Comparative effects of different types of tree nut consumption on blood lipids: a network meta-analysis of clinical trials

2019 ◽  
Vol 111 (1) ◽  
pp. 219-227
Author(s):  
Kai Liu ◽  
Suocheng Hui ◽  
Bin Wang ◽  
Kanakaraju Kaliannan ◽  
Xiaozhong Guo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Blood Lipids ◽  
Randomized Clinical Trials ◽  
Ldl Cholesterol ◽  
Meta Analysis ◽  
Control Diet ◽  
Sensitivity Analyses ◽  
Second Best ◽  
Different Types

ABSTRACT Background Recent evidence has confirmed that nuts are one of the best food groups at reducing LDL cholesterol and total cholesterol (TC). However, the comparative effects of different types of nuts on blood lipids are unclear. Objectives This network meta-analysis of randomized clinical trials aimed to assess the comparative effects of walnuts, pistachios, hazelnuts, cashews, and almonds on typical lipid profiles. Methods We conducted literature searches to identify studies comparing ≥2 of the following diets—walnut-enriched, pistachio-enriched, hazelnut-enriched, cashew-enriched, almond-enriched, and control diets—for the management of triglycerides (TGs), LDL cholesterol, TC, and HDL cholesterol. Random-effects network meta-analyses, ranking analyses based on the surface under the cumulative ranking (SUCRA) curves, and sensitivity analyses according to the potential sources of heterogeneity across the included studies were performed for each outcome. Results Thirty-four trials enrolling 1677 participants were included in this study. The pistachio-enriched diet was ranked best for TG (SUCRA: 85%), LDL cholesterol (SUCRA: 87%), and TC (SUCRA: 96%) reductions. For TG and TC reductions, the walnut-enriched diet was ranked as the second-best diet. Regarding LDL cholesterol reduction, the almond-enriched diet was ranked second best. The pistachio-enriched and walnut-enriched diets were more effective at lowering TG, LDL cholesterol, and TC compared with the control diet. Regarding TG and TC reductions, the pistachio-enriched diet was also more effective than the hazelnut-enriched diet. For TG reduction, the walnut-enriched diet was better than the hazelnut-enriched diet. However, these findings are limited by the low quality of evidence ratings. In addition, the quality of this network meta-analysis was limited by the small number and generally poor reporting of available studies. Conclusions The pistachio-enriched and walnut-enriched diet could be better alternatives for lowering TGs, LDL cholesterol, and TC compared with other nut-enriched diets included in this study. The findings warrant further evaluation by more high-quality studies. This network meta-analysis was registered at www.crd.york.ac.uk/PROSPERO as CRD42019131128.

scholarly journals Blockade of the angiotensin system improves mental health domain of quality of life: A meta-analysis of randomized clinical trials

2017 ◽  
Vol 52 (1) ◽  
pp. 24-38 ◽  
Author(s):  
Daniel J Brownstein ◽  
Estela Salagre ◽  
Cristiano Köhler ◽  
Brendon Stubbs ◽  
João Vian ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Angiotensin System ◽  
Health Domain

scholarly journals Intervention effectiveness by pharmacists integrated within an interdisciplinary health team on chronic complex patients

2019 ◽  
Vol 30 (5) ◽  
pp. 886-899
Author(s):  
Hector Acosta-García ◽  
Eva Rocío Alfaro-Lara ◽  
Susana Sánchez-Fidalgo ◽  
Daniel Sevilla-Sánchez ◽  
Eva Delgado-Silveira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Interdisciplinary Team ◽  
Cost Utility ◽  
Specific Method ◽  
Complex Patients ◽  
Health Related

Abstract Background Nowadays, it is difficult to establish a specific method of intervention by the pharmacist and its clinical repercussions. Our aim was to identify interventions by pharmacists integrated within an interdisciplinary team for chronic complex patients (CCPs) and determine which of them produce the best results. Methods A systematic review (SR) was performed based on PICO(d) question (2008–18): (Population): CCPs; (Intervention): carried out by health system pharmacists in collaboration with an interdisciplinary team; (Comparator): any; (Outcome): clinical and health resources usage outcomes; (Design): meta-analysis, SR and randomized clinical trials. Results Nine articles were included: one SR and eight randomized clinical trials. The interventions consisted mainly in putting in order the pharmacotherapy and the review of the medication adequacy, medication reconciliation in transition of care and educational intervention for health professionals. Only one showed significant improvements in mortality (27.9% vs. 38.5%; HR = 1.49; P = 0.026), two in health-related quality of life [according to EQ-5D (European Quality of Life—5 Dimensions) and EQ-VAS (European Quality of Life—Visual Analog Scale) tests] and four in other health-related results (subjective self-assessment scales, falls or episodes of delirium and negative health outcomes associated with medication). Significant differences between groups were found in hospital stay and frequency of visits to the emergency department. No better results were observed in hospitalization rate. Otherwise, one study measured cost utility and found a cost of €45 987 per quality-adjusted life year gained due to the intervention. Conclusions It was not possible to determine with certainty which interventions produce the best results in CCPs. The clinical heterogeneity of the studies and the short follow-up of most studies probably contributed to this uncertainty.

Mental health quality of life after bariatric surgery: A systematic review and meta-analysis of randomized clinical trials

2018 ◽  
Vol 9 (1) ◽  
pp. e12290 ◽  
Author(s):  
Alejandro Szmulewicz ◽  
Kerollos N. Wanis ◽  
Ashley Gripper ◽  
Federico Angriman ◽  
Jeff Hawel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Systematic Review ◽  
Bariatric Surgery ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Health Quality ◽  
Health Quality Of Life

Efficacy of acupuncture in the management of fatigue related to breast cancer antineoplastic treatment: a systematic review

2019 ◽  
Vol 9 (2) ◽  
pp. 264-272
Author(s):  
Ana Carolina Moraes Costa ◽  
Alena Peixoto Medrado
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Total Sample ◽  
Inclusion Criteria ◽  
Antineoplastic Treatment

INTRODUCTION: Breast cancer is the most prevalent cancer among women worldwide. Similar to chemotherapy, antineoplastic treatment is associated with many side effects, with fatigue being one of the most common. It is important to investigate potential treatments, especially non-pharmacological alternatives, to control symptoms that directly affect women’s quality of life. OBJECTIVE: The objective of this study was to provide scientific evidence to verify the efficacy of acupuncture in the management of fatigue in patients with breast cancer. METHODS: This study involved a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology. Randomized clinical trials published in indexed scientific journals were compiled. The literature search was performed using the electronic databases, PubMed, PEDro, and BIREME, using the descriptors ‘breast cancer’, ‘fatigue’, ‘acupuncture’, and ‘randomized trial’. Inclusion criteria included fully available online articles that were classified as randomised clinical trials published from 2012 to 2017 in either English or Portuguese. Study eligibility was based on the Population, Intervention, Control, Outcome, and Study (PICO) design criteria, in which the (1) population included women 18–65 years of age with breast cancer, (2) intervention was acupuncture, (3) comparison referred to standard care or sham acupuncture, and (4) outcome was the evaluation of fatigue. The PEDro scale was applied to evaluate the quality of the studies. WebQualis was also used to evaluate the quality of the journals of the selected articles. RESULTS: In total, 66 articles were selected, but only four fulfilled all inclusion criteria, giving a total sample size of 620 women. All trials evaluated the effect of acupuncture on fatigue and other symptoms related to the treatment of breast cancer with different treatment durations. Three articles reported statistically significant results, and all articles described clinical improvement in fatigue after the application of acupuncture. The average PEDro score of the manuscripts was 6.25. All articles were published in non-Brazilian journals with WebQualis scores that ranged from B2 to A1. CONCLUSION: Scientific evidence confirms the efficacy of acupuncture in the management of fatigue reported by women with breast cancer. Acupuncture was effective in reducing fatigue in the studies selected for this review.

scholarly journals Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Hao Hu ◽  
Zhi-Yong Xu ◽  
Qian Zhu ◽  
Xi Liu ◽  
Si-Cong Jiang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Clinical Trials ◽  
Brain Metastases ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Advanced Lung Cancer ◽  
Tumor Type ◽  
Significant Difference

BackgroundBrain metastases (BMs) indicate poor outcomes and are commonly excluded in immunotherapy clinical trials in advanced lung cancer; moreover, the effect of BM status on immunotherapy efficacy is inconsistent and inconclusive. Therefore, we conducted a meta-analysis to assess the influence of BM status on immunotherapy efficacy in advanced lung cancer.MethodsElectronic databases and all major conference proceedings were searched without language restrictions according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We extracted randomized clinical trials on lung cancer immunotherapy that had available overall survival (OS) and/or progression-free survival (PFS) data based on the BM status. All analyses were performed using random effects models.ResultsFourteen randomized clinical trials with 9,089 patients were identified. Immunotherapy conferred a survival advantage to BM patients [OS-hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.58–0.90; P = 0.004; and PFS-HR, 0.68; 95% CI, 0.52–0.87, P = 0.003]. Non-BM patients could also derive a survival benefit from immunotherapy (OS-HR, 0.76; 95% CI, 0.71–0.80; P <0.001; and PFS-HR, 0.68; 95% CI, 0.56–0.82, P <0.001). The pooled ratios of OS-HRs and PFS-HRs reported in BM patients versus non-BM patients were 0.96 (95% CI, 0.78–1.18; P = 0.72) and 0.97 (95% CI, 0.79–1.20; P = 0.78), respectively, indicating no statistically significant difference between them. Subsequent sensitivity analyses did not alter the results. Subgroup analyses according to tumor type, line of therapy, immunotherapy type, study design, and representation of BM patients reconfirmed these findings.ConclusionWe demonstrated that BM status did not significantly influence the immunotherapy efficacy in lung cancer, suggesting that both BM and non-BM patients could obtain comparable benefits.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier (CRD42020207446).

scholarly journals Adverse Events Associated With Anti-IL-23 Agents: Clinical Evidence and Possible Mechanisms

2021 ◽  
Vol 12 ◽  
Author(s):  
Yi Ru ◽  
Xiaojie Ding ◽  
Ying Luo ◽  
Hongjin Li ◽  
Xiaoying Sun ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Adverse Event ◽  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
The Cochrane Library ◽  
Specific Symptoms

BackgroundAnti-interleukin (IL)-23 agents are widely used for autoimmune disease treatment; however, the safety and risks of specific symptoms have not been systematically assessed.ObjectivesThe aim of this study was to summarize the characteristics and mechanisms of occurrence of five immunological and non-immunological adverse events caused by different anti-IL-23 agents.MethodsThe Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched for eligible randomized clinical trials published from inception through May 1, 2020. Randomized clinical trials that reported at least one type of adverse event after treatment were included, regardless of sex, age, ethnicity, and diagnosis. Two investigators independently screened and extracted the characteristics of the studies, participants, drugs, and adverse event types. The Cochrane Handbook was used to assess the methodological quality of the included randomized clinical trials. Heterogeneity was assessed using the I2 statistic. Meta-regression was applied to determine the sources of heterogeneity, and subgroup analysis was used to identify the factors contributing to adverse events.ResultsForty-eight studies were included in the meta-analysis, comprising 25,624 patients treated with anti-IL-23 agents. Serious immunological or non-immunological adverse events were rare. Anti-IL-12/23-p40 agents appeared to cause adverse events more easily than anti-IL-23-p19 agents. The incidence of cancer did not appear to be related to anti-IL-23 agent treatment, and long-term medication could lead to mental diseases. The prevention of complications should be carefully monitored when administered for over approximately 40 weeks to avoid further adverse reactions, and the incidence of infection was the highest among general immunological adverse events.ConclusionsThe application of anti-IL-23 agents induced a series of immunological and non-immunological adverse events, but these agents tend to be well-tolerated with good safety profiles.

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