Hyperandrogenism? Increased 17, 20-Lyase Activity? A Metanalysis and Systematic Review of Altered Androgens in Boys and Girls with Autism

Introduction: There is increasing evidence that steroid hormone levels and, especially, androgen levels are elevated in autism. An overactivity of 17, 20-lyase with a higher production of the testosterone precursors dehydroepiandrosterone (DHEA) and androstenedione/androstenediol seems especially present in autism. Methods: An encompassing literature analysis was performed, searching for altered androgens in children with autism and using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Included were all studies published before 31 March 2021 found using the following electronic databases: PubMed, Google Scholar, Cochrane Library, Scopus, and TRIP. Eight studies with boys and three studies with girls where steroid hormone measurements were performed from either plasma, urine, or saliva were found and analyzed. Analyses were performed for DHEA(-S/-C), androstenedione/androstenediol, and testosterone. Effect sizes were calculated for each parameter between mean concentrations for children with autism versus healthy controls. Results: Higher levels of androgens in autism were detected, with the majority of calculated effect sizes being larger than one. Conclusions: We found higher levels of the main testosterone precursors DHEA, androstenedione, and androstenediol, likely causing an additionally higher level of testosterone, and an increased 17, 20-lyase activity is therefore implied. Medications already used in PCOS such as metformin might be considered to treat hyperandrogenism in autism following further research.

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The Effect of Different Intervention Approaches on Gross Motor Outcomes of Children With Autism Spectrum Disorder: A Meta-Analysis

Adapted Physical Activity Quarterly ◽

10.1123/apaq.2018-0174 ◽

2019 ◽

Vol 36 (4) ◽

pp. 501-526 ◽

Cited By ~ 6

Author(s):

Layne Case ◽

Joonkoo Yun

Keyword(s):

Autism Spectrum Disorder ◽

Meta Analysis ◽

Children With Autism ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Effect Sizes ◽

Inclusion Criteria ◽

Gross Motor ◽

Motor Outcomes ◽

Potential Moderator

Despite the rising interest in intervention for children with autism spectrum disorder, the extent to which interventions are effective on gross motor outcomes is currently unknown. The purpose of this study was to analyze the effect of different intervention approaches on gross motor outcomes among children with autism spectrum disorder using meta-analysis. A total of 18 studies met the inclusion criteria for quantitative analysis. Pre- and posttest means and SD s were extracted to calculate effect sizes. Potential moderator variables were chosen based on important intervention characteristics. The results suggest that interventions have a large effect on gross motor outcomes among children with autism spectrum disorder (δ = 0.99, SE = 0.19, p < .001, 95% confidence interval [0.62, 1.36]). The interventions that were 16 total hours or longer had a significantly larger effect than those less than 16 hr. In addition, the interventions in experimental settings had significantly larger effects than the interventions in practical settings. Future interventions should consider intensity, including not only the duration of the intervention but also the intensity in which specific intervention goals are targeted.

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Nutraceutical supplements in management of pain and disability in osteoarthritis: a systematic review and meta-analysis of randomized clinical trials

Scientific Reports ◽

10.1038/s41598-020-78075-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Dawood Aghamohammadi ◽

Neda Dolatkhah ◽

Fahimeh Bakhtiari ◽

Fariba Eslamian ◽

Maryam Hashemian

Keyword(s):

Pain Intensity ◽

Physical Function ◽

Random Effects ◽

Effect Size ◽

Meta Analysis ◽

Effect Sizes ◽

Cochrane Library ◽

Random Effects Model ◽

Womac Index ◽

Pain Subscale

AbstractThis study designed to evaluate the effect of nutraceutical supplementation on pain intensity and physical function in patients with knee/hip OA. The MEDLINE, Web of Science, Cochrane Library, Scopus, EMBASE, Google Scholar, Science direct, and ProQuest in addition to SID, Magiran, and Iranmedex were searched up to March 2020. Records (n = 465) were screened via the PICOS criteria: participants were patients with hip or knee OA; intervention was different nutritional supplements; comparator was any comparator; the outcome was pain intensity (Visual analogue scale [VAS]) and physical function (Western Ontario and McMaster Universities Arthritis [WOMAC] index); study type was randomized controlled trials. The random effects model was used to pool the calculated effect sizes. The standardized mean difference (SMD) of the outcome changes was considered as the effect size. The random effects model was used to combine the effect sizes. Heterogeneity between studies was assessed by Cochran's (Q) and I2 statistics. A total of 42 RCTs were involved in the meta-analysis. Nutritional supplementation were found to improve total WOMAC index (SMD = − 0.23, 95% CI − 0.37 to − 0.08), WOMAC pain (SMD = − 0.36, 95% CI − 0.62 to − 0.10) and WOMAC stiffness (SMD = − 0.47, 95% CI − 0.71 to − 0.23) subscales and VAS (SMD = − 0.79, 95% CI − 1.05 to − 0.05). Results of subgroup analysis according to the supplementation duration showed that the pooled effect size in studies with < 10 months, 10–20 months and > 20 months supplementation duration were 0.05, 0.27, and 0.36, respectively for WOMAC total score, 0.14, 0.55 and 0.05, respectively for WOAMC pain subscale, 0.59, 0.47 and 0.41, respectively for WOMAC stiffness subscale, 0.05, 0.57 and 0.53, respectively for WOMAC physical function subscale and 0.65, 0.99 and 0.12, respectively for VAS pain. The result suggested that nutraceutical supplementation of patients with knee/hip OA may lead to an improvement in pain intensity and physical function.

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A-27 Stroop Color-Word Interference Test in Alcohol Use Disorder

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.27 ◽

2019 ◽

Vol 34 (6) ◽

pp. 886-886

Author(s):

A Holt ◽

A Hauson ◽

P Ujj ◽

K Reszegi ◽

N Nemanim ◽

...

Keyword(s):

Alcohol Use ◽

Inhibitory Control ◽

Alcohol Use Disorder ◽

Color Word ◽

Neuropsychological Functioning ◽

Meta Analysis ◽

Effect Sizes ◽

Calculated Effect ◽

Interference Test ◽

Axis I

Abstract Objective Poor inhibitory control is a characteristic of Alcohol Use Disorder (AUD) that might be associated with worse treatment outcomes because of its contribution to the likelihood of relapse. One valid and efficient tool to examine inhibitory control is the Stroop Color-Word Interference Test (Stroop inhibition). The purpose of this meta-analysis was to examine the consistency of findings on the Stroop inhibition subtest and its relationship to length of use and duration of abstinence in AUD. Data Selection Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared participants with AUD to healthy controls and (b) matched groups on either age, education, or IQ. Studies were excluded if participants were reported to have Axis I diagnoses (other than AUD) or comorbidities known to impact neuropsychological functioning. Twelve articles were coded and analyzed for the current study. Data Synthesis Studies comparing AUD to controls showed a medium statistically significant effect size (g = 0.355, p < 0.001) with no heterogeneity (I2 = 0). Length of use and duration of abstinence did not predict effect sizes. Conclusions The Stroop inhibition measure distinguishes between AUD participants and controls. Given the robustness of this finding, the lack of heterogeneity among studies, and the extensive past use of the Stroop to measure inhibitory control; this test should be considered when examining AUD patients. This is especially important when patients exhibit poor inhibition in daily functioning.

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Is metoclopramide beneficial for the post-pyloric placement of nasoenteric tubes? A systematic review and meta-analysis of randomized controlled trials

10.21203/rs.3.rs-76640/v1 ◽

2020 ◽

Author(s):

Xin Ouyang ◽

Rong Qu ◽

Bei Hu ◽

Yifan Wang ◽

Fen Yao ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Success Rate ◽

Sequential Analysis ◽

Meta Analysis ◽

Effect Sizes ◽

Cochrane Library ◽

Trial Sequential Analysis ◽

Controlled Trials ◽

Beneficial Effects ◽

Randomized Controlled

Abstract BackgroundMetoclopramide is frequently prescribed as an adjuvant for the post-pyloric placement of nasoenteric tubes (NETs). However, the efficacy and safety of metoclopramide remain controversial. The latest meta-analysis showed that metoclopramide was not beneficial in adults. Thus, this study aimed to reevaluate the effect of metoclopramide on the post-pyloric placement of NETs.MethodsA systematic search of PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data was conducted up to August 2020 for randomized controlled trials (RCTs) comparing metoclopramide with placebo or no intervention. The effect sizes of eligible studies were pooled using the relative risk (RR) and 95% confidence interval (CI) in a random-effects model. Trial sequential analysis (TSA) was used for the primary outcomes (the success rate of the post-pyloric placement of NETs).ResultsSeven eligible RCTs that included 520 participants were identified. The results of the pooled effect sizes showed that metoclopramide significantly facilitated the post-pyloric placement of NETs (RR, 1.48; 95% CI, 1.11–1.97; P = 0.007; I2 = 37%). However, the risk of bias assessment and the TSA results indicated that the qualities of the RCTs and the sample sizes were insufficient to confirm the efficacy of metoclopramide. Further subgroup analysis revealed that successful post-pyloric placement was more pronounced in studies in which spiral NETs were employed (RR, 1.85; 95% CI, 1.41–2.43; P < 0.001; I2 = 0%). Additionally, a significant increase in the success rate was also observed for post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), and post-D3 (reaching the fourth portion of the duodenum or beyond) placement of spiral NETs. Overall adverse events were minimal.ConclusionsThe evidence accumulated so far was not strong enough to demonstrate metoclopramide’s beneficial effects on the post-pyloric placement of NETs; however, it might be effective for spiral NETs. Further high-quality, large-sample RCTs are required to elucidate the effects of metoclopramide.Trial registrationPROSPERO CRD42019123424 (10 July 2019)

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Efficacy of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy: a systematic review

Clinical Rehabilitation ◽

10.1177/0269215517698834 ◽

2017 ◽

Vol 31 (11) ◽

pp. 1445-1456 ◽

Cited By ~ 14

Author(s):

MH Tervahauta ◽

GL Girolami ◽

GK Øberg

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Meta Analysis ◽

Movement Therapy ◽

Effect Sizes ◽

System Level ◽

Cochrane Library ◽

Intensive Training ◽

Constraint Induced Movement Therapy ◽

Unilateral Cerebral Palsy

Objective: To systematically review the evidence on the effect of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy. Data sources: Seven electronic databases (Cinahl, Cochrane Library, EMBASE, Ovid MEDLINE, PEDro, PsycINFO, PubMed) were searched from database inception through December 2016. Methods: A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Standardised mean differences (effect sizes) were calculated for each study and outcome. Results: Nine studies met the eligibility criteria. All studies provided level II evidence. Methodological quality was high in two studies, moderate in four studies and low in three studies. The methodology, participant and intervention characteristics were heterogeneous. The participants’ ages ranged from 1.5 to 16 years. Their initial hand function ranged from Manual Ability Classification System Level I to Level III. The total intervention dose ranged from 24 to 210 hours and duration from one week to ten weeks. The studies measured outcomes assessing unimanual and bimanual hand and arm function, participation and attainment of individualised goals. Overall, the effect sizes did not favour one of the interventions at short- or long-term follow-up. The 95% confidence intervals were broad, indicating inaccurate precision of the effect sizes. Pooling of the data for a meta-analysis was judged to be of little clinical value owing to heterogeneity. Conclusion: It is not possible to conclude whether constraint-induced movement therapy or bimanual intensive training is more effective than the other in children with unilateral cerebral palsy.

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Host genetic variability and pneumococcal disease: a systematic review and meta-analysis

BMC Medical Genomics ◽

10.1186/s12920-019-0572-x ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Anne T. Kloek ◽

Matthijs C. Brouwer ◽

Diederik van de Beek

Keyword(s):

Pneumococcal Disease ◽

Meta Analysis ◽

Random Effect ◽

Effect Sizes ◽

Case Definitions ◽

Host Genetics ◽

Gene Coding ◽

Genome Wide ◽

Calculated Effect ◽

Meta Analyses

Abstract Background Pneumonia, sepsis, meningitis, and empyema due to Streptococcus pneumoniae is a major cause of morbidity and mortality. We provide a systemic overview of genetic variants associated with susceptibility, phenotype and outcome of community acquired pneumococcal pneumonia (CAP) and invasive pneumococcal disease (IPD). Methods We searched PubMed for studies on the influence of host genetics on susceptibility, phenotype, and outcome of CAP and IPD between Jan 1, 1983 and Jul 4, 2018. We listed methodological characteristics and when genetic data was available we calculated effect sizes. We used fixed or random effect models to calculate pooled effect sizes in the meta-analysis. Results We identified 1219 studies of which 60 studies involving 15,358 patients were included. Twenty-five studies (42%) focused on susceptibility, 8 (13%) on outcome, 1 (2%) on disease phenotype, and 26 (43%) on multiple categories. We identified five studies with a hypothesis free approach of which one resulted in one genome wide significant association in a gene coding for lincRNA with pneumococcal disease susceptibility. We performed 17 meta-analyses of which two susceptibility polymorphisms had a significant overall effect size: variant alleles of MBL2 (odds ratio [OR] 1·67, 95% confidence interval [CI] 1·04–2·69) and a variant in CD14 (OR 1·77, 95% CI 1·18–2·66) and none of the outcome polymorphisms. Conclusions Studies have identified several host genetics factors influencing risk of pneumococcal disease, but many result in non-reproducible findings due to methodological limitations. Uniform case definitions and pooling of data is necessary to obtain more robust findings.

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The effects of repetitive transcranial magnetic stimulation on empathy: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s003329171700232x ◽

2017 ◽

Vol 48 (5) ◽

pp. 737-750 ◽

Cited By ~ 7

Author(s):

C.-C. Yang ◽

N. Khalifa ◽

B. Völlm

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Therapeutic Interventions ◽

Effect Sizes ◽

Cochrane Library ◽

Subgroup Analyses ◽

Meta Analyses ◽

Clinical Populations

Empathy is a multi-dimensional concept with affective and cognitive components, the latter often referred to as Theory of Mind (ToM). Impaired empathy is prevalent in people with neuropsychiatric disorders, such as personality disorder, psychopathy, and schizophrenia, highlighting the need to develop therapeutic interventions to address this. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive therapeutic technique that has been effective in treating various neuropsychiatric conditions, can be potentially used to modulate empathy. To our knowledge, no systematic reviews or meta-analyses in this field have been conducted. The aim of the current study was to review the literature on the use of rTMS to modulate empathy in adults. Seven electronic databases (AMED, Cochrane library, EMBASE, Medline, Pubmed, PsycInfo, and Web of Science) were searched using appropriate search terms. Twenty-two studies were identified, all bar one study involved interventions in healthy rather than clinical populations, and 18 of them, providing results for 24 trials, were included in the meta-analyses. Results showed an overall small, but statistically significant, effect in favour of active rTMS in healthy individuals. Differential effects across cognitive and affective ToM were evident. Subgroup analyses for cognitive ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Subgroup analyses for affective ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Meta-regression revealed no significant sources of heterogeneity. In conclusion, rTMS may have discernible effects on different components of empathy. Further research is required to examine the effects of rTMS on empathy in clinical and non-clinical populations, using appropriate empathy tasks and rTMS protocols.

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The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753465816677006 ◽

2016 ◽

Vol 11 (1) ◽

pp. 20-29 ◽

Cited By ~ 15

Author(s):

Hsin-Ming Liu ◽

I-Jen Chiang ◽

Ken N. Kuo ◽

Cher-Ming Liou ◽

Chiehfeng Chen

Keyword(s):

Sleep Apnea ◽

High Altitude ◽

Meta Analysis ◽

Periodic Breathing ◽

Effect Sizes ◽

Cochrane Library ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Daily Dose ◽

Healthy Participants

Background: Acetazolamide has been investigated for treating sleep apnea in newcomers ascending to high altitude. This study aimed to assess the effect of acetazolamide on sleep apnea at high altitude, determine the optimal therapeutic dose, and compare its effectiveness in healthy trekkers and obstructive sleep apnea (OSA) patients. Methods: PubMed, Embase, Scopus, Cochrane Library, and Airiti Library databases were searched up to July 2015 for randomized controlled trials (RCTs) performed above 2500 m in lowlanders and that used acetazolamide as intervention in sleep studies. Studies including participants with medical conditions other than OSA were excluded. Results: Eight studies of 190 adults were included. In healthy participants, the pooled mean effect sizes of acetazolamide on Apnea–Hypopnea Index (AHI), percentage of periodic breathing time, and nocturnal oxygenation were 34.66 [95% confidence interval (CI) 25.01–44.30] with low heterogeneity ( p = 0.7, I2 = 0%), 38.56% (95% CI 18.92–58.19%) with low heterogeneity ( p = 0.24, I2 = 28%), and 4.75% (95% CI 1.35–8.15%) with high heterogeneity ( p < 0.01, I2 = 87%), respectively. In OSA patients, the pooled mean effect sizes of acetazolamide on AHI and nocturnal oxygenation were 13.18 (95% CI 9.25–17.1) with low heterogeneity ( p = 0.33, I2 = 0%) and 1.85% (95% CI 1.08–2.62%) with low heterogeneity ( P = 0.56, I2 = 0%). Conclusions: Acetazolamide improves sleep apnea at high altitude by decreasing AHI and percentage of periodic breathing time and increasing nocturnal oxygenation. Acetazolamide is more beneficial in healthy participants than in OSA patients, and a 250 mg daily dose may be as effective as higher daily doses for healthy trekkers.

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Hydroxychloroquine and mortality risk of patients with COVID-19: a systematic review and meta-analysis of human comparative studies

10.1101/2020.06.17.20133884 ◽

2020 ◽

Author(s):

Thibault Fiolet ◽

Anthony Guihur ◽

Mathieu Rebeaud ◽

Matthieu Mulot ◽

Yahya Mahamat-Saleh

Keyword(s):

Systematic Review ◽

Relative Risk ◽

Mortality Risk ◽

Standard Care ◽

Meta Analysis ◽

Grey Literature ◽

Small Sample ◽

Hospitalized Patients ◽

Effect Sizes ◽

Cochrane Library

AbstractBackgroundGlobal COVID-19 deaths reached at least 400,000 fatalities. Hydroxychloroquine is an antimalarial drug that elicit immunomodulatory effects and had shown in vitro antiviral effects against SRAS-CoV-2. This drug divided opinion worldwide in the medical community but also in the press, the general public and in public health policies. The aim of this systematic review and this meta-analysis was to bring a new overview on this controversial drug and to assess whether hydroxychloroquine could reduce COVID-19 mortality risk in hospitalized patients.Methods and FindingsPubmed, Web of Science, Cochrane Library, MedRxiv and grey literature were searched until 10 June 2020. Only studies of COVID-19 patients treated with hydroxychloroquine (with or without azithromycin) compared with a comparative standard care group and with full-text articles in English were included. Studies reporting effect sizes as Odds Ratios, Hazard Ratio and Relative Risk for mortality risk and the number of deaths per groups were included. This meta-analysis was conducted following PRISMA guidelines and registered on PROSPERO (Registration number: CRD42020190801). Independent extraction has been performed by two independent reviewers. Effect sizes were pooled using a random-effects model.The initial search leaded to 112 articles, from which 16 articles met our inclusion criteria. 15 studies were retained for association between hydroxychloroquine and COVID-19 survival including 15,081 patients (8,072 patients in the hydroxychloroquine arm and 7,009 patients in the standard care arm with respectively, 1,578 deaths and 1,423 deaths). 6 studies were retained for hydroxychloroquine with azithromycin. Hydroxychloroquine was not significantly associated with mortality risk (pooled Relative Risk RR=0.82 (95% Confidence Interval: 0.62-1.07, I2=82, Pheterogeneity<0.01, n=15)) within hospitalized patients, nor in association with azithromycin (pooled Relative Risk RR=1.33 (95% CI: 0.92-1.92, I2=75%, Pheterogeneity<0.01, n=6)), nor in the numerous subgroup analysis by study design, median age population, published studies (vs unpublished articles), level of bias risk. However, stratified analysis by continents, we found a significant decreased risk of mortality associated with hydroxychlroquine alone but not with azithromycin among European (RR= 0.62 (95%CI: 0.41-0.93, n=7)) and Asian studies (RR=0.36 (95%CI:0.18-0.73, n=1)), with heterogeneity detected across continent (Pheterogeneity between=0.003). These finding should be interpreted with caution since several included studies had a low quality of evidence with a small sample size, a lack of adjustment on potential confounders or selection and intervention biases.ConclusionOur meta-analysis does not support the use of hydroxychloroquine with or without azithromycin to reduce COVID-19 mortality in hospitalized patients. It raises the question of the hydroxychloroquine use outside of clinical trial. Additional results from larger randomised controlled trials are needed

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An Evidence-Based Review and Meta-Analysis of Active Supervision

Behavioral Disorders ◽

10.1177/0198742919851021 ◽

2019 ◽

Vol 45 (2) ◽

pp. 117-128

Author(s):

Nicholas A. Gage ◽

Todd Haydon ◽

Ashley S. MacSuga-Gage ◽

Emily Flowers ◽

Lyndsie Erdy

Keyword(s):

Meta Analysis ◽

Evidence Base ◽

Effect Sizes ◽

Future Research ◽

Evidence Based ◽

Student Behaviors ◽

Design Standards ◽

Calculated Effect ◽

What Works Clearinghouse

Active supervision—defined as circulating, scanning, interacting with students, and reinforcing demonstrations of expected academic and social behaviors by a teacher or other staff member—is often considered a component of safe and secure schools. Yet, the evidence base supporting the effectiveness of active supervision has not been synthesized or evaluated for its quality. Therefore, we conducted an evidence-based review and meta-analysis of empirical research evaluating the effects of active supervision in schools. We identified 12 research studies evaluating active supervision, assessed the quality of each study, and calculated effect sizes for student behaviors, including disruptive behavior. Results from the four studies meeting data requirements for estimating standardized mean difference effect sizes suggest that, on average, active supervision reduced problem behavior by almost 2.0 standard deviation units. Only four studies met the What Works Clearinghouse (WWC) design standards and the results of those were mixed, thus not meeting the WWC evidence-based criteria. Limitations and recommendations for future research are discussed.

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