Search

Radiomics methods are increasingly used to identify benign and malignant lung nodules, and early monitoring is essential in prognosis and treatment strategy formulation. To evaluate the diagnostic performance of computed tomography (CT)-based radiomics for distinguishing between benign and malignant lung nodules by performing a meta-analysis. Between January 2000 and December 2021, we searched the PubMed and Embase electronic databases for studies in English. Studies were included if they demonstrated the sensitivity and specificity of CT-based radiomics for diagnosing benign and malignant lung nodules. The studies were evaluated using the QUADAS-2 and radiomics quality scores (RQS). The inhomogeneity of the data and publishing bias were also evaluated. Some subgroup analyses were performed to investigate the impact of diagnostic efficiency. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines were followed for this meta-analysis. A total of 20 studies involving 3793 patients were included. The combined sensitivity, specificity, diagnostic odds ratio, and area under the summary receiver operating characteristic curve based on CT radiomics diagnosis of benign and malignant lung nodules were 0.81, 0.86, 27.00, and 0.91, respectively. Deek's funnel plot asymmetry test confirmed no significant publication bias in all studies. Fagan nomograms showed a 40% increase in post-test probability among pretest-positive patients. Current evidence shows that CT-based radiomics has high accuracy in the diagnosis of benign and malignant lung nodules. [ABSTRACT FROM AUTHOR]

What is known and objective: The Helicobacter pylori (H. pylori) eradication rate of proton pump inhibitor (PPI)‐based regimen remains decreasing. Vonoprazan (VPZ), a stronger and longer‐lasting acid blocker, has been proposed to treatment of H. pylori infection. However, previous reviews did not have a pre‐established study protocol and did not conduct a comprehensive search of the database, so the results obtained were not robust. We aimed to perform a meta‐analysis to assess the effectiveness and safety of VPZ‐based regimens for treatment of H. pylori infection in comparison with other regimens. Methods: We conducted a systematic literature search on PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials and ChiCTR Register. Randomized clinical trials comparing VPZ‐based regimens with similar eradication regimens without VPZ in the treatment of H. pylori infection were included. Eradication rate, compliance of the patients and side effects were specified as the primary outcomes. RevMan 5.4 software was used to analyze the RCTs and provide pooled risk ratio (RR) with 95% confidence intervals (CI). Systematic searches, study selection, data extraction, risk of bias assessment and statistical analysis were performed by two independent researchers according to the predesigned criteria on the PROSPERO. Results and discussion: A total of 8 RCTs with 2012 patients qualified for evaluation. The results showed that the eradication rate of VPZ‐containing regimens was significantly superior to PPI‐containing regimens for both intention‐to‐treat (RR, 1.14; 95% CI: 1.06–1.23; p = 0.0006) and per‐protocol analyses (RR, 1.12; 95% CI: 1.04–1.20; p = 0.003). Subgroup analysis based on treatment regimens, eradication experience and clarithromycin resistance, as well as sensitivity analysis further confirmed this finding. In addition, there was no significant difference in compliance (RR, 1.02; 95% CI: 0.98–0.1.05; p = 0.35) and the frequency of adverse events (RR, 0.84; 95% CI: 0.70–1.00; p = 0.05) between the regimens. What is new and conclusion: Compared with PPI‐based regimens, the VPZ‐containing regimens showed a comparable or even superior eradication rate of H. pylori in terms of overall comparison and comparison of different treatment regimens, eradication experience and clarithromycin resistance. In addition, VPZ‐based regimens have better tolerability and fewer adverse events. More future studies are needed to evaluate the impact of some differences in patient characteristics. Trial registration: PROSPERO CRD42021229598. [ABSTRACT FROM AUTHOR]

Background: Preimplantation genetic testing (PGT) includes methods that allow embryos to be tested for severe inherited diseases or chromosomal abnormalities. In addition to IVF/ICSI and repeated freezing and thawing of the embryos, PGT requires a biopsy to obtain embryonic genetic material for analysis. However, the potential effects of PGT on obstetric and neonatal outcomes are currently uncertain.Objective and Rationale: This study aimed to investigate whether pregnancies conceived after PGT were associated with a higher risk of adverse obstetric and neonatal outcomes compared with spontaneously conceived (SC) pregnancies or pregnancies conceived after IVF/ICSI.Search Methods: PubMed, EMBASE, MEDLINE, Web of Science and The Cochrane Library entries from January 1990 to January 2021 were searched. The primary outcomes in this study were low birth weight (LBW) and congenital malformations (CMs), and the secondary outcomes included gestational age, preterm delivery (PTD), very preterm delivery (VPTD), birth weight (BW), very low birth weight (VLBW), neonatal intensive care unit (NICU) admission, hypertensive disorders of pregnancy (HDP), gestational diabetes, placenta previa and preterm premature rupture of membranes (PROM). We further pooled the results of PGT singleton pregnancies. Subgroup analyses included preimplantation genetic diagnosis (PGD), preimplantation genetic screening (PGS), cleavage-stage biopsy combined with fresh embryo transfer (CB-ET) and blastocyst biopsy combined with frozen-thawed embryo transfer (BB-FET).Outcomes: This meta-analysis included 15 studies involving 3682 babies born from PGT pregnancies, 127 719 babies born from IVF/ICSI pregnancies and 915 222 babies born from SC pregnancies. The relative risk (RR) of LBW was higher in PGT pregnancies compared with SC pregnancies (RR = 3.95, 95% confidence interval [CI]: 2.32-6.72), but the risk of CMs was not different between the two groups. The pooled results for the risks of LBW and CMs were similar in PGT and IVF/ICSI pregnancies. The risks of PTD (RR = 3.12, 95% CI: 2.67-3.64) and HDP (RR = 3.12, 95% CI: 2.18-4.47) were significantly higher in PGT pregnancies compared with SC pregnancies. Lower gestational age (mean difference [MD] = -0.76 weeks, 95% CI -1.17 to -0.34) and BW (MD = -163.80 g, 95% CI: -299.35 to -28.24) were also noted for PGT pregnancies compared with SC pregnancies. Nevertheless, compared with IVF/ICSI pregnancies, the risks of VPTD and VLBW in PGT pregnancies were significantly decreased by 41% and 30%, respectively, although the risk of HDP was still significantly increased by 50% in PGT pregnancies compared with IVF/ICSI pregnancies. The combined results of obstetric and neonatal outcomes of PGT and IVF/ICSI singleton pregnancies were consistent with the overall results. Further subgroup analyses indicated that both PGD and PGS pregnancies were associated with a higher risk of PTD and a lower gestational age compared with SC pregnancies.Wider Implications: This meta-analysis showed that PGT pregnancies may be associated with increased risks of LBW, PTD and HDP compared with SC pregnancies. The overall obstetric and neonatal outcomes of PGT pregnancies are favourable compared with those of IVF/ICSI pregnancies, although PGT pregnancies were associated with a higher risk of HDP. However, because the number of studies that could be included was limited, more randomised controlled trials and prospective cohort studies are needed to confirm these conclusions. [ABSTRACT FROM AUTHOR]

Background: Shift work is a workschedule, since industrial era and some employees work in shift. It causes a desynchronization of the biological clock with consequences on sleep amount and quality, such as insomnia and easy fatigue. Obstructive sleep apnea (OSA) is one of the sleep problems that are getting more and more attention, but studies on the association between shift work and OSA were rare. Herein, we aimed to conduct a systematic review and meta-analysis to investigate the association between shift work and possible OSA. Methods: This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed, Embase, and Web of Science databases using a related set of keywords. The inclusion criteria were as follows: (1) participants were adult employees hired by a company or organization; (2) exposure was shift work; and (3) outcome was possible OSA according to examination or assessment. Results: We included six studies in the systematic review and five studies were selected for further meta-analysis. A random-effects model showed an association of shift work with a small, non-significant increase in possible OSA cases (pooled prevalence relative risk = 1.05; 95% CI 0.85–1.30; p = 0.65). This association occurred in both healthcare and non-healthcare workers group. Conclusion: The association between shift work and possible OSA remains inconclusive and could be small if not negligible. Future studies should assess the association between specific work schedules and specific OSA definitions. Trial registration number: PROSPERO ID: CRD42020156837 [ABSTRACT FROM AUTHOR]

Background: Nine previous meta-analyses have been published to analyze the CYP1A1 T3801C and A2455G polymorphisms with BC risk. However, they did not assess the credibility of statistically significant associations. In addition, many new studies have been reported on the above themes. Hence, we conducted an updated systematic review and meta-analysis to further explore the above issues. Objectives: To explore the association on the CYP1A1 T3801C and A2455G polymorphisms with BC risk. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (The PRISMA) were used. Results: In this study, there were 63 case–control studies from 56 publications on the CYP1A1 T3801C polymorphism (including 20,825 BC cases and 25,495 controls) and 51 case–control studies from 46 publications on the CYP1A1 A2455G polymorphism (including 20,124 BC cases and 29,183 controls). Overall, the CYP1A1 T3801C polymorphism was significantly increased BC risk in overall analysis, especially in Asians and Indians; the CYP1A1 A2455G polymorphism was associated with BC risk in overall analysis, Indians, and postmenopausal women. However, when we used BFDP correction, associations remained significant only in Indians (CC vs. TT + TC: BFDP < 0.001) for the CYP1A1 T3801C polymorphism with BC risk, but not in the CYP1A1 A2455G polymorphism. In addition, when we further performed sensitivity analysis, no significant association in overall analysis and any subgroup. Moreover, we found that all studies from Indians was low quality. Therefore, the results may be not credible. Conclusion: This meta-analysis strongly indicates that there is no significant association between the CYP1A1 T3801C and A2455G polymorphisms and BC risk. The increased BC risk may most likely on account of false-positive results. [ABSTRACT FROM AUTHOR]

Background and purpose: Alpha‐synuclein seed amplification assays (α‐syn SAAs) are promising diagnostic methods for Parkinson's disease (PD) and other synucleinopathies. However, there is limited consensus regarding the diagnostic and differential diagnostic performance of α‐syn SAAs on biofluids and peripheral tissues. Methods: A comprehensive research was performed in PubMed, Web of Science, Embase and Cochrane Library. Meta‐analysis was performed using a random‐effects model. A network meta‐analysis based on an ANOVA model was conducted to compare the relative accuracy of α‐syn SAAs with different specimens. Results: The pooled sensitivity and specificity of α‐syn SAAs in distinguishing PD from healthy controls or non‐neurodegenerative neurological controls were 0.91 (95% confidence interval [CI] 0.89‐0.92) and 0.95 (95% CI 0.94‐0.96) for cerebrospinal fluid (CSF); 0.91 (95% CI 0.86–0.94) and 0.92 (95% CI 0.87‐0.95) for skin; 0.80 (95% CI 0.66‐0.89) and 0.87 (95% CI 0.69‐0.96) for submandibular gland; 0.44 (95% CI 0.30–0.59) and 0.92 (95% CI 0.79–0.98) for gastrointestinal tract; 0.79 (95% CI 0.70–0.86) and 0.88 (95% CI 0.77–0.95) for saliva; and 0.51 (95% CI 0.39‐0.62) and 0.91 (95% CI 0.84‐0.96) for olfactory mucosa (OM). The pooled sensitivity and specificity were 0.91 (95% CI 0.89–0.93) and 0.50 (95% CI 0.44–0.55) for CSF, 0.92 (95% CI 0.83–0.97) and 0.22 (95% CI 0.06–0.48) for skin, and 0.55 (95% CI 0.42–0.68) and 0.50 (95% CI 0.35–0.65) for OM in distinguishing PD from multiple system atrophy. The pooled sensitivity and specificity were 0.92 (95% CI 0.89–0.94) and 0.84 (95% CI 0.73–0.91) for CSF, 0.92 (95% CI 0.83–0.97) and 0.88 (95% CI 0.64–0.99) for skin and 0.63 (95% CI 0.52‐0.73) and 0.86 (95% CI 0.64‐0.97) for OM in distinguishing PD from progressive supranuclear palsy. The pooled sensitivity and specificity were 0.94 (95% CI 0.90–0.97) and 0.95 (95% CI 0.77–1.00) for CSF and 0.94 (95% CI 0.84–0.99) and 0.86 (95% CI 0.42–1.00) for skin in distinguishing PD from corticobasal degeneration. Conclusions: α‐Synuclein SAAs of CSF, skin, saliva, submandibular gland, gastrointestinal tract and OM are promising diagnostic assays for PD, with CSF and skin α‐syn SAAs demonstrating higher diagnostic performance. [ABSTRACT FROM AUTHOR]

Purpose: To obtain performance values of PET/CT for determining the nodal status of rectal cancer. Materials: A comprehensive literature search was performed on PubMed and Embase for original diagnostic accuracy studies on the diagnostic performance of PET-CT for detection of LN metastasis in rectal cancer. The QUADAS-2 was used to evaluate the methodological quality of each study. Pooled sensitivity, specificity, and AUC were calculated to estimate the diagnostic role of PET/CT using a random-effects model. A subgroup analysis was performed to investigate the influence of different parameters on diagnostic performance. Results: A total of 15 studies and 1209 patients were included. A publication bias was observed. The pooled sensitivity, specificity, and AUC for PET/CT was 0.62 (95% CI 0.49, 0.74), 0.94 (95% CI 0.87, 0.97), and 0.87 (95% CI 0.83–0.89), respectively. Per-node basis yields higher accuracy than per-patient basis, with pooled sensitivities of 0.65 (95% CI 0.50–0.79) vs. 0.56 (95% CI 0.36–0.77) and specificities of 0.96 (95% CI 0.92–1.00) vs. 0.88 (95% CI 0.76–1.00), but there were no significant differences in diagnostic accuracy. Conclusion: PET/CT has high specificity but moderate sensitivity for the detection of LN metastasis in rectal cancer. The current data suggests that the diagnostic capabilities of this method is limited due to its moderate sensitivity. [ABSTRACT FROM AUTHOR]

Background: Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation. Questions/purposes: We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup. Methods: Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I) and publication bias was assessed using forest plots. Results: There were no differences between the internal fixation and arthroplasty groups for patient mortality at mid-term (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06-0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06-0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02-1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, −0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32-14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40-2.01; p = 0.78) between patients treated with arthroplasty and internal fixation. Conclusions: Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid- and long-term followup, and better mid-term functional recovery. Future studies should investigate the mid- and long-term results of THAs compared with hemiarthroplasty. [ABSTRACT FROM AUTHOR]

Objective: Whether tea consumption decreases the risk of depression remains controversial. We performed a metaanalysis of findings from observational studies to evaluate the association between tea consumption and depression risk. Method: Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from their inception through August 2014 for observational studies that had reported the association between tea consumption and depression risk. We used a fixed effects model when heterogeneity was negligible and a random effect model when heterogeneity was significant to calculate the summary relative risk estimates (RRs) and 95% confidence intervals (CIs). Results: Eleven studies with 13 reports were eligible for inclusion in the meta-analysis (22,817 participants with 4,743 cases of depression). Compared to individuals with lower tea consumption, those with higher tea consumption had a pooled RR of depression risk at 0.69 (95% CI: 0.63-0.75). Eight reports were included in the dose-response analysis of tea consumption and depression risk (10,600 participants with 2,107 cases). There was a linear association between tea consumption and the risk of depression, with an increment of 3 cups/day in tea consumption associated with a decrease in the risk of depression of 37% (RR = 0.63, 95% CI: 0.55-0.71). [ABSTRACT FROM AUTHOR]

Genome-wide association studies have identified two SNPs (rs402710 and rs401681) of CLPTM1L at chromosome 5p15.33 as a new lung cancer (LC) susceptibility locus in populations of European descent. Since then, the relationship between these SNPs and LC has been reported in various ethnic groups; however, these studies have yielded inconsistent results. To investigate this inconsistency, we performed a meta-analysis of 27 studies involving a total of 60,828 cases and 109,135 controls for the two polymorphisms to evaluate its effect on genetic susceptibility for LC. An overall random-effects per-allele odds ratio of 1.14 (95 % CI 1.11-1.16, P < 10) and 1.15 (95 % CI 1.12-1.19, P < 10) was found for the rs401681 and rs402710 polymorphism, respectively. Significant results were also observed for under dominant and recessive genetic models. After stratified by ethnicity, significant associations were found among Caucasians and East Asians. In the subgroup analysis by sample size, significantly increased risks were found for these polymorphisms in all genetic models. In addition, we find both rs402710 and rs401681 conferred significantly greater risks for adenocarcinoma and squamous cell carcinoma when stratified by histological type of tumors. Furthermore, associations of these polymorphisms with LC risk were observed among current smokers and former smokers, as well as never smokers. Our findings demonstrated that rs402710 and rs401681 are risk-conferring factors for the development of lung cancer. [ABSTRACT FROM AUTHOR]

Multimorbidity is highly prevalent amongst older people. Compared with those with a single disease, older people with multimorbidity are more susceptible to medication nonadherence, which causes adverse health outcomes and increased health care costs. The effectiveness of interventions for improving medication adherence in this population is still unclear. To evaluate the effectiveness of interventions to improve medication adherence for community-dwelling older people with multimorbidity. Systematic review and meta-analysis. Ten databases: Airiti Library, China National Knowledge Infrastructure, Cochrane CENTRAL, EBSCO CINAHL, OVID EMBASE, OVID MEDLINE, Proquest Central, PsycINFO, Wanfang Database and Web of Science Core Collection. Studies evaluating the effects of interventions on medication adherence in community-dwelling older people with multimorbidity were included. Two researchers independently performed the study selection, data extraction and risk assessment. Intervention effects were pooled by random-effects meta-analysis. A total of nine studies with 3,292 participants were included. Studies on self-management interventions revealed a significant and modest improvement in medication adherence (n = 3 studies; SMD 0.52; 95% CI 0.04 to 0.99; p = 0.03, I2 = 43%). Studies using electronic health interventions demonstrated a small yet significant benefit for medication adherence (n = 2 studies; SMD 0.22; 95% CI 0.02 to 0.42; p = 0.03, I2 = 0%). There was no pooled significant effect of medication review on medication adherence (n = 4 studies; SMD -0.03; 95% CI -0.21 to 0.15; p = 0.74, I2 = 68%). Most of the studies failed to yield a significant improvement in patients' health outcomes. Self-management interventions and electronic health interventions might be effective in improving medication adherence for older people with multimorbidity. Future adherence interventions are needed to demonstrate improvements in medication adherence and health outcomes. CRD42020150500 [ABSTRACT FROM AUTHOR]

Intradialytic hypotension (IDH) is a global public health problem. A rising number of IDH sufferers resort to Chinese patent medicine, Shengmai Injection (SMI) in China. The objectives of present study are to assess the effectiveness and safety of SMI as an adjunct therapy for IDH. A systematic search of 6 medical databases was performed up to December 2011. Randomized trials involving SMI adjuvant therapy versus conventional therapy were identified. RevMan 5.0 was used for data analysis. Ten randomized clinical trials with 437 participants were identified. Methodological quality was considered inadequate in all trials. Compared with conventional therapy, SMI adjunct therapy showed significant effects in improving the clinic effective rate (P < 0.01), decreasing the incidence of IDH episode (P < 0.01), decreasing the frequency of nursing interventions (P < 0.01), and increasing diastolic blood pressure (P < 0.01). There was no statistical significance in the improvement of mean arterial pressure (P = 0.22) and systolic blood pressure (P = 0.08) between two groups. Four studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, SMI adjunct therapy appears to be potentially effective in treatment of IDH and is generally safe. However, further rigorous designed trials are needed. [ABSTRACT FROM AUTHOR]

Background: Recurrent pregnancy loss (RPL) had said to be related to the angiotensin converting enzyme insertion/deletion polymorphisms (ACE I/D) gene polymorphisms. But the conclusions were controversial. This meta-analysis was conducted to investigate the real association in ACE I/D polymorphisms and RPL firstly. Methods: Combine Pubmed Embase and HuGENet database in data analysis for this meta-analysis from October 2000 to November 2011. The metagen system was used to select the models and effects. Odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of this association. Results: 9 studies from six countries with 1264 RPL and 845 controls were included according to our criterion. Following the metagen system, we used the dominant model with random effects. The summary OR =1.61 (95% CI: 1.10-2.36, I = 59.0%), which suggested the ACE D allele might increase the RPL risk in Asia (OR=1.97, 95% CI: 1.31-2.98, I = 44.4%), among Asians (OR=1.69, 95% CI: 1.06-2.36, I =32.7%). In additional, after conducting sensitivity analysis, the results had no differences except for Caucasian subgroup reached to the significance (OR=2.059, 95% CI: 1.455-2.914), so we couldn't ignore the relationship between the polymorphisms of ACE D/I gene and Caucasians yet. There seemed no publication bias in our eligible studies with Begg's test (P = 0.867). Conclusions: Results in this meta-analysis presented the positive function of the ACE I/D polymorphism in increasing the RPL risk. Furfure prospective studies were needed to confirm the precise relationship between the ACE I/D and RPL. [ABSTRACT FROM AUTHOR]

Background: Gamification has been adopted in the health care field for broaching sensitive topics and increasing motivation for behavior changes. Games developed to stimulate discussion surrounding end-of-life issues, and thereby promoting advance care planning also emerged. Aim: The aim is to integrate the quantitative evidence and qualitative evidence to understand the effectiveness of and experience with games for advance care planning. Design: A mixed-methods systematic review and meta-analysis (PROSPERO ID: CRD42020163312) was undertaken. Joanna Briggs Institute Critical Appraisal tools were used for quality appraisal. Data were synthesized and pooled for meta-analysis or meta-aggregation when appropriate. Data sources: We searched MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, WanFang, China Knowledge Resource Integrated Database, and Chinese Biomedical Literature Database from the inception of the databases for qualitative, quantitative, and mixed-method studies. Results: Eleven articles of ten studies were included, six of which were feasibility studies. The quality of the quantitative component of most included studies (7/8) was rated as low, and the qualitative component of most included studies (7/8) was rated as moderate. The meta-analysis showed that games for advance care planning are effective to increase self-efficacy, readiness, knowledge, and process of advance care planning behaviors. The meta-aggregation showed that games for advance care planning are highly acceptable and the participants perceived the game experience as fun and enjoyable. Conclusions: Advance care planning games seem to be a promising intervention for increasing the uptake of advance care planning behaviors. Well-designed randomized controlled trials evaluating the effectiveness of games for advance care planning are needed in the future. [ABSTRACT FROM AUTHOR]

Background: As parts of the cis-regulatory mechanism of the human genome, interactions between distal enhancers and proximal promoters play a crucial role. Enhancers, promoters, and enhancer-promoter interactions (EPIs) can be detected using many sequencing technologies and computation models. However, a systematic review that summarizes these EPI identification methods and that can help researchers apply and optimize them is still needed. Results: In this review, we first emphasize the role of EPIs in regulating gene expression and describe a generic framework for predicting enhancer-promoter interaction. Next, we review prediction methods for enhancers, promoters, loops, and enhancer-promoter interactions using different data features that have emerged since 2010, and we summarize the websites available for obtaining enhancers, promoters, and enhancer-promoter interaction datasets. Finally, we review the application of the methods for identifying EPIs in diseases such as cancer. Conclusions: The advance of computer technology has allowed traditional machine learning, and deep learning methods to be used to predict enhancer, promoter, and EPIs from genetic, genomic, and epigenomic features. In the past decade, models based on deep learning, especially transfer learning, have been proposed for directly predicting enhancer-promoter interactions from DNA sequences, and these models can reduce the parameter training time required of bioinformatics researchers. We believe this review can provide detailed research frameworks for researchers who are beginning to study enhancers, promoters, and their interactions. [ABSTRACT FROM AUTHOR]

We aimed to determine the effects of exercise training on the function of vascular smooth muscle cells. PubMed and Web of Science about the effects of exercise training on vascular smooth muscle cells were searched up to August 2020. The effect sizes were estimated in terms of the standardized mean difference. The number of studies included was thirty-five overall. Exercise training had positive effects on vascular smooth muscle cells function in participants older than 40. Effect sizes for HIGH intensity and MIX were positive but small, and also when training duration was longer than 12 weeks. We concluded that vascular smooth muscle cells response can be promoted by exercise training. Vigorous aerobic exercise and mixture training modality were the best ways to promote the dilation response of vascular smooth muscle cells. Additionally, the significant improvement induced by exercise training only occurred when training lasted for longer than 12 weeks. [ABSTRACT FROM AUTHOR]

This review aims to investigate the dose-response relationship between the daily step count and all-cause mortality. PubMed, the Cochrane Library, Embase, and Web of Science were searched for all articles of cohort studies investigating the association between the daily step count and all-cause mortality. Cohort research articles were included if they reported mortality with no less than 3 categories of the daily step count, and hazard ratio (HR) with a 95% Confidence Interval (CI) was reported. Dose-response association meta-analysis and subsequent sex subgroup analysis were performed. The final analysis included a total of nine studies. Compared with the low-step count population, the high-step count population had a 62% lower risk of all-cause death (HR = 0.38, 95% CI 0.27–0.49). There was a non-linear dose-response relationship between the daily step count and all-cause mortality. Compared with the least (1895 steps), the first quartile (4000 steps/day) had a 37% lower risk for all causes of death (HR = 0.63, 0.57–0.71), the second quartile (6388 steps/day) had a 60% lower risk for all causes of death (HR = 0.40, 0.32–0.49), the third quartile (9994.3 steps/day) had a 75% lower risk of all-cause death than the first quartile (HR = 0.25, 0.19–0.33). [ABSTRACT FROM AUTHOR]

Older people with frailty are more likely to experience negative psychological well-being, depressive symptoms, anxiety, and stress. Deterioration of psychological outcomes, in turn, further aggravates the frailty status among this vulnerable population. Considering the undesirable effects of polypharmacy on older people, the use of non-pharmacological intervention has attracted increasing attention. However, the effects of non-pharmacological interventions on psychological outcomes are not clear. This review aims to systematically identify and synthesise evidence to examine the effectiveness of non-pharmacological interventions on psychological outcomes among older people with frailty. Eight electronic databases, including PubMed, MEDLINE, EMBASE, CINAHL, APA PsycInfo, Cochrane Library, CNKI and WANFANG were searched from inception to 14 November 2022. Randomised controlled trials and clinical controlled trials of non-pharmacological interventions on psychological outcomes in older people with frailty were included. The quality of the included studies was assessed using The Cochrane Risk of Bias Tool v2. Meta-analysis was performed using the RevMan5.3. The certainty of the evidence was evaluated by GRADE approach. A total of 4726 articles were initially identified and screened for title and abstract. Eventually, 13 articles from 11 studies were included in this review. The results of the overall risk of bias indicated that four studies had low risk; five studies had some concerns, and two studies had high risk. Four types of intervention were identified, including physical exercise (n = 3), complementary and alternative medicine (music therapy = 1, acupressure = 1), case management (n = 5), and advance care planning (n = 1). The pooled analysis showed that group-based physical exercise had significant beneficial effects on depressive symptoms (SMD: − 0.46, 95% CI: − 0.81 to − 0.10, p =.01; low certainty). There is no difference between the effects of case management and usual care on depressive symptoms (SMD: 0.02, 95% CI: − 0.14 to 0.19, p =.79; high certainty). Narrative synthesis of evidence suggested the effects of complementary and alternative medicine on improving depressive symptoms and general mental status. Psychological outcomes in older people with frailty are understudied. Group-based physical exercise could be a strategy to reduce depressive symptoms among older people with frailty. There is limited evidence showing the effects of complementary and alternative medicine on improving psychological outcomes. More rigorous trials are needed to examine the effects of non-pharmacological interventions on psychological outcomes among older people with frailty. (PROSPERO): CRD42022303370. [ABSTRACT FROM AUTHOR]

Purpose: The association between secondhand smoke (SHS) and peripheral arterial disease (PAD) was inconsistent and the studies were relatively scarce, hence, we conducted a meta-analysis of the association between SHS and PAD. Materials and methods: We systematically searched three electronic databases (PubMed, EMBASE, and Web of Science), and calculated the pooled prevalence risk ratio (RR) and estimated standard error by random effect model from the meta-analysis. Furthermore, we performed a subgroup meta-analysis according to the location of SHS exposure. Results: We initially identified 502 articles from the electronic database, and 6 articles, cross-sectional data from 4 cross-sectional studies and 2 prospective cohort studies, were included in the meta-analysis. Among these six articles, two studies showed a significant correlation between SHS exposure and PAD, whereas no study showed a negative correlation between SHS exposure and PAD. In the meta-analysis, pooled prevalence showed a significant association between SHS exposure and PAD (RR = 1.23; 95% confidence interval [CI] 1.08–1.41; z = 3.02, p = 0.003). In the subgroup analysis based on location of SHS exposure, the prevalence RR of PAD at home was 1.30 (95% CI 1.14–1.49, Z-3.99, p < 0.0001). The prevalence RR in the subgroup of SHS exposure at work was not significant (RR = 0.89; 95% CI 0.55–1.44; z = 0.48, p = 0.63). Conclusion: Exposure to SHS was significantly and positively associated with PAD. Moreover, we found a significant association between exposure to SHS and PAD at home, but the association was not significant at work. [ABSTRACT FROM AUTHOR]

Background: Association between smoking and sleep apnea is well-known from previous studies. However, the influence of secondhand smoke (SHS), which is a potential risk factor of obstructive sleep apnea (OSA), remains unclear. Our aim was to investigate the relationship between SHS and OSA using a meta-analysis.Materials and Methods: For the meta-analysis, searches were performed in MEDLINE, EMBASE, and Web of Science databases on January 10, 2022, by combining various keywords including "SHS exposure" and "OSA". Data were extracted using defined inclusion and exclusion criteria. Fixed-effects model meta-analyses were used to pool risk ratio (RR) estimates with their 95% confidence intervals (CI). I2 was used to assess heterogeneity. Moreover, we performed subgroup meta-analyses of children-adults, and smoker fathers and mothers.Results: In total, 267 articles were obtained through an electronic search. Twenty-six articles were included in our analysis according to the inclusion and exclusion criteria. We found evidence of an association between SHS exposure and possible OSA (RR 1.64, 95% CI 1.44-1.88). The results of the subgroup analyses showed that children passive smokers (RR 1.84, 95% CI 1.60-2.13) were at greater risks of possible OSA than adult passive smokers (RR 1.35, 95% CI 1.21-1.50). Also, significant differences were observed in mothers with smoking exposure (RR 2.61, 95% CI 1.62-4.21, p < 0.0001), as well as in fathers with smoking exposure (RR 2.15, 95% CI 0.98-4.72, p = 0.06).Short Conclusion: Our meta-analysis confirmed that SHS exposure is significantly associated with OSA. In the subgroup analyses, the association of SHS and possible OSA was significant in both children and adults, as well as in smoker mothers and fathers. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aims to systematically evaluate adherence to colonoscopy and related factors in cascade screening of colorectal cancer (CRC) among average‐risk populations, which is crucial to achieve the effectiveness of CRC screening. Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library for studies published in English up to October 16, 2020, and reporting the adherence to colonoscopy following positive results of initial screening tests. A random‐effects meta‐analysis was applied to estimate pooled adherence and 95% confidence intervals. Subgroup analysis and mixed‐effects meta‐regression analysis were performed to evaluate heterogeneous factors for adherence level. Results: A total of 245 observational and 97 experimental studies were included and generated a pooled adherence to colonoscopy of 76.6% (95% confidence interval: 74.1–78.9) and 80.4% (95% confidence interval: 77.2–83.1), respectively. The adherence varied substantially by calendar year of screening, continents, CRC incidence, socioeconomic status, recruitment methods, and type of initial screening tests, with the initial tests as the most modifiable heterogeneous factor for adherence across both observational (Q = 162.6, P < 0.001) and experimental studies (Q = 23.2, P < 0.001). The adherence to colonoscopy was at the highest level when using flexible sigmoidoscopy as an initial test, followed by using guaiac fecal occult blood test, quantitative or qualitative fecal immunochemical test, and risk assessment. The pooled estimate of adherence was positively associated with specificity and positive predictive value of initial screening tests, but negatively with sensitivity and positivity rate. Conclusions: Colonoscopy adherence is at a low level and differs by study‐level characteristics of programs and populations. Initial screening tests with high specificity or positive predictive value may be followed by a high adherence to colonoscopy. [ABSTRACT FROM AUTHOR]

It is controversial whether there is a different risk of recurrence between two histological subtypes in craniopharyngioma (CP) patients. Some reported that adamantinomatous craniopharyngioma (ACP) had a higher risk of recurrence than papillary craniopharyngioma (PCP), but others reported that there is no significant difference between them. So, we conducted this systematic review and meta-analysis to determine the association between the histological subtype of CP and the rate of recurrence. A comprehensive literature search was undertaken in PubMed, EMBASE, and Web of Science for all English articles published up to November 2020. Recurrence data stratified by ACP and PCP were extracted from studies meeting inclusion criteria. A pooled analysis of the association between the histological subtype of craniopharyngioma and rates of recurrence was performed. Thirteen articles containing 974 patients were included. When stratified by two pathological subtypes, the total recurrence rate of ACP was 26.0% and PCP was 14.1%, which showed ACP associated with a higher risk of tumor recurrence than PCP (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.36, 3.30, P = 0.00). This is the first meta-analysis focusing on histological subtypes of CP. PCP associates with a lower risk of recurrence than ACP, indicating that ACP could act as one of recurrence risk factors for CP patients. Nevertheless, large sample size and well-designed multicenter studies in which the other clinical variables are controlled to determine the histological subtype of CP as an independent recurrence risk factor are needed. [ABSTRACT FROM AUTHOR]

Objective: Breakfast skipping has been reported to be associated with type 2 diabetes (T2D), but the results are inconsistent. No meta-analyses have applied quantitative techniques to compute summary risk estimates. The present study aimed to conduct a meta-analysis of observational studies summarizing the evidence on the association between breakfast skipping and the risk of T2D.Design: Systematic review and meta-analysis.Setting: Relevant studies were identified by a search of PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI) and SINOMED up to 9 August 2014. We also reviewed reference lists from retrieved articles. We included studies that reported risk estimates (including relative risks, odds ratios and hazard ratios) with 95% confidence intervals for the association between breakfast skipping and the risk of T2D.Subjects: Eight studies involving 106,935 participants and 7419 patients with T2D were included in the meta-analysis.Results: A pooled adjusted relative risk for the association between exposure to breakfast skipping and T2D risk was 1·21 (95% CI 1·12, 1·31; P=0·984; I² =0·0%) in cohort studies and the pooled OR was 1·15 (95% CI, 1·05, 1·24; P=0·770; I² =0·0%) in cross-sectional studies. Visual inspection of a funnel plot and Begg's test indicated no evidence of publication bias.Conclusions: Breakfast skipping is associated with a significantly increased risk of T2D. Regular breakfast consumption is potentially important for the prevention of T2D. [ABSTRACT FROM AUTHOR]

Background: Gastric carcinoma (GC) is one of the highest cancer-mortality diseases with a high incidence rate in Asia. For surgically unfit but medically fit patients, palliative chemotherapy is the main treatment. The chemotherapy regimen of docetaxel, cisplatin and 5-fluorouracil (DCF) has been used to treat the advanced stage or metastatic GC. It is necessary to compare effectiveness and toxicities of DCF regimen with non-taxane-containing palliative chemotherapy for GC. Methods: PubMed, EmBase, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases were searched to select relative randomized controlled trials (RCTs) comparing DCF to non-taxane-containing chemotherapy for patients with palliatively resected, unresectable, recurrent or metastatic GC. Primary outcome measures were 1-year and 2-year overall survival (OS) rates. Secondary outcome measures were median survival time (MST), median time to progression (TTP), response rate and toxicities. Results: Twelve RCTs were eligible and 1089 patients were analyzed totally (549 in DCF and 540 in control). DCF regimen increased partial response rate (38.8% vs 27.9%, p = 0.0003) and reduced progressive disease rate (18.9% vs 33.3%, p = 0.0005) compared to control regimen. Significant improvement of 2-year OS rate was found in DCF regimen (RR = 2.03, p = 0.006), but not of 1-year OS rate (RR = 1.22, p = 0.08). MST was significantly prolonged by DCF regimen (p = 0.039), but not median TTP (p = 0.054). Both 1-year OS rate and median TTP had a trend of prolongation by DCF regimen. Chemotherapy-related mortality was comparable (RR = 1.23, p = 0.49) in both regimens. In grade I-IV toxicities, DCF regimen showed a major raise of febrile neutropenia (RR = 2.33, p<0.0001) and minor raises of leucopenia (RR = 1.25, p<0.00001), neutropenia (RR = 1.19, p<0.00001), and diarrhea (RR = 1.59, p<0.00001), while in other toxicities there were no significant differences. Conclusion: DCF regimen has better response than non-taxane containing regimen and could potentially improve the survival outcomes. The chemotherapy-related toxicity of DCF regimen is acceptable to some extent. [ABSTRACT FROM AUTHOR]

Many published studies reflect the growing application of complementary and alternative medicine, particularly Chinese herbal medicine (CHM) use in combination with conventional cancer therapy for advanced non-small cell lung cancer (NSCLC), but its efficacy remains largely unexplored. The purpose of this study is to evaluate the efficacy of CHM combined with conventional chemotherapy (CT) in the treatment of advanced NSCLC. Publications in 11 electronic databases were extensively searched, and 24 trials were included for analysis. A sum of 2,109 patients was enrolled in these studies, at which 1,064 patients participated in CT combined CHM and 1,039 in CT (six patients dropped out and were not reported the group enrolled). Compared to using CT alone, CHM combined with CT significantly increase one-year survival rate (RR = 1.36, 95% CI = 1.15–1.60, p = 0.0003). Besides, the combined therapy significantly increased immediate tumor response (RR = 1.36, 95% CI = 1.19–1.56, p<1.0E−5) and improved Karnofsky performance score (KPS) (RR = 2.90, 95% CI = 1.62–5.18, p = 0.0003). Combined therapy remarkably reduced the nausea and vomiting at toxicity grade of III–IV (RR = 0.24, 95% CI = 0.12–0.50, p = 0.0001) and prevented the decline of hemoglobin and platelet in patients under CT at toxicity grade of I–IV (RR = 0.64, 95% CI = 0.51–0.80, p<0.0001). Moreover, the herbs that are frequently used in NSCLC patients were identified. This systematic review suggests that CHM as an adjuvant therapy can reduce CT toxicity, prolong survival rate, enhance immediate tumor response, and improve KPS in advanced NSCLC patients. However, due to the lack of large-scale randomized clinical trials in the included studies, further larger scale trials are needed. [ABSTRACT FROM AUTHOR]

Background: It is currently unclear whether parenteral selenium supplementation should be recommended in the management of critically ill patients. Here we conducted a systematic review and meta-analysis to assess the efficacy of parenteral selenium supplementation on clinical outcomes. Methods/Principal Findings: Randomized trials investigating parenteral selenium supplementation administered in addition to standard of care to critically ill patients were included. CENTRAL, Medline, EMBASE, the Science Citation Index, and CINAHL were searched with complementary manual searches. The primary outcome was all-cause mortality. Trials published in any language were included. Two authors independently extracted data and assessed trial quality. A third author was consulted to resolve disagreements and for quality assurance. Twelve trials were included and meta-analysis was performed on nine trials that recruited critically ill septic patients. These comprised 965 participants in total. Of these, 148 patients (30.7%) in the treatment groups, and 180 patients (37.3%) in control groups died. Parenteral selenium treatment significantly reduced all-cause mortality in critically ill patients with sepsis (relative risk [RR] 0.83, 95% CI 0.70--0.99, p = 0.04, I² = 0%). Subgroup analyses demonstrated that the administration schedule employing longer duration (RR 0.77, 95% CI 0.63--0.94, p = 0.01, I² = 0%), loading boluses (RR 0.73, 95% CI 0.58--0.94, p = 0.01, I² = 0%) or high-dose selenium treatment (RR 0.77, 95% CI 0.61--0.99, p = 0.04, I² = 0%) might be associated with a lower mortality risk. There was no evidence of adverse events. Conclusions/Significance: Parenteral selenium supplementation reduces risk of mortality among critically ill patients with sepsis. Owing to the varied methodological quality of the studies, future high-quality randomized trials that directly focus on the effect of adequate-duration of parenteral selenium supplementation for severe septic patients are needed to confirm our results. Clinicians should consider these findings when treating this high-risk population. [ABSTRACT FROM AUTHOR]

Highlights from the article: July 2018, on the combination therapy of PD-1/L1 inhibitors in NSCLC patients. PD-1/L1 inhibitors with CTLA-4 inhibitors or chemotherapy were 35% or 65% (6m PFSr) For the patients receiving anti-PD-1/L1 therapy combination Therapy of PD-1/L1 inhibitors with IDO inhibitors.

Background and Aim: The thiopurines are effective in the management of patients with inflammatory bowel disease (IBD), but the association between thiopurines use and the risk of skin cancer (including nonmelanoma skin cancer [NMSC] and melanoma skin cancer) has already been sufficiently reported. However, the results of these studies are inconsistent, and thus, the objective of our analysis was to explore whether thiopurines can lead to an excess risk of skin cancer in IBD patients. Methods: MEDLINE, EMBASE, and the Cochrane Library were searched to identify relevant studies that evaluated the risk of skin cancer in IBD patients treated with thiopurines. A random effects meta‐analysis was conducted to calculate the pooled incidence rate ratios as well as risk ratios (RRs). Subgroup analysis was performed to explore the potential source of heterogeneity. Results: Thirteen studies comprising 149 198 participants were included. The result suggested that thiopurines significantly increased the risk of overall skin cancer in IBD patients (random effects: RR = 1.80, 95% confidence interval [CI] 1.14–2.87, P = 0.013), among which NMSC showed an excess risk associated with thiopurines use (random effects: RR = 1.88, 95% CI 1.48–2.38, P < 0.001) while no increased risk was observed with respect to melanoma skin cancer (random effects: RR = 1.22, 95% CI 0.90–1.65, P = 0.206). Subgroup analysis regarding sample size and geographic distribution in skin cancer and follow‐up duration in NMSC reached statistical significance, while other subgroups showed no significance. Conclusion: Exposition of thiopurines in patients with IBD is associated with a higher risk of skin cancer. Routine skin screening and daily skin protective practice are recommended for these patients. [ABSTRACT FROM AUTHOR]

Background: Intraarticular steroid injections are widely used in joint arthritis. However, the data regarding an association between an increased risk for arthroplasty infection after an intraarticular steroid injection are still conflicting. We conducted a meta-analysis to evaluate the evidence from relevant studies that examine the relation between intraarticular steroid injections and infection rates in subsequent joint arthroplasty and to develop GRADE based recommendations for using the steroid before arthroplasty. Methods: A systematic search of all studies published through August 2014 was conducted using the MEDLINE, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The relevant studies that examined the relation between intraarticular steroid injections and infection rates in subsequent joint arthroplasty were identified. Demographic characteristics, infection rates and clinical outcomes were manually extracted from all of the selected studies. The evidence quality levels and recommendations were assessed using the GRADE system. Results: Eight studies looking at hip and knee arthroplasties were included. Meta-analysis showed that patients with steroid injection before arthroplasty had a higher deep infection rate than patients without steroid injection (OR = 2.13, 95% CI 1.02-4.45), but no significant effect on superficial infection rate (OR = 1.75, 95% CI 0.74-4.16). The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations. Conclusions: Intraarticular steroid injections may lead to increased deep infection rates of subsequent joint arthroplasty but not the superficial infection rates. Due to the poor quality of the evidence currently available, further studies are still required. [ABSTRACT FROM AUTHOR]

Grassland ecosystems play an important role in subsistence agriculture and the global carbon cycle. However, the global spatio-temporal patterns and environmental controls of grassland biomass are not well quantified and understood. The goal of this study was to estimate the spatial and temporal patterns of the global grassland biomass and analyze their driving forces using field measurements, Normalized Difference Vegetation Index (NDVI) time series from satellite data, climate reanalysis data, and a satellite-based statistical model. Results showed that the NDVI-based biomass carbon model developed from this study explained 60% of the variance across 38 sites globally. The global carbon stock in grassland aboveground live biomass was 1.05 Pg·C, averaged from 1982 to 2006, and increased at a rate of 2.43 Tg·C·y-1 during this period. Temporal change of the global biomass was significantly and positively correlated with temperature and precipitation. The distribution of biomass carbon density followed the precipitation gradient. The dynamics of regional grassland biomass showed various trends largely determined by regional climate variability, disturbances, and management practices (such as grazing for meat production). The methods and results from this study can be used to monitor the dynamics of grassland aboveground biomass and evaluate grassland susceptibility to climate variability and change, disturbances, and management. [ABSTRACT FROM AUTHOR]

• There was no difference of 1/3/5/10 years OS between IST group and haplo-HSCT group. • The 1/3/5/10 years FFS were significantly better in haplo-HSCT group compared with IST group (p < 0.01). • Higher incidence of infections was observed in haplo-HSCT group compared with IST group (76% versus 45%, p < 0.001). • The incidence rates of aGVHD and cGVHD were 54% (95% Cl, 43%～64%) and 43% (95%CI, 18%～68%) in haplo-HSCT group. • Death causes included severe infection, bleeding in IST group and infection, GVHD in haplo-HSCT group. To compare the survivals and treatment related complications between immunosuppression therapy (IST) and haploidentical hematopoietic stem cell transplantation (haplo-HSCT) on children and young adults with severe aplastic anemia (SAA) in East Asia during the last 10 years. After looking through Pubmed, Embase, Web of Science and Wanfang Data, a total of 491 patients from 7 retrospective studies conducted in East-Asia were included for meta-analysis based on Stata program. Publication bias was measured by Begger and Egger tests. 1/3/5/10 years overall survivals (OS), failure free survivals (FFS), incidence rates of adverse events and their 95% confidence intervals (CI) were pooled and compared. There was no difference of 1/3/5/10 years OS between IST group and haplo-HSCT group, but the 1/3/5/10 years FFS were significantly better in haplo-HSCT group compared with IST group (p < 0.01). However, higher incidence of infections was observed in haplo-HSCT group compared with IST group (76% versus 45%, p < 0.001). The pooled estimates for acute graft versus host disease (aGVHD) and chronic graft versus host disease (cGVHD) were 54% (95% Cl, 43%～64%) and 43% (95% CI, 18%～68%), respectively for haplo-HSCT group. Among them 38% (95%CI, 22%～54%) was grade I II aGVHD and 11% (95% Cl, 0%～22%) was grade III-IV aGVHD. Death causes included severe infection, bleeding in IST group and infection, GVHD in haplo-HSCT group. The long-term survivals were similar for young patients with SAA who received IST or haplo-HSCT as the frontline treatment. The haplo-HSCT group showed a better FFS, on the other hand, had higher incidence of infection and GVHD. [ABSTRACT FROM AUTHOR]

Background: There is considerable heterogeneity in the rate of lung function decline in chronic obstructive pulmonary disease (COPD), the determinants of which are largely unknown. Observational studies in COPD indicate that low body mass index (BMI) is associated with worse outcomes, and overweight/obesity has a protective effect - the so-called "obesity paradox". We aimed to determine the relationship between BMI and the rate of FEV1 decline in data from published clinical trials in COPD.Methods: We performed a systematic review of the literature, and identified 5 randomized controlled trials reporting the association between BMI and FEV1 decline. Four of these were included in the meta-analyses. We analyzed BMI in 4 categories: BMI-I (< 18.5 or <  20 kg/m2), BMI-II (18.5 or 20 to < 25 kg/m2), BMI-III (25 to < 29 or < 30 kg/m2) and BMI-IV (≥29 or ≥ 30 kg/m2). We then performed a meta-regression of all the estimates against the BMI category.Results: The estimated rate of FEV1 decline decreased with increasing BMI. Meta-regression of the estimates showed that BMI was significantly associated with the rate of FEV1 decline (linear trend p = 1.21 × 10- 5).Conclusions: These novel findings support the obesity paradox in COPD: compared to normal BMI, low BMI is a risk factor for accelerated lung function decline, whilst high BMI has a protective effect. The relationship may be due to common but as-of-yet unknown causative factors; further investigation into which may reveal novel endotypes or targets for therapeutic intervention. [ABSTRACT FROM AUTHOR]