Important Food Sources of Fructose-Containing Sugars and Blood Pressure: A Systematic Review and Meta-Analysis of Controlled Trials

Abstract Objectives Overconsumption of fructose-containing sugars may increase blood pressure. Whether this effect is mediated by the food matrix is unclear. We conducted a systematic review and meta-analysis of controlled feeding trials of the effect of food sources of fructose-containing sugars at different levels of energy control on blood pressure (NCT02716870). Methods We searched MEDLINE, Embase and the Cochrane Library through January, 2020 for controlled trials ≥7d. Trial designs were prespecified based on energy control: substitution (energy matched replacement of sugars in the diet); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in the diet) trials. Outcomes were systolic blood pressure (SBP) and diastolic blood pressure (DBP). Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed by GRADE. Results We included 76 trials (121 trial comparisons, N = 4 302) assessing 9 food sources (sugar-sweetened beverages [SSBs], sweetened dairy alternatives, 100% fruit juice, fruit, dried fruit, sweets, added nutritive sweetener, sweetened cereal grains/bars, and mixed sources) across the 4 levels of energy control. Total fructose-containing sugars decreased SBP (mean difference, −2.76 mmHg [95% CI, −4.36, −1.16], P = 0.001) and DBP (−1.26 mmHg [−2.29, −0.23], P = 0.016) in addition trials and the removal of these sugars decreased SBP (−1.79 mmHg [−3.36, −0.21], P = 0.026) in subtraction trials. There was evidence of interaction by food source with fruit decreasing and sweets and mixed sources increasing SBP and DBP in addition trials and the removal of SSBs decreased SBP in subtraction trials. The certainty of evidence was generally moderate to low for all food source-outcome relationships, except for the decreasing-effect of fruit on DBP in addition trials (high). Conclusions Food source and energy control appear to mediate the effect of fructose-containing sugars on blood pressure. The evidence provides a good indication that fruit decreases while excess calories from SSBs, sweets and mixed sources increase blood pressure. More high-quality trials of different food sources are needed to improve our estimates. Funding Sources Diabetes Canada.

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Effect of Important Food Sources of Fructose-Containing Sugars on Biomarkers of Inflammation: A Systematic Review and Meta-Analysis of Controlled Trials

Current Developments in Nutrition ◽

10.1093/cdn/nzab053_076 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1083-1083

Author(s):

XinYe Qi ◽

Laura Chiavaroli ◽

Danielle Lee ◽

Sabrina Ayoub-Charette ◽

Tauseef Khan ◽

...

Keyword(s):

Systematic Review ◽

Food Source ◽

Meta Analysis ◽

Energy Levels ◽

Food Sources ◽

Cochrane Library ◽

Controlled Trials ◽

Energy Control ◽

Necrosis Factor Alpha ◽

Tnf Α

Abstract Objectives Excess calories as fructose may initiate pathways increasing biomarkers of inflammation. Whether this effect is mediated by the food matrix at different energy levels is unknown. We conducted a systematic review and meta-analysis of controlled feeding trials of the effect of food sources of fructose-containing sugars at different energy control levels on biomarkers of inflammation (NCT02716870). Methods We searched MEDLINE, Embase, and the Cochrane Library through January 15 2020 for controlled trials ≥7d. Trial designs were prespecified based on energy control: substitution (energy-matched replacement of sugar in the diet); addition (excess energy from sugar added to diets); subtraction (energy from sugar subtracted from diets); ad libitum (energy from sugar freely replaced in the diet). The primary outcome was C-reactive protein (CRP). Secondary outcomes were tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6). Independent reviewers extracted data and assessed the risk of bias. Certainty of evidence was assessed by GRADE. Results We included 48 trials (109 trial comparisons, n = 2108) assessing the effect of 10 food sources (SSBs, sweetened dairy, sweetened dairy alternatives (soy), fruit, 100% fruit juice, dried fruit, sweetened cereal grains/bars, sweets, added nutritive sweetener, and mixed sources) across the 4 levels of energy control. Total fructose-containing sugars had no effect on any outcome in any level of energy control. There was evidence of interaction by food source; in substitution trials, sweetened dairy alternative (soy) decreased CRP. In addition trials, fruit decreased while added nutritive sweetener increased TNF-α. The certainty of evidence was low for the effect of sweetened dairy alternative (soy) on CRP in substitution trials, and generally moderate for all other comparisons. Conclusions Food source more than energy control appears to mediate the effect of fructose-containing sugars on inflammation. The evidence provides some indication that sweetened dairy alternatives (soy) and fruit decrease and added nutritive sweeteners increase biomarkers of inflammation. More high-quality randomized trials of different fructose containing food sources are needed to improve our estimates. Funding Sources Diabetes Canada.

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Important Food Sources of Fructose-Containing Sugars and Adiposity: A Systematic Review and Meta-Analysis of Controlled Feeding Trials

Current Developments in Nutrition ◽

10.1093/cdn/nzab053_010 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1017-1017

Author(s):

Laura Chiavaroli ◽

Annette Cheung ◽

Sabrina Ayoub-Charette ◽

Amna Ahmed ◽

Danielle Lee ◽

...

Keyword(s):

Systematic Review ◽

Body Weight ◽

Body Fat ◽

Food Source ◽

Fruit Juice ◽

Meta Analysis ◽

Food Sources ◽

Cochrane Library ◽

Energy Control ◽

Feeding Trials

Abstract Objectives Sugar-sweetened beverages (SSBs) have been linked to weight gain. It is unclear if other food sources of fructose-containing sugars behave similarly. We conducted a systematic review and meta-analysis of controlled feeding trials to assess the effect of different food sources of fructose-containing sugars on body weight and markers of adiposity. Methods MEDLINE, Embase, and the Cochrane Library were searched through January 2020 for controlled feeding trials ≥2 weeks on the effect of fructose-containing sugars. Trial designs were prespecified by energy control: substitution (energy matched replacement of sugars in diets); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in diets). The primary outcome was body weight. Secondary outcomes were body mass index, body fat and waist circumference. Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed using GRADE. (NCT02558920) Results We identified 119 controlled trials (368 trial comparisons, N = 5263) assessing the effect of 10 food sources (SSBs, sweetened dairy alternative (soy), fruit juice, fruit drink, fruit, dried fruit, sweetened cereal grains/bars, sweets, added sweeteners and mixed sources). Total fructose-containing sugars increased body weight (mean difference, 0.29 kg [95% confidence interval, 0.05 to 0.53 kg], P = 0.017) and body fat in addition trials with no effect in other analyses or outcomes. There was evidence of interaction by food source in substitution trials with fruit reducing and mixed sources increasing some outcomes and in addition trials with 100% fruit juice reducing and SSBs and mixed sources increasing some outcomes. The overall certainty of evidence was moderate for the decreasing effect of fruit and fruit juice and the increasing effect of SSBs and mixed sources and high-to-very low for other comparisons. Conclusions Energy control and food source may mediate the effect of fructose-containing sugars on adiposity. The evidence provides good indication that fruit and 100% fruit juice decrease and SSBs and mixed sources increase markers of adiposity. More high-quality randomized trials of different foods are needed to improve our estimates. Funding Sources American Society for Nutrition, Diabetes Canada, CIHR, Mitacs.

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Important Food Sources of Fructose-Containing Sugars and Postprandial Lipids: A Systematic Review and Meta-Analysis of Controlled Feeding Trials

Current Developments in Nutrition ◽

10.1093/cdn/nzab053_003 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1010-1010

Author(s):

Fei Au-Yeung ◽

Laura Chiavaroli ◽

Tauseef Khan ◽

Andreea Zurbau ◽

Sabrina Ayoub-Charette ◽

...

Keyword(s):

Systematic Review ◽

Food Source ◽

Meta Analysis ◽

Good Evidence ◽

Food Sources ◽

Cochrane Library ◽

Energy Control ◽

Feeding Trials ◽

Ad Libitum ◽

Postprandial Lipids

Abstract Objectives Fructose providing excess calories has been shown to increase postprandial triglycerides (TAG). Whether this effect holds for different food sources of fructose-containing sugars is unclear. We conducted a systematic review and meta-analysis of controlled feeding trials on the effect of different food sources of fructose-containing sugars at different levels of energy control on postprandial blood lipids (NCT02716870). Methods MEDLINE, EMBASE, and Cochrane Library were searched through June 1st, 2020 for controlled feeding trials ≥7-days assessing the effect of food sources of fructose-containing sugars on postprandial lipids. Trial designs were prespecified based on energy control: substitution (energy matched replacement of sugars by other macronutrients); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients) trials. Independent reviewers extracted data and assessed risk of bias. Outcomes were postprandial TAG and apoB48. Certainty of evidence was assessed using GRADE. Results We included 29 trials (60 trial comparisons, N = 943) assessing 5 food sources (SSBs, fruit, sweets and desserts, added caloric sweetener and mixed sources) across 4 levels of energy control. Total fructose-containing sugars increased postprandial TAG in substitution (MD: 0.17 mmol/L [95% CI: 0.05, 0.30], P = 0.007), addition (0.38 mmol/L [0.13, 0.62], P = 0.003), and ad libitum (0.17 mmol/L [0.02, 0.31], P = 0.024) trials and increased apoB48 in addition trials (0.12 g/L [0.07, 0.18], P < 0.001).There was evidence of interaction by food source with SSBs increasing postprandial TAG and apoB48 in addition trials and mixed sources increasing postprandial TAG in ad libitum trials. The certainty of the evidence was “moderate” for SSBs increasing TAG in addition trials and mixed sources increasing TAG in ad libitum trials and “low” for all other comparisons. Conclusions Food source more than energy control appears to mediate fructose-containing sugars on postprandial lipids. Good evidence suggests that SSBs and mixed sources increase postprandial lipids while evidence is less certain for the lack of effect of other food sources. More high-quality trials of different food sources are needed. Funding Sources Primary: Diabetes Canada.

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Important Food Sources of Sugars and Body Weight: A Systematic Review and Meta-Analysis of Controlled Feeding Trials

Current Developments in Nutrition ◽

10.1093/cdn/nzaa063_018 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1620-1620

Author(s):

Annette Cheung ◽

Danielle Lee ◽

Nema McGlynn ◽

Sabrina Ayoub-Charette ◽

Fei Au-Yeung ◽

...

Keyword(s):

Systematic Review ◽

Body Weight ◽

Weight Gain ◽

Food Source ◽

Meta Analysis ◽

Food Sources ◽

Energy Control ◽

Sweetened Beverages ◽

Feeding Trials ◽

Ad Libitum

Abstract Objectives Sugar-sweetened beverages (SSBs) have been linked to weight gain, and it is unclear if other food sources of fructose-containing sugars behave similarily. We conducted a systematic review and meta-analysis of controlled feeding trials to assess the effect of different food sources of fructose-containing sugars on body weight. Methods MEDLINE, EMBASE, and The Cochrane library were searched through January 2019. We included controlled feeding trials of ≥2 weeks investigating the effect of different food sources of sugars. Four levels of energy control were prespecified: substitution (energy-matched comparisons); addition (energy from sugars added to diet); subtraction (energy from sugars subtracted from diet); or ad libitum (energy from sugars freely replaced). The primary outcome was body weight. Two independent reviewers extracted data and assessed risk of bias. Data were pooled using random effects models and expressed as mean differences (MDs) with 95% confidence intervals (CIs). GRADE assessed the certainty of evidence. Results We identified 110 controlled trials (N = 5133) assessing the effect of 7 different food sources of fructose-containing sugars (SSBs, fruit, fruit juice, dried fruit; baked goods, sweets, & desserts; mixed sources; added caloric sweeteners). No effect on body weight was observed in substitution trials, whereas there was an increasing effect in addition trials (MD, 0.23 kg [95% CI, 0.06 to 0.40]) and ad libitum trials (1.43 kg [0.78 to 2.16]), and a decreasing effect in subtraction trials (–0.52 kg [–1.02 to −0.02]). There was evidence of interaction by food source with fruit showing weight loss in substitution trials and SSBs showing weight gain in addition trials. The certainty of evidence was moderate for the effects in the addition and subtraction trials and high for the effects in the substitution and ad libitum trials. Conclusions Energy control and food source appear to mediate the effect of fructose-containing sugars on body weight. Food sources of fructose-containing sugars adding excess energy to diets (especially sugars-sweetened beverages) appear to lead to weight gain. There is low to moderate likelihood that more research will substantially alter our estimates (ClinicalTrials.gov Identifier, NCT02558920) Funding Sources American Society for Nutrition Foundation (commissioned and funded), Diabetes Canada.

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Effects of Melatonin Supplementation On Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Hormone and Metabolic Research ◽

10.1055/a-0841-6638 ◽

2019 ◽

Vol 51 (03) ◽

pp. 157-164 ◽

Cited By ~ 5

Author(s):

Amir Hadi ◽

Ehsan Ghaedi ◽

Sajjad Moradi ◽

Makan Pourmasoumi ◽

Abed Ghavami ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Sensitivity Analysis ◽

Randomized Controlled Trials ◽

Publication Bias ◽

Meta Analysis ◽

Favorable Effect ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled

AbstractMelatonin is a physiological indoleamine secreted from the pineal gland into the bloodstream. This hormone has antioxidant effects in cardiovascular disease, but the evidence regarding its effects on blood pressure (BP) has not been conclusive. Therefore, we assessed the impact of melatonin supplementation on systolic BP (SBP) and diastolic BP (DBP) through a systematic review and meta—analysis of available randomized controlled trials (RCTs). Medline, Scopus, Web of Science, Cochrane library, and Google scholar (until May 2018) were searched to identify potential RCTs with information on melatonin supplementation and BP. Mean Differences (MD) were pooled using a random-effects model. Standard methods were used for assessment of heterogeneity, sensitivity analysis, and publication bias. Pooling 5 RCTs (6 treatment arms) together identified significant reduction for SBP (MD: −3.43 mmHg, 95% confidence interval (CI): −5.76 to −1.09, p=0.004) and DBP (MD: −3.33 mmHg, 95% CI: −4.57 to −2.08, p<0.001) after supplementation with melatonin compared with control treatment. The sensitivity analysis indicated that the results were robust. We did not observe any evidence regarding publication bias. The findings of this meta-analysis support the overall favorable effect of melatonin supplementation on BP regulation.

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Effects of Telemedicine and mHealth on Systolic Blood Pressure Management in Stroke Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials

JMIR mhealth and uhealth ◽

10.2196/24116 ◽

2021 ◽

Vol 9 (6) ◽

pp. e24116

Author(s):

Meina Lv ◽

Tingting Wu ◽

Shaojun Jiang ◽

Wenjun Chen ◽

Jinhua Zhang

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Randomized Controlled Trials ◽

Usual Care ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Stroke Survivors ◽

Randomized Controlled

Background Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. Objective This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. Methods The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95% CI and 95% prediction interval (PI) were calculated. Results In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD –5.49; 95% CI –7.87 to –3.10; P<.001; 95% PI –10.46 to –0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD –9.09; 95% CI –12.71 to –5.46; P<.001) or only telephone (MD –4.34; 95% CI –6.55 to –2.13; P<.001; 95% PI –7.24 to –1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ≤1 week (MD –6.51; 95% CI –9.36 to –3.66; P<.001; 95% PI –12.91 to –0.10) or a baseline systolic blood pressure ≥140 mm Hg (MD –6.15; 95% CI –9.44 to –2.86; P<.001; 95% PI –13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. Conclusions In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke.

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Effects of Telemedicine and mHealth on Systolic Blood Pressure Management in Stroke Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials (Preprint)

10.2196/preprints.24116 ◽

2020 ◽

Author(s):

Meina Lv ◽

Tingting Wu ◽

Shaojun Jiang ◽

Wenjun Chen ◽

Jinhua Zhang

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Randomized Controlled Trials ◽

Usual Care ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Stroke Survivors ◽

Randomized Controlled

BACKGROUND Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. OBJECTIVE This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. METHODS The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95% CI and 95% prediction interval (PI) were calculated. RESULTS In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD –5.49; 95% CI –7.87 to –3.10; P<.001; 95% PI –10.46 to –0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD –9.09; 95% CI –12.71 to –5.46; P<.001) or only telephone (MD –4.34; 95% CI –6.55 to –2.13; P<.001; 95% PI –7.24 to –1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ≤1 week (MD –6.51; 95% CI –9.36 to –3.66; P<.001; 95% PI –12.91 to –0.10) or a baseline systolic blood pressure ≥140 mm Hg (MD –6.15; 95% CI –9.44 to –2.86; P<.001; 95% PI –13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. CONCLUSIONS In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke. CLINICALTRIAL

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Effects of pistachios on anthropometric indices, inflammatory markers, endothelial function, and blood pressure in adults: A systematic review and meta-analysis of randomized controlled trials

British Journal Of Nutrition ◽

10.1017/s0007114520004523 ◽

2020 ◽

pp. 1-27

Author(s):

Omid Asbaghi ◽

Amir Hadi ◽

Marilyn S. Campbell ◽

Kamesh Venkatakrishnan ◽

Ehsan Ghaedi

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Endothelial Dysfunction ◽

Randomized Controlled Trials ◽

Inflammatory Markers ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Anthropometric Indices ◽

Randomized Controlled

Abstract Evidence suggests that eating nuts may reduce the risk of cardiovascular disease (CVD). This study was intended to pool the data of all randomized controlled trials (RCTs) available to determine if pistachios confer a beneficial effect on anthropometric indices, inflammatory markers, endothelial dysfunction, and blood pressure. Without language restriction, PubMed, Scopus, Cochrane Library and Web of Science were searched for articles published from the earliest records to June 2019 investigating the effect of pistachio consumption on inflammation, endothelial dysfunction, and hypertension. Mean difference (MD) was pooled using a random-effects model. The Cochrane Risk of Bias tool was used to evaluate the quality of the studies. The meta-analysis of 13 RCTs with 563 participants indicated that pistachio consumption significantly decreased systolic blood pressure (SBP) (MD: -2.12 mmHg, 95% CI: -3.65 to -0.59, p=0.007), whereas changes in flow-mediated dilation (MD: 0.94 %, 95% CI: -0.99 to 2.86, p=0.813), diastolic blood pressure (MD: 0.32 mmHg, 95% CI: -1.37 to 2.02, p=0.707), C-reactive protein (MD: 0.00 mg/l, 95% CI: -0.21 to 0.23, p=0.942), tumor necrosis factor alpha (MD: -0.09 pg/ml, 95% CI: -0.38 to 0.20, p=0.541), body weight (MD: 0.09 kg, 95% CI: -0.38 to 0.69, p=0.697), body mass index (MD: 0.07 kg/m2, 95% CI: -0.16 to 0.31, p=0.553) and waist circumference (MD: 0.77 cm, 95% CI: -0.09 to 1.64, p=0.140) were not statistically significant. This systematic review and meta-analysis suggested the efficacy of pistachio consumption to reduce SBP levels. However, further large-scale studies are needed to confirm these results.

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Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽

10.3390/cancers13122984 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2984

Author(s):

Stepan M. Esagian ◽

Christos D. Kakos ◽

Emmanouil Giorgakis ◽

Lyle Burdine ◽

J. Camilo Barreto ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Transarterial Chemoembolization ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Curative Intent ◽

Randomized Controlled

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

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Efficacy of hydrofibre dressing following total joint arthroplasty: a meta-analysis of randomised controlled trials

Hip International ◽

10.1177/11207000211012669 ◽

2021 ◽

pp. 112070002110126

Author(s):

Raman Mundi ◽

Harman Chaudhry ◽

Seper Ekhtiari ◽

Prabjit Ajrawat ◽

Daniel M Tushinski ◽

...

Keyword(s):

Systematic Review ◽

Total Joint Arthroplasty ◽

Meta Analysis ◽

Joint Infection ◽

The United States ◽

Joint Arthroplasty ◽

Cochrane Library ◽

Controlled Trials ◽

Observable Effect ◽

The Impact

Introduction: In the United States, over 1,000,000 total joint arthroplasty (TJA) surgeries are performed annually and has been forecasted that this number will exceed 4,000,000 by the year 2030. Many different types of dressing exist for use in TJA surgery, and it is unclear if any of the newer, hydrofibre dressings are superior to traditional dressings at reducing rates of infections or improving wound healing. Thus, the aim of this systematic review and meta-analysis was to assess the impact of hydrofiber dressings on reducing complications. Methods: A systematic review and meta-analysis was performed using the online databases MEDLINE and the Cochrane Library. Randomized controlled trials (RCTs) comparing hydrofibre dressings to a standard dressing were included. Summary measures are reported as odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Our primary outcome was prosthetic joint infection (PJI). Secondary outcomes included blisters, dressing changes and wound irritation. Results: 5 RCTs were included. Hydrofibre dressing had no observable effect on PJI or wound irritation (OR 0.53; 95% CI, 0.14–1.98; p = 0.35). Hydrofibre dressings reduced the rate of blisters (OR 0.36; 95% CI, 0.14–0.90; p = 0.03) and number of dressing changes (MD -1.89; 95% CI, -2.68 to -1.11). Conclusions: In conclusion, evidence suggests hydrofibre dressings have no observable effect on PJI and wound irritation. Evidence for reduction in blisters and number of dressings is modest given wide CIs and biased trial methodologies. Use of hydrofibre dressings should be considered inconclusive for mitigating major complications in light of current best evidence.

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