Statin Use and the Risk of Hepatocellular Carcinoma: A Meta-Analysis of Observational Studies

Background and Aims: Statins are the first-line medication to treating hypercholesterolemia. Several studies have investigated the impact of statins on the risk of hepatocellular carcinoma (HCC). However, the extent to which statins may prevent HCC remains uncertain. Therefore, we performed a meta-analysis of relevant studies to quantify the magnitude of the association between statins use and the risk of HCC. Methods: A systematic literature search of PubMed, EMBASE, Google Scholar, Web of Science, and Scopus was performed for studies published between January 1, 1990, and September 1, 2019, with no restriction of language. Two reviewers independently evaluated the literature and included observational and experimental studies that reported the association between statin use and HCC risk. The random-effect model was used to calculate the overall risk ratio (RR) with a 95% confidence interval (CI), and the heterogeneity among the studies was assessed using the Q statistic and I2 statistic. The Newcastle Ottawa Scale (NOS) was also used to evaluate the quality of the included studies. Results: A total of 24 studies with 59,073 HCC patients was identified. Statin use was associated with a reduced risk of HCC development (RR: 0.54, 95% CI: 0.47–0.61, I2 = 84.39%) compared with nonusers. Moreover, the rate of HCC reduction was also significant among patients with diabetes (RR: 0.44, 95% CI: 0.28–0.70), liver cirrhosis (RR: 0.36, 95% CI: 0.30–0.42), and antiviral therapy (RR: 0.21, 95% CI: 0.08–0.59) compared with nonusers. Conclusion: This study serves as additional evidence supporting the beneficial inhibitory effect of statins on HCC incidence. The subgroup analyses of this study also highlight that statins are significantly associated with a reduced risk of HCC and may help to direct future prevention efforts. Additional large clinical studies are needed to determine whether statins are associated with a lower risk of HCC.

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The Correlation of Glycemic Index, Glycemic Load, and Carbohydrates with the Risk of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-1117792/v1 ◽

2021 ◽

Author(s):

Long-Shan Yang ◽

Guang-Xiao Meng ◽

Zi-Niu Ding ◽

Lun-Jie Yan ◽

Sheng-Yu Yao ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Glycemic Index ◽

Hepatitis Virus ◽

Meta Analysis ◽

Glycemic Load ◽

Random Effect ◽

Random Effect Model ◽

Fixed Effect Model ◽

Case Control Studies ◽

Effect Model

Abstract Background Glycemic index (GI), glycemic load (GL), and carbohydrates have been shown to be associated with a variety of cancers, but their correlation with hepatocellular carcinoma (HCC) remains controversial. The purpose of our study was to investigate the correlation of GI, GL and carbohydrate with risk of HCC.Methods Systematic searches were conducted in PubMed, Embase and Web of Science until November 2020. According to the size of heterogeneity, the random effect model or the fixed effect model was performed to calculate the pooled relative risks (RRs) and 95% confidence intervals (CIs) for the correlation of GI, GL, and carbohydrates with the risk of HCC.Results Seven cohort studies involving 1,193,523 participants and 1,004 cases, and 3 case-control studies involving 827 cases and 5,502 controls were eventually included. The pooled results showed no significant correlation of GI (RR=1.11, 95%CI 0.80-1.53, I2= 62.2%), GL (RR=1.09, 95%CI 0.76-1.55, I2 = 66%), and carbohydrate (RR=1.09, 95%CI 0.84-1.32, I2=0%) with the risk of HCC in general population. Subgroup analysis revealed that in hepatitis B virus (HBV) or/and hepatitis C virus (HCV)-positive group, GI was not correlated with the risk of HCC (RR=0.65, 95%CI 0.32-1.32, p=0.475, I2=0.0%), while GL was significantly correlated with the risk of HCC (RR=1.52, 95%CI 1.04-2.23, p=0.016, I2=70.9%). In contrast, in HBV and HCV-negative group, both GI (RR=1.23, 95%CI 0.88-1.70, p=0.222, I2=33.6%) and GL (RR=1.17, 95% CI 0.83-1.64, p=0.648, I2=0%) were not correlated with the risk of HCC. Conclusion A high GL diet is correlated with a higher risk of HCC in people with hepatitis virus. A low GL diet may be recommended for patients with viral hepatitis to reduce the risk of HCC.

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The impact of leptomeningeal collaterals in acute ischemic stroke

10.21203/rs.3.rs-36392/v1 ◽

2020 ◽

Author(s):

Nida Fatima ◽

Maher Saqqur ◽

Ashfaq Shuaib

Keyword(s):

Blood Flow ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Mesh Terms ◽

Favorable Clinical Outcome ◽

The Impact

Abstract Objectives: Leptomeningeal collaterals provide an alternate pathway to maintain cerebral blood flow in stroke to prevent ischemia, but their role in predicting outcome is still unclear. So, our study aims at assessing the significance of collateral blood flow (CBF) in acute stroke. Methods: Electronic databases were searched under different MeSH terms from Jan 2000 to Feb 2019. Studies were included if there was available data on good and poor CBF in acute ischemic stroke (AIS). The clinical outcomes included were modified rankin scale (mRS), recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days. Data was analyzed using random-effect model.Results: A total of 47 studies with 8,194 patients were included. Pooled meta-analysis revealed that there exist 2-fold higher likelihood of favorable clinical outcome (mRS≤2) at 90 days with good CBF compared with poor CBF (RR: 2.27; 95%CI: 1.94-2.65; p<0.00001) irrespective of the thrombolytic therapy [RR with IVT: 2.90; 95%CI: 2.14-3.94; p<0.00001, and RR with IAT/EVT: 1.99; 95% CI: 1.55-2.55; p<0.00001]. Moreover, there exists 1-fold higher probability of successful recanalization with good CBF (RR: 1.31; 95% CI: 1.15-1.49; p<0.00001). However, there was 54% and 64% lower risk of sICH and mortality respectively in patients with good CBF in AIS (p<0.00001).Conclusions: The relative risk of favorable clinical outcome is more in patients with good pretreatment CBF. This could be explained due to better chances of recanalization, combined with lesser risk of intracerebral hemorrhage in good CBF status.

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Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2620-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Marta Berta ◽

Helena Lindgren ◽

Kyllike Christensson ◽

Sollomon Mekonnen ◽

Mulat Adefris

Keyword(s):

Weighted Mean Difference ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Significant Heterogeneity ◽

Second Stage Of Labor ◽

Second Stage ◽

Birth Position ◽

Study Designs ◽

The Impact

Abstract Background It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2–34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839–30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%, p < 000). Conclusion The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

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The Impact of Dementia on the Clinical Outcome of COVID-19: A Systematic Review and Meta-Analysis

Journal of Alzheimer s Disease ◽

10.3233/jad-201016 ◽

2020 ◽

Vol 78 (4) ◽

pp. 1775-1782

Author(s):

Nanyang Liu ◽

Jiahui Sun ◽

Xiyuan Wang ◽

Ming Zhao ◽

Qianqian Huang ◽

...

Keyword(s):

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Dementia Patients ◽

Effect Model ◽

Incidence And Mortality ◽

High Risk Factor ◽

The Impact ◽

Substantial Heterogeneity ◽

Significant Publication Bias

Background: The emergence of the coronavirus disease 2019 (COVID-19) has brought large challenges to dementia patients. We reviewed the existing literature on COVID-19 to assess the incidence and mortality of dementia comorbidities in COVID-19 patients. Objective: To investigate the impact of pre-existing dementia comorbidities on COVID-19. Methods: We searched the PubMed, Embase, and Web of Science databases for patients with preexisting dementia who were diagnosed with COVID-19. The statistical data on the prevalence and mortality of dementia comorbidities were examined. A fixed-or random-effect model was used to calculate the overall pooled risk estimates. Forest plots were generated to show the summarized results. Results: A total of 265 articles were retrieved from the three databases. After removing duplicates and performing two screenings, 10 articles were selected for meta-analysis, including 119,218 participants. Overall, the meta-analysis of the 10 studies showed that the incidence of dementia in COVID-19 patients was (R: 9%, [95% CI: 6% to 13%]). Moreover, the meta-analysis of 9 studies showed that the mortality rate of individuals with dementia after being infected with COVID-19 was higher than that of individuals with no dementia (OR: 5.17 [95% CI: 2.31 to 11.59]). Substantial heterogeneity was observed in this meta-analysis. Significant publication bias was also found. Conclusion: Emerging literature shows that dementia comorbidities are a high risk factor for the prevalence and mortality of COVID-19. Our results should have an impact on preventive interventions and encourage more targeted approaches to prioritize older people with specific risk factors, such as dementia.

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Breast Cancer Risk in Rheumatoid Arthritis: An Update Meta-Analysis

BioMed Research International ◽

10.1155/2014/453012 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Guo Tian ◽

Jia-Ning Liang ◽

Zhuo-Yun Wang ◽

Dian Zhou

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Subgroup Analysis ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cochrane Library ◽

Number Of Patients ◽

The Impact

Background. The incidence of breast cancer in RA patients remains controversial. Thus we performed a meta-analysis to investigate the impact of RA on breast cancer.Methods. Published literature was available from PubMed, Embase, and Cochrane Library. Pooled standardized incidence rate (SIR) was computed by random-effect model analysis.Results. We identified 16 separate studies in the present study, in which the number of patients ranged from 458 to 84,475. We did not find the increased cancer risk in RA patients (SIR=0.86, 95%CI=0.72–1.02). However, subgroup analysis showed that breast cancer risk in RA patients was positively different in Caucasians (SIR=0.82, 95%CI=0.73–0.93) and non-Caucasians (SIR=1.21, 95%CI=1.19–1.23), respectively. In subgroup analysis by style, a reduced incidence was found in hospital-based case subjects (SIR=0.82, 95%CI=0.69–0.97). Similarly, subgroup analysis for adjusted factors indicated that in A3 (age and sex) and A4 (age, sex, and race/ethnicity) the risk was decreased (SIR=0.87, 95%CI=0.76–0.99;SIR=0.63, 95%CI=0.59–0.67).Conclusions. The meta-analysis revealed no increased breast cancer risk in RA patients. However, in the subgroup analysis, the risk of breast cancer is increased in non-Caucasians patients with RA while it decreased in Caucasian population, hospital-based case subjects, and A3 group. Such relationship may provide preference for risk of breast cancer in different population.

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Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis

10.21203/rs.2.13898/v1 ◽

2019 ◽

Author(s):

Marta Berta Badi ◽

Helena Lindgren ◽

Kyllike Christensson ◽

Sollomon Mekonnen ◽

Mulat Adefris

Keyword(s):

Weighted Mean Difference ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Significant Heterogeneity ◽

Second Stage Of Labor ◽

Second Stage ◽

Birth Position ◽

Study Designs ◽

The Impact

Abstract Background: it is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Objective: The aim of this review was to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method: The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1,985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results: We identified 1,680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I2=96.8%, p<000). Conclusion: The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

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Profiling Inflammatory Cytokines Following Zinc Supplementation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

British Journal Of Nutrition ◽

10.1017/s0007114521000192 ◽

2021 ◽

pp. 1-28

Author(s):

Amir Hossein Faghfouri ◽

Behzad Baradaran ◽

Alireza Khabbazi ◽

Yaser Khaje Bishak ◽

Meysam Zarezadeh ◽

...

Keyword(s):

Systematic Review ◽

Sensitivity Analysis ◽

Inflammatory Cytokines ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Controlled Trials ◽

Tnf Α ◽

Trim And Fill ◽

The Impact

Abstract Chronic inflammation has been considered as the main cause of chronic diseases. Zn has anti-inflammatory effects by decreasing the expression of inflammatory markers. The present systematic review and meta-analysis study aims to evaluate the impact of Zn supplementation on inflammation. Pubmed (Medline), Scopus, Web of Science, and Embase databases were searched up to December 10th, 2020. Randomized placebo-controlled trials have investigated the effects of Zn supplementation on serum/plasma levels of inflammatory cytokines in >15 years’ subjects were included. A pooled meta-analysis was performed using a random-effect model. Sensitivity analysis was performed to determine the robustness of the observed effect sizes. Potential causes of heterogeneity were determined using subgroup analyses. The relationship between effect size and co-variables was explored using meta-regression. In the cases of the presence of publication bias, trim and fill analysis was carried out. Cochrane Collaboration’s tool was used for assessing the quality of the included studies. A total of 12 studies was included in meta-analysis. Zn could decrease IL-6 levels (SMD= -0.76 pg/ml; 95% CI: -1.28, -0.24; P= 0.004). There was no significant change in TNF-α (SMD= 0.42 pg/ml; 95% CI: -0.31, 1.16; P= 0.257) and IL-2 levels (SMD= 1.64 pg/ml; 95% CI: -1.31, 4.59; P= 0.277) following Zn supplementation. However, Zn could increase IL-2 significantly after deletion of one arm in sensitivity analysis (SMD= 2.96 pg/ml; 95% CI: 2.03, 3.88; P< 0.05). Conclusively, Zn supplementation can decrease the IL-6 level. Zn increased IL-2 level after sensitivity analysis. Zn supplementation has not ameliorative effects on TNF-α.

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School reopening and risks accelerating the COVID-19 pandemic: A systematic review and meta-analysis protocol

PLoS ONE ◽

10.1371/journal.pone.0260189 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260189

Author(s):

Luís Carlos Lopes-Júnior ◽

Priscila Carminati Siqueira ◽

Ethel Leonor Noia Maciel

Keyword(s):

Systematic Review ◽

Potential Risk ◽

Disease Transmission ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cochrane Library ◽

British Library ◽

The Impact ◽

Analysis Protocol

Background One of the most recent concerns of this pandemic regards the role of schools reopening in disease transmission, as well as the impact of keeping schools closed. While school reopening seems critical for the education and mental health of children, adolescents, and adults, so far the literature has not systematically reached a consensus whether to recommend the return to schools in a way that would be safe for students and staff. Objective To synthesize and critically evaluate the scientific evidence on the potential risk of accelerating the Coronavirus Disease 2019 (COVID-19) pandemic among children, adolescents, young adults, and adults with school reopening. Methods This systematic review and meta-analysis protocol was elaborated following the PRISMA-P. We will include all observational study designs, which report on the potential risk of accelerating the COVID-2019 pandemic with school reopening. Electronic databases included were MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, SCOPUS and CNKI. Additional sources will be also retrieved, including Clinical trials.gov-NIH, The British Library, Pro Quest Dissertations Database, Public Health Gray Literature Sources and Health Evidence, Google Scholar, and pre-prints [medRXiv]. No restriction to language or date will be used as search strategy. In an independently manner, two investigators will select studies, perform data extraction, as well as perform a critical appraisal of the risk of bias and overall quality of the selected observational studies, based on their designs. The heterogeneity among the studies will be assessed using the I2 statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the R statistical software, v.4.0.4. In addition, we will rate the certainty of evidence based on Cochrane methods and in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Expected results This systematic review and meta-analysis will provide better insights into safety in the return to school in the context of the COVID-2019 pandemic, at a time when vaccination advances unevenly in several countries around the world. Hence, consistent data and robust evidence will be provided to help decision-makers and stakeholders in the current pandemic scenario. PROSPERO registration number CRD42021265283; https://clinicaltrials.gov.

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Effects of vitamin D supplementation on apolipoprotein A1 and B100 levels in adults: Systematic review and meta-analysis of controlled clinical trials

Journal of Cardiovascular and Thoracic Research ◽

10.34172/jcvtr.2021.21 ◽

2021 ◽

Vol 13 (3) ◽

pp. 190-197

Author(s):

Nima Radkhah ◽

Sakineh Shabbidar ◽

Meysam Zarezadeh ◽

Abdolrasoul Safaeiyan ◽

Ali Barzegar

Keyword(s):

Vitamin D ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Vitamin D Supplementation ◽

Mean Difference ◽

Apolipoprotein A1 ◽

Sensitivity Analyses ◽

Standardized Mean Difference ◽

The Impact

Cardiovascular disease (CVD) is a leading cause of death around the world. According to the studies, apolipoproteins A1 and B100 play crucial role in CVD development and progression. Also, findings have indicated the positive role of vitamin D on these factors. Thus, we conducted the present meta-analysis of randomized controlled trials (RCTs) to demonstrate the impact of vitamin D supplementation on apolipoproteins A1 and B100 levels in adults. PubMed and Scopus databases and Google Scholar were searched up to 21 December 2020. Relevant articles were screened, extracted, and assessed for quality based on the Cochrane collaboration’s risk of bias tool. Data analysis conducted by random-effect model and expressed by standardized mean difference (SMD). The heterogeneity between studies was assessed by I-squared (I2) test. Subgroups and sensitivity Analyses were also conducted. Seven RCTs were identified investigating the impact of vitamin D on Apo A1 levels and six on Apo B100 levels. The findings showed the insignificant effect of vitamin D supplementation on Apo A1 (SMD=0.26 mg/dL; 95% confidence interval (CI), −0.10, 0.61; P= 0.155) and Apo B100 (standardized mean difference (SMD)=-0.06 mg/dL; 95% CI, −0.24, 0.12; P=0.530) in adults. There was a significant between-study heterogeneity in Apo A1 (I2=89.3%, P<0.001) and Apo B100 (I2=57.1%, P=0.030). However, significant increase in Apo A1 in daily dosage of vitamin D (SMD=0.56 mg/dL; 95% CI, 0.02, 1.11; P=0.044) and ≤12 weeks of supplementation duration (SMD=0.71 mg/dL; 95% CI, 0.08, 1.34; P=0.028) was observed. No significant effects of vitamin D on Apo A1 and Apo B100 levels after subgroup analysis by mean age, gender, study population, dosage and duration of study. Overall, daily vitamin D supplementation and ≤12 weeks of supplementation might have beneficial effects in increasing Apo A1 levels, however, future high-quality trials considering these a primary outcome are required.

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The Impact of Delirium On Prognosis In Stroke: A Systematic Review and Meta-Analyses of Observational Studies

10.21203/rs.3.rs-750658/v1 ◽

2021 ◽

Author(s):

jing zhang ◽

xin wang ◽

jie wang ◽

kai liu ◽

tao he ◽

...

Keyword(s):

Hospital Stay ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Length Of Hospital Stay ◽

Clinical Problem ◽

Cochrane Library ◽

Inpatient Mortality ◽

Increased Risk ◽

The Impact

Abstract Background The outcomes of post-stroke delirium are inconsistent. Therefore, we conduct a meta-analysis to provide a comprehensive description of the impact of delirium on the outcomes including including length of hospital stay and inpatient mortality after stroke. Methods We searched electronic databases including PubMed, Google scholar, Web of Science and Cochrane Library databases up to April, 2021. Fixed-effect or random-effect model was used to summary odds ratio (OR) and mean difference (MD ) with 95% confidence interval (CI). Results 13 individual studies with total of 3592 patients met the inclusion criteria. The summary results revealed that stroke patients with delirium increased risk of inpatient mortality (OR = 6.35, 95% CI: 4.35–9.25, p < 0.0001), and had longer length of hospital stay (MD = 5.93, 95% CI: 2.79–9.07, p < 0.0001) compared to non-delirious patients. Conclusions Delirium is associated with unfavorable outcomes in patients with stroke, particularly in higher inpatient mortality and longer length of stay. We should pay more attention to this clinical problem and managed appropriately to prevent poor prognosis.

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