P1435 The impact of intermediate wall shear strain on changes of plaque morphology in CAD: A systematic review and meta-analysis

Abstract Background and Aim The experimental studies found that high wall shear strain (WSS) resulted in the development of more vulnerable plaque compared to low WSS. The aim of this meta-analysis is to assess the role of intermediate WSS on atherosclerotic plaque. Methods We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry from 1989 to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and plaque morphology in CAD. Results A total of 32,083 segments were recruited in 7 studies with mean follow up 8.4 months. The pooled analysis showed that baseline low WSS is associated with similar plaque morphology to that with intermediate WSS: lumen area WMD 0.96 [-0.12 to 2.04, p = 0.08], plaque area WMD -0.43 [-0.09 to 0.13, p = 0.13], necrotic core area WMD -0.18 [-0.45 to 0.08, p = 0.18], dense calcium score WMD -0.12 [-0.26 to 0.02, p = 0.09] as well as fibrous WMD -0.35 [-0.89 to 0.19, p = 0.21] and fibro-fatty area WMD -0.05 [-0.12 to 0.02, p = 0.12]. At follow-up, the only difference found was an increase of fibrous WMD 0.08 [0.01 to 0.16, p = 0.04] and fibro-fatty area, WMD 0.07 [0.01 to 0.12, p = 0.02] in low WSS compared intermediate WSS. Conclusions Intermediate WSS group is associated with plaque features changes similar to those occurring with low WSS. This finding emphasis the role of IVUS in outcome of atherosclerotic plaque in CAD.

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1178 High coronary wall shear strain developed more vulnerable plaque compared to low shear strain: a systematic review and meta-analysis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.677 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A B Bajraktari ◽

I B Bytyci ◽

S E Elezi ◽

M Y H Henein

Keyword(s):

Shear Strain ◽

Vulnerable Plaque ◽

Meta Analysis ◽

Necrotic Core ◽

Core Area ◽

Plaque Area ◽

Central Registry ◽

Wall Shear ◽

The Impact

Abstract Background and Aim Arterial wall strain has been proposed to impact the features of developed plaques. The aim of this meta-analysis is to assess the impact of different types of wall shear strain (WSS) on the changes of vulnerable plaque in coronary artery disease (CAD). Methods We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, from 1989 up to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and morphology of plaque in CAD. Results In 7 studies, a total of 724 patients with 32,083 segments were recruited, with mean follow up 8.4 months. The pooled analysis showed that low WSS was associated with larger baseline lumen area WMD 2.55 [1.34 to 3.76, p < 0.001], smaller plaque area WMD -1.16 [-0.1.84 to -0.49, p = 0007] and necrotic core area WMD -0.45 [-0.78 to 0.14, p = 0.004], dense calcium score WMD -0.18 [-0.46 to 0.10, p = 0.01], and fibrous area WMD -0.79 [-1.84 to 0.30, p = 0.02] as well as smaller fibro-fatty area WMD -0.22 [-0.57 to 0.13, p = 0.02] compared to high WSS. At follow-up, the high WSS had regression of fibrous area, WMD -0.12 [-0.22 to -0.02, p = 0.02] and fibro-fatty area WMD -0.11 [-0.23 to -0.01, p = 0.04], reduction of plaque area WMD -0.09 [-0.17 to -0.02, p = 0.01] and increased dense calcium WMD 0.08 [0.02 to 0.14, p = 0.006] and necrotic core area WMD 0.07 [0.01 to 0.13, p = 0.03] compared to low WSS (Figure 1). The high WSS developed more profound remodeling compared to low WSS (40 vs. 18%, p < 0.05) with more constructive remodelling with low WSS (78%vs. 40 %, p < 0.01). Conclusions. Baseline high WSS is associated with higher necrotic core, calcium, fibrous and fibro-fatty area compared with low WSS, and during follow up the high WSS resulted in the development of more profound remodeling compared with low WSS. These findings highlighted the role of IVUS in detecting the vulnerable plaque in CAD. Abstract 1178 Figure 1. Mean change of plaque morpholo

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The Relationship between Coronary Artery Wall Shear Strain and Plaque Morphology: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics10020091 ◽

2020 ◽

Vol 10 (2) ◽

pp. 91 ◽

Cited By ~ 2

Author(s):

Artan Bajraktari ◽

Ibadete Bytyçi ◽

Michael Y. Henein

Keyword(s):

Coronary Artery ◽

Shear Strain ◽

Meta Analysis ◽

Calcium Score ◽

Necrotic Core ◽

Plaque Burden ◽

Plaque Morphology ◽

Wall Shear ◽

The Impact ◽

The Relationship

Background and Aim: Arterial wall shear strain (WSS) has been proposed to impact the features of atherosclerotic plaques. The aim of this meta-analysis was to assess the impact of different types of WSS on plaque features in coronary artery disease (CAD). Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar, and the Cochrane Central Registry, from 1989 up to January 2020 and selected clinical trials and observational studies which assessed the relationship between WSS, measured by intravascular ultrasound (IVUS), and plaque morphology in patients with CAD. Results: In four studies, a total of 72 patients with 13,098 coronary artery segments were recruited, with mean age 57.5 ± 9.5 years. The pooled analysis showed that low WSS was associated with larger baseline lumen area (WMD 2.55 [1.34 to 3.76, p < 0.001]), smaller plaque area (WMD −1.16 [−1.84 to −0.49, p = 0.0007]), lower plaque burden (WMD −12.7 [−21.4 to −4.01, p = 0.04]), and lower necrotic core area (WMD −0.32 [−0.78 to 0.14, p = 0.04]). Low WSS also had smaller fibrous area (WMD −0.79 [−1.88 to 0.30, p = 0.02]) and smaller fibro-fatty area (WMD −0.22 [−0.57 to 0.13, p = 0.02]), compared with high WSS, but the dense calcium score was similar between the two groups (WMD −0.17 [−0.47 to 0.13, p = 0.26]). No differences were found between intermediate and high WSS. Conclusions: High WSS is associated with signs of plaque instability such as higher necrotic core, higher calcium score, and higher plaque burden compared with low WSS. These findings highlight the role of IVUS in assessing plaque vulnerability.

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High Coronary Wall Shear Stress Worsens Plaque Vulnerability: A Systematic Review and Meta-Analysis

Angiology ◽

10.1177/0003319721991722 ◽

2021 ◽

pp. 000331972199172

Author(s):

Artan Bajraktari ◽

Ibadete Bytyçi ◽

Michael Y. Henein

Keyword(s):

Shear Stress ◽

Wall Shear Stress ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Pooled Analysis ◽

Plaque Vulnerability ◽

Coronary Wall ◽

Wall Shear ◽

The Impact

Aim: The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability. Methods: We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) −0.11 (95% CI: −0.20 to −0.02, P = .02) and fibrofatty area, WMD −0.09 (95% CI: −0.17 to −0.01, P = .02), reduction in plaque total area, WMD −0.09 (95% CI: −0.14 to −0.04, P = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, P = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm2; P > .05). High WSS resulted in profound remodeling (40% vs 18%, P < .05) and with more constructive remodeling than low WSS (78% vs 40%, P < .01). Conclusions: High WSS in coronary arteries is associated with worsening plaque vulnerability and more profound arterial wall remodeling compared with low WSS.

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The haematological side effects of clozapine: literature review and meta-analysis

BJPsych Open ◽

10.1192/bjo.2021.729 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S274-S274

Author(s):

Tariq Munshi ◽

Farooq Naeem ◽

Mohammed Ayub ◽

Saeed Farooq ◽

Davit Khachatryan ◽

...

Keyword(s):

Cumulative Incidence ◽

Meta Analysis ◽

Blood Dyscrasia ◽

Treatment Resistant ◽

National Guidelines ◽

True Incidence ◽

Number Of Patients ◽

The Impact

AimsThis review and meta-analysis aim to estimate the cumulative incidence of clozapine induced agranulocytosis and leukopenia the impact of the associated factors such as dose of clozapine, duration of follow-up, gender and race on the cumulative incidence.BackgroundClozapine is the only medication licensed for treatment-resistant schizophrenia. There has been a renewed interest in the role of Clozapine in the treatment of Schizophrenia based on strong evidence that favours its efficacy and safety. Despite the evidence that Clozapine has superior efficacy and has been recommended for treatment-resistant cases by the national guidelines, the drug is underutilised.MethodWe included all studies in which clozapine was used for a psychotic illness. We included studies which provided data on two primary indices; Leucopenia or agranulocytosis and neutropenia; defined according to the cut off used by CPMS for total WBC and neutrophil count. Additionally we included studies reporting another blood dyscrasia or death due to agranulocytosis. Studies were identified by searching AMED, BIOSIS, CINAHL, EMBASE, MEDLINE, PsycINFO, PubMed, and registries of Clinical Trials and their monthly updates, hand searches, gray literature, and conference proceedings from the first available date until 2nd February, 2015. The search was updated on 15th March, 2017. The Protocol was initiated and then registered with PROSPERO International prospective register of systematic reviews University of York, Centre for Reviews and Dissemination.ResultThe cumulative incidence of the agranulocytosis in all studies was 00.32 % (CI 00.1-0.63). The cumulative incidence in all studies for different types of blood dyscrasia were following: leucopenia 00.96 % (CI 0.39-1.70), neutropenia 2.93 % (CI 1.49-4.72), other blood dyscrasias 4.64% (CI 2.34-7.52) and any blood dyscrasia was 2.23 (CI 1.46-3.12).ConclusionThe limitations of this review are mainly due to the nature of evidence from the included studies. We adopted a broad inclusion criteria to include all the available evidence. Number of patients started on Clozapine may be withdrawn from the Clozapine on the earliest signs of blood dyscrasias since the introduction of Clozapine monitoring services. This means that the true incidence of agranulocytosis and neutropenia may be higher and this may be a major bias in finding the true incidence of Clozapine induced neutropenia.

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Reducing repeat paediatric emergency department attendance for non-urgent care: a systematic review of the effectiveness of interventions

Emergency Medicine Journal ◽

10.1136/emermed-2018-207536 ◽

2019 ◽

pp. emermed-2018-207536 ◽

Cited By ~ 1

Author(s):

Brenda Agyeiwaa Poku ◽

Pippa Hemingway

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Experimental Studies ◽

Primary Care Providers ◽

Urgent Care ◽

Care Providers ◽

Quasi Experimental ◽

The Usa ◽

The Impact

ObjectiveNon-urgent paediatric ED (PED) visits appear to contribute a large portion to the growing use of EDs globally. Several interventions have tried to curb repeated non-urgent attendances, but no systematic review of their effectiveness exists. This review examines the effectiveness of interventions designed to reduce subsequent non-urgent PED visits after a non-urgent attendance.MethodA systematic review design. A systematic search of four databases and key journals was conducted from their inception to November 2018. Experimental studies, involving children aged 0–18 years presenting to an ED for non-urgent care, which assessed the effectiveness of interventions on subsequent non-urgent attendance were considered.Results2120 studies were identified. Six studies, including four randomised controlled trials (RCTs) and two quasi-experimental, were included. Studies were of moderate quality methodologically. All studies originated from the USA and involved informational and/or follow-up support interventions. Only two RCTs demonstrated the longest duration of intervention effects on reducing subsequent non-urgent PED attendance. These studies identified participants retrospectively after ED evaluation. The RCT with the largest number of participants involved follow-up support by primary physicians. Meta-analysis was impractical due to wide heterogeneity of the interventions.ConclusionsThere is inconclusive evidence to support any intervention aimed at reducing subsequent non-urgent PED visits following a non-urgent attendance. The long-term impact of interventions is limited, although the effect may be maximised if delivered by primary care providers in children identified after their ED attendance. However, further research is required to evaluate the impact of any such strategies in settings outside the USA.

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Family Influences on Youth Offending

The Oxford Handbook of Developmental and Life-Course Criminology ◽

10.1093/oxfordhb/9780190201371.013.18 ◽

2018 ◽

pp. 377-403

Author(s):

Abigail A. Fagan ◽

Kristen M. Benedini

Keyword(s):

Life Course ◽

Family Environment ◽

Parenting Practices ◽

Experimental Studies ◽

The United States ◽

Parental Violence ◽

Youth Delinquency ◽

The Impact ◽

Children’S Exposure

This chapter reviews the degree to which empirical evidence demonstrates that families influence youth delinquency. Because they are most likely to be emphasized in life-course theories, this chapter focuses on parenting practices such as parental warmth and involvement, supervision and discipline of children, and child maltreatment. It also summarizes literature examining the role of children's exposure to parental violence, family criminality, and young (teenage) parents in affecting delinquency. Because life-course theories are ideally tested using longitudinal data, which allow examination of, in this case, the impact of parenting practices on children's subsequent behaviors, this chapter focuses on evidence generated from prospective studies conducted in the United States and other countries. It also discusses findings from experimental studies designed to reduce youth substance use and delinquency by improving the family environment.

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Why Do Firms Participate in Voluntary Environmental Programs? A Meta-Analysis of the Role of Institutions, Resources, and Program Stringency

Organization & Environment ◽

10.1177/1086026621990063 ◽

2021 ◽

pp. 108602662199006

Author(s):

Peter Tashman ◽

Svetlana Flankova ◽

Marc van Essen ◽

Valentina Marano

Keyword(s):

Quality Management ◽

Prior Experience ◽

Meta Analysis ◽

Institutional Pressures ◽

Environmental Programs ◽

Voluntary Environmental Programs ◽

Management Standards ◽

Trade Offs ◽

The Impact

We meta-analyze research on why firms join voluntary environmental programs (VEPs) to assess the impact of program stringency, or the extent to which they have rigorous, enforceable standards on these decisions. Stringency creates trade-offs for firms by affecting programs’ effectiveness, legitimacy, and adoption costs. Most research considers singular programs and lacks cross program variation needed to analyze program stringency’s impact. Our meta-analysis addresses this by sampling 127 studies and 23 VEPs. We begin by identifying common institutional and resource-based drivers of participation in the literature, and then analyze how program stringency moderates their impacts. Our results suggest that strictly governed VEPs encourage participation among highly visible and profitable firms, and discourage it when informal institutional pressures are higher, and firms have prior experience with other VEPs or quality management standards. We demonstrate that VEP stringency has nuanced effects on firm participation based on the institutional and resource-based factors facing them.

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The Impact of Dental Implant Length on Failure Rates: A Systematic Review and Meta-Analysis

Materials ◽

10.3390/ma14143972 ◽

2021 ◽

Vol 14 (14) ◽

pp. 3972

Author(s):

Maha Abdel-Halim ◽

Dalia Issa ◽

Bruno Ramos Chrcanovic

Keyword(s):

Treatment Plan ◽

Meta Analysis ◽

Implant Failure ◽

Failure Rates ◽

Manual Search ◽

Short Implants ◽

The Many ◽

The Impact ◽

Implant Length

The present review aimed to evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants. An electronic search was undertaken in three databases, as well as a manual search of journals. Implant failure was the outcome evaluated. Meta-analysis was performed in addition to a meta-regression in order to verify how the risk ratio (RR) was associated with the follow-up time. The review included 353 publications. Altogether, there were 25,490 short and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher failure risk than long implants (RR 2.437, p < 0.001). There was a decrease in the probability of implant failure with longer implants when implants of different length groups were compared. A sensitivity analysis, which plotted together only studies with follow-up times of 7 years or less, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up. In conclusion, short implants showed a 2.5 times higher risk of failure than long implants. Implant failure is multifactorial, and the implant length is only one of the many factors contributing to the loss of an implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.

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Therapeutic Value of Single Nucleotide Polymorphisms on the Efficacy of New Therapies in Patients with Multiple Sclerosis

Journal of Personalized Medicine ◽

10.3390/jpm11050335 ◽

2021 ◽

Vol 11 (5) ◽

pp. 335

Author(s):

María José Zarzuelo Romero ◽

Cristina Pérez Ramírez ◽

María Isabel Carrasco Campos ◽

Almudena Sánchez Martín ◽

Miguel Ángel Calleja Hernández ◽

...

Keyword(s):

Multiple Sclerosis ◽

Mechanism Of Action ◽

Dimethyl Fumarate ◽

Response To Treatment ◽

Nucleotide Polymorphisms ◽

New Therapies ◽

Therapeutic Value ◽

The Impact

The introduction of new therapies for the treatment of multiple sclerosis (MS) is a very recent phenomenon and little is known of their mechanism of action. Moreover, the response is subject to interindividual variability and may be affected by genetic factors, such as polymorphisms in the genes implicated in the pathologic environment, pharmacodynamics, and metabolism of the disease or in the mechanism of action of the medications, influencing the effectiveness of these therapies. This review evaluates the impact of pharmacogenetics on the response to treatment with new therapies in patients diagnosed with MS. The results suggest that polymorphisms detected in the GSTP1, ITGA4, NQO1, AKT1, and GP6 genes, for treatment with natalizumab, ZMIZ1, for fingolimod and dimethyl fumarate, ADA, for cladribine, and NOX3, for dimethyl fumarate, may be used in the future as predictive markers of treatment response to new therapies in MS patients. However, there are few existing studies and their samples are small, making it difficult to generalize the role of these genes in treatment with new therapies. Studies with larger sample sizes and longer follow-up are therefore needed to confirm the results of these studies.

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Impact of non-menthol flavours in e-cigarettes on perceptions and use: an updated systematic review

BMJ Open ◽

10.1136/bmjopen-2019-031598 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031598 ◽

Cited By ~ 14

Author(s):

Clare Meernik ◽

Hannah M Baker ◽

Sarah D Kowitt ◽

Leah M Ranney ◽

Adam O Goldstein

Keyword(s):

Systematic Review ◽

Risk Perceptions ◽

Longitudinal Research ◽

Age Groups ◽

Experimental Studies ◽

Final Analysis ◽

Eligibility Criteria ◽

Product Appeal ◽

The Impact

ObjectivesGiven the exponential increase in the use of e-cigarettes among younger age groups and in the growth in research on e-cigarette flavours, we conducted a systematic review examining the impact of non-menthol flavoured e-cigarettes on e-cigarette perceptions and use among youth and adults.DesignPubMed, Embase, PyscINFO and CINAHL were systematically searched for studies published and indexed through March 2018.Eligibility criteriaQuantitative observational and experimental studies that assessed the effect of non-menthol flavours in e-cigarettes on perceptions and use behaviours were included. Specific outcome measures assessed are appeal, reasons for use, risk perceptions, susceptibility, intention to try, initiation, preference, current use, quit intentions and cessation.Data extraction and synthesisThree authors independently extracted data related to the impact of flavours in tobacco products. Data from a previous review were then combined with those from the updated review for final analysis. Results were then grouped and analysed by outcome measure.ResultsThe review included 51 articles for synthesis, including 17 published up to 2016 and an additional 34 published between 2016 and 2018. Results indicate that non-menthol flavours in e-cigarettes decrease harm perceptions (five studies) and increase willingness to try and initiation of e-cigarettes (six studies). Among adults, e-cigarette flavours increase product appeal (seven studies) and are a primary reason many adults use the product (five studies). The role of flavoured e-cigarettes on smoking cessation remains unclear (six studies).ConclusionThis review provides summary data on the role of non-menthol flavours in e-cigarette perceptions and use. Consistent evidence shows that flavours attract both youth and adults to use e-cigarettes. Given the clear findings that such flavours increase product appeal, willingness to try and initiation among youth, banning non-menthol flavours in e-cigarettes may reduce youth e-cigarette use. Longitudinal research is needed to examine any role flavours may play in quit behaviours among adults.

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