Towards qualification of FDG PET as biomarker of response to neo-adjuvant therapy: A meta-analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22128-e22128
Author(s):  
Andrew D. Vincent ◽  
Saiyada N. F. Rizivi ◽  
Harm van Tinteren ◽  
Ingrid Riphagen ◽  
Otto S. Hoekstra
Keyword(s):  
Publication Bias ◽  
Fdg Pet ◽  
Meta Analysis ◽  
Model Development ◽  
Histopathological Response ◽  
Treatment Type ◽  
Neoadjuvant Systemic Therapy ◽  
Before And After ◽  
Maximal Sensitivity ◽  
Meta Regression

e22128 Background: For FDG PET to qualify as a biomarker of response to cancer therapy beyond proof of principle, the evidence should be aggregated. Methods: A systematic literature search (Jan 1995-May 2011) for studies in solid extracerebral tumors with distinct cohorts of n≥10 patients, PET before and after cytotoxic neoadjuvant systemic therapy (with or without radiotherapy), dichotomized histopathological (PA) response. For model development we selected studies reporting individual or dichotomous aggregated level data, and performed bivariate SROC meta-regression. Results: 52 studies were identified, comprising data from 1,710 patients: rectal (32%), esophageal (21%), sarcoma (20%), breast (13%) and other cancers (14%). Most PET measures were SUVmax (65%) and other SUV measures (32%). Treatment type ChT (38%) and ChRT (62%); 46% were PA responders. The meta-regression indicated a weak increase in specificity for chemotherapy studies over chemoradiotherapy studies (p=0.08), however this disappeared after adjusting for publication bias. High baseline uptake rates improved diagnostic sensitivity (p=0.01). The SROC-AUC after adjusting for publication bias was 0.77. Maximal sensitivity and specificity was achieved with a PET reduction of 60%. Conclusions: There is a moderate association between FDG-PET change and histopathological response. This relation appears to be a function of baseline uptake, which may (at least in part) relate to repeatability issues.

scholarly journals Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG–PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1030
Author(s):  
Malene M. Clausen ◽  
Ivan R. Vogelius ◽  
Andreas Kjær ◽  
Søren M. Bentzen
Keyword(s):  
Lung Cancer ◽  
Head And Neck ◽  
Publication Bias ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Prognostic Value ◽  
Statistical Tests ◽  
Meta Analysis ◽  
Cut Points ◽  
Cut Point

Positron emission tomography (PET) imaging with 2-deoxy-2-[18F]-fluorodeoxyglucose (FDG) was proposed as prognostic marker in radiotherapy. Various uptake metrics and cut points were used, potentially leading to inflated effect estimates. Here, we performed a meta-analysis and systematic review of the prognostic value of pretreatment FDG–PET in head and neck squamous cell carcinoma (HNSCC) and non-small cell lung cancer (NSCLC), with tests for publication bias. Hazard ratio (HR) for overall survival (OS), disease free survival (DFS), and local control was extracted or derived from the 57 studies included. Test for publication bias was performed, and the number of statistical tests and cut-point optimizations were registered. Eggers regression related to correlation of SUVmax with OS/DFS yielded p = 0.08/p = 0.02 for HNSCC and p < 0.001/p = 0.014 for NSCLC. No outcomes showed significant correlation with SUVmax, when adjusting for publication bias effect, whereas all four showed a correlation in the conventional meta-analysis. The number of statistical tests and cut points were high with no indication of improvement over time. Our analysis showed significant evidence of publication bias leading to inflated estimates of the prognostic value of SUVmax. We suggest that improved management of these complexities, including predefined statistical analysis plans, are critical for a reliable assessment of FDG–PET.

scholarly journals Case fatality rate in COVID-19: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Chanaka Kahathuduwa ◽  
Chathurika Dhanasekara ◽  
Shao-Hua Chin
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Critical Illness ◽  
Publication Bias ◽  
Case Fatality Rate ◽  
Meta Analysis ◽  
Case Fatality ◽  
Severe Illness ◽  
Fatality Rate ◽  
Meta Regression

AbstractBackgroundEstimating the prevalence of severe or critical illness and case fatality of COVID-19 outbreak in December, 2019 remains a challenge due to biases associated with surveillance, data synthesis and reporting. We aimed to address this limitation in a systematic review and meta-analysis and to examine the clinical, biochemical and radiological risk factors in a meta-regression.MethodsPRISMA guidelines were followed. PubMed, Scopus and Web of Science were searched using pre-specified keywords on March 07, 2020. Peer-reviewed empirical studies examining rates of severe illness, critical illness and case fatality among COVID-19 patients were examined. Numerators and denominators to compute the prevalence rates and risk factors were extracted. Random-effects meta-analyses were performed. Results were corrected for publication bias. Meta-regression analyses examined the moderator effects of potential risk factors.ResultsThe meta-analysis included 29 studies representing 2,090 individuals. Pooled rates of severe illness, critical illness and case fatality among COVID-19 patients were 15%, 5% and 0.8% respectively. Adjusting for potential underreporting and publication bias, increased these estimates to 26%, 16% and 7.4% respectively. Increasing age and elevated LDH consistently predicted severe / critical disease and case fatality. Hypertension; fever and dyspnea at presentation; and elevated CRP predicted increased severity.ConclusionsRisk factors that emerged in our analyses predicting severity and case fatality should inform clinicians to define endophenotypes possessing a greater risk. Estimated case fatality rate of 7.4% after correcting for publication bias underscores the importance of strict adherence to preventive measures, case detection, surveillance and reporting.

scholarly journals Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Hany Hasan Elsayed ◽  
Aly Sherif Hassaballa ◽  
Taha Aly Ahmed ◽  
Mohamed Gumaa ◽  
Hazem Youssef Sharkawy
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Publication Bias ◽  
Risk Ratio ◽  
Mortality Risk ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Random Effect ◽  
Meta Regression

Abstract Background: COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Invasive mechanical ventilation IMV can support gas exchange in patients failing non-invasive ventilation, but its reported outcome is highly variable between countries. We conducted a systematic review and meta-analysis on IMV for COVID-associated ARDS to study its outcome among different countries.Methods: CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from June 8 2019 to June 8, 2020. Studies reporting five or more patients with end point outcome for severe COVID 19 infection treated with IMV were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. Subgroup analysis for different countries was performed. Meta-regression for the effect of study timing and patient age and were tested. Publication bias was examined. This trial was registered with PROSPERO under registration number CRD42020190365Findings: Our electronic search retrieved 4770 citations, 103 of which were selected for full-text review. Twenty-one studies with a combined population of 37359 patients with COVID-19 fulfilled the inclusion criteria. From this population, 5800 patients were treated by invasive mechanical ventilation. Out of those, 3301 patients reached an endpoint of ICU discharge or death after invasive mechanical ventilation while the rest were still in the ICU. Mortality from IMV was highly variable among the included studies ranging between 21% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.70 (95% confidence interval 0.608 to 0.797; I2 = 98%). Subgroup analysis according to country of origin showed homogeneity in the 8 Chinese studies with high pooled mortality risk ratio of 0.97 (I2 = 24%, p=0.23) (95% CI = 0.94-1.00), similar to Italy with a low pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p=0.86) while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.60 (95% CI 0.43-0.76) with persistent heterogeneity (I2 = 98%, p<0.001). Meta-regression showed that outcome from IMV improved with time (p<0.001). Age had no statistically significant effect on mortality (p= 0.102). Publication bias was excluded by visualizing the funnel plot of standard error, Egger's test with p=0.714 and Begg&Mazumdar test with p=0.334Interpretation: The study included the largest number of patients with outcome findings of IMV in this current pandemic. Our findings showed that the use of IMV for selected COVID 19 patients with severe ARDS carries a high mortality, but outcome has improved over the last few months and in more recent studies. The results should encourage physicians to use this facility when indicated for severely ill COVID-19 patients.

scholarly journals Vancomycin-Resistant Enterococci (VRE) in Nigeria: The First Systematic Review and Meta-Analysis

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 565
Author(s):  
Yusuf Wada ◽  
Azian Binti Harun ◽  
Chan Yean Yean ◽  
Abdul Rahman Zaidah
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Forest Plot ◽  
Funnel Plot ◽  
Vancomycin Resistant Enterococci ◽  
Pooled Prevalence ◽  
Vancomycin Resistant ◽  
Meta Regression ◽  
Leave One Out

Vancomycin-Resistant Enterococci (VRE) are on the rise worldwide. Here, we report the first prevalence of VRE in Nigeria using systematic review and meta-analysis. International databases MedLib, PubMed, International Scientific Indexing (ISI), Web of Science, Scopus, Google Scholar, and African journals online (AJOL) were searched. Information was extracted by two independent reviewers, and results were reviewed by the third. Two reviewers independently assessed the study quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. OpenMeta analyst was used. The random effect was used, and publication bias was assessed using a funnel plot. Between-study heterogeneity was assessed, and the sources were analysed using the leave-one-out meta-analysis, subgroup analysis, and meta-regression. Nineteen studies met the eligibility criteria and were added to the final meta-analysis, and the study period was from 2009–2018. Of the 2552 isolates tested, 349 were VRE, and E. faecalis was reported the most. The pooled prevalence of VRE in Nigeria was estimated at 25.3% (95% CI; 19.8–30.8%; I2 = 96.26%; p < 0.001). Between-study variability was high (t2 = 0.011; heterogeneity I2 = 96.26% with heterogeneity chi-square (Q) = 480.667, degrees of freedom (df) = 18, and p = 0.001). The funnel plot showed no publication bias, and the leave-one-out forest plot did not affect the pooled prevalence. The South-East region had a moderate heterogeneity though not significant (I2 = 51.15%, p = 0.129). Meta-regression showed that all the variables listed contributed to the heterogeneity except for the animal isolate source (p = 0.188) and studies that were done in 2013 (p = 0.219). Adherence to proper and accurate antimicrobial usage, comprehensive testing, and continuous surveillance of VRE are required.

Abstract MP89: Effectiveness of School Procurement Policies for Improving Dietary Behaviors: A Systematic Review and Meta-analysis

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Renata Micha ◽  
Ioanna Bakogianni ◽  
Dimitra Karageorgou ◽  
Eirini Trichia ◽  
Masha L Shulkin ◽  
...  
Keyword(s):  
Publication Bias ◽  
Vegetable Intake ◽  
Average Duration ◽  
Meta Analysis ◽  
Quality Standards ◽  
Portion Size ◽  
School Meals ◽  
Statistical Heterogeneity ◽  
Competitive Foods ◽  
Meta Regression

Background: School procurement policies - e.g., free/reduced price provision of healthful foods/beverages, quality standards for competitive foods/beverages, or quality standards for school meals - are increasingly being used to promote healthy diets in kids. However, their effectiveness has not been systematically evaluated. Methods: We used MOOSE and PRISMA guidelines to systematically search multiple online databases for original interventions (randomized, quasi-experimental) assessing influence of school procurement policies, alone or as part of multi-component strategies, on dietary intakes in children. Data were extracted independently and in duplicate. Inverse variance-weighted meta-analysis was used to pool estimates. Pre-specified sources of heterogeneity (study design, location; intervention duration, coverage, components; outcome type, ascertainment) were analyzed using meta-regression and subgroup analysis. Funnel plots, Begg’s, and Egger’s tests evaluated potential publication bias. Results: From 6,193 abstracts, 76 interventional studies met inclusion criteria. Many were multicomponent. Thirty-two assessed free/reduced price provision of healthful foods/beverages, mostly in cafeterias or classrooms, with average duration 18 mo. In pooled analysis, free/reduced price provision of fruits and vegetables increased fruit intake by 0.22 servings/d (n=14 studies; 95% CI: 0.10, 0.34) and total fruit and vegetable intake by 0.28 servings/d (n=12; 0.07, 0.49), but not vegetable intake alone (n=8; 0.01 servings/d [-0.03, 0.05]). Twenty-seven interventions evaluated policies on competitive foods/beverages (most often sugar-sweetened beverages), with average duration 23 mo. Strategies included restrictions/bans, quality standards, or both. These interventions reduced sugar-sweetened beverage intake by 0.11 (12-oz) servings/d (n=7; -0.16, -0.05). Thirty-two interventions assessed quality standards for school meals (lunch and/or breakfast), with average follow-up 28 mo. Standards were typically based on types of foods, nutrient content, and/or portion size. Dietary targets varied appreciably, and results were generally inconsistent across studies, with no significant overall pooled effect. Findings for secondary outcomes of food content, food availability, and adiposity will be presented. Statistical heterogeneity in these analyses was variable; meta-regression did not identify significant sources. Little evidence for publication bias was seen. Conclusions: These findings support efficacy of school procurement policies that provide free/reduced price healthful choices or target competitive foods/beverages. Efficacy of quality standards for school meals appears heterogeneous with less consistent benefits. These findings inform policy priorities for improving diets in children.

scholarly journals Change in newly diagnosed Graves’ disease phenotype between the twentieth and the twenty-first centuries: meta-analysis and meta-regression

2020 ◽  
Author(s):  
S. Ippolito ◽  
C. Cusini ◽  
P. Lasalvia ◽  
F. Gianfagna ◽  
G. Veronesi ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Graves Disease ◽  
Free Triiodothyronine ◽  
Significant Difference ◽  
Before And After ◽  
Goiter Prevalence ◽  
Meta Regression ◽  
Annual Reduction ◽  
Serological Data ◽  
Year 2000

Abstract Purpose According to a few recent studies, the clinical phenotype of Graves’ disease (GD) at onset is becoming milder in recent years, in terms of prevalence and severity of hyperthyroidism, goiter and overt eye disease. The aim of this study was to assess the change in GD phenotype across the late twentieth and the early twenty-first centuries. Materials and methods We carried out a systematic search of studies published between 1/1/1980 and 12/31/2017 describing naïve GD patients at diagnosis. We collected epidemiological, clinical, biochemical and serological data reported in the selected studies, and (1) conducted a single-arm meta-analysis to compare clinical and biochemical characteristics of naïve GD patients before and after year 2000 and (2) performed a meta-regression to identify the trend of the observed clinical presentations. Results Eighty selected articles were related to the period before the year 2000, 30 to the years 2000–2017. According to demographics, the two defined populations were homogeneous at meta-analysis: overall estimated female prevalence was 81% [95% CI 79–82], mean estimated age of the entire population was 39.8 years [95% CI 38.4–41.1], with no significant differences between pre- and post-2000 groups (p > 0.05). The overall estimated prevalence of smokers was 40% [95% CI 33–46], with no significant difference between the two groups (p > 0.05). Mean estimated free thyroxine (FT4) and free triiodothyronine (FT3) levels at diagnosis were higher in the pre-2000 group: 4.7 ng/dl [95% CI 4.5–4.9] for FT4 and 14.2 pg/ml [95% CI 13.3–15.1] for FT3, as compared to the post-2000 group: 3.9 ng/dl [95% CI 3.6–4.2] for FT4 and 12.1 pg/ml [95% CI 11.0–13.3] for FT3 (all p < 0.01). Goiter estimated prevalence was higher in the pre-2000 group, 87% [95% CI 84–90], than in the post-2000 group, 56% [95% CI 45–67]. Estimated prevalence for Graves’ Orbitopathy (GO) was 34% [95% CI 27–41] in the pre-2000 group and 25% [95% CI 19–30] in the post-2000 group (p = 0.03). Accordingly, meta-regression adjusted for covariates showed an average annual reduction of FT4 (− 0.040 ± 0.008 ng/dl, p < 0.0001), FT3 (− 0.316 ± 0.019 pg/ml, p < 0.0001), goiter prevalence (− 0.023 ± 0.008%, p = 0.006), and goiter size (− 0.560 ± 0.031 ml, p < 0.0001). Conclusions Our meta-analysis and meta-regression confirmed that GD phenotype at diagnosis is nowadays milder than in the past; we hypothesize that conceivable factors involved in this change are iodoprophylaxis, worldwide decrease in smoking habits, larger use of contraceptive pill and micronutrient supplementation, as well as earlier diagnosis and management.

scholarly journals Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 (8) ◽  
pp. 704
Author(s):  
Alessia Romito ◽  
Sonia Bove ◽  
Ilaria Romito ◽  
Drieda Zace ◽  
Ivano Raimondo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Publication Bias ◽  
Young Women ◽  
Ovarian Reserve ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Female Population ◽  
Before And After

Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. Methods: A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger’s and Begg’s tests were used to assess the risk of publication bias. Results: Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of −1.97 (95% CI: −3.12, −0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. Conclusions: Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women before starting treatment.

Relationship Between Smoking and Pressure Injury Risk: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 67 (9) ◽  
pp. 34-46
Author(s):  
Bing-Bing Wu ◽  
Dong-Zhou Gu ◽  
Jia-Ning Yu ◽  
Li-Peng Feng ◽  
Rong Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Publication Bias ◽  
Injury Risk ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
China National Knowledge Infrastructure ◽  
Pressure Injury ◽  
Meta Regression ◽  
Meta Regression Analysis

BACKGROUND: Smoking is a risk factor for many diseases. PURPOSE: This study explored the relationship between current or past smoking and pressure injury (PI) risk through a systematic review and meta-analysis. METHODS: The databases PubMed, Web of Science, and China National Knowledge Infrastructure were searched for the years between 2001 and 2020. Quality of evidence was estimated by the Newcastle-Ottawa Scale. The random effects model was applied to assess the odds ratios (OR) and 95% confidence intervals (CI); pooled adjusted OR and 95% CI, subgroup analysis, publication bias, sensitivity analyses, and meta-regression analysis were performed. RESULTS: Fifteen (15) studies (12 retrospective and 3 prospective) comprising data on 11 304 patients were eligible for inclusion in the review. The meta-analysis demonstrated that smoking increased the risk of PI (OR = 1.498; 95% CI, 1.058-2.122), and the pooled adjusted OR (1.969) and 95% CI (1.406-2.757) confirmed this finding. Publication bias was not detected by funnel plot, Begg’s test (P = .322), or Egger’s test (P = .666). Subgroup analyses yielded the same observations in both retrospective (OR = 1.607; 95% CI, 1.043-2.475) and prospective (OR = 1.218; 95% CI, 0.735-2.017) studies. The results were consistent across sensitivity analyses (OR = 1.07; 95% CI, 1.043-2.475). Relevant heterogeneity moderators were not identified by meta-regression analysis with PI incidence (P = .466), years of patient data included (P = .637), mean patient age (P = .650), and diabetes mellitus diagnosis (P = .509). CONCLUSION: This study found that individuals who are current or formers smokers have an almost 1.5 times higher risk of PI development than do those who do not smoke.

P1014INCRETIN BASED THERAPIES IN DIABETIC KIDNEY TRANSPLANT RECIPIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Theodora Oikonomaki ◽  
Evangelia Ntounousi ◽  
ANILA DUNI ◽  
Stefanos Roumeliotis ◽  
Dimitrios Divanis ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Publication Bias ◽  
Meta Analysis ◽  
P Value ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Before And After ◽  
Secondary Outcomes

Abstract Background and Aims Diabetes mellitus (DM) is the major cause of ESRD. New-onset DM after transplantation (NODAT) frequently occurs and increases the risk of infection and mortality. Kidney transplant recipients (KTR) with pre-existing risk factors for DMt2 are more prone to develop NODAT. An intriguing novel concept is the use of the incretin-based therapies including dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1-RAs) and Sodium-glucose co-transporter-2 inhibitors (SGLT2i) in solid organ transplantation. This class of antidiabetic therapy is not yet established in KTR. Our aim was to examine the efficacy and safety of incretin-based therapies in DM or NODAT in KTR. Method We searched without language restrictions for all publications on Kidney/Renal Transplantation and DPP-4i, GLP-1-RAs and SGLT-2i using electronic databases including Medline, Embase, Cochrane, PubMed. We hand-search the reference lists of every relevant study for additional publications. Further searches were done by reviewing abstract and review articles. We included every study (retrospective/prospective) that used these classes of antidiabetics as treatment of NODAT or DMt2 in KTR. All the primary and secondary outcomes were calculated as mean ± sd. Heterogeneity was assessed with Cochrane’s Q statistics and quantified using the I stat, which indicated the proportion of variability across studies that was due to heterogeneity. We used the DerSimonian-Laird estimator for tau^2. Meta-regression was used to assess the effect of different antidiabetics on the primary and secondary outcomes. We assumed a priori the presence of heterogeneity and we used the model of random effects in all analyses. We assessed publication bias using the Begg-Mazumdar test and to nullify the estimated bias the trim-and-fill method, where it was necessary. A p-value &lt; 0.05 was considered statistical significant. Results On the 1512 references screened, 16 studies were included in the final analysis. In total, 310 individuals were analyzed with a mean age of 55.98 ± 8.81 years, similar between studies. In 10 of them, participants were diagnosed with NODAT, whereas in all other trials were DMt2 or NODAT. In 8 studies participants received DPP-4i, in 6 SGLT-2i i and in rest 2 GLP-1-RAs. All included KTR were stable and transplanted over 6 months. The mean follow-up of all trials included was 22,03±14.95 weeks. Glycemic control reduces HbA1c (10 studies, MD=-0.38 %, I=45%). The MD of HbA1c for the DPP-4i group was -0.3741 and for the SGLT-2i group was -0.4596 mg/dl. Within every group of each different category of drugs, there was homogeneity (QM, p-value&gt;0.05) and it was explained the most of the variance of the previous meta-analysis (QE= 15.76). The Begg-Mazumdar test showed that publication bias was not present (p&gt; 0.05). Nine trials reported the difference of FPG and 5 of PPG before and after the administration of antidiabetics. The common MD estimator with a random effect model was – 25.76 for FPG and – 6.61 for PPG with a high grade of heterogeneity for both. Seven trials reported the change of body mass index (BMI) and body weight (BW) before and after the administration of this class of antidiabetics. The BW reduction, where reported, was significant in KTR on SGLT1i or DPP-4i whereas BMI wasn’t significantly reduced in this group, possible due to statistical artifact. The majority of the studies showed that GFR and hepatic biochemical parameters, didn’t change during therapy (DPP-4i, GLP-1-RAs, SGLT-2i). Conclusion Evidence concerning the efficacy of incretins in diabetes on KTR is limited. SGLT2i and DPP-4i are efficacious for glucose-lowering. The safety profile based on renal and hepatic function is indicative for the use of this class of antidiabetics in this population. More high-quality studies are required to help guide therapeutic choice for antidiabetics in KTR.

scholarly journals Normative Values for Colonic Transit Time and Patient Assessment of Constipation in Adults With Functional Constipation: Systematic Review With Meta-Analysis

2017 ◽  
Vol 10 ◽  
pp. 117955221772934 ◽  
Author(s):  
Larry E Miller ◽  
Alvin Ibarra ◽  
Arthur C Ouwehand
Keyword(s):  
Publication Bias ◽  
Transit Time ◽  
Meta Analysis ◽  
Functional Constipation ◽  
Colonic Transit ◽  
Colonic Transit Time ◽  
Significant Heterogeneity ◽  
Patient Assessment ◽  
Rome Iii ◽  
Meta Regression

Availability of normative patient outcome data may assist in designing experiments and estimating sample sizes. The purpose of this review was to determine normative ranges for colonic transit time (CTT), Patient Assessment of Constipation-Symptoms (PAC-SYM), and Patient Assessment of Constipation-Quality of Life (PAC-QOL) in adults diagnosed with functional constipation per Rome III guidelines. Pooled estimates were derived from random-effects meta-analysis. Meta-regression was used to explore sources of heterogeneity among studies. A total of 24 studies (3786 patients) were included in the review. In 10 studies with 1119 patients, pooled CTT was 58 hours (95% confidence interval [CI]: 50-65 hours). Publication bias was not evident (Egger P = .51); heterogeneity was high ( I2 = 92%, P < .001). In meta-regression, geographical location explained 57% of the between-study variance, with CTT significantly longer in studies conducted in Europe (71 hours) compared with Asia (49 hours) or the Americas (44 hours). In 9 studies with 2061 patients, pooled PAC-SYM was 1.70 (95% CI: 1.58-1.83). Publication bias was not evident (Egger P = .44). Heterogeneity was high ( I2 = 90%, P < .001); however, no study or patient factor influenced PAC-SYM in meta-regression. In 12 studies with 1805 patients, pooled PAC-QOL was 1.97 (95% CI: 1.70-2.24). Publication bias was not evident (Egger P = .28); heterogeneity was high ( I2 = 98%, P < .001). In meta-regression, age explained 52% of the between-study variance, with older age associated with lower PAC-QOL scores. Overall, in adults diagnosed with functional constipation per Rome III criteria, significant heterogeneity in CTT, PAC-SYM, and PAC-QOL exists among studies. Variability among studies may be explained by geography and patient factors.

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