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Background and Aim: Migraine patients can exhibit autonomic dysregulation, in turn leading to cardiac conduction and repolarization abnormalities. This systematic review and meta-analysis evaluated the electrocardiographic changes in migraineurs.Method: PubMed and Embase databases were searched for human studies using the search terms 'migraine' and 'electrocardiogram' until 15th December 2018, identifying 108 and 131 studies.Results: Thirteen studies involving 667 migraineurs and 208 normal subjects included (mean age=30.7, total male percentage=19.8%) were included. A longer mean QTc interval (standard mean difference=7.89, 95% confidence interval=[3.29, 12.49], p=0.0008) and higher frequency of QTc prolongation (risk ratio [RR]=6.23, [2.86-13.58], p<0.00001), but no difference in PR-interval (SMD=4.33, [-3.90-12.56], p=0.30) were observed during migraine attacks compared to pain-free periods. P-wave dispersion was higher in migraine patients compared to controls (mean difference=3.62, [1.03-6.21], p=0.006). RR-interval were statistically indistinguishable between migraine patients and controls (SMD=0.08, [-0.65-0.81], p=0.83), or between migraineurs with and without aura (SMD=-0.03, [-0.44-0.38], p=0.89). Deep breathing ratio was significantly lower in migraineurs compared to controls (SMD=-0.27, 95% CI=[-0.46, -0.08], p=0.006) but similar between migraineurs with and without aura (SMD=-0.04, [-0.27-0.19], p=0.74). No significant difference in Valsalva ratio is found between migraineurs and controls (SMD=0.10, [-0.32-0.53], p=0.63) or between migraineurs with and without aura (SMD=-0.17, [-0.40-0.06], p=0.14). Root mean square of successive differences (RMSSD) (SMD=-0.07, [-1.10-0.95], p=0.89) and standard deviation of NN intervals (SDNN) (SMD=-0.10, [-0.61-0.41], p=0.71) did not significantly differ between migraine patients and controls.Conclusion: Electrocardiographic alterations are observed in migraine patients compared to controls, especially during migraine attacks. [ABSTRACT FROM AUTHOR]

Background Fibroblast growth factor 21 is a signalling protein involved in cell differentiation, morphogenesis, proliferation and metabolism. Recent studies have associated increased levels of FGF21 in the development of cardiovascular diseases, whereas others have reported no significant associations. Therefore, this systematic review and meta-analysis evaluated the value in predicting the risk of cardio-metabolic disorders and mortality. Methods PubMed and EMBASE were searched until 5th September 2017 for studies that evaluated the roles of FGF21 levels in cardio-metabolic disorders. Results A total of 183 and 301 entries were retrieved; 24 studies met the inclusion criteria. Four studies were identified by an additional search. Therefore, 28 studies were included in the final meta-analysis. High FGF21 levels significantly predicted the incidence of coronary artery disease (hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.06–1.55; P  < 0. 01; I 2  = 48%) and the risk of metabolic syndrome (HR: 1.70, 95% CI: 1.35–2.15; P  < 0.0001 I 2  = 24%). In diabetes mellitus, FGF21 predicted disease incidence or progression (HR: 1.35, 95% CI: 1.06–1.72, P  < 0.05, I 2  = 69%) and worsening renal failure (HR: 1.06, 95% CI: 1.03–1.09, P  < 0.0001, I 2  = 47%). FGF21 also predicted all-cause mortality (HR: 3.00, 95% CI: 1.23–7.33; P  < 0.05; I 2  = 51%), and cardiovascular mortality (HR: 2.33, 95% CI: 1.08–4.99, P < 0.05, I 2  = 75%). Conclusion FGF21 significantly predicts the incidence of coronary artery disease, the risks of metabolic syndrome, diabetes mellitus and renal progression in diabetes. It also predicted all-cause and cardiovascular mortality. [ABSTRACT FROM AUTHOR]

Background and Objectives: Congenital long QT syndrome (LQTS) predisposes affected individuals to ventricular tachycardia/fibrillation (VF/VF), potentially resulting in sudden cardiac death. The Tpeak-Tend interval and the Tpeak-Tend/QT ratio, electrocardiographic markers of dispersion of ventricular repolarization, were proposed for risk stratification but their predictive values in LQTS have been controversial. A systematic review and meta-analysis was conducted to examine the value of Tpeak-Tend intervals and Tpeak-Tend/QT ratios in predicting arrhythmic and mortality outcomes in congenital LQTS.Method: PubMed and Embase databases were searched until 9th May 2017, identifying 199 studies.Results: Five studies on long QT syndrome were included in the final meta-analysis. Tpeak-Tend intervals were longer (mean difference [MD]: 13ms, standard error [SE]: 4ms, P=0.002; I2=34%) in congenital LQTS patients with adverse events [syncope, ventricular arrhythmias or sudden cardiac death] compared to LQTS patients without such events. By contrast, Tpeak-Tend/QT ratios were not significantly different between the two groups (MD: 0.02, SE: 0.02, P=0.26; I2=0%).Conclusion: This meta-analysis showed that Tpeak-Tend interval is significant higher in individuals who are at elevated risk of adverse events in congenital LQTS, offering incremental value for risk stratification. [ABSTRACT FROM AUTHOR]

Objectives: Pentraxin-3 (PTX-3) is a multi-functional pattern recognition molecule produced by various cell types of peripheral tissues in different infections. It is raised in sepsis, but its values in predicting disease severity or mortality outcomes have been controversial. Therefore, we conducted a systematic review and meta-analysis of these associations.Methods: PubMed and Embase were searched until July 18, 2017 for studies that evaluated the relationship between PTX-3 levels and disease severity or mortality in sepsis.Results: A total of 23 and 10 entries were retrieved from both databases, respectively, of which 16 studies were included in the final meta-analysis. A total of 3001 patients (56% male, mean age 63 ± 15 years; mean follow-up duration of 207 days) were analysed. PTX-3 was significantly higher in patients with more severe sepsis compared to those with less severe sepsis (standard mean difference = 18.5 ng/mL, standard error: 4.5 ng/mL, P < 0.0001) and higher in non-survivors compared to survivors (standard mean difference = 40.3 ng/mL, standard error: 6.8 ng/mL, P < 0.0001). Elevated PTX-3 levels significantly increased the risk of all-cause mortality (hazard ratio: 1.91, 95% CI: 1.53 to 2.46, P < 0.0001).Conclusions: PTX-3 significantly predicts disease severity and mortality in sepsis. [ABSTRACT FROM AUTHOR]

Background: The Tpeak - Tend interval (the interval from the peak to the end of the T wave), an electrocardiographic marker reflecting transmural dispersion of repolarization, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death in different clinical settings.Objective: This systematic review and meta-analysis evaluated the significance of the Tpeak - Tend interval in predicting arrhythmic and/or mortality end points.Methods: PubMed, Embase, Cochrane Library, and CINAHL Plus databases were searched through November 30, 2016.Results: Of the 854 studies identified initially, 33 observational studies involving 155,856 patients were included in our meta-analysis. Tpeak - Tend interval prolongation (mean cutoff value 103.3 ± 17.4 ms) was a significant predictor of the arrhythmic or mortality outcomes (odds ratio [OR] 1.14; 95% confidence interval [CI] 1.11-1.17; P < .001). When different end points were analyzed, the ORs were as follows: VT/VF, 1.10 (95% CI 1.06-1.13; P < .0001); sudden cardiac death, 1.27 (95% CI 1.17-1.39; P < .0001); cardiovascular death, 1.40 (95% CI 1.19-1.64; P < .0001); and all-cause mortality, 4.56 (95% CI 0.62-33.68; P < .0001). Subgroup analysis for each disease revealed that the risk of VT/VF or death was highest for Brugada syndrome (OR 5.68; 95% CI 1.57-20.53; P < .01), followed by hypertension (OR 1.52; 95% CI 1.26-1.85; P < .0001), heart failure (OR 1.07; 95% CI 1.04-1.11; P < .0001), and ischemic heart disease (OR 1.06; 95% CI 1.02-1.10; P = 0.001).Conclusion: The Tpeak - Tend interval is a useful risk stratification tool in different diseases and in the general population. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials (RCTs) on the use of ranolazine (RN) for prevention and cardioversion of atrial fibrillation (AF) have yielded conflicting results.Objective: The purpose of this study was to conduct a meta-analysis of RCTs to examine the potential role of RN in the prevention and cardioversion of AF.Methods: PubMed and EMBASE were searched until June 2016. Of 484 initially identified studies, 8 RCTs were finally analyzed.Results: The analysis of RCTs showed that RN significantly reduced the incidence of AF compared to the control group in various clinical settings, such as after cardiac surgery, in acute coronary syndromes, and post-electrical cardioversion of AF (relative risk [RR] 0.67, 95% confidence interval [CI] 0.52-0.87, Z = 3.06, P = .002). Furthermore, a higher conversion rate of AF from the combined use of RN and amiodarone compared to amiodarone alone (RR 1.23, 95% CI 1.08-1.40, Z = 3.07, P = .002) was clear, with conversion time significantly shorter in RN plus amiodarone compared to the amiodarone group (weighted mean difference [WMD] = -10.38 hours, 95% CI -18.18 to -2.57, Z = 2.61, P = .009).Conclusion: Our meta-analysis suggests that RN may be effective in AF prevention, whereas it potentiates and accelerates the conversion effect of amiodarone of recent-onset AF. Larger RCTs with long-term follow-up in diverse clinical settings are needed to further clarify the impact of RN on AF therapy. [ABSTRACT FROM AUTHOR]

The recovery of spent lithium-ion batteries and the treatment of phenol wastewater are both environmental and social issues. In this study, the enhanced recovery of spent lithium-ion batteries and the efficient treatment of phenol wastewater are smartly coupled via a "treating waste with waste" strategy. Under optimal conditions, the leaching process involving phenol achieves 98% and 96% efficiency for Co and Li, respectively. After precipitation, Co and Li could be recovered as Co(OH) 2 and Li 2 CO 3 , and the precipitated Co(OH) 2 was further calcined to generate Co 3 O 4. Furthermore, the organic contaminants that remained in the waste-leaching solution could be removed by a spent graphite-activating peroxymonosulfate (PMS) process. It is noteworthy that the total organic carbon (TOC) in the waste-leaching solution could be removed using fewer PMS compared with the original phenol wastewater owing to the pre-oxidation of phenol during the leaching process, further confirming the advantage of this "treating waste with waste" strategy. Herein, enhanced recovery of valuable metals from spent lithium-ion batteries and efficient treatment of phenol-wastewater are smartly coupled with a 'treating waste with waste' strategy. [Display omitted] • Phenol wastewater is used to enhance the recovery of valuable metals from spent cathode material. • Li and Co have maximum leaching efficiencies of 98% and 96%, respectively. • The organic residues in the waste solution are removed more efficiently by the spent graphite activating PMS process. [ABSTRACT FROM AUTHOR]

Background Frailty has been identified as a risk factor for adverse clinical outcomes after cardiac intervention or surgery. However, whether it increases the risk of adverse outcomes in patients undergoing left ventricular assist device (LVAD) therapy has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and clinical outcomes of length of stay and mortality in this setting. Methods PubMed and Embase were searched until September 11, 2017, for studies evaluating the association between frailty and clinical outcomes in advanced heart failure patients undergoing LVAD implantation. Results A total of 46 and 79 entries were retrieved from our search strategy. A total of 13 studies involving 3435 patients were included in the final meta-analysis (mean age: 57.7 ± 15.3 years; 79% male, follow-up duration was 13 ± 14 months). Compared to nonfrail patients (n = 2721), frail patients (n = 579) had significantly longer time-to-extubation (n = 3; mean difference: 45 ± 6 hours; I 2 : 0%) and hospital length of stay (n = 4; mean difference: 2.9 ± 1.2 days; P = .001; I 2 : 21%). Frailty was not a predictor of inpatient or short-term mortality [n = 3; hazard ratio (HR): 1.22, 95% confidence interval (CI): 0.66-2.26; P > .05; I 2 : 0%] but predicted long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P = .001; I 2 : 0%). Conclusions Frailty leads to significantly longer time to extubation, hospital length of stay, and long-term mortality in advanced heart failure patients who have undergone LVAD implantation. Older patients being considered for LVAD implantation should therefore be assessed for frailty status. The risk and benefit of the procedure should be explained to the patient, emphasizing that frailty increases the likelihood of adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

Background Frailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting. Methods PubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI. Results A total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56–5.66, P = .001]. This was substantial heterogeneity present ( I 2 : 79%). Subgroup analysis using the Fried score reduced I 2 to 68% without altering the pooled HR (2.78, 95% CI 1.02–7.76; P < .05). Using the Canadian Study of Health and Aging Clinical Frailty Scale reduced I 2 to 0% while preserving the pooled HR (5.99, 95% CI 2.77–12.95, P < .001). Conclusions Frailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization. [ABSTRACT FROM AUTHOR]

Abstract Objective Frailty is a known risk factor for adverse outcomes after cardiac interventions. However, the extent to which it increases the likelihood of adverse outcomes in heart failure (HF) patients remains unexplored. Therefore, we conducted this systematic review and meta-analysis to quantify the impact of frailty on prognosis in this patient population. Design Meta-analysis. Setting and Participants PubMed and Embase were searched for studies that investigated the relationship between frailty and outcomes in patients with HF. The search period was from the beginning of the databases through to December 3, 2017. Measures A total of 342 and 919 entries were retrieved from PubMed and Embase, respectively. Of these, 20 met our inclusion criteria and were therefore included. Results Frailty significantly increased the risk of all-cause mortality [hazard ratio (HR) = 1.59, 95% confidence interval (CI) = 1.39-1.82, P <.0001, I2 = 55%] and hospitalizations (HR = 1.31, 95% CI = 1.21-1.42, P <.0001, I2 = 0%). Moreover, it was predictive of all-cause mortality after ventricular assist device implantation for advanced HF (HR = 1.62, 95% CI = 1.35-1.94, P <.0001, I2 = 2%). Conclusions/Implications: Frailty is a significant predictor of all-cause mortality and hospital readmissions in HF. Assessment and close monitoring of frailty status of heart failure patients can potentially better guide clinical management of this population. [ABSTRACT FROM AUTHOR]