Relationship between Surgery under General Anesthesia and the Development of Dementia: A Systematic Review and Meta-Analysis

Objective. To investigate the association between exposure to general anesthesia and the development of Alzheimer’s disease (AD) and dementia by reviewing and integrating the evidence from epidemiological studies published to date. Methods. We searched MEDLINE, EMBASE, and Google Scholar to identify all relevant articles up to April 2018 reporting the risk of AD/dementia following exposure to general anesthesia and finally updated in February 2020. We included patients older than 60 or 65 years who had not been diagnosed with dementia or AD before the study period. The overall pooled effect size (ES) was evaluated with a random-effect model. Subgroup analyses were conducted and possibility of publication bias was assessed. Results. A total of 23 studies with 412253 patients were included in our analysis. A statistically significant positive association between exposure to general anesthesia and the occurrence of AD was detected in the overall analysis (pooled ES=1.11, 95%confidence interval=1.07–1.15), but with substantial heterogeneity (pχ2<0.001, I2=79.4). Although the overall analysis revealed a significant association, the results of the subgroup analyses were inconsistent, and the possibility of publication bias was detected. Conclusions. This meta-analysis demonstrated a significant positive association between general anesthesia and AD. However, considering other results, our meta-analysis must be interpreted with caution. Particularly, it should be considered that it was nearly impossible to discriminate the influence of general anesthesia from the effect of surgery itself on the development of AD. Further, large-scale studies devised to reduce the risk of bias are needed to elucidate the evidence of association between general anesthesia and AD. Trial registration. PROSPERO International prospective register of systematic reviews CRD42017073790.

Download Full-text

Association between selenium intake and the risk of pancreatic cancer: a meta-analysis of observational studies

Bioscience Reports ◽

10.1042/bsr20160345 ◽

2016 ◽

Vol 36 (5) ◽

Cited By ~ 6

Author(s):

Lei Wang ◽

Jianfeng Wang ◽

Xudong Liu ◽

Qian Liu ◽

Guozhuan Zhang ◽

...

Keyword(s):

Pancreatic Cancer ◽

Publication Bias ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Epidemiological Studies ◽

Case Control Studies ◽

Selenium Intake ◽

Effect Model ◽

Summary Relative Risk

Quantification of the association between the intake of selenium and risk of pancreatic cancer is still conflicting. Thus, we conducted a meta-analysis to summarize the evidence from epidemiological studies of selenium intake with the risk of pancreatic cancer. Pertinent studies were identified by a search of PubMed and Web of Knowledge to July 2016. The random-effect model was used. Sensitivity analysis and publication bias were conducted. Data from six studies including 1424 pancreatic cancer cases were used in this meta-analysis. Pooled results suggested that highest selenium intake amount compared with lowest amount was significantly associated with the risk of pancreatic cancer [summary relative risk (RR)=0.659, 95% confidence interval (CI)=0.489–0.889, I2=47.6%]. The associations were significant both in case–control studies [RR=0.618, 95%CI=0.399–0.956, I2=59.1%] and Americas [RR=0.570, 95%CI=0.357–0.909, I2=65.6%]. No publication bias was found. Our analysis suggested that the higher intake of selenium might reduce the risk of pancreatic cancer.

Download Full-text

Dietary Intake of Meat Cooking-Related Mutagens (HCAs) and Risk of Colorectal Adenoma and Cancer: A Systematic Review and Meta-Analysis

10.20944/preprints201705.0079.v1 ◽

2017 ◽

Author(s):

Manuela Chiavarini ◽

Gaia Bertarelli ◽

Liliana Minelli ◽

Roberto Fabiani

Keyword(s):

Systematic Review ◽

High Temperature ◽

Colorectal Adenoma ◽

Mutagenic Activity ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Positive Association ◽

Epidemiological Studies ◽

Meat Cooking

Several evidences suggest that the positive association between meat intake and colorectal adenoma (CRA) and cancer (CRC) risk is mediated by mutagenic compounds generated during cooking at high temperature. A number of epidemiological studies have estimated the effect of meat-related mutagens intake on CRC/CRA risk with contradictory and sometime inconsistent results. A literature search was carried out (PubMed, Web of Science and Scopus) to identify articles reporting the relationship between the intake of meat-related mutagens (2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine: PhIP, 2-amino-3,8-dimethylimidazo[4,5-f] quinoxaline: MeIQx, 2-amino-3,4,8-trimethylimidazo[4,5-f] quinoxaline: DiMeIQx, benzo(a) pyrene: (B(a)P) and “meat derived mutagenic activity”: MDM) and CRC/CRA risk. A random-effect model was used to calculate the risk association. Thirty-nine studies were included in the systematic review and meta-analysis. Polled CRA risk (15229 cases) was significantly increased by intake of PhIP (OR=1.20; 95%CI:1.13,1.28; p<0.001), MeIQx (OR=1.14; 95%CI:1.05,1.23; p=0.001), DiMeIQx (OR=1.13; 95%CI:1.05,1.21; p=0.001), B(a)P (OR=1.10; 95%CI:1.02,1.19; p=0.017) and MDM (OR=1.17; 95%CI:1.07,1.28; p=0.001). A linear and curvilinear trend was observed in dose-response meta-analisis between CRA risk in association with PhIP and MDM, MeIQx, respectively. CRC risk (21344 cases) was increased by uptake of MeIQx (OR=1.14; 95%CI:1.04,1.25; p=0.004), DiMeIQx (OR=1.12; 95%CI:1.02,1.22; p=0.014) and MDM (OR=1.12; 95%CI:1.06,1.19; p<0.001). No publication bias could be detected whereas heterogeneity was in some cases rather high. Mutagenic compounds formed during cooking of meat at high temperature may be responsible of its carcinogenicity.

Download Full-text

Association between Oral Contraceptives and cutaneous melanoma: a systematic review and metanalysis

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1093 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

I Giacchetta ◽

M Chiavarini ◽

G Naldini ◽

R Fabiani

Keyword(s):

Systematic Review ◽

Malignant Melanoma ◽

Publication Bias ◽

Oral Contraceptives ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cutaneous Malignant Melanoma ◽

Hormonal Factors ◽

Increased Risk

Abstract Background The probability of developing invasive cutaneous malignant melanoma (CMM) is higher in women than in men up until the age of 49. Several studies investigated the association between hormonal factors and CMM. The aim of this systematic review and meta-analysis is to summarize the evidence on the association between Oral Contraceptives (OC) and the risk of CMM. Methods This review and meta-analysis follow the PRISMA guidelines. A systematic literature search was conducted on Medline and Web of Science until December 2019. Studies were eligible if reported a risk estimate for the association between OC and CMM. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger's test and Begg's test. Meta-analysis was performed using random effect model. Results The results of the pooled analysis of all 32 studies showed no significant association between OC and the risk of CMM (OR 1.02; 95% CI 0.94-1.11; I2=39.32%, p = 0.013). The stratified analyses by study design found no significant association between OC and the risk of CMM neither in the 18 case-control studies (OR 1.02; 95% CI 0.87-1.21; I2=56.91%, p = 0.002) nor in the 14 cohort studies (OR 1.04; 95% CI 0.98-1.11; I2=0.00%, p = 0.557). No significant publication bias could be detected by Egger's test or Begg's test. Conclusions This meta-analysis of available literature suggests no significant association between OC and the risk of developing CMM. Further investigations are needed to evaluate the possible relationship of OC use and other hormonal factors potentially contributing to the increased risk of CMM in women during their reproductive years. Key messages Oral contraceptives (OC) do not significantly contribute to the risk of Cutaneous Malignant Melanoma (CMM). Further studies are needed to investigate the potential role of other hormonal factors in the increased probability of developing CMM in women during their reproductive years.

Download Full-text

Is Routine Preoperative Esophagogastroduodenoscopy Prior to Bariatric Surgery Mandatory? Systematic Review and Meta-analysis of 10,685 Patients

Obesity Surgery ◽

10.1007/s11695-020-04672-4 ◽

2020 ◽

Vol 30 (8) ◽

pp. 3073-3083 ◽

Cited By ~ 1

Author(s):

Walid El Ansari ◽

Ayman El-Menyar ◽

Brijesh Sathian ◽

Hassan Al-Thani ◽

Mohammed Al-Kuwari ◽

...

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Publication Bias ◽

Surgical Approach ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Background This systematic review and meta-analysis searched, retrieved and synthesized the evidence as to whether preoperative esophagogastroduodenoscopy (p-EGD) should be routine before bariatric surgery (BS). Methods Databases searched for retrospective, prospective, and randomized (RCT) or quasi-RCT studies (01 January 2000–30 April 2019) of outcomes of routine p-EGD before BS. STROBE checklist assessed the quality of the studies. P-EGD findings were categorized: Group 0 (no abnormal findings); Group 1 (abnormal findings that do not necessitate changing the surgical approach or postponing surgery); Group 2 (abnormal findings that change the surgical approach or postpone surgery); and Group 3 (findings that signify absolute contraindications to surgery). We assessed data heterogeneity and publication bias. Random effect model was used. Results Twenty-five eligible studies were included (10,685 patients). Studies were heterogeneous, and there was publication bias. Group 0 comprised 5424 patients (56%, 95% CI: 45–67%); Group 1, 2064 patients (26%, 95% CI: 23–50%); Group 2, 1351 patients (16%, 95% CI: 11–21%); and Group 3 included 31 patients (0.4%, 95% CI: 0–1%). Conclusion For 82% of patients, routine p-EGD did not change surgical plan/ postpone surgery. For 16% of patients, p-EGD findings necessitated changing the surgical approach/ postponing surgery, but the proportion of postponements due to medical treatment of H Pylori as opposed to “necessary” substantial change in surgical approach is unclear. For 0.4% patients, p-EGD findings signified absolute contraindication to surgery. These findings invite a revisit to whether p-EGD should be routine before BS, and whether it is judicious to expose many obese patients to an invasive procedure that has potential risk and insufficient evidence of effectiveness. Further justification is required.

Download Full-text

Comparison of problem-based learning and traditional teaching methods in medical psychology education in China: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0243897 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243897

Author(s):

Junwei Gao ◽

Ling Yang ◽

Jinghui Zhao ◽

Lian Wang ◽

Jiao Zou ◽

...

Keyword(s):

Systematic Review ◽

Teaching Method ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Medical Psychology ◽

Psychology Education ◽

Subgroup Analyses ◽

Psychology Curriculum ◽

Education In China

Background PBL approach has been widely used in many Chinese universities over the past decade. However, the effects of PBL approach on medical psychology education in China are inconsistent. The purpose of this study was to ascertain whether the PBL approach was superior to the lecture-based teaching method in the context of the medical psychology curriculum in China. Methods A systematic review and meta-analysis was performed to confirm the effectiveness of PBL in Chinese medical psychology. Corresponding databases were searched for available studies, where data were extracted to calculated Hedges’ g and its 95% confidence interval in total and subgroup analyses. Subgroup analyses were also carried out. Results Nine studies with 551 cases and 496 controls were identified. The total examination scores of students in the PBL approach group were significantly higher compared with students in the traditional lecture-based teaching group under the random effect model (Hedges’ g = 1.510, 95%CI 0.792–2.227, p<0.001). Subgroup analyses based on major and school system exhibited similar results. Conclusions Our study supported the notion that the PBL approach may be applicable to Chinese medical psychology education.

Download Full-text

Association between metabolic syndrome and venous thromboembolism after total joint arthroplasty: a meta-analysis of cohort studies

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02097-4 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yipei Yang ◽

Ziyue Li ◽

Haifeng Liang ◽

Jing Tian

Keyword(s):

Metabolic Syndrome ◽

Cohort Studies ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Joint Arthroplasty ◽

Effect Model ◽

Increased Risk ◽

Subgroup Analyses

Abstract Objective Metabolic syndrome (MetS) has been associated with hypercoagulative status. However, previous studies evaluating the association between MetS and incidence of venous thromboembolism (VTE) after total joint arthroplasty (TJA) showed inconsistent results. We performed a meta-analysis to evaluate the influence of MetS on the risk of VTE following TJA. Methods Cohort studies were identified by the search of PubMed, Embase, and the Cochrane’s Library databases. A random-effect model was used if considerable heterogeneity was detected; otherwise, a fixed-effect model was used. Subgroup analyses according to the category of VTE, definition of MetS, category of procedure, and follow-up durations were performed. Results Seven cohort studies with 1,341,457 patients that underwent TJA were included, with 118,060 MetS patients (8.8%) at baseline. With a follow-up duration up to 3 months after surgery, 9788 patients had VTE. Pooled results with a random-effect model showed that MetS was not associated with increased overall VTE after TJA (adjusted risk ratio [RR] = 1.24, 95% confidence interval [CI] 0.89 ~ 1.72, p = 0.20; I2 = 69%). The results were not significantly affected by the diagnostic criteria of MetS, category of the procedure, and follow-up durations. Subgroup analyses showed that MetS was not associated with an increased the risk of pulmonary embolism ([PE], RR 1.06, 95% CI 0.37 ~ 3.02, p = 0.91), but an increased risk of deep vein thrombosis (DVT) after TJA (RR 3.38, 95% CI 1.83 ~ 6.24, p < 0.001). Conclusions Current evidence from observational studies suggests MetS might be associated with an increased risk of DVT but not PE after TJA.

Download Full-text

An updated meta-analysis of the association between Toxoplasma gondii infection and risk of epilepsy

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/trz025 ◽

2019 ◽

Vol 113 (8) ◽

pp. 453-462 ◽

Cited By ~ 4

Author(s):

Maryam Sadeghi ◽

Seyed Mohammad Riahi ◽

Mona Mohammadi ◽

Vafa Saber ◽

Somayeh Aghamolaie ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Meta Analysis ◽

Experimental Studies ◽

Positive Association ◽

Final Analysis ◽

Toxoplasma Infection ◽

Significant Positive Association ◽

Worldwide Distribution ◽

Subgroup Analyses ◽

Toxoplasma Gondii Infection

Abstract Toxoplasma gondii is a neurotropic pathogen with worldwide distribution. To evaluate the association between Toxoplasma infection and the risk of epilepsy by meta-analysis, observational peer-reviewed studies were retrieved from PubMed, Embase, Web of Science, Scopus and Google Scholar (up to 10 October 2018) and by reference review. Pooled risk estimates were calculated using a random effects model. Heterogeneity was assessed using Cochrane’s Q-test and I2. In total, 16 eligible studies involving 19 data sets were included for the final analysis. A total 7897 participants (3771 epileptic patients, 4026 healthy controls) were included. The pooled odds ratio (OR) for Toxoplasma infection was increased to 1.72 (95% confidence interval [CI] 1.37 to 2.16) among patients with epilepsy. There was moderate heterogeneity among the studies (χ2=39.8, I2=62.3%, p=0.001). The ORs from subgroup analyses showed that both cryptogenic epilepsy (OR 2.65 [95% CI 1.91 to 3.68]) and active convulsive epilepsy (OR 1.37 [95% CI 1.09 to 1.72]) were significantly associated with Toxoplasma infection. Another subgroup analyses according to age showed a significant positive association in children (OR 1.33), adults (OR 1.57) and in all ages (OR 1.89). Our findings support the association between Toxoplasma infection and epilepsy. More prospective studies with larger sample sizes and more experimental studies are recommended to elucidate a causative relationship.

Download Full-text

Apple intake and cancer risk: a systematic review and meta-analysis of observational studies

Public Health Nutrition ◽

10.1017/s136898001600032x ◽

2016 ◽

Vol 19 (14) ◽

pp. 2603-2617 ◽

Cited By ~ 8

Author(s):

Roberto Fabiani ◽

Liliana Minelli ◽

Patrizia Rosignoli

Keyword(s):

Cancer Risk ◽

Oral Cavity ◽

Publication Bias ◽

Observational Studies ◽

Statistical Tests ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Case Control ◽

Risk Of Cancer

AbstractObjectiveConflicting results on the association between fruit consumption and cancer risk have been reported. Little is known about the cancer preventive effects of different fruit types. The present meta-analysis investigates whether an association exists between apple intake and cancer risk.DesignRelevant observational studies were identified by literature search (PubMed, Web of Science and Embase). A random-effect model was used to estimate the cancer risk in different anatomical sites. Between-study heterogeneity and publication bias were assessed using adequate statistical tests.ResultsTwenty case–control (three on lung, five on colorectal, five on breast, two on oesophageal, three on oral cavity, two on prostate and one each on pancreas, bladder, larynx, ovary, kidney and brain cancer) and twenty-one cohort (seven on lung, two on colorectal, three on breast and one each on oesophageal, pancreas, bladder, kidney, endometrial, head–neck, urothelial and stomach cancer) studies met the inclusion criteria. Comparing the highest v. lowest level of apple consumption, the reduction of lung cancer risk was statistically highly significant in both case–control (OR=0·75; 95% CI 0·63, 0·88; P=0·001, I2=0 %) and cohort studies (relative risk=0·89; 95% CI 0·84, 0·94; P<0·001, I2=53 %). Instead, in the case of colorectal (OR=0·66; 95% CI 0·54, 0·81; P<0·001, I2=55%), breast (OR=0·79; 95% CI 0·73, 0·87; P<0·001, I2=1 %) and overall digestive tract (OR=0·50; 95% CI 0·36, 0·69; P<0·001, I2=90 %) cancers a significant preventive effect of apples was found only in case–control studies while prospective studies indicated no effect. No evidence of publication bias could be detected for colorectal, oral cavity, oesophageal and breast cancer. However, some confounding effects may be present and related to the consumption of other fruit which have not been considered as adjusting factors.ConclusionsThe present meta-analysis indicates that consumption of apples is associated with a reduced risk of cancer in different anatomical sites.

Download Full-text

Association of human papilloma Virus infection other than cervical cancer: Systematic Review and Meta Analysis

SINET Ethiopian Journal of Science ◽

10.4314/sinet.v44i1.11 ◽

2021 ◽

Vol 44 (1) ◽

pp. 119-128

Author(s):

Habtamu Molla ◽

Habtamu Temesgen ◽

Dereje Beyene

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Human Papilloma Virus ◽

Publication Bias ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Hpv Infection ◽

Papilloma Virus ◽

Pooled Prevalence

Human Papilloma Virus (hpv) infection causes different cancer diseases. Cervical cancer is the most common hpv related disease. hpv infection also causes cancer of anus, vulva, vagina, penis, skin, bladder, prostate, breast, oral and others because the hpv virus is epithelium-tropic. But the association of hpv infection other than cervical cancer, for example breast cancer, bladder cancer, prostate cancer etc is still inconclusive. Thus, the objective of this review was to collect published information on hpv infection other than cervix to explore the pooled prevalence of hpv infection as well as related types of cancers. Publish research articles of hpv infection and cancer risks other than cervical cancer were systematically searched through Internet. The preferred reporting items for systematic review and meta-analysis guidelines were followed. Joanna Brigg’s Institute Meta-Analysis of Statistics Assessment and Review Instrument (jbi-mastari) adapted for cross sectional/case control study design was used for quality assessment of each individual study. A total of 22 studies were extracted and analyzed using stata 14. The random effect model was used to estimate the pooled prevalence; whereas subgroup analysis and meta-regression was performed to identify the probable source of heterogeneity. Both Egger’s and Begg’s tests were used to check publication bias. The totals of 486 studies were retrieved and 22 studies were included in this meta- analysis. The meta-analysis result showed that the pooled prevalence of hpv infection other than cervix was 34.36% (95% CI: 23.75, 44.97) with severe heterogeneity (I2 = 99.5%; p<0.001) with no publication bias. The highest pooled prevalence of hpv infection other than cervix was related to genital cancer which is 58.63% (95% CI: 51.86, 65.39), followed by oral cancer (47.15% with 95% CI: 19.67, 74.63). Although cervical cancer is primarily hpv induced cancer which well articulated with so many researches, other cancer types (based on the location of the hpv infection) are also increasing across the world based on this systematic and meta-analysis study. hpv infection increases the risk of developing cancers other than cervical cancer.

Download Full-text

QuantiFERON-TB Gold In-Tube in Saudi Arabia benchmarked with other sites of the Middle East: A meta-analysis review

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10311 ◽

2018 ◽

Vol 12 (09) ◽

pp. 687-699

Author(s):

Hawra Al-Ghafli ◽

Sahal Al-Hajoj

Keyword(s):

Saudi Arabia ◽

High Risk ◽

Middle East ◽

Publication Bias ◽

Meta Analysis ◽

Skin Testing ◽

Random Effect ◽

Random Effect Model ◽

Risk Groups ◽

Tuberculin Skin Testing

Introduction: Screening for Latent Tuberculosis Infections (LTBI) constitutes a key step in health surveillance programs especially among adults of high-risk groups. To our knowledge, this is the first systematic and meta-analysis review that aims to critically assess and compare the agreement of QuantiFERON-TB Gold In-Tube (QFT-GIT) and Tuberculin Skin Testing (TST) among adults of high-risk groups in Saudi Arabia and compare results with other sites of the Middle East. Methodology: Kappa estimates were meta-analyzed using random effect model and several subgroup analyzes were performed to explain overall heterogeneity. Funnel plot, Begg’s and Egger’s tests were employed to assess overall publication bias. Results: 18 studies were meta-analyzed, comprising 5070 adults of high-risk groups. Pooled kappa estimates from Saudi Arabia (κ = 0.29, 95% CI: 0.16, 0.41) showed lower rate of agreement compared to other sites of the Middle East (κ = 0.33, 95% CI: 0.25, 0.41). However, a significant level of heterogeneity (I2 = 96.7%, p > 0.001) were identified across collected evidence. Begg’s and Egger’s tests confirmed absence of significant publication bias in this review (p = 0.49 and p = 0.16, respectively). Conclusion: This work revealed fair to poor agreement between TST and QFT-GIT, indicating that these two tests are not interchangeable in such settings. Substantial evidence is still needed before considering the sole use of QFT-GIT as an alternative to TST in these populations. Moreover, there is an urgent need for longitudinal studies in Saudi Arabia and the Middle East to accurately assess precision of LTBI diagnosis.

Download Full-text