The accuracy of diagnostic tests for GH deficiency in adults: a systematic review and meta-analysis

ContextThe diagnostic accuracy of tests used to diagnose GH deficiency (GHD) in adults is unclear.ObjectiveWe conducted a systematic review and meta-analysis of studies that provided data on the available diagnostic tests.Data sourcesWe searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Sciences, and Scopus) through April 2011.Study selectionReview of reference lists and contact with experts identified additional candidate studies. Reviewers, working independently and in duplicate, determined study eligibility.Data extractionReviewers, working independently and in duplicate, determined the methodological quality of studies and collected descriptive, quality, and outcome data.Data synthesisTwenty-three studies provided diagnostic accuracy data; none provided patient outcome data. Studies had fair methodological quality, used several reference standards, and included over 1100 patients. Several tests based on direct or indirect stimulation of GH release were associated with good diagnostic accuracy, although most were assessed in one or two studies decreasing the strength of inference due to small sample size. Serum levels of GH or IGF1 had low diagnostic accuracy. Pooled sensitivity and specificity of the two most commonly used stimulation tests were found to be 95 and 89% for the insulin tolerance test and 73 and 81% for the GHRH+arginine test respectively. Meta-analytic estimates for accuracy were associated with substantial heterogeneity.ConclusionSeveral tests with reasonable diagnostic accuracy are available for the diagnosis of GHD in adults. The supporting evidence, however, is at high risk of bias (due to heterogeneity, methodological limitations, and imprecision).

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A Systematic Review with Meta-analysis of Studies Comparing Response to Experimentally-evoked Pain Between Obese and Non-Obese Individuals

The Open Pain Journal ◽

10.2174/1876386301811010001 ◽

2018 ◽

Vol 11 (1) ◽

pp. 1-11

Author(s):

Rehab Astita ◽

Osama A. Tashani ◽

Carole A. Paley ◽

Duncan Sharp ◽

Mark I. Johnson

Keyword(s):

Systematic Review ◽

Methodological Quality ◽

Small Sample Size ◽

Meta Analysis ◽

Pressure Pain Threshold ◽

Ideal Body Weight ◽

Small Sample ◽

Forest Plot ◽

Pressure Pain ◽

Obese Human

Background:The relationship between obesity and pain remains unclear. The aim of this systematic review was to determine whether response to experimentally-evoked pain differed between obese and non-obese individuals. Studies that compared responses to experimentally-evoked pain between obese and non-obese human participants post-puberty (i.e.>16 years) were sought. Eligible studies published between January 1950 and May 2017 were identified by searching OVID, MEDLINE, EMBASE and Science Direct.Explanation:Methodological quality of included studies was assessed using the ‘QualSyst’ questionnaire. Of 1106 references identified only nine studies (683 participants) were eligible for review. Pressure pain was assessed in five studies and electrical pain in three studies. Two studies investigated thermal pain. Obesity was categorized according to body mass index (BMI) or as weight as a percentage of ideal body weight. Six of the nine included studies were of low methodological quality. There was a lack of extractable data to pool for meta-analysis of studies using thermal or electrical pain. A forest plot of data extracted from four studies on pressure pain threshold found no differences between obese and non-obese groups (overall effect size was Z=0.57, p=0.57).Conclusion:Small sample size was the main limitation in all studies. Participants with obesity were more sensitive to mechanical noxious stimuli than non-obese participants in three of five studies. However, overall, it was not possible to determine whether there are differences in pain sensitivity response to experimental stimuli between obese and non-obese individuals.

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The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

Rheumatology International ◽

10.1007/s00296-021-04876-6 ◽

2021 ◽

Author(s):

Peter Cox ◽

Sonal Gupta ◽

Sizheng Steven Zhao ◽

David M. Hughes

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Diseases ◽

Small Sample Size ◽

Meta Analysis ◽

Random Effect ◽

Small Sample ◽

Future Research ◽

Increased Risk

AbstractThe aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

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DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis

Acta Endocrinologica ◽

10.1530/eje-16-0297 ◽

2016 ◽

Vol 175 (2) ◽

pp. R65-R80 ◽

Cited By ~ 40

Author(s):

Irina Bancos ◽

Shrikant Tamhane ◽

Muhammad Shah ◽

Danae A Delivanis ◽

Fares Alahdab ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Performance ◽

Small Sample Size ◽

Controlled Trial ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Central Register ◽

Moderate Risk ◽

Adrenal Biopsy ◽

Adrenocortical Carcinomas

ObjectiveTo perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy.MethodsMedline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate.ResultsWe included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6–11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5–3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively.ConclusionsEvidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.

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Mesenchymal Stem Cell Therapy for Acetaminophen-Related Liver Injury: A Systematic Review and Meta-Analysis of Experimental Studies in Vivo

Current Stem Cell Research & Therapy ◽

10.2174/1574888x16666211007092055 ◽

2021 ◽

Vol 16 ◽

Author(s):

Li Wang ◽

Yiwen Zhang ◽

Jiajun Zhong ◽

Yuan Zhang ◽

Shuisheng Zhou ◽

...

Keyword(s):

Systematic Review ◽

Stem Cell ◽

Liver Injury ◽

Mesenchymal Stem Cell ◽

Small Sample Size ◽

Meta Analysis ◽

Experimental Studies ◽

Small Sample ◽

Control Group

Objective: The efficacy of mesenchymal stem cell (MSC) therapy in acetaminophen-induced liver injury has been investigated in animal experiments, but individual studies with a small sample size cannot be used to draw a clear conclusion. Therefore, we conducted a systematic review and meta-analysis of preclinical studies to explore the potential of using MSCs in acetaminophen-induced liver injury. Methods: Eight databases were searched for studies reporting the effects of MSCs on acetaminophen hepatoxicity. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. SYRCLE’s risk of bias tool for animal studies was applied to assess the methodological quality. A meta-analysis was performed by using RevMan 5.4 and STATA/SE 16.0 software. Results: Eleven studies involving 159 animals were included according to PRISMA statement guidelines. Significant associations were found for MSCs with the levels of alanine transaminase (ALT) (standardized mean difference (SMD) − 2.58, p < 0.0001), aspartate aminotransferase (AST) (SMD − 1.75, p = 0.001), glutathione (GSH) (SMD 3.7, p < 0.0001), superoxide dismutase (SOD) (SMD 1.86, p = 0.022), interleukin 10 (IL-10) (SMD 5.14, p = 0.0002) and tumor necrosis factor-α (TNF-α) (SMD − 4.48, p = 0.011) compared with those in the control group. The subgroup analysis showed that the tissue source of MSCs significantly affected the therapeutic efficacy (p < 0.05). Conclusion: Our meta-analysis results demonstrate that MSCs could be a potential treatment for acetaminophen-related liver injury.

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Rapid diagnostic test for antenatal syphilis screening in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-018132 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018132 ◽

Cited By ~ 5

Author(s):

Carmen Phang Romero Casas ◽

Marrissa Martyn-St James ◽

Jean Hamilton ◽

Daniel S Marinho ◽

Rodolfo Castro ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Diagnostic Accuracy ◽

Pregnant Women ◽

Sensitivity And Specificity ◽

Methodological Quality ◽

Meta Analysis ◽

Risk Of Bias ◽

Antenatal Clinics

ObjectivesTo undertake a systematic review and meta-analysis to evaluate the test performance including sensitivity and specificity of rapid immunochromatographic syphilis (ICS) point-of-care (POC) tests at antenatal clinics compared with reference standard tests (non-treponemal (TP) and TP tests) for active syphilis in pregnant women.MethodsFive electronic databases were searched (PubMed, EMBASE, CRD, Cochrane Library and LILACS) to March 2016 for diagnostic accuracy studies of ICS test and standard reference tests for syphilis in pregnant women. Methodological quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). A bivariate meta-analysis was undertaken to generate pooled estimates of diagnostic parameters. Results were presented using a coupled forest plot of sensitivity and specificity and a scatter plot.ResultsThe methodological quality of the five included studies with regards to risk of bias and applicability concern judgements was either low or unclear. One study was judged as high risk of bias for patient selection due to exclusion of pregnant women with a previous history of syphilis, and one study was judged at high risk of bias for study flow and timing as not all patients were included in the analysis. Five studies contributed to the meta-analysis, providing a pooled sensitivity and specificity for ICS of 0.85 (95% CrI: 0.73 to 0.92) and 0.98 (95% CrI: 0.95 to 0.99), respectively.ConclusionsThis review and meta-analysis observed that rapid ICS POC tests have a high sensitivity and specificity when performed in pregnant women at antenatal clinics. However, the methodological quality of the existing evidence base should be taken into consideration when interpreting these results.PROSPERO registration numberCRD42016036335.

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Abstract 181: A Systematic Review of Interventions to Increase tPA Administration

Stroke ◽

10.1161/str.47.suppl_1.181 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Mollie McDermott ◽

Lesli E Skolarus ◽

James F Burke

Keyword(s):

Systematic Review ◽

Public Education ◽

Small Sample Size ◽

Case Reports ◽

Meta Analysis ◽

Experimental Studies ◽

Fixed Effect Model ◽

Small Sample ◽

Eligibility Criteria ◽

Design Elements

Introduction: Rates of tPA administration remain low nationally and globally despite its demonstrated efficacy. We performed a systematic review and meta-analysis of interventions to increase the rate of tPA administration. Methods: We searched PubMed and EMBASE to identify all studies (excluding case reports) published between 1995 and January 8, 2015 documenting interventions to increase the utilization of tPA. We screened each study with pre-specified inclusion and exclusion criteria. Design elements and study data were extracted from eligible studies. The principal summary measure was the percentage change in rate of tPA administration. Fixed and random effects meta-analytic models were built to summarize the effect of intervention compared to control as well as intervention subtypes. Results: Our search yielded 1457 results of which 25 met eligibility criteria. We identified 13 pre-post studies and 11 randomized or quasi-experimental studies. Included studies utilized EMS (n=14), telemedicine (n=6), and public education (n=5). Intervention settings included urban (n=13), rural (n=4), and combined (n=4). In a fixed effect model, tPA administration was significantly higher in the intervention arm across all studies that limited enrollment to ischemic stroke patients (n=14) with a risk ratio (RR) of 1.71. Interventions involving EMS were associated with an increased rate of tPA administration with a RR of 1.51, (95% CI: 1.43-1.59, p<0.0001); promoting public education RR = 2.62, (95% CI: 1.54-4.43, p<0.01); and utilizing telemedicine RR = 2.97, (95% CI: 2.61-3.39, p<0.0001). Conclusions: Interventions to increase tPA use appear to have considerable efficacy. Comparative inferences between intervention types are limited by small sample size and intervention heterogeneity.

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Efficacy of heavy eccentric calf training for treating mid-portion Achilles tendinopathy: a systematic review and meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099934 ◽

2019 ◽

Vol 53 (17) ◽

pp. 1070-1077 ◽

Cited By ~ 15

Author(s):

Myles Calder Murphy ◽

Mervyn J Travers ◽

Paola Chivers ◽

James Robert Debenham ◽

Sean Iain Docking ◽

...

Keyword(s):

Systematic Review ◽

Natural History ◽

Small Sample Size ◽

Meta Analysis ◽

Achilles Tendinopathy ◽

Small Sample ◽

Current Evidence ◽

Eligibility Criteria ◽

Exercise Interventions ◽

And Function

ObjectiveTo assess the effectiveness of heavy eccentric calf training (HECT) in comparison with natural history, traditional physiotherapy, sham interventions or other exercise interventions for improvements in pain and function in mid-portion Achilles tendinopathy.DesignA systematic review and meta-analysis were conducted as per the PRISMA guidelines.Data sourcesPUBMED, CINAHL (Ovid) and CINAHL (EBSCO) were searched from inception until 24 September 2018.Eligibility criteriaRandomised controlled trials comparing HECT to natural history, sham exercise, traditional physiotherapy and other exercise interventions were included. Primary outcome assessing pain and function was the Victorian Institute of Sports Assessment-Achilles.ResultsSeven studies met the inclusion criteria. This review suggests HECT may be superior to both natural history, mean difference (MD) (95% CI) of 20.6 (11.7 to 29.5, one study) and traditional physiotherapy, MD (95% CI) of 17.70 (3.75 to 31.66, two studies). Following removal of one study, at high risk of bias, due to pre-planned sensitivity analysis, this review suggests HECT may be inferior to other exercise interventions, MD (95% CI) of −5.65 (-10.51 to −0.79, three studies). However, this difference is unlikely to be clinically significant.ConclusionCurrent evidence suggests that HECT may be superior to natural history and traditional physiotherapy while HECT may be inferior to other exercise interventions. However, due to methodological limitations, small sample size and a lack of data we are unable to be confident in the results of the estimate of the effect, as the true effect is likely to be substantially different.Systematic review registryPROSPERO registration number: CRD4201804493Protocol referenceThis protocol has been published open access: Murphy M, Travers MJ, Gibson, W. Is heavy eccentric calf training superior to natural history, sham rehabilitation, traditional physiotherapy and other exercise interventions for pain and function in mid-portion Achilles tendinopathy? Systematic Reviews 2018; 7: 58

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Increased risk of liver-related outcomes in chronic hepatitis B patients with metabolic syndrome: A systematic review and meta-analysis

Digestive Diseases ◽

10.1159/000521768 ◽

2022 ◽

Author(s):

Khin Naing Thin ◽

Andrew Tran ◽

Jie Li ◽

Eunice Yewon Lee ◽

Hongli Yang ◽

...

Keyword(s):

Systematic Review ◽

Metabolic Syndrome ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Library ◽

Increased Risk

Introduction: Chronic hepatitis B (CHB) patients with metabolic syndrome (MetS) may present increased risk of liver-related outcomes (LROs) but prior studies were limited by small sample size and/or conflicting results. Using a systematic review and meta-analytic approach, we aimed to determine the association between MetS and LROs in CHB. Methods: Two researchers independently screened studies from the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to January 21, 2020 and extracted the data. Estimates were pooled using a random-effects model. Results: We screened 2,228 articles and included 10 eligible studies (18,360 CHB patients, 2,557 with MetS). MetS was significantly associated with LROs overall (OR=2.45, 95%CI=1.39-4.32) but not the individual LRO components but subgroup analyses were limited by small study numbers. Discussion/Conclusion: MetS is associated with almost 3 folds higher risk of LROs in CHB and should be considered in management decisions. However, additional studies are needed.

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Effect of vitamins C and E supplementation onHelicobacter pylorieradication: a meta-analysis

British Journal Of Nutrition ◽

10.1017/s0007114511003813 ◽

2011 ◽

Vol 106 (11) ◽

pp. 1632-1637 ◽

Cited By ~ 11

Author(s):

Guogang Li ◽

Lan Li ◽

Chaohui Yu ◽

Li Chen

Keyword(s):

Methodological Quality ◽

Eradication Rate ◽

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Library ◽

Significant Difference ◽

H Pylori ◽

Randomised Controlled

Vitamins C and E can act as potent antioxidants to reduce the damage caused by reactive oxygen species in gastric mucosa. Whether vitamin supplements forHelicobacter pylorieradication regimen could improve the rate of eradication remains uncertain. Therefore, we performed a meta-analysis to evaluate the efficacy of vitamins C and E supplementation for the eradication ofH. pylori. Searches were conducted in the databases PubMed, EMBASE and Cochrane Library. Randomised controlled trials (RCT) that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed. Of the six RCT included, five had a low methodological quality. Of the six RCT, three compared the efficacy of the eradication regimenv.eradication regimen plus vitamins C and E. The result of the meta-analysis showed a non-significant difference in the eradication rate ofH. pyloribetween the two groups (risk ratio (RR) 0·93,P = 0·76). Another three RCT compared the eradication regimenv.eradication regimen plus vitamin C only, and there too there was no significant difference in the eradication rate (RR 0·83,P = 0·32). In conclusion, vitamins C and/or E supplements to theH. pylorieradication regimen could not improve the eradication rate. However, currently available data do not draw a definitive conclusion about the effectiveness of antioxidant vitamins onH. pylorieradication, owing to the small sample size and low-to-moderate methodological quality.

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Acupuncture for the Treatment of Gastro-Oesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Acupuncture in Medicine ◽

10.1136/acupmed-2016-011205 ◽

2017 ◽

Vol 35 (5) ◽

pp. 316-323 ◽

Cited By ~ 11

Author(s):

Jiajie Zhu ◽

Yu Guo ◽

Shan Liu ◽

Xiaolan Su ◽

Yijie Li ◽

...

Keyword(s):

Systematic Review ◽

Reflux Disease ◽

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Oesophageal Reflux ◽

Symptom Improvement ◽

Significant Heterogeneity ◽

Oesophageal Reflux Disease

Background Gastro-oesophageal reflux disease (GORD) is one of the most common diseases presenting to gastroenterology clinics. Acupuncture is widely used as a complementary and alternative treatment for patients with GORD. Objective To explore the effectiveness of acupuncture for the treatment of GORD. Methods Four English and four Chinese databases were searched through June 2016. Randomised controlled trials investigating the effectiveness of manual acupuncture or electroacupuncture (MA/EA) for GORD versus or as an adjunct to Western medicine (WM) were selected. Data extraction and quality evaluation were performed by two authors independently and RevMan 5.2.0 was used to analyse data. Results A total of 12 trials involving 1235 patients were included. Meta-analyses demonstrated that patients receiving MA/EA combined with WM had a superior global symptom improvement compared with those receiving WM alone (relative risk (RR) 1.17, 95% CI 1.09 to 1.26; p=0.03; six studies) with no significant heterogeneity (I2=0%, p=0.41). Recurrence rates of those receiving MA/EA alone were lower than those receiving WM (RR 0.42,95% CI 0.29 to 0.61; p<0.001; three studies) with low heterogeneity (I2=7%, p=0.34), while global symptom improvement (six studies) and symptom scores (three studies) were similar (both p>0.05). Descriptive analyses suggested that acupuncture also improves quality of life in patients with GORD. Conclusion This meta-analysis suggests that acupuncture is an effective and safe treatment for GORD. However, due to the small sample size and poor methodological quality of the included trials, further studies are required to validate our conclusions. Trial registration number PROSPERO Systematic review registration no. CRD42016041916.

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