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Cardiometabolic disorders (CMD) are a growing public health problem across the world. Among the known cardiometabolic risk factors are compounds that induce endocrine and metabolic dysfunctions, such as endocrine disrupting chemicals (EDCs). To date, how EDCs influence molecular programs and cardiometabolic risks has yet to be fully elucidated, especially considering the complexity contributed by species-, chemical-, and dose-specific effects. Moreover, different experimental and analytical methodologies employed by different studies pose challenges when comparing findings across studies. To explore the molecular mechanisms of EDCs in a systematic manner, we established a data-driven computational approach to meta-analyze 30 human, mouse, and rat liver transcriptomic datasets for 4 EDCs, namely bisphenol A (BPA), bis(2-ethylhexyl) phthalate (DEHP), tributyltin (TBT), and perfluorooctanoic acid (PFOA). Our computational pipeline uniformly re-analyzed pre-processed quality-controlled microarray data and raw RNAseq data, derived differentially expressed genes (DEGs) and biological pathways, modeled gene regulatory networks and regulators, and determined CMD associations based on gene overlap analysis. Our approach revealed that DEHP and PFOA shared stable transcriptomic signatures that are enriched for genes associated with CMDs, suggesting similar mechanisms of action such as perturbations of peroxisome proliferator-activated receptor gamma (PPARγ) signaling and liver gene network regulators VNN1 and ACOT2. In contrast, TBT exhibited highly divergent gene signatures, pathways, network regulators, and disease associations from the other EDCs. In addition, we found that the rat, mouse, and human BPA studies showed highly variable transcriptomic patterns, providing molecular support for the variability in BPA responses. Our work offers insights into the commonality and differences in the molecular mechanisms of various EDCs and establishes a streamlined data-driven workflow to compare molecular mechanisms of environmental substances to elucidate the underlying connections between chemical exposure and disease risks.

Objective: Radiotherapy (RT) is the first choice in the treatment of nasopharyngeal carcinoma (NPC) but there are many adverse reactions. There is evidence that Aidi injection can improve the effect of RT and reduce the occurrence of adverse reactions after RT, but there is still a lack of evidence-based study. The objective of this study was to evaluate the efficacy and safety of Aidi injection combined with RT in the treatment of NPC. Methods: The PubMed, Cochrane Library, CNKI, EMBASE, Web of Science, CBM, Wanfang, and VIP data were thoroughly searched for randomized controlled trials (RCTs) on Aidi injection combined with RT against NPC until February 2021. The literature was screened, extracted, and evaluated by 2 investigators independently. Meta-analysis was performed by RevMan5.3 and Stata 14.0, and the quality of evidence was evaluated by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: In this study, we included 9 RCT studies involving 422 patients. The results showed significant between-group differences in complete remission rate (CRR) [relative risk (RR) = 1.17, 95% CI (1.04, 1.31), P =.009], Karnofsky Performance Status Scale (KPS) score [RR = 1.30, 95% CI (1.19, 1.42), P <.00001], leukopenia [RR = 0.65, 95% CI (0.54, 0.78), P <.00001], hemoglobin reduction [RR = 0.60, 95% CI (0.43, 0.84), P =.003], nausea and vomiting [RR = 0.60, 95% CI (0.45, 0.80), P =.0004], oropharyngeal mucosa injury (OMI) [RR = 0.25, 95% CI (0.15, 0.44), P <.00001], but the differences were not statistically significant in total effective rate (TER) [RR = 1.03, 95% CI (0.98, 1.08), P =.20 > 0.05], thrombocytopenia [RR = 0.78, 95%CI (0.52,1.16), P =.22 >.05], and skin injury [RR = 0.81, 95% CI (0.64, 1.04), P =.1 >.05]. Conclusion: Aidi injection combined with RT can improve patients' quality of life (KPS score) and reduce the adverse reactions caused by RT (such as leukopenia, hemoglobin reductio，OMI，nausea, and vomiting). However, limited by the quality and quantity of the included trials，more high-quality studies should be performed to verify our conclusions. [ABSTRACT FROM AUTHOR]

Abstract Background This paper is a systematic review and meta-analysis of the efficacy of available medications for the treatment of restricted/repetitive behavior (RRBs) in Autism Spectrum Disorder (ASD). Method We searched MEDLINE, Embase, PsycINFO, The Cochrane Library (Cochrane Database of Systematic Reviews (CDRS), the Cochrane Central Register of Controlled Trials (CENTRAL), database of Abstracts of Reviews of Effects (DARE)), Scopus, Epistimonikos, Clinicaltrials.gov, and included all randomized controlled trials published after 1993 that were directed at RRBs in patients with ASD of all ages. We extracted the relevant data from the published studies with a predefined data extraction form and assessed the risk of bias. The primary outcomes were change in restricted/repetitive behavior. We performed a meta-analysis using the random effect model and included studies with given mean and standard deviation. This study is registered with PROSPERO number CRD42018092660). Results We identified 14 randomized controlled trials that met initial inclusion criteria. After closer inspection, nine trials – involving 552 patients in total – were included in the final analysis. The meta-analysis found no significant difference between medications (including fluvoxamine, risperidone, fluoxetine, citalopram, oxytocin, N-Acetylcysteine, buspirone) and placebo in the treatment of RRBs in ASD (P = 0.20). Similarly, the sub-group meta-analysis also showed no significant difference between Selective Serotonin Reuptake Inhibitor (SSRIs) and placebo in the treatment of RRBs in ASD (P = 0.68). There was no evidence of publication bias. Conclusion This meta-analysis finds little support for the routine use of medications to treat restricted/repetitive behaviors in Autism Spectrum Disorder. Further research of large, balanced trials with precise assessment tools and long-term follow-up are needed. Trial registration The study protocol is registered in PROSPERO (Reference number: CRD42018092660) .

Impaired procedural learning has been suggested as a possible cause of developmental dyslexia (DD) and developmental language disorder (DLD), We evaluate this theory by performing a series of meta-analyses on evidence from the six procedural learning tasks that have most commonly been used to test this theory: the serial reaction time, Hebb learning, artificial grammar and statistical learning, weather prediction, and contextual cuing tasks. Studies using serial reaction time and Hebb learning tasks yielded small group deficits in comparisons between language impaired and typically developing controls (g = -.30 and -.32, respectively). However, a meta-analysis of correlational studies showed that the serial reaction time task was not a reliable correlate of language-related ability in unselected samples (r = .03). Larger group deficits were, however, found in studies using artificial grammar and statistical learning tasks (g = -.48) and the weather prediction task (g = -.63). Possible reasons for the discrepancy in results from different tasks that all purportedly measure procedural learning are highlighted. We conclude that current data do not provide an adequate test of the theory that a generalized procedural learning deficit is a causal risk factor for developmental dyslexia or developmental language disorder. [ABSTRACT FROM AUTHOR]

Background: This paper is a systematic review and meta-analysis of the efficacy of available medications for the treatment of restricted/repetitive behavior (RRBs) in Autism Spectrum Disorder (ASD). Method: We searched MEDLINE, Embase, PsycINFO, The Cochrane Library (Cochrane Database of Systematic Reviews (CDRS), the Cochrane Central Register of Controlled Trials (CENTRAL), database of Abstracts of Reviews of Effects (DARE)), Scopus, Epistimonikos, Clinicaltrials.gov, and included all randomized controlled trials published after 1993 that were directed at RRBs in patients with ASD of all ages. We extracted the relevant data from the published studies with a predefined data extraction form and assessed the risk of bias. The primary outcomes were change in restricted/repetitive behavior. We performed a meta-analysis using the random effect model and included studies with given mean and standard deviation. This study is registered with PROSPERO number CRD42018092660). Results: We identified 14 randomized controlled trials that met initial inclusion criteria. After closer inspection, nine trials – involving 552 patients in total – were included in the final analysis. The meta-analysis found no significant difference between medications (including fluvoxamine, risperidone, fluoxetine, citalopram, oxytocin, N-Acetylcysteine, buspirone) and placebo in the treatment of RRBs in ASD (P = 0.20). Similarly, the sub-group meta-analysis also showed no significant difference between Selective Serotonin Reuptake Inhibitor (SSRIs) and placebo in the treatment of RRBs in ASD (P = 0.68). There was no evidence of publication bias. Conclusion: This meta-analysis finds little support for the routine use of medications to treat restricted/repetitive behaviors in Autism Spectrum Disorder. Further research of large, balanced trials with precise assessment tools and long-term follow-up are needed. Trial registration: The study protocol is registered in PROSPERO (Reference number: CRD42018092660). [ABSTRACT FROM AUTHOR]

At present, surgical resection is the main method of the treatment of haemorrhoids, but is easy to recur after surgery. Recently, it is reported that acupuncture has a beneficial influence on haemorrhoids. Thus, whether acupuncture is effective in the treatment of haemorrhoids is the key in this meta-analysis. To evaluate the clinical efficacy of the treatment of combination of acupuncture and Chinese medicine in haemorrhoids by meta-analysis, which provide a scientific, effective and feasible evidence for clinical decision-making and practice. A systematic review and meta-analysis of randomized clinical trials (RCTs). A meta-analysis was performed by using Review Manager 5.3. All RCTs about combination of acupuncture and Chinese medicine versus Chinese medicine alone were selected and assessed for inclusion. The effective rate (ER), recurrence rate(RR),Symptom score before and after treatment (perianal edema, hemafecia, perianal pain, pruritus ani, prolapse of haemorrhoids) were the outcomes analyzed in this meta-analysis. II RCTs and 976 patients were included. The methodological quality of most included trials was low to moderate. In this meta-analysis, the clinical efficacy of combination of acupuncture and Chinese medicine was more effective than only Chinese medicine used in haemorrhoids. The effective rate [OR=5.24,95%CI(3.72,7.40),P<0.00001], recurrence rate [0R=0.29, 95%CI(O.II, 0.73),P=0.009], perianal edema [WMD=-0.74,95%CI-0.90 to-0.59,P<0.00001], hemafecia [WMD=-0.78,95%CI-0.89 to-0.67.P<0.00001], perianal pain[WMD=-0.72,95%CI-0.94 to-0.50,p<0.00001], pruritus ani [WMD=-0.75,95%CI-0.92 to-0.58,P<0.00001] and prolapse of haemorrhoids [WMD=-0.43,95%CI-0.84 to-0.02,P=0.04] were shown in this meta-analysis.(OR: odds ratio; CI: confidence interval; WMD: weighted mean difference). There was about 96% of the clinical efficiency in the treatment of acupuncture plus Chinese medicine in haemorrhoids and 89% of that used in Chinese medicine alone, which indicates clearly that 7% higher efficiency in the experimental group compared with the control group. The treatment of combination of acupuncture and Chinese medicine in haemorrhoids is more useful than Chinese medicine alone applied in piles, which is shown in 91% of clinical effects in average. [ABSTRACT FROM AUTHOR]

The metabolic syndrome (MetS) is responsible for an increased risk of type 2 diabetes, cardiovascular diseases and is associated with all-cause and cardiovascular mortality. Economic and social vulnerability is not an easy concept to grasp, but some studies investigate the association between MetS and socioeconomic and demographic factors, deprivation (more often correlations rather than causal one due to data). This work aims to assess the association between MetS and socio-economic gradient (SEG) in the literature by performing a meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews were followed. The raw list of studies extracted from PubMed as regard to the inclusion/exclusion criteria was imported in Word. Studies were filed with regard to our three definitions of SEG and their title. Subgroup analysis were performed considering several definitions of Mets: NCEP-ATPIII and IDF2006. The overall multivariable-adjusted OR showed that the risk of MetS was significantly increased in association with SEG The results of the subgroup analysis showed an increased risk of MetS in association with SEG when IDF definition was considered. Targeted interventions must be implemented in a specific way as prevention campaigns aimed at the general population are generally not adapted to this particular vulnerable population. [ABSTRACT FROM AUTHOR]

The paper deals with meta-analysis of 259 dendrochronological series of mountain trees – Bosnian pine, Norway spruce and beech from 14 locations in Bulgaria for eustress investigation. The chronologies were analyzed by the original SPPAM 2.0 application. The tree ring width sequences were approximated with polynomials with determination coefficients, R2 ≥ 0.45. The growth index (It – the ratio between measured and approximated value of tree ring width) was computed. Years with It less than the threshold values were considered as eustress ones. The four grade scales for assessment of frequency, duration and depth of eustress was proposed. For the studied tree species and locations, the obtained eustress periods are as follows, respectively for the Bosnian pine, Norway spruce and beech: 42 (K=9.1), 30 (K=3.4) and 37 (K=3) on average. The obtained eustress characteristics are respectively: Average Depth, Aav = 0.16, 0.26 and 0.28; Average Duration, Dav = 2, 2.5 and 2.3 years; and Average Frequency, Fav = 10, 33 and 34 years over 100 years. The risk for The stands of two studied locations of spruce and three locations of beech were established to be in some risk. They require further monitoring. The predominance of cold-dry and hot-wet years in total number of adverse climatic years (with eustress) for the Bosnian pine, as well as hot-dry and cold-wet years for spruce and beech stands was established. The influence of climatic types of years on the eustress appearance for tree years periods have also been investigated. Proposed holistic approach for meta-analyses of series (eustress identification in radial growth of stems) is convenient for the fast monitoring of forest communities state and for recognizing the stands under risk. The capability of approach allows expression of reactive functional types of trees (PFTs) as groups of trees with the similar behavior to the influence of climatic types of years, and with similar characteristics of eustress periods. These PFTs can support the development of different local, regional and global models. The originality of approach applied includes: meta-analysis, new software, characteristics, indixes and coefficients.

Objective Oral candidiasis is the most common fungal infection and can be attributed in part to dysbiosis, an imbalance in the resident oral microflora. Therefore, probiotics, which counter pathogenic microorganisms through competitive, antagonistic, and immunological effects, have been used by some clinicians. To date, the effect of probiotics in preventing oral candidiasis in the elderly is controversial. A systematic review that summarizes and critically appraises the available clinical trials is therefore necessary. Design Electronic searches were performed using the Pubmed, Embase, and Cochrane databases. Only randomized controlled trials were included. The Mantel–Haenszel test was used to appraise the odds ratio for single studies and an overall combined odds ratio for all studies combined. Results Three studies matched the inclusion criteria and were homogeneous. The data from one study that estimated candida growth from plaque and saliva were subdivided, thus a total of four studies with 595 people were included. The overall combined odds ratio was 0.54 (95% CI: 0.38–0.77). Three studies provided that active treatment reduced the risk of oral candidiasis more than placebo: Hatakka et al. (OR 0.51, 95% CI 0.26 to 0.97; 192 participants, plaque); Kraft-Bodi et al. (OR 0.46, 95% CI 0.24 to 0.86; 174 participants, palatal); Kraft-Bodi et al. (OR 0.50, 95% CI 0.26 to 0.98; 174 participants, plaque), while one study provided reverse result: Ishikawa et al. (OR 1.24, 95% CI 0.48 to 3.58; 55 participants, saliva). Conclusion Probiotics have a preventative effect on oral candidiasis in the elderly. [ABSTRACT FROM AUTHOR]

In a Bayesian approach, uncertainty explained by a prior distribution that contains information about an uncertain parameter. Determination of the prior distribution is important in because it impacts the posterior inference. The objective of this study is to use metaanalysis for proportion to obtain prior information about patients with breast cancer stage I who undergoing modified radical mastectomy treatment and applied Bayesian approach. R and WinBUGS programs are performed for meta-analysis and Bayesian approach respectively. [ABSTRACT FROM AUTHOR]

Peer Instruction is an interactive teaching method to improve learning in higher education. It has been used in a wide range of courses and countries to create interactivity during lectures. The meta -analysis is based on 29 studies ( N = 4738), and aims to examine the effect of Peer Instruction on learning gains and identify moderating variables. Peer Instruction has a positive impact on learning compared to traditional teaching methods, and differences can be observed in both informational and cultural variables. It appears to be most effective in collectivist countries and in individualist countries that place a high value on social interaction, compared to those encouraging individual learning. Findings invite researchers to take the cultural values of countries into consideration. [ABSTRACT FROM AUTHOR]

As a result of climate change, drought is predicted to pose greater pressure on food production system than in the past. At the same time, crop yield co-varies with both environmental (e.g., water, temperature, aridity) and agronomic variables (i.e., crop species, soil texture, phenological phase). To improve our quantitative understanding on the effects of these co-varying factors on agricultural productivity, we synthesized previous meta -analysis studies summarizing the results of numerous independent field experiments on drought and its effect on the production of cereal, legume, root and/or tuber (root/tuber) crops. We also included new crops species that were not covered in previous meta -analyses and the effects of heat stress. Our results indicated that cereals tended to be more drought resistant than legumes and root/tubers. Most crops were more sensitive to drought during their reproductive (i.e., grains filling, tuber initiation) than during their vegetative phase, except for wheat, which was also sensitive during vegetative phase. Recovery from drought impact at reproductive phase was either: (i) unfeasible for crops experiencing damage to their reproductive organs (e.g., maize, rice) or (ii) limited for root/tuber crops, provided that water was abundant during the subsequent root/tuber bulking period. Across soil texture, the variability of yield reduction for cereals was also lower in comparison to legume or root/tuber crops, probably due to the extensive and deep rooting system of cereal crops. As crop species, plant phenology, and soil texture were important co-varying factors in determining drought-induced crop yield reduction, no single approach would be sufficient to improve crop performance during drought. Consequently, a combination of approaches, particularly site-specific management practices that consider soil conditions (i.e., intercropping, mulching, and crop rotation) and selection of crop varieties adjusted to the local climate should be adopted in order to improve the sustainability of agricultural production in a changing climate. [ABSTRACT FROM AUTHOR]

Background and objective Lung cancer is one of the most common cancers worldwide, especially in China. It has been proved that matrix metalloproteases (MMPs) play a key role in malignant cell metastasis. There have been a considerable number of studies investigating MMP polymorphisms in relation to various cancers. However, the associations of MMP polymorphisms with risk of lung cancer are lack of consistency. The aim of this study is to assessthe association of MMP polymorphisms with risk of lung cancer by conducting a Meta -analysis from all eligible casecontrol studies published to date. Methods To identify all studies that examined the association of polymorphisms in the promoter of MMP1, MMP2 and MMP9 with lung cancer, we conducted a computerized literature search of PubMed and MEDLINE database (before March, 2009). Two investigators independently extracted the data and reached a consensus on all items. Results Eight case-control studies, including 4 467 lung cancer cases and 4 051 controls, were selected for Meta -analysis to better assess the purported associations of common MMPs polymorphisms with risk of lung cancer. Our results suggest that MMP2 -735C/T polymorphism is significantly modified risk of lung cancer. Comparing with the wild-735C allele, the variant T allele decreased risk of developing lung cancer (OR=0.72, 95%CI: 0.61-0.85, P =0.0001). Other polymorphisms, including MMP1 -1607 1G/2G, MMP2 -1306C/T and MMP9 -1562C/T, are not associated with risk of lung cancer. Conclusion The present study indicates that the MMP2 -735C/T polymorphism is associated with the risk of lung cancer. Lager studies should be required to warrant the association of MMP9-1562C/T polymorphism with risk of lung cancer.

Background and objective In the past years, many reports on Kanglaite were publicated in China, researchers across the country. The aim of this study is to review the effectiveness and safety of Kanglaite for treating advanced non-small-cell lung cancer. Methods Authors searched the Cochrane Library, Pubmed, Embase, Cancerlit,CBM, CNKI and VIP. Mannual and additional search were also conducted. All randomized controlled trials/quasi- RCT comparing Kanglaite with other lung cancer treatment were included. Two reviewers independently performed data extraction and appraised the publications using the Juni instrument, disagreements were resolved by consensus. Double data were entered and analyzed by RevMan 4.2 software are by Cochrane Collaboration. Results Sixteen reports wereincluded in the meta-analysis. The quality of 16 studies was low. Pooling data of 5 studies indicated that the effect of Kanglaite+NP (Vinorelbine+Cisplatin) was better than NP with RR 1.46, 95% Confidence Interval 1.13 to 1.91. Pooling data of 3 studies of MVP (Mitomycin+Vindsine+ Cisplatin) plus Kanglaite indicated that the effect was better with RR 1.84, 95%CI 1.22 to 2.76. Pooling data of 2 studies showed that the effect of GP (Gemcitabine+Cisplatin) plus Kanglaite was better than GP with RR 1.63, 95%CI 1.09 to 2.43. Fourteen studies revealed that Kanglaite may reduce the side-effectinduced by regular treatment. Ten studies showed regular treatment plus Kanglaite can stabilite/improve quality of life. Conclusion Kanglaite can enhance clinical effect of regular treatment, reduce side-effect and stabilite/improve quality of life, but the effect of Kanglaite being used in clinical settings needs to be confirmed by further large and multicenter.

Anthropogenic inputs of reactive nitrogen (N) to terrestrial ecosystems have increased considerably over the past several decades. Soil microorganisms provide numerous ecosystem services and are closely linked to the global carbon cycle through decomposition of organic material. The objectives of this study were to quantify the long- and short-term effects of mineral N input (ammonium, nitrate or urea) on soil microorganisms in permanent grassland and annual cropping systems. Conducting a meta -analysis, we found that in grassland studies (n = 54), soil microbial biomass (SMB) decreased significantly by 12% with N addition, while SMB increased significantly by 13.6% in annual crops (n = 150). Pronounced shifts among major microbial groups from N additions were not evident in our analysis, even though individual studies sometimes found significant effects of N input on PLFA profiles. We found the best support for the hypothesis that higher crop productivity in annual cropping systems brought on by fertilization increases plant residue inputs, which in turn increases SMB in the long term. In the short term, N inputs may also increase primary production in permanent grassland. However, N inputs gradually reduce grassland plant species richness which likely leads to the observed decrease in SMB. Over time, the effect of plant species richness on SMB becomes more pronounced. Our analysis reveals that management is an important consideration in predicting how ecosystems respond to environmental change and highlights the complexity and diversity of plant-microbial interactions, and underscores the immense value of long-term field trials. [ABSTRACT FROM AUTHOR]

Toxoplasmosis is a common and serious parasitic disease with high prevalence and global distribution in human and other warm-blooded vertebrates. Though the infection of Toxoplasma gondii is usually asymptomatic in healthy people, it can lead to severe pathological effects to the fetus of infected women and immunocompromised patients. So pinpointing the risk factors and control procedures are of important works among these populations. In order to reach this goal, we conducted a systematic review and meta -analysis to identify the seroprevalence rate of T. gondii infection among Iranian pregnant women population to achieve a comprehensive explanation of the disease condition in Iran for future use. English electronic databases (PubMed, Science Direct, Scopus, Ovid and Cochrane) and Persian language databases (Scientific Information Database, Iran Medex, Magiran and Iran Doc) were searched. Furthermore, the proceedings of Iranian parasitology congresses were explored manually. Our review resulted in a total of 50 publications meeting the inclusion criteria during Jan 1990–June 2015. Totally, 20221 women had been tested during this period of which 7724 women had seropositivity for IgG. According to results of heterogeneity test, either Der Simonian and Laird’s random‐effects method or Mantel‐Haenszel’s fixed‐effects method were used to pool the estimations. Weighted overall prevalence of toxoplasmosis in pregnant women were obtained using random-effects model, which was estimated 41% (95% CI = 36–45%). Also IgG and IgM antibodies was obtained 38% (95% CI = 34–42%) and 4% (95% CI = 3–5%), respectively. The highest and the lowest seroprevalence of toxoplasmosis in five geographical zones of Iran were observed in South 53% (95% CI = 30–77%) and East 33% (95% CI = 23–42%), respectively. In order to detect publication bias, Egger’s regression test was done which revealed that publication bias might not have a significant influence on overall prevalence estimate ( P = 0.89). Multivariate analysis showed that there’s a statistically significant correlation between toxoplasmosis and two risk factors including “place of residence” ( P = 0.005) and “contact with cat” ( P = 0.002). There was no significant difference between toxoplasmosis and the other surveyed risk factors. It is highly recommended to further study for the aim of better disease management and developing more efficient diagnostic tests. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk factors for posthepatectomy liver failure (PHLF)in patients with hepatocellular carcinoma (HCC)and to provide a theoretical basis for the prediction and prevention of PHLF.Methods A meta -analysis was performed on the studies on risk factors for PHLF in HCC patients published in China from January 1990 to June 2013 by searching SinoMed,VIP,CNKI, and Wanfang Data and manual retrieval of related articles and references.Results A total of 11 studies involving 2859 patients treated with hepatectomy were included in the meta -analysis.The incidence of PHLF was significantly lower in Child -Pugh A patients than in the con-trol group (pooled OR =6.28,95% CI:4.55 -8.65).Patients with prealbumin levels less than 170 mg/dl had an increased incidence of PHLF (pooled OR =4.96,95% CI:3.03 -8.10).Patients with cirrhosis had a higher incidence of PHLF than those without cirrhosis (pooled OR =4.14,95% CI:2.46 -6.98). Patients with an intraoperative blood loss less than 1000 ml had a lower incidence of PHLF than the control group (pooled OR =5.62,95% CI:3.46 -9.11).The incidence of PHLF was lower in patients with a tumor diameter less than 10 cm and patients with an extent of resection less than hepatectomy than in the control group (pooled OR =2.69,95% CI:1.58-4.57; pooled OR =1.64,95%CI:1.12 -2.40). Age ≥60 years and intraoperative blood transfusion increased the incidence of PHLF (pooled OR =1.73,95% CI:1.25 -2.39; pooled OR =3.79,95% CI:2.20 -6.51). Sex and hepatic inflow occlusion were not sig-nificantly associated with the development of PHLF (P >0.05) Conclusion Advanced age,advanced preoperative Child -Pugh class,low prealbumin level,high intraoperative blood loss,large tumor diameter, large extent of hepatectomy, cirrhosis, and intraoperative blood transfusion are risk factors for the development of PHLF. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa (PA) is an opportunistic pathogen that produces widespread and often overwhelming infections. Among different virulence factors, toxins are important bacterial agent which increases PA pathogenesis especially in immunocompromised patients. The aim of this meta-analysis was to determine the prevalence of exotoxin production in PA isolates in the world. Also according to the importance of drug resistance in isolates with more pathogenicity this estimation was conducted in resistant isolates. A systematic search was conducted in international database like PubMed, Scopus, Web of Science and Embase up to December 2018. Joanna Briggs Institute Checklist was used to evaluate the quality assessment of studies. Random effect model was applied to pool the prevalence data. Stata 13 software was used to analyze the data. Total of 58 eligible studies that fulfilled the inclusion criteria of the study were selected for qualitative synthesis. Among exotoxins; the highest prevalence was related to exoT (0.83 (CI95%: 0.64–0.96)). Lowest prevalence rate was seen in exoU with estimated prevalence 0.32 (CI95%: 0.24–0.41). In Carbapenem resistance isolates exoA and exoT had the highest prevalence (1.00 (CI95%: 0.98–1.00)). This first meta-analysis on PA isolates with toxin potency indicated high prevalence of exotoxin production in clinical isolates of PA which is an alarming point as a clinical aspect. It was found that the ExoT has the most prevalence rate among toxins. The results of simultaneous evaluation of exotoxins and antimicrobial resistance can develop treatment policies against PA infections in hospitals and hospitalized patients. • Pseudomonas aeruginosa (PA) as an opportunistic pathogen is the main cause of widespread and overwhelming hospital acquired infection due to an arsenal virulence factors such as toxins. • Among exotoxins; the highest prevalence was related to exoT (0.83 (CI95%: 0.64 – 0.96)). Lowest prevalence rate was seen in exoU with estimated prevalence 0.32 (CI95%: 0.24 – 0.41). • This first meta-analysis on PA isolates with toxin potency indicated high prevalence of exotoxin production in clinical isolates of PA which is an alarming point as a clinical aspect. [ABSTRACT FROM AUTHOR]