Prevention of Preeclampsia: Is it Still a Disappointment?

2009 ◽  
Vol 2 ◽  
pp. CMWH.S2385 ◽  
Author(s):  
Abeer Eddib ◽  
John Yeh
Keyword(s):  
Low Dose ◽  
Meta Analysis ◽  
Risk Groups ◽  
Low Risk ◽  
Therapeutic Interventions ◽  
Preventive Strategies ◽  
Ongoing Research ◽  
Angiogenic Proteins ◽  
Receptor Antibodies ◽  
Risk Of Preeclampsia

Preeclampsia is a major cause of maternal mortality worldwide, with many preventive strategies tested. In this review we intend to provide a synthesis of available studies of these strategies that have been tested, including systematic reviews. We will not be performing systematic review of the studies here. Of these strategies tested only low dose acetyl salicylic acid (ASA) and calcium can be considered helpful for prevention at this time. A recent meta-analysis showed a benefit of low dose ASA for both high (RR 0.75, 95% CI 0.66 to 0.85) and moderate risk groups (RR 0.86, 95% CI 0.79 to 0.95). Therefore, low dose ASA in high risk groups may be useful, with a possible smaller benefit in moderate to low risk women. Another meta-analysis looking at calcium shows benefit for both high and low risk groups with an overall reduction in the risk of preeclampsia (RR 0.48, 95% CI 0.33 to 0.69). As a result, prenatal supplementation of calcium may be beneficial for the prevention of preeclampsia. However, vitamins C and E, zinc, fish oil, and magnesium supplementation have been discounted as potential preventive strategies. Nitric oxide, folic acid, and antithrombotics have not been well studied and there is insufficient data for reliable conclusions to be made. Areas of ongoing research that appear promising in the prevention of preeclampsia include modifiable metabolic factors, angiogenic proteins, angiotensin receptor antibodies, and syncytiotrophoblast microparticles. Strategies targeting these areas may provide opportunities for therapeutic interventions.

scholarly journals Protective operative techniques in radical hysterectomy in early cervical carcinoma and their influence on disease-free and overall survival: a systematic review and meta-analysis of risk groups

2021 ◽  
Author(s):  
Johanna Kampers ◽  
E. Gerhardt ◽  
P. Sibbertsen ◽  
T. Flock ◽  
R. Klapdor ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Radical Hysterectomy ◽  
Risk Group ◽  
Meta Analysis ◽  
Risk Groups ◽  
Minimal Invasive ◽  
Pelvic Lymphadenectomy ◽  
High Risk Group ◽  
Low Risk ◽  
Intermediate Risk

Abstract Purpose Radical hysterectomy with pelvic lymphadenectomy presents the standard treatment for early cervical cancer. Recently, studies have shown a superior oncological outcome for open versus minimal invasive surgery, however, the reasons remain to be speculated. This meta-analysis evaluates the outcomes of robotic and laparoscopic hysterectomy compared to open hysterectomy. Risk groups including the use of uterine manipulators or colpotomy were created. Methods Ovid-Medline and Embase databases were systematically searched in June 2020. No limitation in date of publication or country was made. Subgroup analyses were performed regarding the surgical approach and the endpoints OS and DFS. Results 30 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Patients were analyzed concerning the surgical approach [open surgery (AH), laparoscopic surgery (LH), robotic surgery (RH)]. Additionally, three subgroups were created from the LH group: the LH high-risk group (manipulator), intermediate-risk group (no manipulator, intracorporal colpotomy) and LH low-risk group (no manipulator, vaginal colpotomy). Regarding OS, the meta-analysis showed inferiority of LH in total over AH (0.97 [0.96; 0.98]). The OS was significantly higher in LH low risk (0.96 [0.94; 0.98) compared to LH intermediate risk (0.93 [0.91; 0.94]). OS rates were comparable in AH and LH Low-risk group. DFS was higher in the AH group compared to the LH group in general (0.92 [95%-CI 0.88; 0.95] vs. 0.87 [0.82; 0.91]), whereas the application of protective measures (no uterine manipulator in combination with vaginal colpotomy) was associated with increased DFS in laparoscopy (0.91 [0.91; 0.95]). Conclusion DFS and OS in laparoscopy appear to be depending on surgical technique. Protective operating techniques in laparoscopy result in improved minimal invasive survival.

scholarly journals Identification of a costimulatory molecule-based signature for predicting prognosis risk and immunotherapy response in patients with lung adenocarcinoma

2020 ◽  
Author(s):  
Chaoqi Zhang ◽  
Zhihui Zhang ◽  
Nan Sun ◽  
Zhen Zhang ◽  
Guochao Zhang ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Cox Regression ◽  
Meta Analysis ◽  
Costimulatory Molecule ◽  
Prognostic Significance ◽  
Response Prediction ◽  
Risk Groups ◽  
Costimulatory Molecules ◽  
Low Risk ◽  
Cox Regression Analysis

Abstract Background Costimulatory molecules play significant roles in mounting anti-tumor immune responses, and antibodies targeting these molecules are recognized as promising adjunctive cancer immunotherapies. Here, we aim to conduct a first full-scale exploration of costimulatory molecules from the B7-CD28 and TNF families in patients with lung adenocarcinoma (LUAD) and generated a costimulatory molecule-based signature (CMS) to predict survival and response to immunotherapy. Methods We enrolled 1549 LUAD cases across 10 different cohorts and included 502 samples from TCGA for discovery. The validation set included 970 cases from eight different Gene Expression Omnibus (GEO) datasets and 77 frozen tumor tissues with qPCR data. The underlying mechanisms and predictive immunotherapy capabilities of the CMS were also explored. Results A five gene-based CMS (CD40LG, TNFRSF6B, TNFSF13, TNFRSF13C, and TNFRSF19) was initially constructed using the bioinformatics method from TCGA that classifies cases as high- vs. low-risk groups per OS. Multivariable Cox regression analysis confirmed that the CMS was an independent prognostic factor. As expected, CMS exhibited prognostic significance in the stratified cohorts and different validation cohorts. Additionally, the prognostic meta-analysis revealed that CMS was superior to the previous signature. Samples in high- and low-risk groups exhibited significantly different tumor-infiltrating leukocytes and inflammatory activities. Importantly, we found that signature high-risk patients were optimal candidates for immunotherapy. Conclusion We conducted the first and most comprehensive costimulatory molecule landscape analysis of patients with LUAD and built a clinically feasible CMS for prognosis and immunotherapy response prediction, which will be helpful for further optimize immunotherapies for cancer.

scholarly journals Validation of the ability of ESER score to predict recurrent stroke: a meta-analysis

2021 ◽  
Author(s):  
chengju liao ◽  
zhe luo ◽  
ying ru ◽  
jian yang ◽  
chenghong luo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Intervals ◽  
Risk Score ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Risk Groups ◽  
Low Risk ◽  
Risk Stratification Model ◽  
One Year

IntroductionA risk stratification model is pretty important to prevent the recurrent stroke for ischemic stroke patients. The present study aimed to meta-analysis the ability of Essen Stroke Risk Score (ESRS) to accurately predict recurrence of ischemic stroke.Material and methodsStudies on the diagnostic performance of Essen Stroke Risk Score in predicting recurrent stroke were searched by electronic and manual methods. Quality pooled C-statistics, and 95% confidence intervals (95% CI) were evaluated.ResultsFifteen studies with a total of 94,052 patients were included in the meta-analysis. The pooled C-statistics of ESER for patients without atrial fibrillation (AF) experiencing recurring strokes at 90-day or one-year were 0.65 (95% CI: 0.58-0.73) and 0.57 (95% CI: 0.53-0.60), and the heterogeneity was weak. The average ratio of one-year recurrent stroke in the low-risk and high-risk groups classified according to ESRS is 5.6%(range 1.4 to 12.1%) and 9.2%( range 3.2 to 20.1%), respectively. And the calibration analysis showed the pooled RR in the low-risk group is 0.88 (95%CI: 0.24-3.19) and 0.88 (0.24-3.31) with wide confidence intervals and high levels of heterogeneity, indicating the calibration ability was low.ConclusionsESRS had low to moderate ability to predict recurrence of stroke in patients with ischemic stroke and low calibration ability, which need to be further improved.

scholarly journals Overdiagnosis of lung cancer with low-dose computed tomography screening: meta-analysis of the randomised clinical trials

Breathe ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 200013 ◽  
Author(s):  
John Brodersen ◽  
Theis Voss ◽  
Frederik Martiny ◽  
Volkert Siersma ◽  
Alexandra Barratt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Randomised Controlled Trials ◽  
Low Dose ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Low Risk ◽  
Randomised Controlled ◽  
Low Dose Computed Tomography

In low-dose computed tomography (LDCT) screening for lung cancer, all three main conditions for overdiagnosis in cancer screening are present: 1) a reservoir of slowly or nongrowing lung cancer exists; 2) LDCT is a high-resolution imaging technology with the potential to identify this reservoir; and 3) eligible screening participants have a high risk of dying from causes other than lung cancer. The degree of overdiagnosis in cancer screening is most validly estimated in high-quality randomised controlled trials (RCTs), with enough follow-up time after the end of screening to avoid lead-time bias and without contamination of the control group.Nine RCTs investigating LDCT screening were identified. Two RCTs were excluded because lung cancer incidence after the end of screening was not published. Two other RCTs using active comparators were also excluded. Therefore, five RCTs were included: two trials were at low risk of bias, two of some concern and one at high risk of bias. In a meta-analysis of the two low risk of bias RCTs including 8156 healthy current or former smokers, 49% of the screen-detected cancers were overdiagnosed. There is uncertainty about this substantial degree of overdiagnosis due to unexplained heterogeneity and low precision of the summed estimate across the two trials.Key pointsNine randomised controlled trials (RCTs) on low-dose computed tomography screening were identified; five were included for meta-analysis but only two of those were at low risk of bias.In a meta-analysis of recent low risk of bias RCTs including 8156 healthy current or former smokers from developed countries, we found that 49% of the screen-detected cancers may be overdiagnosed.There is uncertainty about the degree of overdiagnosis in lung cancer screening due to unexplained heterogeneity and low precision of the point estimate.If only high-quality RCTs are included in the meta-analysis, the degree of overdiagnosis is substantial.Educational aimsTo appreciate that low-dose computed tomography screening for lung cancer meets all three main conditions for overdiagnosis in cancer screening: a reservoir of indolent cancers exists in the population; the screening test is able to “tap” this reservoir by detecting biologically indolent cancers as well as biologically important cancers; and the population being screened is characterised by a relatively high competing risk of death from other causesTo learn about biases that might affect the estimates of overdiagnosis in randomised controlled trials in cancer screening

scholarly journals Different Doses of Calcium Supplementation to Prevent Gestational Hypertension and Pre-Eclampsia: A Systematic Review and Network Meta-Analysis

2022 ◽  
Vol 8 ◽  
Author(s):  
Dexin Chen ◽  
Hong Wang ◽  
Xing Xin ◽  
Long Zhang ◽  
Aihong Yu ◽  
...  
Keyword(s):  
High Risk ◽  
Low Dose ◽  
Gestational Hypertension ◽  
Calcium Supplementation ◽  
Risk Groups ◽  
Low Risk ◽  
Cochrane Library ◽  
High Dose ◽  
Risk Population ◽  
Medium Dose

ObjectiveCalcium supplementation can prevent gestational hypertension and pre-eclampsia. However, besides the non-consensus of existing studies, there is a lack of evidence regarding the optimal dosing of calcium.MethodEight electronic databases, namely, the Cochrane Library, PUBMED, Web of Science, EMBASE, WANGFANG, VIP, CBM, and CNKI, were searched. The studies were retrieved from inception to July 13, 2021. Two researchers independently screened the literature, extracted data, and evaluated the methodological quality based on the inclusion criteria. In particular, the calcium supplementation doses were divided into three groups, namely, the high-dose (≥1.5 g), medium-dose (1.0–1.49 g), and the low-dose group (<1.0 g). The participants were also divided into high-risk and low-risk groups, according to the risk of developing gestational hypertension and pre-eclampsia.Results and DiscussionA total of 48 studies were incorporated into the final analyses. All doses of calcium supplementation reduced the incidence of gestational hypertension in the low-risk population (low dose - three studies; medium dose- 11 studies; high dose- 28 studies), whereas the medium-dose (three studies) reduced the incidence of gestational hypertension in high-risk groups. Moreover, a medium dose of calcium supplementation had the maximum effect in reducing gestational hypertension in low-risk and high-risk populations. The medium (three studies) and high doses (13 studies) of calcium supplementation reduced the incidence of pre-eclampsia in the low-risk groups. However, a medium-dose calcium supplementation maximally prevented pre-eclampsia in the low-risk population. The authenticity and reliability of the results were reduced due to the limitations of contemporary studies in terms of experimental design, result measurement, statistics, and evidence quality. Therefore, high-quality studies with larger sample size are required to evaluate further the effect of calcium supplementation in preventing gestational hypertension and pre-eclampsia.

Rumination in Borderline Personality Disorder: Meta-Analysis

2018 ◽  
Author(s):  
Mara J. Richman ◽  
Zsolt Unoka ◽  
Robert Dudas ◽  
Zsolt Demetrovics
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Sample Type ◽  
Moderator Variables ◽  
Analytic Review ◽  
Self Harm

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability. Of this domain, ruminative behaviors have been considered a core feature of emotion dysregulation difficulties. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in those with BPD symptoms. Moreover, no meta-analytic review has been performed to date on rumination in BPD. Taking this into consideration, a meta-analysis was performed to assess how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, co-morbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of correlation across rumination domains for the entire sample revealed a medium overall correlation between BPD symptoms and rumination. When assessing types of rumination, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/ impulsivity, respectively. Demographic variables showed no significance. Clinical implications are considered and further therapeutic interventions are discussed in the context of rumination.

Sign in / Sign up

Export Citation Format

Share Document