced colorectal cancer risk. Further investigations are necessary to clarify the discrepancy between results obtained from different types of epidemiological studies.

  12. Medicinal plants with promising antileishmanial activity in Iran: a systematic review and meta-analysis.

    Science.gov (United States)

    Soosaraei, Masoud; Fakhar, Mahdi; Hosseini Teshnizi, Saeed; Ziaei Hezarjaribi, Hajar; Banimostafavi, Elham Sadat

    2017-09-01

    Leishmaniasis is a major public health problem worldwide. The aim of the present study was to investigate medicinal plants with anti- Leishmania activity which used in Iran. Data were systematically gathered from five English databases including Ebsco, Science Direct, PubMed, Google Scholar and Scopus, four Persian databases including Magiran, Iran doc, Iran medex and the Scientific Information Database (SID) from 1999 to April 2015. Information obtained included plant family, extraction method, concentrations of extracts, animal models and parasite strains. A total of 68 articles including 188 experiments (140 in vitro and 48 in vivo) between 1999 and 2015, met our eligibility criteria. Thoroughly, 98 types of plants were examined against three genera of Leishmania spp. For the heterogeneity study conducted, it was showed that there was a great deal of variation among studies. Based on random effect, meta-analysis pooled mean of IC50 was obtained 456.64 (95% CI: 396.15, 517.12). The most Iranian plants used as anti-leishmanial activity were Artemisia species , Allium sativum , Achilleamille folium , Peganum harmala and Thymus vulgaris . The present systematic and meta-analysis review provide valuable information about natural products with anti- Leishmania activity, which would be examined in the future experimental and clinical trials and herbal combination therapy.

  13. Association of vitamin C with the risk of age-related cataract: a meta-analysis.

    Science.gov (United States)

    Wei, Lin; Liang, Ge; Cai, Chunmei; Lv, Jin

    2016-05-01

    Whether vitamin C is a protective factor for age-related cataract remains unclear. Thus, we conducted a meta-analysis to summarize the evidence from epidemiological studies of vitamin C and the risk of age-related cataract. Pertinent studies were identified by searching in PubMed and in Webscience. The random effect model was used to combine the results. Meta-regression and subgroups analyses were used to explore potential sources of between-study heterogeneity. Publication bias was estimated using Egger's regression asymmetry test. Finally, 15 articles with 20 studies for vitamin C intake and eight articles with 10 studies for serum ascorbate were included in this meta-analysis. The relative risk (RR) and 95% confidence interval of cataract for the highest versus the lowest category of vitamin C intake was 0.814 (0.707-0.938), and the associations were significant in America and Asia. Significant association of cataract risk with highest versus the lowest category of serum ascorbate was found in general [0.704 (0.564-0.879)]. Inverse associations were also found between serum ascorbate and nuclear cataract and posterior subcapsular cataract. Higher vitamin C intake and serum ascorbate might be inversely associated with risk of cataract. Vitamin C intake should be advocated for the primary prevention of cataract. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  14. Maternal MTHFR polymorphism (677 C-T) and risk of Down's syndrome child: meta-analysis.

    Science.gov (United States)

    Kaur, Amandeep; Kaur, Anupam

    2016-09-01

    Methylenetetrahydrofolate reductase (MTHFR) is the most important gene that participates in folate metabolism. Presence of valine instead of alanine at position 677 and elevated levels of homocystein causes DNA hypomethylation which in turn favours nondisjunction. In this study, we conducted a meta-analysis to establish link between maternal single-nucleotide polymorphism (SNP) and birth of Down's syndrome (DS) child. A total of 37 case-control studies were selected for analysis including our own, in which we investigated 110 cases and 111 control mothers. Overall, the result of meta-analysis showed significant risk of DS affected by the presence of maternal SNP (MTHFR 677 C-T OR = 0.816, 95% CI = 0.741-0.900, P <0.0001). Heterogeneity of high magnitude was observed among the studies. The chi-square value suggested a highly significant association between homozygous mutant TT genotype and birth of DS child (χ² = 23.63, P = 0.000). Genetic models suggested that 'T' allele possesses high risk for DS whether present in dominant (OR = 1.23, 95% CI = 1.13-1.34); codominant (OR = 1.17, 95% CI = 1.10-1.25) or recessive (OR = 1.21, 95% CI = 1.05-1.38) form. The analysis from all 37 studies combined together suggested that MTHFR 677 C-T is a major risk factor for DS birth.

  15. bspmma: An R Package for Bayesian Semiparametric Models for Meta-Analysis

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    Deborah Burr

    2012-07-01

    Full Text Available We introduce an R package, bspmma, which implements a Dirichlet-based random effects model specific to meta-analysis. In meta-analysis, when combining effect estimates from several heterogeneous studies, it is common to use a random-effects model. The usual frequentist or Bayesian models specify a normal distribution for the true effects. However, in many situations, the effect distribution is not normal, e.g., it can have thick tails, be skewed, or be multi-modal. A Bayesian nonparametric model based on mixtures of Dirichlet process priors has been proposed in the literature, for the purpose of accommodating the non-normality. We review this model and then describe a competitor, a semiparametric version which has the feature that it allows for a well-defined centrality parameter convenient for determining whether the overall effect is significant. This second Bayesian model is based on a different version of the Dirichlet process prior, and we call it the "conditional Dirichlet model". The package contains functions to carry out analyses based on either the ordinary or the conditional Dirichlet model, functions for calculating certain Bayes factors that provide a check on the appropriateness of the conditional Dirichlet model, and functions that enable an empirical Bayes selection of the precision parameter of the Dirichlet process. We illustrate the use of the package on two examples, and give an interpretation of the results in these two different scenarios.

  16. A genome-wide association meta-analysis identifies new childhood obesity loci

    Science.gov (United States)

    Bradfield, Jonathan P.; Taal, H. Rob; Timpson, Nicholas J.; Scherag, André; Lecoeur, Cecile; Warrington, Nicole M.; Hypponen, Elina; Holst, Claus; Valcarcel, Beatriz; Thiering, Elisabeth; Salem, Rany M.; Schumacher, Fredrick R.; Cousminer, Diana L.; Sleiman, Patrick M.A.; Zhao, Jianhua; Berkowitz, Robert I.; Vimaleswaran, Karani S.; Jarick, Ivonne; Pennell, Craig E.; Evans, David M.; St. Pourcain, Beate; Berry, Diane J.; Mook-Kanamori, Dennis O; Hofman, Albert; Rivadeinera, Fernando; Uitterlinden, André G.; van Duijn, Cornelia M.; van der Valk, Ralf J.P.; de Jongste, Johan C.; Postma, Dirkje S.; Boomsma, Dorret I.; Gauderman, William J.; Hassanein, Mohamed T.; Lindgren, Cecilia M.; Mägi, Reedik; Boreham, Colin A.G.; Neville, Charlotte E.; Moreno, Luis A.; Elliott, Paul; Pouta, Anneli; Hartikainen, Anna-Liisa; Li, Mingyao; Raitakari, Olli; Lehtimäki, Terho; Eriksson, Johan G.; Palotie, Aarno; Dallongeville, Jean; Das, Shikta; Deloukas, Panos; McMahon, George; Ring, Susan M.; Kemp, John P.; Buxton, Jessica L.; Blakemore, Alexandra I.F.; Bustamante, Mariona; Guxens, Mònica; Hirschhorn, Joel N.; Gillman, Matthew W.; Kreiner-Møller, Eskil; Bisgaard, Hans; Gilliland, Frank D.; Heinrich, Joachim; Wheeler, Eleanor; Barroso, Inês; O'Rahilly, Stephen; Meirhaeghe, Aline; Sørensen, Thorkild I.A.; Power, Chris; Palmer, Lyle J.; Hinney, Anke; Widen, Elisabeth; Farooqi, I. Sadaf; McCarthy, Mark I.; Froguel, Philippe; Meyre, David; Hebebrand, Johannes; Jarvelin, Marjo-Riitta; Jaddoe, Vincent W.V.; Smith, George Davey; Hakonarson, Hakon; Grant, Struan F.A.

    2012-01-01

    Multiple genetic variants have been associated with adult obesity and a few with severe obesity in childhood; however, less progress has been made to establish genetic influences on common early-onset obesity. We performed a North American-Australian-European collaborative meta-analysis of fourteen studies consisting of 5,530 cases (≥95th percentile of body mass index (BMI)) and 8,318 controls (<50th percentile of BMI) of European ancestry. Taking forward the eight novel signals yielding association with P < 5×10−6 in to nine independent datasets (n = 2,818 cases and 4,083 controls) we observed two loci that yielded a genome wide significant combined P-value, namely near OLFM4 on 13q14 (rs9568856; P=1.82×10−9; OR=1.22) and within HOXB5 on 17q21 (rs9299; P=3.54×10−9; OR=1.14). Both loci continued to show association when including two extreme childhood obesity cohorts (n = 2,214 cases and 2,674 controls). Finally, these two loci yielded directionally consistent associations in the GIANT meta-analysis of adult BMI1. PMID:22484627

  17. Mapping vulnerability to bipolar disorder: a systematic review and meta-analysis of neuroimaging studies

    Science.gov (United States)

    Fusar-Poli, Paolo; Howes, Oliver; Bechdolf, Andreas; Borgwardt, Stefan

    2012-01-01

    Background Although early interventions in individuals with bipolar disorder may reduce the associated personal and economic burden, the neurobiologic markers of enhanced risk are unknown. Methods Neuroimaging studies involving individuals at enhanced genetic risk for bipolar disorder (HR) were included in a systematic review. We then performed a region of interest (ROI) analysis and a whole-brain meta-analysis combined with a formal effect-sizes meta-analysis in a subset of studies. Results There were 37 studies included in our systematic review. The overall sample for the systematic review included 1258 controls and 996 HR individuals. No significant differences were detected between HR individuals and controls in the selected ROIs: striatum, amygdala, hippocampus, pituitary and frontal lobe. The HR group showed increased grey matter volume compared with patients with established bipolar disorder. The HR individuals showed increased neural response in the left superior frontal gyrus, medial frontal gyrus and left insula compared with controls, independent from the functional magnetic resonance imaging task used. There were no publication biases. Sensitivity analysis confirmed the robustness of these results. Limitations As the included studies were cross-sectional, it remains to be determined whether the observed neurofunctional and structural alterations represent risk factors that can be clinically used in preventive interventions for prodromal bipolar disorder. Conclusion Accumulating structural and functional imaging evidence supports the existence of neurobiologic trait abnormalities in individuals at genetic risk for bipolar disorder at various scales of investigation. PMID:22297067

  18. Efficacy of intensive versus nonintensive physiotherapy in children with cerebral palsy: a meta-analysis.

    Science.gov (United States)

    Arpino, Carla; Vescio, Maria Fenicia; De Luca, Angela; Curatolo, Paolo

    2010-06-01

    A commonly used treatment for cerebral palsy in children is so-called 'conventional therapy', which includes physiotherapy or the neurodevelopmental approach. Although more intensive rehabilitative treatment is thought to be more effective than less intensive interventions, this assumption has not been proven. In this study we compared the efficacy of intensive versus nonintensive rehabilitative treatment in children with cerebral palsy. A meta-analysis of the studies published between January 1996 and July 2007 was performed. infants/children/adolescents (1-18 years old); randomized controlled trials using, as outcome measure, the Gross Motor Function Measure score. studies that included therapies not generally used in 'so-called' conventional treatment (i.e. constraint, taping). Treatment effects were combined using the weighted mean difference method. Fixed and random effect meta-analyses were carried out and results were compared. Heterogeneity was also assessed. Funnel plots were examined and the presence of small-study effects was tested. Intensive therapy tended to have a greater effect than nonintensive therapy (1.32; 95% confidence interval: 0.55-2.10). The effect of intensive treatment tended to be apparently stronger for children 2 years of age. Our meta-analysis shows that, in children with cerebral palsy, intensive conventional therapy may improve the functional motor outcome, but the effect size seems to be modest.

  19. Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients.

    Science.gov (United States)

    Lian, Lei; Wu, Xian-Rui; He, Xiao-Sheng; Zou, Yi-Feng; Wu, Xiao-Jian; Lan, Ping; Wang, Jian-Ping

    2012-01-01

    Parastomal hernia is a common complication after colostomy construction. Whether an extraperitoneal route for colostomy creation can reduce the risk of parastomal hernia remains controversial. A meta-analysis was performed to evaluate the value of extraperitoneal route in the prevention of parastomal hernia and other postoperative complications related to colostomy. A literature search of Medline, Embase, Ovid, and Cochrane databases from the years 1966 to 2010 was performed. Studies comparing extraperitoneal colostomy with intraperitoneal colostomy were identified. Extraperitoneal colostomy was performed to prevent colostomy-related complications. Data on the following outcomes were sought: incidence of postoperative colostomy complications including parastomal hernia, prolapse, and bowel obstruction. Seven retrospective studies with a combined total of 1,071 patients (250 extraperitoneal colostomy and 821 intraperitoneal colostomy) were identified. There was a significantly lower rate of parastomal hernia (odds ratio, 0.41; 95% confidence interval, 0.23-0.73, p = 0.002) in the extraperitoneal colostomy group. However, the occurrences of bowel obstruction and prolapse were not significantly different between the two groups. A limitation of the study lies on the meta-analysis of observational studies. Extraperitoneal colostomy is associated with a lower rate of postoperative parastomal hernia as compared to intraperitoneal colostomy. Prospective randomized controlled trial is warranted to further determine the role of extraperitoneal route in the prevention of parastomal hernia.

  20. Meta-Analysis of the Reasoned Action Approach (RAA) to Understanding Health Behaviors.

    Science.gov (United States)

    McEachan, Rosemary; Taylor, Natalie; Harrison, Reema; Lawton, Rebecca; Gardner, Peter; Conner, Mark

    2016-08-01

    Reasoned action approach (RAA) includes subcomponents of attitude (experiential/instrumental), perceived norm (injunctive/descriptive), and perceived behavioral control (capacity/autonomy) to predict intention and behavior. To provide a meta-analysis of the RAA for health behaviors focusing on comparing the pairs of RAA subcomponents and differences between health protection and health-risk behaviors. The present research reports a meta-analysis of correlational tests of RAA subcomponents, examination of moderators, and combined effects of subcomponents on intention and behavior. Regressions were used to predict intention and behavior based on data from studies measuring all variables. Capacity and experiential attitude had large, and other constructs had small-medium-sized correlations with intention; all constructs except autonomy were significant independent predictors of intention in regressions. Intention, capacity, and experiential attitude had medium-large, and other constructs had small-medium-sized correlations with behavior; intention, capacity, experiential attitude, and descriptive norm were significant independent predictors of behavior in regressions. The RAA subcomponents have utility in predicting and understanding health behaviors.

  1. Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

    Science.gov (United States)

    Vest, Joshua R.; Jung, Hye-Young; Ostrovsky, Aaron; Das, Lala Tanmoy; McGinty, Geraldine B.

    2016-01-01

    Introduction Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization. Methods Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004–2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models. Results A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = −0.17; 95% confidence interval [CI] = [−0.25, −0.09]; P utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias. Conclusions Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings. PMID:26614882

  2. Network meta-analysis using R: a review of currently available automated packages.

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    Binod Neupane

    Full Text Available Network meta-analysis (NMA--a statistical technique that allows comparison of multiple treatments in the same meta-analysis simultaneously--has become increasingly popular in the medical literature in recent years. The statistical methodology underpinning this technique and software tools for implementing the methods are evolving. Both commercial and freely available statistical software packages have been developed to facilitate the statistical computations using NMA with varying degrees of functionality and ease of use. This paper aims to introduce the reader to three R packages, namely, gemtc, pcnetmeta, and netmeta, which are freely available software tools implemented in R. Each automates the process of performing NMA so that users can perform the analysis with minimal computational effort. We present, compare and contrast the availability and functionality of different important features of NMA in these three packages so that clinical investigators and researchers can determine which R packages to implement depending on their analysis needs. Four summary tables detailing (i data input and network plotting, (ii modeling options, (iii assumption checking and diagnostic testing, and (iv inference and reporting tools, are provided, along with an analysis of a previously published dataset to illustrate the outputs available from each package. We demonstrate that each of the three packages provides a useful set of tools, and combined provide users with nearly all functionality that might be desired when conducting a NMA.

  3. A joint frailty-copula model between tumour progression and death for meta-analysis.

    Science.gov (United States)

    Emura, Takeshi; Nakatochi, Masahiro; Murotani, Kenta; Rondeau, Virginie

    2017-12-01

    Dependent censoring often arises in biomedical studies when time to tumour progression (e.g., relapse of cancer) is censored by an informative terminal event (e.g., death). For meta-analysis combining existing studies, a joint survival model between tumour progression and death has been considered under semicompeting risks, which induces dependence through the study-specific frailty. Our paper here utilizes copulas to generalize the joint frailty model by introducing additional source of dependence arising from intra-subject association between tumour progression and death. The practical value of the new model is particularly evident for meta-analyses in which only a few covariates are consistently measured across studies and hence there exist residual dependence. The covariate effects are formulated through the Cox proportional hazards model, and the baseline hazards are nonparametrically modeled on a basis of splines. The estimator is then obtained by maximizing a penalized log-likelihood function. We also show that the present methodologies are easily modified for the competing risks or recurrent event data, and are generalized to accommodate left-truncation. Simulations are performed to examine the performance of the proposed estimator. The method is applied to a meta-analysis for assessing a recently suggested biomarker CXCL12 for survival in ovarian cancer patients. We implement our proposed methods in R joint.Cox package.

  4. High-Intensity Interval Training in Heart Transplant Recipients: A Systematic Review with Meta-Analysis

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    Raphael José Perrier-Melo

    2018-02-01

    Full Text Available Abstract Heart transplantation (HTx is considered an efficient and gold-standard procedure for patients with end-stage heart failure. After surgery, patients have lower aerobic power (VO2max and compensatory hemodynamic responses. The aim of the present study was to assess through a systematic review with meta-analysis whether high-intensity interval training (HIIT can provide benefits for those parameters. This is a systematic review with meta-analysis, which searched the databases and data portals PubMed, Web of Science, Scopus, Science Direct and Wiley until December 2016 (pairs. The following terms and descriptors were used: “heart recipient” OR “heart transplant recipient” OR ”heart transplant” OR “cardiac transplant” OR “heart graft”. Descriptors via DeCS and Mesh were: “heart transplantation’’ OR “cardiac transplantation”. The words used in combination (AND were: “exercise training” OR “interval training” OR “high intensity interval training” OR “high intensity training” OR “anaerobic training” OR “intermittent training” OR “sprint training”. The initial search identified 1064 studies. Then, only those studies assessing the influence of HIIT on the post-HTx period were added, resulting in three studies analyzed. The significance level adopted was 0.05. Heart transplant recipients showed significant improvement in VO2peak, heart rate and peak blood pressure in 8 to 12 weeks of intervention.

  5. Maternal Anemia during pregnancy and infant low birth weight: A systematic review and Meta-analysis.

    Science.gov (United States)

    Rahmati, Shoboo; Delpishe, Ali; Azami, Milad; Hafezi Ahmadi, Mohammed Reza; Sayehmiri, Kurosh

    2017-03-01

    Infant low birth weight is one of the major problems in different societies. Different reports have provided different results regarding the relationship between maternal anemia and infant low birth weight in different months of pregnancy. The aim of this study was to determine the relationship between maternal anemia during pregnancy and infant low birth weight. This systematic review was conducted using related keywords in national (Sid, Iran.doc, Iran medex and Magiran) and international (PubMed, Science Direct, Cochrane, Medline, Web of Science, Scopus, Springer, Embase, Google scholar) databases. Relative risks and confidence intervals were extracted from each study. The results were combined using random-effects model for meta-analysis. The I 2 index was also used to measure heterogeneity between the studies. Overall, 17 studies with a total sample size of 245407 entered the final meta-analysis and demonstrated that the relative risk for maternal anemia in the first, second and third trimester of pregnancy were 1.26 (95% CI: 1.03-1.55), 0.97 (95% CI: 0.57-1.65), and 1.21 (95% CI: 0.84-1.76), respectively. The relationship between maternal anemia and infant low birth weight in the first trimester of pregnancy was significant. Maternal anemia, especially during the first trimester of pregnancy, can be considered as a risk factor for pregnancy outcomes. Therefore, one needs to take the necessary steps to cure this disease in order to reduce the incidence of infant low birth weight.

  6. How does peer teaching compare to faculty teaching? A systematic review and meta-analysis (.).

    Science.gov (United States)

    Rees, Eliot L; Quinn, Patrick J; Davies, Benjamin; Fotheringham, Victoria

    2016-08-01

    In undergraduate medical education, peer-teaching has become an established and common method to enhance student learning. Evidence suggests that peer-teaching provides learning benefits for both learners and tutors. We aimed to describe the outcomes for medical students taught by peers through systematic review and meta-analysis of existing literature. Seven databases were searched through 21 terms and their Boolean combinations. Studies reporting knowledge or skills outcomes of students taught by peers compared to those taught by faculty or qualified clinicians were included. Extracted data on students' knowledge and skills outcomes were synthesised through a random effects model meta-analysis. The search yielded 2292 studies. Five hundred and fifty-three duplicates and 1611 irrelevant articles were removed during title-screening. The abstracts of 128 papers were screened against the inclusion and exclusion criteria. Ten studies have been included in the review. Meta-analyses showed no significant difference in peer-teaching compared to faculty teaching for knowledge or skills outcomes, standardised mean differences were 0.07 (95% CI: -0.07, 0.21) and 0.11 (95% CI: -0.07, 1.29), respectively. Students taught by peers do not have significantly different outcomes to those taught by faculty. As the process of teaching helps to develop both tutor knowledge and teaching skills, peer-teaching should be supported.

  7. ALE Meta-Analysis of Schizophrenics Performing the N-Back Task

    Science.gov (United States)

    Harrell, Zachary

    2010-10-01

    MRI/fMRI has already proven itself as a valuable tool in the diagnosis and treatment of many illnesses of the brain, including cognitive problems. By exploiting the differences in magnetic susceptibility between oxygenated and deoxygenated hemoglobin, fMRI can measure blood flow in various regions of interest within the brain. This can determine the level of brain activity in relation to motor or cognitive functions and provide a metric for tissue damage or illness symptoms. Structural imaging techniques have shown lesions or deficiencies in tissue volumes in schizophrenics corresponding to areas primarily in the frontal and temporal lobes. These areas are currently known to be involved in working memory and attention, which many schizophrenics have trouble with. The ALE (Activation Likelihood Estimation) Meta-Analysis is able to statistically determine the significance of brain area activations based on the post-hoc combination of multiple studies. This process is useful for giving a general model of brain function in relation to a particular task designed to engage the affected areas (such as working memory for the n-back task). The advantages of the ALE Meta-Analysis include elimination of single subject anomalies, elimination of false/extremely weak activations, and verification of function/location hypotheses.

  8. A Meta-Analysis of Maternal Smoking during Pregnancy and Autism Spectrum Disorder Risk in Offspring

    Directory of Open Access Journals (Sweden)

    Shiming Tang

    2015-08-01

    Full Text Available The association between maternal smoking during pregnancy and autism spectrum disorder (ASD risk in offspring has been investigated in several studies, but the evidence is not conclusive. We, therefore, conducted this meta-analysis to explore whether an association exists between maternal smoking during pregnancy and ASD risk in offspring. We searched PubMed, Embase, Web of Science, and the Cochrane Library for studies of maternal smoking during pregnancy and ASD risk in offspring up to 10 June 2015. The random-effects model was used to combine results from individual studies. 15 observational studies (6 cohort studies and 9 case-control studies, with 17,890 ASD cases and 1,810,258 participants were included for analysis. The pooled odds ratio (OR was 1.02 (95% confidence interval (CI: 0.93–1.13 comparing mothers who smoked during pregnancy with those who did not. Subgroup and sensitivity analysis suggested the overall result of this analysis was robust. Results from this meta-analysis indicate that maternal smoking during pregnancy is not associated with ASD risk in offspring. Further well-designed cohort studies are needed to confirm the present findings.

  9. Acupuncture in the treatment of tinnitus: a systematic review and meta-analysis.

    Science.gov (United States)

    Liu, Fenye; Han, Xiuli; Li, Yunfeng; Yu, Shudong

    2016-02-01

    This study aimed at a systematic review and meta-analysis of all available randomized controlled trials (RCTs) using acupuncture to treat tinnitus. Five electronic databases, in both English and Chinese, were searched. All studies in our review and meta-analysis included parallel RCTs of tinnitus patients which compared subjects receiving acupuncture (or its other forms, such as electroacupuncture) to subjects receiving no treatment, sham treatment, drugs or basic medical therapy. Data from the articles were validated and extracted using a predefined data extraction form. Nearly all of Chinese studies reported positive results, while most of English studies reported negative results. Analysis of the combined data found that the acupuncture treatments seemed to provide some advantages over conventional therapies for tinnitus. It had difference in acupuncture points and sessions between Chinese studies and English studies. Methodological flaws were also found in many of the RCTs, especially in Chinese studies. The results of this review suggest that acupuncture therapy may offer subjective benefit to some tinnitus patients. Acupuncture points and sessions used in Chinese studies may be more appropriate, whereas these studies have many methodological flaws and risk bias, which prevents us making a definitive conclusion.

  10. Hepatitis C virus infections in oral lichen planus: a systematic review and meta-analysis.

    Science.gov (United States)

    Alaizari, N A; Al-Maweri, S A; Al-Shamiri, H M; Tarakji, B; Shugaa-Addin, B

    2016-09-01

    A role for hepatitis C virus in oral lichen planus has been postulated. This systematic review and meta-analysis of the existing epidemiological studies was conducted to determine if there is a correlation between oral lichen planus and hepatitis C virus infection. We examined the association between hepatitis C virus and oral lichen planus by conducting a systematic review and meta-analysis of case-control studies that examined the prevalence of anti-HCV antibodies in the serum of cases and controls. We searched PubMed, Embase and The Cochrane Library databases from 2005 to January 2015. Associations were measured using random-effect odds ratios (ORs) combined with 95% confidence intervals. Nineteen eligible studies, encompassing 1807 cases of OLP and 2519 controls, were retrieved and included in this review. The summary estimate OR for all studies was 6.07 (95% CI: 2.73-13.48), showing a statistically significant difference in the proportion of HCV seropositivity among oral lichen planus patients, compared with controls and substantial heterogeneity between studies (I(2) = 65%) as a result of a variety of geographical distributions. The association of hepatitis C virus infection with oral lichen planus emphasizes the importance of hepatitis C virus screening in oral lichen planus patients. © 2015 Australian Dental Association.

  11. Traumatic stress and accelerated DNA methylation age: A meta-analysis.

    Science.gov (United States)

    Wolf, Erika J; Maniates, Hannah; Nugent, Nicole; Maihofer, Adam X; Armstrong, Don; Ratanatharathorn, Andrew; Ashley-Koch, Allison E; Garrett, Melanie; Kimbrel, Nathan A; Lori, Adriana; Va Mid-Atlantic Mirecc Workgroup; Aiello, Allison E; Baker, Dewleen G; Beckham, Jean C; Boks, Marco P; Galea, Sandro; Geuze, Elbert; Hauser, Michael A; Kessler, Ronald C; Koenen, Karestan C; Miller, Mark W; Ressler, Kerry J; Risbrough, Victoria; Rutten, Bart P F; Stein, Murray B; Ursano, Robert J; Vermetten, Eric; Vinkers, Christiaan H; Uddin, Monica; Smith, Alicia K; Nievergelt, Caroline M; Logue, Mark W

    2018-06-01

    Recent studies examining the association between posttraumatic stress disorder (PTSD) and accelerated aging, as defined by DNA methylation-based estimates of cellular age that exceed chronological age, have yielded mixed results. We conducted a meta-analysis of trauma exposure and PTSD diagnosis and symptom severity in association with accelerated DNA methylation age using data from 9 cohorts contributing to the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (combined N = 2186). Associations between demographic and cellular variables and accelerated DNA methylation age were also examined, as was the moderating influence of demographic variables. Meta-analysis of regression coefficients from contributing cohorts revealed that childhood trauma exposure (when measured with the Childhood Trauma Questionnaire) and lifetime PTSD severity evidenced significant, albeit small, meta-analytic associations with accelerated DNA methylation age (ps = 0.028 and 0.016, respectively). Sex, CD4T cell proportions, and natural killer cell proportions were also significantly associated with accelerated DNA methylation age (all ps age. There was no evidence of moderation of the trauma or PTSD variables by demographic factors. Results suggest that traumatic stress is associated with advanced epigenetic age and raise the possibility that cells integral to immune system maintenance and responsivity play a role in this. This study highlights the need for additional research into the biological mechanisms linking traumatic stress to accelerated DNA methylation age and the importance of furthering our understanding of the neurobiological and health consequences of PTSD. Published by Elsevier Ltd.

  12. Curative effects of small incision cataract surgery versus phacoemulsification: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Chang-Jian Yang

    2013-08-01

    Full Text Available AIM: To evaluate the curative efficacy of small incision cataract surgery(SICSversus phacoemulsification(Phaco.METHODS: A computerized literature search was carried out in Chinese Biomedical Database(CBM, Wanfang Data, VIP and Chinese National Knowledge Infrastructure(CNKIto collect articles published between 1989-2013 concerning the curative efficacy of SICS versus Phaco. The studies were assessed in terms of clinical case-control criteria. Meta-analysis were performed to assess the visual acuity, the complications rates between SICS and Phaco 90 days after surgery. Treatment effects were measured as risk difference(RDbetween SICS and Phaco. Fixed and random effect models were employed to combine results after a heterogeneity test. RESULTS:A total of 8 studies were included in our Meta-analysis. At 90 days postoperative time, there were no significant differences between the two groups at the visual acuity >0.5(P=0.14; and no significant differences on the complications rates of corneal astigmatism, corneal edema, posterior capsular rupture and anterior iris reaction(P>0.05.CONCLUSION: These results suggest that there is no different on the curative effects of SICS and Phaco for cataract.

  13. Association of STAT4 rs7574865 polymorphism with autoimmune diseases: a meta-analysis.

    Science.gov (United States)

    Liang, Ya-Ling; Wu, Hua; Shen, Xi; Li, Pei-Qiang; Yang, Xiao-Qing; Liang, Li; Tian, Wei-Hua; Zhang, Li-Feng; Xie, Xiao-Dong

    2012-09-01

    The association between the signal transducer and activator of transcription 4 (STAT4) gene rs7574865 single nucleotide polymorphism and different autoimmune diseases remains controversial and ambiguous. We conducted this study to investigate whether combined evidence shows the association between STAT4 rs7574865 polymorphism and autoimmune diseases. Comprehensive Medline search and review of the references were used to get the relevant reports published before September 2011. Meta-analysis was conducted for genotype T/T (recessive effect), T/T + G/T (dominant effect) and T allele in random effects models. 40 studies with 90 comparisons including 32 systemic lupus erythematosus (SLE), 19 rheumatoid arthritis (RA), 3 type 1 diabetes (T1D), 11 Systemeric Sclerosis (SSc), 4 inflammatory bowed diseases (IBD), 3 Primary Sjogren's syndrome (pSS), 4 juvenile idiopathic arthritis (JIA), 2 Primary antiphospholipid syndrome (APS), 1 Autoimmune thyroid diseases, 1 multiple sclerosis, 1 Psoriasis, 1 Wegener's granulomatosis, 1 Type 2 diabetes, and 1 giant cell arteritis disease were available for this meta-analysis. The overall odds ratios for rs7574865 T-allele significantly increased in SLE, RA, T1D, SSc, JIA, and APS (OR = 1.56, 1.25, 1.13, 1.34, 1.25, and 2.15, respectively, P rs7574865 T allele confers susceptibility to SLE, RA, T1D, SSc, JIA, APS, IBD-UC, and pSS patients, supporting the hypothesis of association between STAT4 gene polymorphism and subgroup of autoimmune diseases.

  14. A meta-analysis of the association between cytokine gene polymorphisms and systemic sclerosis.

    Science.gov (United States)

    Peng, Wen-jia; Pan, Hai-feng; Tao, Jin-hui; Wang, Bing-xiang; Lu, Man-man; Wang, Song; He, Qian; Wang, Jing

    2012-09-01

    We conducted a comprehensive meta-analysis to quantitatively evaluate the association of cytokine gene polymorphisms with systemic sclerosis (SSc) susceptibility. Electronic databases were used to identify published studies before July 2011. In total, 23 case-control studies including 3524 SSc cases and 6086 healthy controls were included in the meta-analysis. We examined the relationship between five gene polymorphisms [cytotoxic T lymphocyte associated antigen 4 (CTLA-4) -1722T/C, CTLA-4 -318C/T, CTLA-4 +49A/G, angiotensin-converting enzyme I/D, STAT-4 rs7574865] and susceptibility to SSc. The combined odds ratio (OR) with 95% confidence interval (95% CI) was calculated to estimate the strength of the association in a fixed or random effect model. Heterogeneity and publication bias were also assessed. We found a significant association between SSc and STAT rs7574865 (TT vs. GG: OR 0.44, 95% CI 0.36-0.54; TT vs. TG + GG: OR 0.48, 95% CI 0.39-0.59; TT + TG vs. GG: OR 0.74, 95% CI 0.66-0.83; T vs. G: OR 0.72, 95% CI 0.66-0.79), but there were no other statistically significant associations with other gene polymorphisms. Our study suggested that SSc is associated with STAT gene rs7574865 polymorphism.

  15. Triple therapy in type 2 diabetes; a systematic review and network meta-analysis

    Directory of Open Access Journals (Sweden)

    Martin J. Downes

    2015-12-01

    Full Text Available Aims. The purpose was to evaluate the evidence for triple therapy regimen using medicines available in Australia for type 2 diabetes.Methods. A systematic literature review was performed to update the relevant evidence from 2002 to 2014 on triple therapy for type 2 diabetes. A multiple-treatments network meta-analysis was undertaken to summarise the comparative efficacy and harms of different triple therapies.Results. Twenty seven trials were identified, most were six months of duration. The following combinations were included in the network meta-analysis: metformin (MET + sulfonylureas (SU (used as reference combination; MET + SU+ dipeptidyl peptidase 4 inhibitors (DPP-4-i; MET + SU+ thiazolidinediones (TZD; MET + SU+ glucagon-like peptide-1 receptor agonists (GLP-1-RA; MET + SU+ insulins; MET + TZD + DPP-4-i; and MET + SU+ sodium/glucose cotransporter 2 inhibitors (SGLT2-i. For HbA1c reduction, all triple therapies were statistically superior to MET+SU dual therapy, except for MET + TZD + DPP-4-i. None of the triple therapy combinations demonstrated differences in HbA1c compared with other triple therapies. MET + SU + SGLT2-i and MET + SU + GLP-1-RA resulted in significantly lower body weight than MET + SU + DPP-4-i, MET+SU+insulin and MET + SU + TZDs; MET + SU + DPP-4-i resulted in significantly lower body weight than MET + SU + insulin and MET + SU + TZD. MET + SU + insulin, MET + SU + TZD and MET + SU + DPP-4-i increased the odds of hypoglycaemia when compared to MET + SU. MET + SU + GLP-1-RA reduced the odds of hypoglycaemia compared to MET + SU + insulin.Conclusion. Care when choosing a triple therapy combination is needed as there is often a risk of increased hypoglycaemia events associated with this regimen and there are very limited data surrounding the long-term effectiveness and safety of combined therapies.

  16. Systematic Review and Meta-Analysis of In Vitro Synergy of Polymyxins and Carbapenems

    Science.gov (United States)

    Avni, Tomer; Leibovici, Leonard; Adler, Amos; Friberg, Lena; Stergiopoulou, Theodouli; Carmeli, Yehuda; Paul, Mical

    2013-01-01

    Our objective was to examine the evidence of in vitro synergy of polymyxin-carbapenem combination therapy against Gram-negative bacteria (GNB). A systematic review and meta-analysis were performed. All studies examining in vitro interactions of antibiotic combinations consisting of any carbapenem with colistin or polymyxin B against any GNB were used. A broad search was conducted with no language, date, or publication status restrictions. Synergy rates, defined as a fractional inhibitory concentration index of ≤0.5 or a >2-log reduction in CFU, were pooled separately for time-kill, checkerboard, and Etest methods in a mixed-effect meta-analysis of rates. We examined whether the synergy rate depended on the testing method, type of antibiotic, bacteria, and resistance to carbapenems. Pooled rates with 95% confidence intervals (CI) are shown. Thirty-nine published studies and 15 conference proceeding were included, reporting on 246 different tests on 1,054 bacterial isolates. In time-kill studies, combination therapy showed synergy rates of 77% (95% CI, 64 to 87%) for Acinetobacter baumannii, 44% (95% CI, 30 to 59%) for Klebsiella pneumoniae, and 50% (95% CI, 30 to 69%) for Pseudomonas aeruginosa, with low antagonism rates for all. Doripenem showed high synergy rates for all three bacteria. For A. baumannii, meropenem was more synergistic than imipenem, whereas for P. aeruginosa the opposite was true. Checkerboard and Etest studies generally reported lower synergy rates than time-kill studies. The use of combination therapy led to less resistance development in vitro. The combination of a carbapenem with a polymyxin against GNB, especially A. baumannii, is supported in vitro by high synergy rates, with low antagonism and less resistance development. These findings should be examined in clinical studies. PMID:23917322

  17. Systematic review and meta-analysis of in vitro synergy of polymyxins and carbapenems.

    Science.gov (United States)

    Zusman, Oren; Avni, Tomer; Leibovici, Leonard; Adler, Amos; Friberg, Lena; Stergiopoulou, Theodouli; Carmeli, Yehuda; Paul, Mical

    2013-10-01

    Our objective was to examine the evidence of in vitro synergy of polymyxin-carbapenem combination therapy against Gram-negative bacteria (GNB). A systematic review and meta-analysis were performed. All studies examining in vitro interactions of antibiotic combinations consisting of any carbapenem with colistin or polymyxin B against any GNB were used. A broad search was conducted with no language, date, or publication status restrictions. Synergy rates, defined as a fractional inhibitory concentration index of ≤0.5 or a >2-log reduction in CFU, were pooled separately for time-kill, checkerboard, and Etest methods in a mixed-effect meta-analysis of rates. We examined whether the synergy rate depended on the testing method, type of antibiotic, bacteria, and resistance to carbapenems. Pooled rates with 95% confidence intervals (CI) are shown. Thirty-nine published studies and 15 conference proceeding were included, reporting on 246 different tests on 1,054 bacterial isolates. In time-kill studies, combination therapy showed synergy rates of 77% (95% CI, 64 to 87%) for Acinetobacter baumannii, 44% (95% CI, 30 to 59%) for Klebsiella pneumoniae, and 50% (95% CI, 30 to 69%) for Pseudomonas aeruginosa, with low antagonism rates for all. Doripenem showed high synergy rates for all three bacteria. For A. baumannii, meropenem was more synergistic than imipenem, whereas for P. aeruginosa the opposite was true. Checkerboard and Etest studies generally reported lower synergy rates than time-kill studies. The use of combination therapy led to less resistance development in vitro. The combination of a carbapenem with a polymyxin against GNB, especially A. baumannii, is supported in vitro by high synergy rates, with low antagonism and less resistance development. These findings should be examined in clinical studies.

  18. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis.

    Science.gov (United States)

    Uthman, Olalekan A; van der Windt, Danielle A; Jordan, Joanne L; Dziedzic, Krysia S; Healey, Emma L; Peat, George M; Foster, Nadine E

    2014-11-01

    Which types of exercise intervention are most effective in relieving pain and improving function in people with lower limb osteoarthritis? As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise. An approach combining exercises to increase strength, flexibility, and aerobic capacity is most likely to be effective for relieving pain and improving function. Current international guidelines recommend therapeutic exercise (land or water based) as "core" and effective management of osteoarthritis. Evidence from this first network meta-analysis, largely based on studies in knee osteoarthritis, indicates that an intervention combining strengthening exercises with flexibility and aerobic exercise is most likely to improve outcomes of pain and function. Further trials of exercise versus no exercise are unlikely to overturn this positive result. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. [Effect of acupuncture therapy on patients with low back pain: a Meta-analysis].

    Science.gov (United States)

    Liang, Fei-fan; Chen, Wei-ye; Chen, Bo; Xu, Qin-guang; Zhan, Hong-sheng

    2016-05-01

    To systematically review the clinical efficacy of acupuncture on the patients with low back pain (LBP). Randomized controlled trials (RCTs) about pure acupuncture therapy versus other treatments in treating LBP were electronically searched in PubMed, CBM, EMbase, The Cochrane Library, CNKI, VIP and Wanfang Data from January 2004 to May 2014. The observed index on the results were the changed scores of VAS, ODI, JOA and RMDQ. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, as well as the extracted data, and assessed the methodological quality. The results of Meta-analysis was conducted by RevMan 5.2 software. Ten RCTs involved 751 patients were finally included. The results of Meta-analysis indicated that the role of pure acupuncture group in improving the VAS score was better than that of the control group, and the combined effect size was RR = -.32, 95% CI (-1.41, -1.22); Z=27.28, Pacupuncture group in improving the ODI score was better than that of the control group, and the combined effect size was RR = -5.07, 95% CI (-7.50, -2.65); Z=4.10, Pacupuncture group on improved JOA score was better than that of the control group and the combined effect size was RR=2.83, 95% CI (2.02, 3.63), Z=6.90, Pacupuncture group in improving the RMDQ score was better than that of the control group, and the combined effect size was RR = -2.80, 95% CI (-3.49, -2.11), Z=7.95, Pacupuncture may have a favorable effect on self-reported pain and functional limitations in LBP patients.

  20. Corticosteroids vs corticosteroids plus antiviral agents in the treatment of Bell palsy: a systematic review and meta-analysis.

    Science.gov (United States)

    Goudakos, John K; Markou, Konstantinos D

    2009-06-01

    To review systematically and meta-analyze the results of all randomized controlled trials (RCTs) for the treatment of patients with Bell palsy with corticosteroids vs corticosteroids plus antiviral agents. A MEDLINE, EMBASE, Cochrane Library, and CENTRAL database search, followed by extensive hand-searching for the identification of relevant studies. No time and language limitations were applied. Prospective RCTs on the treatment of patients with Bell palsy. Odds ratios (ORs), 95% confidence intervals (CIs), and tests for heterogeneity were reported. Five studies were eventually identified and systematically reviewed. Meta-analysis was performed for 4 studies. Regarding the complete recovery rate of facial nerve paralysis 3 months after initiation of therapy, the current systematic review and meta-analysis suggests that the addition of an antiviral agent does not provide any benefit (OR, 1.03 [95% CI, 0.74-1.42]; P = .88). The same conclusion emerged at posterior (fourth, sixth, and ninth) months of assessment. Subgroup analysis, conducted on the basis of time point of therapy initiation, type of antiviral agent, and blindness of assessments did not change the results obtained. The occurrence rate of adverse effects attributable to therapy choice was not significantly different between patients receiving corticosteroids and those following combined treatment. The present systematic review and meta-analysis, based on the currently available evidence, suggests that the addition of an antiviral agent to corticosteroids for the treatment of Bell palsy is not associated with an increase in the complete recovery rate of the facial motor function.

  1. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty.

    LENUS (Irish Health Repository)

    Kelly, Enda G

    2014-03-01

    The routine use of drains in surgery has been dogmatically instituted in some disciplines. Orthopaedic surgery is one such sub-speciality. The use of postoperative closed suction drainage in total hip arthroplasty (THA) has become increasingly controversial with multiple randomised control trials performed to assess the benefit to outcome in THA. The hypothesis of this systematic review is that closed suction drainage does not infer a benefit and increase transfusion requirements of primary total hip arthroplasty patients. A systematic review and meta-analysis was conducted adhering to the PRISMA guidelines. A search of the available literature was performed on PubMed, Cochrane Central Registry of Controlled Trials, MEDLINE (OVID) and EMBASE using a combination of MeSH terms and Boolean operators. All data analysis was performed using the Cochrane Collaboration\\'s Review Manager 5.1. Sixteen studies (n=2705) were included in the analysis. Post-operative closed suction drainage was found to increase total blood loss and blood transfusion requirements (p<0.05). Surgical site infection demonstrated no significant difference between the two groups (p=0.82). No significant difference in haematoma formation between groups (p=0.19) was elicited. The routine use of closed suction drainage systems post primary hip arthroplasty is not supported by this meta-analysis. However, the heterogeneity between studies does limit the accuracy of the meta-analysis.

  2. Genome-wide association study to identify common variants associated with brachial circumference: a meta-analysis of 14 cohorts.

    Directory of Open Access Journals (Sweden)

    Vesna Boraska

    Full Text Available Brachial circumference (BC, also known as upper arm or mid arm circumference, can be used as an indicator of muscle mass and fat tissue, which are distributed differently in men and women. Analysis of anthropometric measures of peripheral fat distribution such as BC could help in understanding the complex pathophysiology behind overweight and obesity. The purpose of this study is to identify genetic variants associated with BC through a large-scale genome-wide association scan (GWAS meta-analysis. We used fixed-effects meta-analysis to synthesise summary results across 14 GWAS discovery and 4 replication cohorts comprising overall 22,376 individuals (12,031 women and 10,345 men of European ancestry. Individual analyses were carried out for men, women, and combined across sexes using linear regression and an additive genetic model: adjusted for age and adjusted for age and BMI. We prioritised signals for follow-up in two-stages. We did not detect any signals reaching genome-wide significance. The FTO rs9939609 SNP showed nominal evidence for association (p<0.05 in the age-adjusted strata for men and across both sexes. In this first GWAS meta-analysis for BC to date, we have not identified any genome-wide significant signals and do not observe robust association of previously established obesity loci with BC. Large-scale collaborations will be necessary to achieve higher power to detect loci underlying BC.

  3. Using simulation to improve the cognitive and psychomotor skills of novice students in advanced laparoscopic surgery: a meta-analysis.

    Science.gov (United States)

    Al-Kadi, Azzam S; Donnon, Tyrone

    2013-01-01

    Advances in simulation technologies have enhanced the ability to introduce the teaching and learning of laparoscopic surgical skills to novice students. In this meta-analysis, a total of 18 randomized controlled studies were identified that specifically looked at training novices in comparison with a control group as it pertains to knowledge retention, time to completion and suturing and knotting skills. The combined random-effect sizes (ESs) showed that novice students who trained on laparoscopic simulators have considerably developed better laparoscopic suturing and knot tying skills (d = 1.96, p < 0.01), conducted fewer errors (d = 2.13, p < 0.01), retained more knowledge (d = 1.57, p < 0.01) than their respective control groups, and were significantly faster on time to completion (d = 1.98, p < 0.01). As illustrated in corresponding Forest plots, the majority of the primary study outcomes included in this meta-analysis show statistically significant support (p < 0.05) for the use of laparoscopic simulators for novice student training on both knowledge and advanced surgical skill development (28 of 35 outcomes, 80%). The findings of this meta-analysis support strongly the use of simulators for teaching laparoscopic surgery skills to novice students in surgical residency programs.

  4. SLC6A3 polymorphism and response to methylphenidate in children with ADHD: A systematic review and meta-analysis.

    Science.gov (United States)

    Soleimani, Robabeh; Salehi, Zivar; Soltanipour, Soheil; Hasandokht, Tolou; Jalali, Mir Mohammad

    2018-04-01

    Methylphenidate (MPH) is the most commonly used treatment for attention-deficit hyperactivity disorder (ADHD) in children. However, the response to MPH is not similar in all patients. This meta-analysis investigated the potential role of SLC6A3 polymorphisms in response to MPH in children with ADHD. Clinical trials or naturalistic studies were selected from electronic databases. A meta-analysis was conducted using a random-effects model. Cohen's d effect size and 95% confidence intervals (CIs) were determined. Sensitivity analysis and meta-regression were performed. Q-statistic and Egger's tests were conducted to evaluate heterogeneity and publication bias, respectively. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Sixteen studies with follow-up periods of 1-28 weeks were eligible. The mean treatment acceptability of MPH was 97.2%. In contrast to clinical trials, the meta-analysis of naturalistic studies indicated that children without 10/10 repeat carriers had better response to MPH (Cohen's d: -0.09 and 0.44, respectively). The 9/9 repeat polymorphism had no effect on the response rate (Cohen's d: -0.43). In the meta-regression, a significant association was observed between baseline severity of ADHD, MPH dosage, and combined type of ADHD in some genetic models. Sensitivity analysis indicated the robustness of our findings. No publication bias was observed in our meta-analysis. The GRADE evaluations revealed very low levels of confidence for each outcome of response to MPH. The results of clinical trials and naturalistic studies regarding the effect size between different polymorphisms of SLC6A3 were contradictory. Therefore, further research is recommended. © 2017 Wiley Periodicals, Inc.

  5. Testosterone level and risk of type 2 diabetes in men: a systematic review and meta-analysis

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    Qiu-ming Yao

    2018-01-01

    Full Text Available Background: Type 2 diabetes is a risk factor for testosterone deficiency and impaired sex steroid status. Some studies also investigated the association of testosterone level with diabetes risk in men, but reported controversial findings. To clarify this issue, we conducted a systematic review and meta-analysis. Methods: PubMed, EMBASE and Web of Science were searched for eligible cohort or nested case–control studies published up to August 15, 2017. Meta-analysis was used to calculate the pooled relative risk (RR of type 2 diabetes associated with higher testosterone level. Results: Thirteen cohort or nested case–control studies with 16,709 participants were included. Meta-analysis showed that higher total testosterone level could significantly decrease the risk of type 2 diabetes in men (RR = 0.65; 95% CI 0.50–0.84; P = 0.001, and higher free testosterone level could also decrease the risk of type 2 diabetes in men (RR = 0.94; 95% CI 0.90–0.99; P = 0.014. After excluding two studies that did not calculate RRs by quartiles of testosterone levels, both higher total testosterone and free testosterone levels could decrease the risk of type 2 diabetes in men, and the pooled RRs were 0.62 (95% CI 0.51–0.76; P < 0.001 and 0.77 (95% CI 0.61–0.98; P = 0.03, respectively. Conclusion: This meta-analysis suggests that higher testosterone level can significantly decrease the risk of type 2 diabetes in men. Therefore, combined with previous researches, the findings above suggest a reverse-causality scenario in the relation between testosterone deficiency and risk of type 2 diabetes in men.

  6. Dacron® vs. PTFE as bypass materials in peripheral vascular surgery – systematic review and meta-analysis

    Science.gov (United States)

    Roll, Stephanie; Müller-Nordhorn, Jacqueline; Keil, Thomas; Scholz, Hans; Eidt, Daniela; Greiner, Wolfgang; Willich, Stefan N

    2008-01-01

    Background In peripheral vascular bypass surgery different synthetic materials are available for bypass grafting. It is unclear which of the two commonly used materials, polytetrafluoroethylene (PTFE) or polyester (Dacron®) grafts, is to be preferred. Thus, the aim of this meta-analysis and systematic review was to compare the effectiveness of these two prosthetic bypass materials (Dacron® and PTFE). Methods We performed a systematic literature search in MEDLINE, Cochrane-Library – CENTRAL, EMBASE and other databases for relevant publications in English and German published between 1999 and 2008. Only randomized controlled trials were considered for inclusion. We assessed the methodological quality by means of standardized checklists. Primary patency was used as the main endpoint. Random-effect meta-analysis as well as pooling data in life table format was performed to combine study results. Results Nine randomized controlled trials (RCT) were included. Two trials showed statistically significant differences in primary patency, one favouring Dacron® and one favouring PTFE grafts, while 7 trials did not show statistically significant differences between the two materials. Meta-analysis on the comparison of PTFE vs. Dacron® grafts yielded no differences with regard to primary patency rates (hazard ratio 1.04 (95% confidence interval [0.85;1.28]), no significant heterogeneity (p = 0.32, I2 = 14%)). Similarly, there were no significant differences with regard to secondary patency rates. Conclusion Systematic evaluation and meta-analysis of randomized controlled trials comparing Dacron® and PTFE as bypass materials for peripheral vascular surgery showed no evidence of an advantage of one synthetic material over the other. PMID:19099583

  7. Dacron® vs. PTFE as bypass materials in peripheral vascular surgery – systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Eidt Daniela

    2008-12-01

    Full Text Available Abstract Background In peripheral vascular bypass surgery different synthetic materials are available for bypass grafting. It is unclear which of the two commonly used materials, polytetrafluoroethylene (PTFE or polyester (Dacron® grafts, is to be preferred. Thus, the aim of this meta-analysis and systematic review was to compare the effectiveness of these two prosthetic bypass materials (Dacron® and PTFE. Methods We performed a systematic literature search in MEDLINE, Cochrane-Library – CENTRAL, EMBASE and other databases for relevant publications in English and German published between 1999 and 2008. Only randomized controlled trials were considered for inclusion. We assessed the methodological quality by means of standardized checklists. Primary patency was used as the main endpoint. Random-effect meta-analysis as well as pooling data in life table format was performed to combine study results. Results Nine randomized controlled trials (RCT were included. Two trials showed statistically significant differences in primary patency, one favouring Dacron® and one favouring PTFE grafts, while 7 trials did not show statistically significant differences between the two materials. Meta-analysis on the comparison of PTFE vs. Dacron® grafts yielded no differences with regard to primary patency rates (hazard ratio 1.04 (95% confidence interval [0.85;1.28], no significant heterogeneity (p = 0.32, I2 = 14%. Similarly, there were no significant differences with regard to secondary patency rates. Conclusion Systematic evaluation and meta-analysis of randomized controlled trials comparing Dacron® and PTFE as bypass materials for peripheral vascular surgery showed no evidence of an advantage of one synthetic material over the other.

  8. Long-term Hearing Preservation After Resection of Vestibular Schwannoma: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Ahsan, Syed F; Huq, Farhan; Seidman, Michael; Taylor, Andrew

    2017-12-01

    The objective is to perform a systematic review and meta-analysis of the literature on the long-term results of hearing preservation after vestibular schwannoma resection. Ovid/Medline, PubMed, Embase, and the Cochrane library from January 1980 to January 2015. Inclusion criteria: age ≥18 years, minimum 10 patients in the treatment group, hearing preserving microsurgery, no previous radiation treatment, serviceable hearing at immediate postop follow-up, hearing outcomes reported using Gardner Robinson or the American Academy of Otolaryngology-Head and Neck Surgeons hearing grading scales, and average follow-up of 5 years. Preoperative, immediate postoperative, and last follow-up audiograms were required. Exclusion criteria included neurofibromatosis type 2 patients and surgery for salvage therapy or decompression. Quality evaluated using Methodological Index for Non-Randomized Studies. Meta-analysis was performed using R v3.2.2, Metafor package v 1.9-7. Cohen's D was used to determine effect size. Ten reports had at least 5-year follow-up and used standardized hearing grading scales. The systematic review found that if hearing was preserved at Class A or B at early postop visit, the chance of preserving hearing at 5 years was excellent. Those who maintained speech discrimination score ≥ 89% at the early postoperative follow-up had better long-term hearing preservation. The meta-analysis reveals that only preoperative and postoperative pure-tone average was associated with long-term hearing preservation. Long-term (>5 yr) hearing durability rates are generally very good. Most studies do not report patient and tumor characteristics, therefore precluding combining studies for meta-analysis. Only preoperative and postoperative postoperative pure-tone average was associated with long-term hearing durability.

  9. Robotic thyroidectomy versus endoscopic thyroidectomy: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Lin Shuang

    2012-11-01

    Full Text Available Abstract Background To conduct a meta-analysis to determine the relative merits of robotic thyroidectomy (RT and endoscopic thyroidectomy (ET. Methods A literature search was performed to identify comparative studies reporting peri-operative outcomes for RT and ET. Pooled odds ratios (ORs and weighted mean differences (WMDs with 95% confidence interval (95% CI were calculated using either a fixed-effects or a random-effects model. Results Six studies matched the selection criteria, which reported on 2048 subjects, of whom 978 underwent RT and 1070 underwent ET. Comparing the outcomes of RT with ET, this meta-analysis indicated that RT was associated with more complications (WMD = 1.51, 95% CI 1.18 to 1.94 and greater amount of drainage fluid (WMD = 17.10, 95% CI 5.69 to 28.51. Meanwhile, operating time (WMD = 1.50, 95% CI −39.59 to 42.58, conversion (WMD = 0.63, 95% CI 0.07 to 6.17, post-operative hospital stay (WMD = −0.05; 95% CI −0.18 to 0.08, and the number of lymph nodes harvested (WMD = 0.62, 95% CI −0.29 to 1.53 were similar for both procedures. Conclusion The results of this meta-analysis indicated that RT is associated with an increased risk of complications and a greater amount of drainage fluid. Therefore, RT does not appear to have any advantage over ET. Further studies are required to confirm these results.

  10. Toxocariasis and epilepsy: systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Graziella Quattrocchi

    Full Text Available OBJECTIVE: Human toxocariasis is a zoonotic infection caused by the larval stages of Toxocara canis (T. canis and less frequently Toxocara cati (T. cati. A relationship between toxocariasis and epilepsy has been hypothesized. We conducted a systematic review and a meta-analysis of available data to evaluate the strength of association between epilepsy and Toxocara spp. seropositivity and to propose some guidelines for future surveys. DATA SOURCES: Electronic databases, the database from the Institute of Neuroepidemiology and Tropical Neurology of the University of Limoges (http://www-ient.unilim.fr/ and the reference lists of all relevant papers and books were screened up to October 2011. METHODS: We performed a systematic review of literature on toxocariasis (the exposure and epilepsy (the outcome. Two authors independently assessed eligibility and study quality and extracted data. A common odds ratio (OR was estimated using a random-effects meta-analysis model of aggregated published data. RESULTS: Seven case-control studies met the inclusion criteria, for a total of 1867 participants (850 cases and 1017 controls. The percentage of seropositivity (presence of anti-Toxocara spp. antibodies was higher among people with epilepsy (PWE in all the included studies even if the association between epilepsy and Toxocara spp. seropositivity was statistically significant in only 4 studies, with crude ORs ranging 2.04-2.85. Another study bordered statistical significance, while in 2 of the included studies no significant association was found. A significant (p < 0.001 common OR of 1.92 [95% confidence interval (CI 1.50-2.44] was estimated. Similar results were found when meta-analysis was restricted to the studies considering an exclusively juvenile population and to surveys using Western Blot as confirmatory or diagnostic serological assay. CONCLUSION: Our results support the existence of a positive association between Toxocara spp. seropositivity and

  11. Economic effectiveness of disease management programs: a meta-analysis.

    Science.gov (United States)

    Krause, David S

    2005-04-01

    The economic effectiveness of disease management programs, which are designed to improve the clinical and economic outcomes for chronically ill individuals, has been evaluated extensively. A literature search was performed with MEDLINE and other published sources for the period covering January 1995 to September 2003. The search was limited to empirical articles that measured the direct economic outcomes for asthma, diabetes, and heart disease management programs. Of the 360 articles and presentations evaluated, only 67 met the selection criteria for meta-analysis, which included 32,041 subjects. Although some studies contained multiple measurements of direct economic outcomes, only one average effect size per study was included in the meta-analysis. Based on the studies included in the research, a meta-analysis provided a statistically significant answer to the question of whether disease management programs are economically effective. The magnitude of the observed average effect size for equally weighted studies was 0.311 (95% CI = 0.272-0.350). Statistically significant differences of effect sizes by study design, disease type and intensity of disease management program interventions were not found after a moderating variable, disease severity, was taken into consideration. The results suggest that disease management programs are more effective economically with severely ill enrollees and that chronic disease program interventions are most effective when coordinated with the overall level of disease severity. The findings can be generalized, which may assist health care policy makers and practitioners in addressing the issue of providing economically effective care for the growing number of individuals with chronic illness.

  12. Pooling, meta-analysis, and the evaluation of drug safety

    Directory of Open Access Journals (Sweden)

    Leizorovicz Alain

    2002-03-01

    Full Text Available Abstract Background The "integrated safety report" of the drug registration files submitted to health authorities usually summarizes the rates of adverse events observed for a new drug, placebo or active control drugs by pooling the safety data across the trials. Pooling consists of adding the numbers of events observed in a given treatment group across the trials and dividing the results by the total number of patients included in this group. Because it considers treatment groups rather than studies, pooling ignores validity of the comparisons and is subject to a particular kind of bias, termed "Simpson's paradox." In contrast, meta-analysis and other stratified analyses are less susceptible to bias. Methods We use a hypothetical, but not atypical, application to demonstrate that the results of a meta-analysis can differ greatly from those obtained by pooling the same data. In our hypothetical model, a new drug is compared to 1 a placebo in 4 relatively small trials in patients at high risk for a certain adverse event and 2 an active reference drug in 2 larger trials of patients at low risk for this event. Results Using meta-analysis, the relative risk of experiencing the adverse event with the new drug was 1.78 (95% confidence interval [1.02; 3.12] compared to placebo and 2.20 [0.76; 6.32] compared to active control. By pooling the data, the results were, respectively, 1.00 [0.59; 1.70] and 5.20 [2.07; 13.08]. Conclusions Because these findings could mislead health authorities and doctors, regulatory agencies should require meta-analyses or stratified analyses of safety data in drug registration files.

  13. Scientists Admitting to Plagiarism: A Meta-analysis of Surveys.

    Science.gov (United States)

    Pupovac, Vanja; Fanelli, Daniele

    2015-10-01

    We conducted a systematic review and meta-analysis of anonymous surveys asking scientists whether they ever committed various forms of plagiarism. From May to December 2011 we searched 35 bibliographic databases, five grey literature databases and hand searched nine journals for potentially relevant studies. We included surveys that asked scientists if, in a given recall period, they had committed or knew of a colleague who committed plagiarism, and from each survey extracted the proportion of those who reported at least one case. Studies that focused on academic (i.e. student) plagiarism were excluded. Literature searches returned 12,460 titles from which 17 relevant survey studies were identified. Meta-analysis of studies reporting committed (N = 7) and witnessed (N = 11) plagiarism yielded a pooled estimate of, respectively, 1.7% (95% CI 1.2-2.4) and 30% (95% CI 17-46). Basic methodological factors, including sample size, year of survey, delivery method and whether survey questions were explicit rather than indirect made a significant difference on survey results. Even after controlling for these methodological factors, between-study differences in admission rates were significantly above those expected by sampling error alone and remained largely unexplained. Despite several limitations of the data and of this meta-analysis, we draw three robust conclusions: (1) The rate at which scientists report knowing a colleague who committed plagiarism is higher than for data fabrication and falsification; (2) The rate at which scientists report knowing a colleague who committed plagiarism is correlated to that of fabrication and falsification; (3) The rate at which scientists admit having committed either form of misconduct (i.e. fabrication, falsification and plagiarism) in surveys has declined over time.

  14. A meta-analysis and review of holistic face processing.

    Science.gov (United States)

    Richler, Jennifer J; Gauthier, Isabel

    2014-09-01

    The concept of holistic processing is a cornerstone of face recognition research, yet central questions related to holistic processing remain unanswered, and debates have thus far failed to reach a resolution despite accumulating empirical evidence. We argue that a considerable source of confusion in this literature stems from a methodological problem. Specifically, 2 measures of holistic processing based on the composite paradigm (complete design and partial design) are used in the literature, but they often lead to qualitatively different results. First, we present a comprehensive review of the work that directly compares the 2 designs, and which clearly favors the complete design over the partial design. Second, we report a meta-analysis of holistic face processing according to both designs and use this as further evidence for one design over the other. The meta-analysis effect size of holistic processing in the complete design is nearly 3 times that of the partial design. Effect sizes were not correlated between measures, consistent with the suggestion that they do not measure the same thing. Our meta-analysis also examines the correlation between conditions in the complete design of the composite task, and suggests that in an individual differences context, little is gained by including a misaligned baseline. Finally, we offer a comprehensive review of the state of knowledge about holistic processing based on evidence gathered from the measure we favor based on the 1st sections of our review-the complete design-and outline outstanding research questions in that new context. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  15. Exhaled carbon monoxide in asthmatics: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Huang Mao

    2010-04-01

    Full Text Available Abstract Background The non-invasive assessment of airway inflammation is potentially advantageous in asthma management. Exhaled carbon monoxide (eCO measurement is cheap and has been proposed to reflect airway inflammation and oxidative stress but current data are conflicting. The purpose of this meta-analysis is to determine whether eCO is elevated in asthmatics, is regulated by steroid treatment and reflects disease severity and control. Methods A systematic search for English language articles published between 1997 and 2009 was performed using Medline, Embase and Cochrane databases. Observational studies comparing eCO in non-smoking asthmatics and healthy subjects or asthmatics before and after steroid treatment were included. Data were independently extracted by two investigators and analyzed to generate weighted mean differences using either a fixed or random effects meta-analysis depending upon the degree of heterogeneity. Results 18 studies were included in the meta-analysis. The eCO level was significantly higher in asthmatics as compared to healthy subjects and in intermittent asthma as compared to persistent asthma. However, eCO could not distinguish between steroid-treated asthmatics and steroid-free patients nor separate controlled and partly-controlled asthma from uncontrolled asthma in cross-sectional studies. In contrast, eCO was significantly reduced following a course of corticosteroid treatment. Conclusions eCO is elevated in asthmatics but levels only partially reflect disease severity and control. eCO might be a potentially useful non-invasive biomarker of airway inflammation and oxidative stress in nonsmoking asthmatics.

  16. Meta-Analysis of Massage Therapy on Cancer Pain.

    Science.gov (United States)

    Lee, Sook-Hyun; Kim, Jong-Yeop; Yeo, Sujung; Kim, Sung-Hoon; Lim, Sabina

    2015-07-01

    Cancer pain is the most common complaint among patients with cancer. Conventional treatment does not always relieve cancer pain satisfactorily. Therefore, many patients with cancer have turned to complementary therapies to help them with their physical, emotional, and spiritual well-being. Massage therapy is increasingly used for symptom relief in patients with cancer. The current study aimed to investigate by meta-analysis the effects of massage therapy for cancer patients experiencing pain. Nine electronic databases were systematically searched for studies published through August 2013 in English, Chinese, and Korean. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) and Cochrane risk-of-bias scales. Twelve studies, including 559 participants, were used in the meta-analysis. In 9 high-quality studies based on the PEDro scale (standardized mean difference, -1.24; 95% confidence interval, -1.72 to -0.75), we observed reduction in cancer pain after massage. Massage therapy significantly reduced cancer pain compared with no massage treatment or conventional care (standardized mean difference, -1.25; 95% confidence interval, -1.63 to -0.87). Our results indicate that massage is effective for the relief of cancer pain, especially for surgery-related pain. Among the various types of massage, foot reflexology appeared to be more effective than body or aroma massage. Our meta-analysis indicated a beneficial effect of massage for relief of cancer pain. Further well-designed, large studies with longer follow-up periods are needed to be able to draw firmer conclusions regarding the effectiveness. © The Author(s) 2015.

  17. Methicillin resistant Staphylococcus aureus in Ethiopia: a meta-analysis.

    Science.gov (United States)

    Eshetie, Setegn; Tarekegn, Fentahun; Moges, Feleke; Amsalu, Anteneh; Birhan, Wubet; Huruy, Kahsay

    2016-11-21

    The burden of methicillin resistant Staphylococcus aureus is a major public health concern worldwide; however the overall epidemiology of multidrug resistant strains is neither coordinated nor harmonized, particularly in developing countries including Ethiopia. Therefore, the aim of this meta-analysis was to assess the burden of methicillin resistant Staphylococcos aureus and its antibiotic resistance pattern in Ethiopia at large. PubMed, Google Scholar, and lancet databases were searched and a total of 20 studies have been selected for meta-analysis. Six authors have independently extracts data on the prevalence of methicillin resistant Staphylococcus aureus among clinical isolates of Staphylococcus aureus. Statistical analysis was achieved by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3) softwares. The overall prevalence of methicillin resistant Staphylococcus aureus and its antibiotic resistance pattern were pooled by using the forest plot, table and figure with 95% CI. The pooled prevalence of methicillin resistant Staphylococcus aureus was 32.5% (95% CI, 24.1 to 40.9%). Moreover, methicillin resistant Staphylococcus aureus strains were found to be highly resistant to penicillin, ampicillin, erythromycin, and amoxicillin, with a pooled resistance ratio of 99.1, 98.1, 97.2 and 97.1%, respectively. On the other hand, comparably low levels of resistance ratio were noted to vancomycin, 5.3%. The overall burden of methicillin resistant Staphylococcus aureus is considerably high, besides these strains showed extreme resistance to penicillin, ampicillin, erythromycin and amoxicillin. In principle, appropriate use of antibiotics, applying safety precautions are the key to reduce the spread of multidrug resistant strains, methicillin resistant Staphylococcus aureus in particular.

  18. Trial Sequential Analysis in systematic reviews with meta-analysis

    DEFF Research Database (Denmark)

    Wetterslev, Jørn; Jakobsen, Janus Christian; Gluud, Christian

    2017-01-01

    BACKGROUND: Most meta-analyses in systematic reviews, including Cochrane ones, do not have sufficient statistical power to detect or refute even large intervention effects. This is why a meta-analysis ought to be regarded as an interim analysis on its way towards a required information size...... from traditional meta-analyses using unadjusted naïve 95% confidence intervals and 5% thresholds for statistical significance. Spurious conclusions in systematic reviews with traditional meta-analyses can be reduced using Trial Sequential Analysis. Several empirical studies have demonstrated...

  19. Complementary and alternative exercise for fibromyalgia: a meta-analysis.

    Science.gov (United States)

    Mist, Scott David; Firestone, Kari A; Jones, Kim Dupree

    2013-01-01

    Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management.

  20. A meta-analysis of emotional intelligence and work attitudes

    OpenAIRE

    Miao, Chao; Humphrey, Ronald; Qian, Shanshan

    2017-01-01

    Our meta-analysis of emotional intelligence (EI) demonstrates that: First, all three types of EI are significantly related with job satisfaction (ability EI: ρ ̂ = .08; self-report EI: ρ ̂ = .32; and mixed EI: ρ ̂ = .39). Second, both self-report EI and mixed EI exhibit modest yet statistically significant incremental validity (ΔR2 = .03 for self-report EI and ΔR2 = .06 for mixed EI) and large relative importance (31.3% for self-report EI and 42.8% for mixed EI) in the presence of cognitive a...

  1. Does chocolate reduce blood pressure? A meta-analysis

    Directory of Open Access Journals (Sweden)

    Ried Karin

    2010-06-01

    Full Text Available Abstract Background Dark chocolate and flavanol-rich cocoa products have attracted interest as an alternative treatment option for hypertension, a known risk factor for cardiovascular disease. Previous meta-analyses concluded that cocoa-rich foods may reduce blood pressure. Recently, several additional trials have been conducted with conflicting results. Our study summarises current evidence on the effect of flavanol-rich cocoa products on blood pressure in hypertensive and normotensive individuals. Methods We searched Medline, Cochrane and international trial registries between 1955 and 2009 for randomised controlled trials investigating the effect of cocoa as food or drink compared with placebo on systolic and diastolic blood pressure (SBP/DBP for a minimum duration of 2 weeks. We conducted random effects meta-analysis of all studies fitting the inclusion criteria, as well as subgroup analysis by baseline blood pressure (hypertensive/normotensive. Meta-regression analysis explored the association between type of treatment, dosage, duration or baseline blood pressure and blood pressure outcome. Statistical significance was set at P Results Fifteen trial arms of 13 assessed studies met the inclusion criteria. Pooled meta-analysis of all trials revealed a significant blood pressure-reducing effect of cocoa-chocolate compared with control (mean BP change ± SE: SBP: -3.2 ± 1.9 mmHg, P = 0.001; DBP: -2.0 ± 1.3 mmHg, P = 0.003. However, subgroup meta-analysis was significant only for the hypertensive or prehypertensive subgroups (SBP: -5.0 ± 3.0 mmHg; P = 0.0009; DBP: -2.7 ± 2.2 mm Hg, P = 0.01, while BP was not significantly reduced in the normotensive subgroups (SBP: -1.6 ± 2.3 mmHg, P = 0.17; DBP: -1.3 ± 1.6 mmHg, P = 0.12. Nine trials used chocolate containing 50% to 70% cocoa compared with white chocolate or other cocoa-free controls, while six trials compared high- with low-flavanol cocoa products. Daily flavanol dosages ranged from 30

  2. Immune checkpoint inhibitors and targeted therapies for metastatic melanoma: A network meta-analysis.

    Science.gov (United States)

    Pasquali, Sandro; Chiarion-Sileni, Vanna; Rossi, Carlo Riccardo; Mocellin, Simone

    2017-03-01

    Immune checkpoint inhibitors and targeted therapies, two new class of drugs for treatment of metastatic melanoma, have not been compared in randomized controlled trials (RCT). We quantitatively summarized the evidence and compared immune and targeted therapies in terms of both efficacy and toxicity. A comprehensive search for RCTs of immune checkpoint inhibitors and targeted therapies was conducted to August 2016. Using a network meta-analysis approach, treatments were compared with each other and ranked based on their effectiveness (as measured by the impact on progression-free survival [PFS]) and acceptability (the inverse of high grade toxicity). Twelve RCTs enrolling 6207 patients were included. Network meta-analysis generated 15 comparisons. Combined BRAF and MEK inhibitors were associated with longer PFS as compared to anti-CTLA4 (HR: 0.22; 95% confidence interval [CI]: 0.12-0.41) and anti-PD1 antibodies alone (HR: 0.38; CI: 0.20-0.72). However, anti-PD1 monoclonal antibodies were less toxic than anti-CTLA4 monoclonal antibodies (RR: 0.65; CI: 0.40-0.78) and their combination significantly increased toxicity compared to either single agent anti-CTLA4 (RR: 2.06; CI: 1.45-2.93) or anti-PD1 monoclonal antibodies (RR: 3.67; CI: 2.27-5.96). Consistently, ranking analysis suggested that the combination of targeted therapies is the most effective strategy, whereas single agent anti-PD1 antibodies have the best acceptability. The GRADE level of evidence quality for these findings was moderate to low. The simultaneous inhibition of BRAF and MEK appears the most effective treatment for melanomas harboring BRAF V600 mutation, although anti-PD1 antibodies appear to be less toxic. Further research is needed to increase the quality of evidence. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta-Analysis.

    Science.gov (United States)

    Lee, Seon Heui; Kim, Hee Sun

    2017-02-01

    Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial. To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities. A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality. Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97). This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings. © 2016 Sigma Theta Tau International.

  4. Integration of machine learning and meta-analysis identifies the transcriptomic bio-signature of mastitis disease in cattle.

    Science.gov (United States)

    Sharifi, Somayeh; Pakdel, Abbas; Ebrahimi, Mansour; Reecy, James M; Fazeli Farsani, Samaneh; Ebrahimie, Esmaeil

    2018-01-01

    Gram-negative bacteria such as Escherichia coli (E. coli) are assumed to be among the main agents that cause severe mastitis disease with clinical signs in dairy cattle. Rapid detection of this disease is so important in order to prevent transmission to other cows and helps to reduce inappropriate use of antibiotics. With the rapid progress in high-throughput technologies, and accumulation of various kinds of '-omics' data in public repositories, there is an opportunity to retrieve, integrate, and reanalyze these resources to improve the diagnosis and treatment of different diseases and to provide mechanistic insights into host resistance in an efficient way. Meta-analysis is a relatively inexpensive option with good potential to increase the statistical power and generalizability of single-study analysis. In the current meta-analysis research, six microarray-based studies that investigate the transcriptome profile of mammary gland tissue after induced mastitis by E. coli infection were used. This meta-analysis not only reinforced the findings in individual studies, but also several novel terms including responses to hypoxia, response to drug, anti-apoptosis and positive regulation of transcription from RNA polymerase II promoter enriched by up-regulated genes. Finally, in order to identify the small sets of genes that are sufficiently informative in E. coli mastitis, the differentially expressed gene introduced by meta-analysis were prioritized by using ten different attribute weighting algorithms. Twelve meta-genes were detected by the majority of attribute weighting algorithms (with weight above 0.7) as most informative genes including CXCL8 (IL8), NFKBIZ, HP, ZC3H12A, PDE4B, CASP4, CXCL2, CCL20, GRO1(CXCL1), CFB, S100A9, and S100A8. Interestingly, the results have been demonstrated that all of these genes are the key genes in the immune response, inflammation or mastitis. The Decision tree models efficiently discovered the best combination of the meta-genes as

  5. Infant search and object permanence: a meta-analysis of the A-not-B error.

    Science.gov (United States)

    Wellman, H M; Cross, D; Bartsch, K

    1987-01-01

    Research on Piaget's stage 4 object concept has failed to reveal a clear or consistent pattern of results. Piaget found that 8-12-month-old infants would make perserverative errors; his explanation for this phenomenon was that the infant's concept of the object was contextually dependent on his or her actions. Some studies designed to test Piaget's explanation have replicated Piaget's basic finding, yet many have found no preference for the A location or the B location or an actual preference for the B location. More recently, researchers have attempted to uncover the causes for these results concerning the A-not-B error. Again, however, different studies have yielded different results, and qualitative reviews have failed to yield a consistent explanation for the results of the individual studies. This state of affairs suggests that the phenomenon may simply be too complex to be captured by individual studies varying 1 factor at a time and by reviews based on similar qualitative considerations. Therefore, the current investigation undertook a meta-analysis, a synthesis capturing the quantitative information across the now sizable number of studies. We entered several important factors into the meta-analysis, including the effects of age, the number of A trials, the length of delay between hiding and search, the number of locations, the distances between locations, and the distinctive visual properties of the hiding arrays. Of these, the analysis consistently indicated that age, delay, and number of hiding locations strongly influence infants' search. The pattern of specific findings also yielded new information about infant search. A general characterization of the results is that, at every age, both above-chance and below-chance performance was observed. That is, at each age at least 1 combination of delay and number of locations yielded above-chance A-not-B errors or significant perseverative search. At the same time, at each age at least 1 alternative

  6. Efficacy of nystatin for the treatment of oral candidiasis: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Lyu X

    2016-03-01

    Full Text Available Xin Lyu, Chen Zhao, Zhi-min Yan, Hong HuaDepartment of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of ChinaObjective: To systematically review and assess the efficacy, different treatment protocols (formulation, dosage, and duration, and safety of nystatin for treating oral candidiasis.Methods: Four electronic databases were searched for trials published in English till July 1, 2015. Randomized controlled trials comparing nystatin with other antifungal therapies or a placebo were included. Clinical and/or mycological cure was the outcome evaluation. A meta-analysis or descriptive study on the efficacy, treatment protocols, and safety of nystatin was conducted.Results: The meta-analysis showed that nystatin pastille was significantly superior to placebo in treating denture stomatitis. Nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients. The descriptive investigations showed that administration of nystatin suspension and pastilles in combination for 2 weeks might achieve a higher clinical and mycological cure rate, and using the nystatin pastilles alone might have a higher mycological cure rate, when compared with using nystatin suspensions alone. Nystatin pastilles at a dose of 400,000 IU resulted in a significantly higher mycological cure rate than that administrated at a dose of 200,000 IU. Furthermore, treatment with nystatin pastilles for 4 weeks seemed to have better clinical efficacy than treatment for 2 weeks. Descriptive safety assessment showed that poor taste and gastrointestinal adverse reaction are the most common adverse effects of nystatin.Conclusion: Nystatin pastille was significantly superior to placebo in treating denture stomatitis, while nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients. Indirect evidence from a descriptive study

  7. Inhaled Nitric Oxide in preterm infants: a systematic review and individual patient data meta-analysis

    Directory of Open Access Journals (Sweden)

    Schreiber Michael D

    2010-03-01

    Full Text Available Abstract Background Preterm infants requiring assisted ventilation are at significant risk of both pulmonary and cerebral injury. Inhaled Nitric Oxide, an effective therapy for pulmonary hypertension and hypoxic respiratory failure in the full term infant, has also been studied in preterm infants. The most recent Cochrane review of preterm infants includes 11 studies and 3,370 participants. The results show a statistically significant reduction in the combined outcome of death or chronic lung disease (CLD in two studies with routine use of iNO in intubated preterm infants. However, uncertainty remains as a larger study (Kinsella 2006 showed no significant benefit for iNO for this combined outcome. Also, trials that included very ill infants do not demonstrate significant benefit. One trial of iNO treatment at a later postnatal age reported a decrease in the incidence of CLD. The aim of this individual patient meta-analysis is to confirm or refute these potentially conflicting results and to determine the extent to which patient or treatment characteristics may explain the results and/or may predict benefit from inhaled Nitric Oxide in preterm infants. Methods/Design The Meta-Analysis of Preterm Patients on inhaled Nitric Oxide (MAPPiNO Collaboration will perform an individual patient data meta-analysis to answer these important clinical questions. Studies will be included if preterm infants receiving assisted ventilation are randomized to receive inhaled Nitric Oxide or to a control group. The individual patient data provided by the Collaborators will be analyzed on an intention-to-treat basis where possible. Binary outcomes will be analyzed using log-binomial regression models and continuous outcomes will be analyzed using linear fixed effects models. Adjustments for trial differences will be made by including the trial variable in the model specification. Discussion Thirteen (13 trials, with a total of 3567 infants are eligible for inclusion

  8. Emotional Freedom Techniques for Anxiety: A Systematic Review With Meta-analysis.

    Science.gov (United States)

    Clond, Morgan

    2016-05-01

    Emotional Freedom Technique (EFT) combines elements of exposure and cognitive therapies with acupressure for the treatment of psychological distress. Randomized controlled trials retrieved by literature search were assessed for quality using the criteria developed by the American Psychological Association's Division 12 Task Force on Empirically Validated Treatments. As of December 2015, 14 studies (n = 658) met inclusion criteria. Results were analyzed using an inverse variance weighted meta-analysis. The pre-post effect size for the EFT treatment group was 1.23 (95% confidence interval, 0.82-1.64; p freedom technique treatment demonstrated a significant decrease in anxiety scores, even when accounting for the effect size of control treatment. However, there were too few data available comparing EFT to standard-of-care treatments such as cognitive behavioral therapy, and further research is needed to establish the relative efficacy of EFT to established protocols.

  9. The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Sheafer, Heather; Tepper, Deborah

    2016-01-01

    Background. Aromatherapy refers to the medicinal or therapeutic use of essential oils absorbed through the skin or olfactory system. Recent literature has examined the effectiveness of aromatherapy in treating pain. Methods. 12 studies examining the use of aromatherapy for pain management were identified through an electronic database search. A meta-analysis was performed to determine the effects of aromatherapy on pain. Results. There is a significant positive effect of aromatherapy (compared to placebo or treatments as usual controls) in reducing pain reported on a visual analog scale (SMD = −1.18, 95% CI: −1.33, −1.03; p aromatherapy is more consistent for treating nociceptive (SMD = −1.57, 95% CI: −1.76, −1.39, p aromatherapy is most effective in treating postoperative pain (SMD = −1.79, 95% CI: −2.08, −1.51, p aromatherapy can successfully treat pain when combined with conventional treatments. PMID:28070420

  10. Self-concept and academic achievement: a meta-analysis of longitudinal relations.

    Science.gov (United States)

    Huang, Chiungjung

    2011-10-01

    The relation between self-concept and academic achievement was examined in 39 independent and longitudinal samples through the integration of meta-analysis and path analysis procedures. For relations with more than 3 independent samples, the mean observed correlations ranged from .20 to .27 between prior self-concept and subsequent academic achievement and from .19 to .25 between prior academic achievement and subsequent self-concept. Globality/specificity of self-concept was the only significant moderating factor in the relation between (a) prior self-concept and subsequent academic achievement and (b) prior academic achievement and subsequent self-concept. As high self-concept is related to high academic performance and vice-versa, intervention programs that combine self-enhancement and skill development should be integrated. Copyright © 2011 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  11. The Effectiveness of Cognitive Bias Modification Interventions for Substance Addictions: A Meta-Analysis

    DEFF Research Database (Denmark)

    Cristea, Ioana; Kok, Robin; Cuijpers, Pim

    2016-01-01

    Background and Aims Cognitive bias modification (CBM) interventions, presumably targeting automatic processes, are considered particularly promising for addictions. We conducted a meta-analysis examining randomized controlled trials (RCTs) of CBM for substance addiction outcomes. Methods Studies...... were identified through systematic searches in bibliographical databases. We included RCTs of CBM interventions, alone or in combination with other treatments, for any type of addiction. We examined trial risk of bias, publication bias and possible moderators. Effects sizes were computed for post......-test and follow-up, using a random-effects model. We grouped outcome measures and reported results for addiction (all related measures), craving and cognitive bias. Results We identified 25 trials, 18 for alcohol problems, and 7 for smoking. At post-test, there was no significant effect of CBM for addiction, g...

  12. Narcissism and Social Networking Behavior: A Meta-Analysis.

    Science.gov (United States)

    Gnambs, Timo; Appel, Markus

    2018-04-01

    The increasing popularity of social networking sites (SNS) such as Facebook and Twitter has given rise to speculations that the intensity of using these platforms is associated with narcissistic tendencies. However, recent research on this issue has been all but conclusive. We present a three-level, random effects meta-analysis including 289 effect sizes from 57 studies (total N = 25,631) on the association between trait narcissism and social networking behavior. The meta-analysis identified a small to moderate effect of ρ = .17 (τ = .11), 95% CI [.13, .21], for grandiose narcissism that replicated across different social networking platforms, respondent characteristics, and time. Moderator analyses revealed pronounced cultural differences, with stronger associations in power-distant cultures. Moreover, social networking behaviors geared toward self-presentation and the number of SNS friends exhibited stronger effects than usage durations. Overall, the study not only supported but also refined the notion of a relationship between engaging in social networking sites and narcissistic personality traits. © 2017 Wiley Periodicals, Inc.

  13. Meta-analysis of social cognition in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Bora, Emre

    2017-03-01

    Amyotrophic lateral sclerosis (ALS) is associated with executive dysfunction and behavioural impairment. Recent studies suggested that social cognitive deficits might also be a prominent feature of ALS. Current meta-analysis aimed to summarize available evidence for deficits in social cognition including theory of mind (ToM) and emotion recognition in ALS. In this meta-analysis of 15 studies, facial emotion recognition and ToM performances of 389 patients with ALS and 471 healthy controls were compared. ALS was associated with significant impairments with medium effect sizes in ToM (d = .65) and facial emotion recognition (d = .69). Among individual emotions recognition of disgust and surprise were particularly impaired. Deficits in perspective taking (d = .73) aspects of ToM (ToM-PT) was more pronounced in comparison to decoding (d = .28) aspects of ToM (ToM-decoding). The severity of social cognitive impairment was similar to level of executive dysfunction and there was a significant relationship between social cognition and executive dysfunction. Deficits in social cognition are part of the cognitive phenotype of ALS. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Symmetric or asymmetric oil prices? A meta-analysis approach

    International Nuclear Information System (INIS)

    Perdiguero-García, Jordi

    2013-01-01

    The analysis of price asymmetries in the gasoline market is one of the most widely studied in energy economics. However, the great variation in the outcomes reported makes the drawing of any definitive conclusions difficult. Given this situation, a meta-analysis serves as an excellent tool to discover which characteristics of the various markets analyzed, and which specific features of these studies, might account for these differences. In adopting such an approach, this paper shows how the particular segment of the industry analyzed, the characteristics of the data, the years under review, the type of publication and the introduction of control variables might explain this heterogeneity in results. The paper concludes on these grounds that increased competition may significantly reduce the possibility of occurrence of asymmetric behavior. These results should be taken into consideration therefore in future studies of asymmetries in the oil industry. - Highlights: ► I study asymmetries in the price gasoline industry through a meta-analysis regression. ► The asymmetries are produced mainly in the retail market. ► The asymmetries are less frequent when we analyze recent cases. ► There may be some degree of publication bias. ► The level of competition may explain the patterns of asymmetry

  15. Transparent meta-analysis of prospective memory and aging.

    Directory of Open Access Journals (Sweden)

    Bob Uttl

    Full Text Available Prospective memory (ProM refers to our ability to become aware of a previously formed plan at the right time and place. After two decades of research on prospective memory and aging, narrative reviews and summaries have arrived at widely different conclusions. One view is that prospective memory shows large age declines, larger than age declines on retrospective memory (RetM. Another view is that prospective memory is an exception to age declines and remains invariant across the adult lifespan. The present meta-analysis of over twenty years of research settles this controversy. It shows that prospective memory declines with aging and that the magnitude of age decline varies by prospective memory subdomain (vigilance, prospective memory proper, habitual prospective memory as well as test setting (laboratory, natural. Moreover, this meta-analysis demonstrates that previous claims of no age declines in prospective memory are artifacts of methodological and conceptual issues afflicting prior research including widespread ceiling effects, low statistical power, age confounds, and failure to distinguish between various subdomains of prospective memory (e.g., vigilance and prospective memory proper.

  16. A meta-analysis of math performance in Turner syndrome.

    Science.gov (United States)

    Baker, Joseph M; Reiss, Allan L

    2016-02-01

    Studies investigating the relationship between Turner syndrome and math learning disability have used a wide variation of tasks designed to test various aspects of mathematical competencies. Although these studies have revealed much about the math deficits common to Turner syndrome, their diversity makes comparisons between individual studies difficult. As a result, the consistency of outcomes among these diverse measures remains unknown. The overarching aim of this review is to provide a systematic meta-analysis of the differences in math and number performance between females with Turner syndrome and age-matched neurotypical peers. We provide a meta-analysis of behavioral performance in Turner syndrome relative to age-matched neurotypical populations on assessments of math and number aptitude. In total, 112 comparisons collected across 17 studies were included. Although 54% of all statistical comparisons in our analyses failed to reject the null hypothesis, our results indicate that meaningful group differences exist on all comparisons except those that do not require explicit calculation. Taken together, these results help elucidate our current understanding of math and number weaknesses in Turner syndrome, while highlighting specific topics that require further investigation. © 2015 Mac Keith Press.

  17. Inflammation and sarcopenia: A systematic review and meta-analysis.

    Science.gov (United States)

    Bano, Giulia; Trevisan, Caterina; Carraro, Sara; Solmi, Marco; Luchini, Claudio; Stubbs, Brendon; Manzato, Enzo; Sergi, Giuseppe; Veronese, Nicola

    2017-02-01

    Inflammatory cytokines have been shown to prompt muscle wasting, ultimately stimulating protein catabolism and suppressing muscle synthesis. However, the possible association between inflammatory parameters and sarcopenia is poorly understood. We therefore aimed to summarize the current evidence about this topic with a meta-analysis of studies reporting serum inflammatory parameters in patients with sarcopenia vs. people without sarcopenia (controls). An electronic PubMed and Scopus search through to 09/01/2016 and meta-analysis of cross-sectional studies comparing serum levels of inflammatory cytokines between patients with sarcopenia and controls was made, calculating random-effects standardized mean differences (SMDs) ±95% confidence intervals (CIs) as the effect size. Out of 1370 initial hits, 17 studies with a total of 11249 participants (3072 with sarcopenia and 8177 without) were meta-analyzed. Sarcopenic participants had significantly higher levels of CRP (SMD=0.51; 95%CI 0.26, 0.77; psarcopenia versus controls. Sarcopenic people did not have higher levels of TNF-α than controls (SMD=0.28; 95%CI -0.26, 0.83; p=0.31; I 2 =97%). In conclusion, sarcopenia seems to be associated with elevated serum CRP levels; future longitudinal studies are needed to clarify this relationship. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Bayesian nonparametric meta-analysis using Polya tree mixture models.

    Science.gov (United States)

    Branscum, Adam J; Hanson, Timothy E

    2008-09-01

    Summary. A common goal in meta-analysis is estimation of a single effect measure using data from several studies that are each designed to address the same scientific inquiry. Because studies are typically conducted in geographically disperse locations, recent developments in the statistical analysis of meta-analytic data involve the use of random effects models that account for study-to-study variability attributable to differences in environments, demographics, genetics, and other sources that lead to heterogeneity in populations. Stemming from asymptotic theory, study-specific summary statistics are modeled according to normal distributions with means representing latent true effect measures. A parametric approach subsequently models these latent measures using a normal distribution, which is strictly a convenient modeling assumption absent of theoretical justification. To eliminate the influence of overly restrictive parametric models on inferences, we consider a broader class of random effects distributions. We develop a novel hierarchical Bayesian nonparametric Polya tree mixture (PTM) model. We present methodology for testing the PTM versus a normal random effects model. These methods provide researchers a straightforward approach for conducting a sensitivity analysis of the normality assumption for random effects. An application involving meta-analysis of epidemiologic studies designed to characterize the association between alcohol consumption and breast cancer is presented, which together with results from simulated data highlight the performance of PTMs in the presence of nonnormality of effect measures in the source population.

  19. Validity of the alcohol purchase task: a meta-analysis.

    Science.gov (United States)

    Kiselica, Andrew M; Webber, Troy A; Bornovalova, Marina A

    2016-05-01

    Behavioral economists assess alcohol consumption as a function of unit price. This method allows construction of demand curves and demand indices, which are thought to provide precise numerical estimates of risk for alcohol problems. One of the more commonly used behavioral economic measures is the Alcohol Purchase Task (APT). Although the APT has shown promise as a measure of risk for alcohol problems, the construct validity and incremental utility of the APT remain unclear. This paper presents a meta-analysis of the APT literature. Sixteen studies were included in the meta-analysis. Studies were gathered via searches of the PsycInfo, PubMed, Web of Science and EconLit research databases. Random-effects meta-analyses with inverse variance weighting were used to calculate summary effect sizes for each demand index-drinking outcome relationship. Moderation of these effects by drinking status (regular versus heavy drinkers) was examined. Additionally, tests of the incremental utility of the APT indices in predicting drinking problems above and beyond measuring alcohol consumption were performed. The APT indices were correlated in the expected directions with drinking outcomes, although many effects were small in size. These effects were typically not moderated by the drinking status of the samples. Additionally, the intensity metric demonstrated incremental utility in predicting alcohol use disorder symptoms beyond measuring drinking. The Alcohol Purchase Task appears to have good construct validity, but limited incremental utility in estimating risk for alcohol problems. © 2015 Society for the Study of Addiction.

  20. Acupuncture for Alcohol Use Disorder: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Na Young Shin

    2017-01-01

    Full Text Available Empirical research has produced mixed results regarding the effects of acupuncture on the treatment of alcohol use disorder in humans. Few studies have provided a comprehensive review or a systematic overview of the magnitude of the treatment effect of acupuncture on alcoholism. This study investigated the effects of acupuncture on alcohol-related symptoms and behaviors in patients with this disorder. The PubMed database was searched until 23 August 2016, and reference lists from review studies were also reviewed. Seventeen studies were identified for a full-text inspection, and seven (243 patients of these met our inclusion criteria. The outcomes assessed at the last posttreatment point and any available follow-up data were extracted from each of the studies. Our meta-analysis demonstrated that an acupuncture intervention had a stronger effect on reducing alcohol-related symptoms and behaviors than did the control intervention (g=0.67. A beneficial but weak effect of acupuncture treatment was also found in the follow-up data (g=0.29. Although our analysis showed a significant difference between acupuncture and the control intervention in patients with alcohol use disorder, this meta-analysis is limited by the small number of studies included. Thus, a larger cohort study is required to provide a firm conclusion.

  1. Prognostic factors in pediatric pulmonary arterial hypertension: A systematic review and meta-analysis.

    Science.gov (United States)

    Ploegstra, Mark-Jan; Zijlstra, Willemijn M H; Douwes, Johannes M; Hillege, Hans L; Berger, Rolf M F

    2015-04-01

    Despite the introduction of targeted therapies in pediatric pulmonary arterial hypertension (PAH), prognosis remains poor. For the definition of treatment strategies and guidelines, there is a high need for an evidence-based recapitulation of prognostic factors. The aim of this study was to identify and evaluate prognostic factors in pediatric PAH by a systematic review of the literature and to summarize the prognostic value of currently reported prognostic factors using meta-analysis. Medline, EMBASE and Cochrane Library were searched on April 1st 2014 to identify original studies that described predictors of mortality or lung-transplantation exclusively in children with PAH. 1053 citations were identified, of which 25 were included for further analysis. Hazard ratios (HR) and 95% confidence intervals were extracted from the papers. For variables studied in at least three non-overlapping cohorts, a combined HR was calculated using random-effects meta-analysis. WHO functional class (WHO-FC, HR 2.7), (N-terminal pro-) brain natriuretic peptide ([NT-pro]BNP, HR 3.2), mean right atrial pressure (mRAP, HR 1.1), cardiac index (HR 0.7), indexed pulmonary vascular resistance (PVRi, HR 1.3) and acute vasodilator response (HR 0.3) were identified as significant prognostic factors (p ≤ 0.001). This systematic review combined with separate meta-analyses shows that WHO-FC, (NT-pro)BNP, mRAP, PVRi, cardiac index and acute vasodilator response are consistently reported prognostic factors for outcome in pediatric PAH. These variables are useful clinical tools to assess prognosis and should be incorporated in treatment strategies and guidelines for children with PAH. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Reduced Risk of Barrett's Esophagus in Statin Users: Case-Control Study and Meta-Analysis.

    Science.gov (United States)

    Beales, Ian L P; Dearman, Leanne; Vardi, Inna; Loke, Yoon

    2016-01-01

    Use of statins has been associated with a reduced incidence of esophageal adenocarcinoma in population-based studies. However there are few studies examining statin use and the development of Barrett's esophagus. The purpose of this study was to examine the association between statin use and the presence of Barrett's esophagus in patients having their first gastroscopy. We have performed a case-control study comparing statin use between patients with, and without, an incident diagnosis of non-dysplastic Barrett's esophagus. Male Barrett's cases (134) were compared to 268 male age-matched controls in each of two control groups (erosive gastro-esophageal reflux and dyspepsia without significant upper gastroint