فصل سوم: تعریف معیار ورود مطالعات

🔎 @Meditorha

فصل چهارم: سرچ

🔎 @Meditorha

مقاله شماره ۲۳
#Internal_Medicine
#Transplantation
عنوان:
Hepatic Encephalopathy Is Reversible in the Long Term After Liver Transplantation

نوع مطالعه:
Case - Control study

مجله:
Liver Transplantation

تاریخ انتشار:
22 August 2019

چکیده:

Cognitive dysfunction caused by hepatic encephalopathy (HE) improves within the first year after liver transplantation (LT). However, cognitive restitution seems to be incomplete in a subset of patients and after LT a new-onset cognitive decline was described. Data about the longterm development of cognitive function after liver transplantation (LT) are sparse. This prospective study analyzed whether a history of hepatic encephalopathy (HE) before LT had an impact on the longterm outcome of cognitive function after LT and if patients who underwent LT 5 years earlier showed worse cognitive function than healthy controls. The cognitive function of 34 patients was assessed before LT and at 1 year and 5 years after LT by psychometric tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the portosystemic encephalopathy syndrome test, which provides the psychometric hepatic encephalopathy score (PHES). Furthermore, patients completed surveys to assess health-related quality of life (HRQOL). An 22 additional patients were included after LT. Patients were subdivided by having a history of HE before LT. The control group consisted of 55 healthy patients adjusted for age and education. Before LT, patients performed significantly worse than controls in the psychometric tests: RBANS Total Scale (TS), mean ± standard deviation (SD), 92.6 ± 13.3 versus 99.9 ± 12.0, P = 0.01; and PHES, median (interquartile range [IQR]), 0 (-3 to 1) versus 1 (0-2), P < 0.001. At 1 year after LT, patients with a history of HE still showed cognitive impairment compared with controls: RBANS TS, mean ± SD, 89.8 ± 15.1 versus 99.9 ± 12.0, P < 0.01; and PHES, median (IQR), 0 (-2 to 1.25) versus 1 (0-2), P = 0.03. At 5 years after LT, patients with and without a history of HE showed normal cognitive function and improved HRQOL. In conclusion, HE-associated cognitive impairment seems to be reversible within 5 years after LT.

DOI: https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/lt.25626

توضیحات مهم:

✅ در این مطالعه آینده نگر ، وضعیت شناختی بیماران تحت پیوند ارزیابی شده است.

✔️ بیماران با و بدون سابقه انسفالوپاتی کبدی با کنترل های وابسته به سن با استفاده از ارزیابی های مختلف شناختی مقایسه شدند.

✔️ همانطور که انتظار می رفت ، بیماران قبل از پیوند کبد نسبت به کنترل ها در ارزیابی های شناختی بدتر بودند.

✔️ به طور جالب توجه ، با گذشت 5 سال از پیوند ، کاهش شناخت معکوس شده بود و با کنترل های مربوط به سن قابل مقایسه بود.

🔎 @Meditorha

✔️ از مطالعات کوهورت یا همگروهی چه میدانید؟

در این مقاله سعی داشتیم تا به بهترین شیوه، مطالعه کوهورت را توضیح داده و مراحل انجام آن را بررسی کنیم. در پایان نقاط ضعف و قوت این مطالعه آورده شده است.

مطالعه کوهورت و انواع آن‌را بیشتر بشناسیم:

🌐 http://meditorha.com/cohortstudy/

🔎 @Meditorha

مقاله شماره ۲۴
#Cardiology
#Neurology
#Pharmacology
#BasicSciences
#Psychology
عنوان:
No Association Between Statin Use and Memory, Cognition, or Brain Volume in the Elderly

نوع مطالعه:
Prospective observational study

مجله:
JACC

تاریخ انتشار:
Nov, 2019

چکیده:
BACKGROUND

There is widespread consumer concern that statin use may be associated with impaired memory and cognitive decline.

OBJECTIVES

This study sought to examine the association between statin use and changes in memory and global cognition in the elderly population over 6 years and brain volumes over 2 years. Interactions between statin use and known dementia risk factors were examined.

METHODS

Prospective observational study of community-dwelling elderly Australians age 70 to 90 years (the MAS [Sydney Memory and Ageing Study], n = 1,037). Outcome measures were memory and global cognition (by neuropsychological testing every 2 years) and total brain, hippocampal and parahippocampal volumes (by magnetic resonance) in a subgroup (n = 526). Analyses applied linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking, and apolipoprotein Eε4 carriage. Interactions were sought between statin use and dementia risk factors.

RESULTS

Over 6 years there was no difference in the rate of decline in memory or global cognition between statin users and never users. Statin initiation during the observation period was associated with blunting the rate of memory decline. Exploratory analyses found statin use was associated with attenuated decline in specific memory test performance in participants with heart disease and apolipoprotein Eε4 carriage. There was no difference in brain volume changes between statin users and never users.

CONCLUSIONS

In community-dwelling elderly Australians, statin therapy was not associated with any greater decline in memory or cognition over 6 years. These data are reassuring for consumers concerned about statin use and risk of memory decline.


DOI: 10.1016/j.jacc.2019.09.041

توضیحات مهم:

✅ این مطالعه مشاهده ای آینده نگر ، نتایج شناختی و مغزی در 1037 سالمند ساکن جامعه استرالیا (سنین 70-90 ساله) طی یک دوره 6 ساله با توجه به قرار گرفتن در معرض استاتین مقایسه کرده است.

✔️ افراد شرکت کننده در این مطالعه شامل 395 نفر بودند که هرگز از استاتین (never users) استفاده نکرده بودند و 642 نفر در برخی موارد از استاتین استفاده کرده بودند (ever users).

✔️ همه شرکت کنندگان هر 2 سال یکبار تحت آزمایش neuropsychological قرار گرفتند ، و 526 نیز تحت ارزیابی MRI قرار گرفتند تا حجم مغز ، هیپوکامپ و پاراهیپوکامپ را ارزیابی کنند.

✔️ هیچ مدرکی مبنی بر تفاوت در میزان کاهش شناخت گلوبال یا حافظه بین گروه های never user و ever user مشاهده نشد.

✔️ در مقایسه با never user ها ، در 99 شرکت کننده که در طول مطالعه شروع به درمان استاتین کردند ، میزان کاهش حافظه ضعیف بود ، اما در شناخت global هیچ تفاوتی نداشتند.

✔️ تغییرات حجم مغز بین گروهها مشابه بود.

✔️✔️ با اینکه این مطالعه دارای محدودیت از نظر حجم نمونه و مشاهده ای بودن می باشد، اما به بیماران سالمند تا حدودی اطمینان خاطر می دهد که نگران اثرات #استاتین روی شناخت نباشند.

🔎 @Meditorha

مقاله شماره ۲۵
#internalmedicine
#diabete
عنوان:
Racial and Ethnic Differences in 30-Day Hospital Readmissions Among Adults With Diabetes

نوع مطالعه:
Cohort study

مجله:
JAMA

تاریخ انتشار:
Oct, 2019

چکیده:
IMPORTANCE

Differences in readmission rates among racial and ethnic minorities have been reported, but data among people with diabetes are lacking despite the high burden of diabetes and its complications in these populations.

OBJECTIVES

To examine racial/ethnic differences in all-cause readmission among US adults with diabetes and categorize patient- and system-level factors associated with these differences.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study includes 272 758 adult patients with diabetes, discharged alive from the hospital between January 1, 2009, and December 31, 2014, and stratified by race/ethnicity. An administrative claims data set of commercially insured and Medicare Advantage beneficiaries across the United States was used. Data analysis took place between October 2016 and February 2019.

MAIN OUTCOMES AND MEASURES

Unplanned all-cause readmission within 30 days of discharge and individual-, clinical-, economic-, index hospitalization-, and hospital-level risk factors for readmission.

RESULTS

A total of 467 324 index hospitalizations among 272 758 adults with diabetes (mean [SD] age, 67.7 [12.7]; 143 498 [52.6%] women) were examined. The rates of 30-day all-cause readmission were 10.2% (33 683 of 329 264) among white individuals, 12.2% (11 014 of 89 989) among black individuals, 10.9% (4151 of 38 137) among Hispanic individuals, and 9.9% (980 of 9934) among Asian individuals (P < .001). After adjustment for all factors, only black patients had a higher risk of readmission compared with white patients (odds ratio, 1.05; 95% CI, 1.02-1.08). This increased readmission risk among black patients was sequentially attenuated, but not entirely explained, by other demographic factors, comorbidities, income, reason for index hospitalization, or place of hospitalization. Compared with white patients, both black and Hispanic patients had the highest observed-to-expected (OE) readmission rate ratio when their income was low (annual household income <$40 000 among black patients: OE ratio, 1.11; 95% CI, 1.09-1.14; among Hispanic patients: OE ratio, 1.11; 95% CI, 1.07-1.16) and when they were hospitalized in nonprofit hospitals (black patients: OE ratio, 1.10; 95% CI, 1.08-1.12; among Hispanic patients: OE ratio, 1.08; 95% CI, 1.05-1.12), academic hospitals (black patients: OE ratio, 1.16; 95% CI, 1.13-1.20; Hispanic patients: OE ratio, 1.12; 95% CI, 1.06-1.19), or large hospitals (ie, with ≥400 beds; black patients: OE ratio, 1.11; 95% CI, 1.09-1.14; Hispanic patients: OE ratio, 1.09; 95% CI, 1.04-1.14).

CONCLUSIONS AND RELEVANCE

In this study, black patients with diabetes had a significantly higher risk of readmission than members of other racial/ethnic groups. This increased risk was most pronounced among lower-income patients hospitalized in nonprofit, academic, or large hospitals. These findings reinforce the importance of identifying and addressing the many reasons for persistent racial/ethnic differences in health care quality and outcomes.



https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752820

توضیحات مهم:

✅ در این مطالعه کوهورت گذشته نگر ۲۷۲۷۵۸ بیمار بزرگسال مبتلا به دیابت که از بیمارستان مرخص شده بودند ، برای ارزیابی تفاوت های نژادی و قومی ازنظر تمام علت های بستری مجدد مورد بررسی قرار گرفتند.

✔️ بیماران سیاه پوست ، اما نه Hispanic یا آسیایی ، در مقایسه با بیماران سفیدپوست خطر بیشتری برای بستری مجدد داشتند.

✔️ هر دو بیمار سیاه پوست و Hispanic نسبت به بیماران سفیدپوست که درامد خانوادگی آن ها پایین بود و در بیمارستان های خصوصی، بزرگ یا دانشگاهی بستری شده بودند؛ بستری مجدد بیشتری داشتند.

✔✔ این مطالعه کوهورت که به صورت گذشته نگر انجام شد ، نشان داد که از بین نزدیک به 273،000 بزرگسال بستری مبتلا به دیابت، بیماران سیاهپوست در 30 روز پس از ترخیص از بیمارستان ، نسبت به سایر گروه های نژادی / قومی خطر قابل توجهی برای بستری مجدد داشتند.

مقاله شماره ۲۶
#Neurology
عنوان:
Scientific Advances in and Clinical Approaches to Small-Fiber Polyneuropathy

نوع مطالعه:
Review

مجله:
JAMA Neurology

تاریخ انتشار:
Sep, 2019

چکیده:
IMPORTANCE

Small-fiber polyneuropathy involves preferential damage to the thinly myelinated A-delta fibers, unmyelinated C sensory fibers, or autonomic or trophic fibers. Although this condition is common, most patients still remain undiagnosed and untreated because of lagging medical and public awareness of research advances. Chronic bilateral neuropathic pain, fatigue, and nausea are cardinal symptoms that can cause disability and dependence, including pain medication dependence.

OBSERVATIONS

Biomarker confirmation is recommended, given the nonspecificity of symptoms. The standard test involves measuring epidermal neurite density within a 3-mm protein gene product 9.5 (PGP9.5)-immunolabeled lower-leg skin biopsy. Biopsies and autonomic function testing confirm that small-fiber neuropathy not uncommonly affects otherwise healthy children and young adults, in whom it is often associated with inflammation or dysimmunity. A recent meta-analysis concluded that small-fiber neuropathy underlies 49% of illnesses labeled as fibromyalgia. Initially, patients with idiopathic small-fiber disorders should be screened by medical history and blood tests for potentially treatable causes, which are identifiable in one-third to one-half of patients. Then, secondary genetic testing is particularly important for familial and childhood cases. Treatable genetic causes include Fabry disease, transthyretin and primary systemic amyloidosis, hereditary sensory autonomic neuropathy-1, and ion-channel mutations. Immunohistopathologic evidence suggests that small-fiber dysfunction and denervation, especially of blood vessels, contributes to diverse symptoms, including postexertional malaise, postural orthostatic tachycardia, and functional gastrointestinal distress. Preliminary evidence implicates acute or chronic autoreactivity in some cases, particularly in female patients and otherwise healthy children and young adults. Different temporal patterns akin to Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy have been described; here, corticosteroids and immunoglobulins, which are often efficacious for inflammatory neuropathic conditions, are increasingly considered.

CONCLUSIONS AND RELEVANCE

Because small fibers normally grow throughout life, improving contributory conditions may permit regrowth, slow progression, and prevent permanent damage. The prognosis is often hopeful for improving quality of life and sometimes for abatement or resolution, particularly in the young and otherwise healthy individuals. Examples include diabetic, infectious, toxic, genetic, and inflammatory causes. The current standard of care requires prompt diagnosis and treatment, particularly in children and young adults, to restore life trajectory. Consensus diagnostic and tracking metrics should be established to facilitate treatment trials.

https://dx.doi.org/10.1001/jamaneurol.2019.2917

توضیحات مهم:
✅ نویسندگان این مطالعه ، به روزرسانی در مورد وضعیت پژوهش و رویکردهای بالینی small-fiber polyneuropathy ، فراهم کردند.

✔️ پلی نوروپاتی small-fibet یک بیماری شایع است با این وجود بسیاری از بیماران تشخیص داده نشده یا اشتباه تشخیص داده می شوند. تظاهرات بالینی شامل درد ، همراه با یافته های autonomic است ، و اریترومالالژیا stocking-and-glove یک نمایش کلاسیک محسوب می شود.

ادامه این مقاله ارزشمند را از فایل زیر بخوانید ...

🔎 @Meditorha

مقاله شماره ۲۷
#Pain
#Neurology
عنوان:
Shooting Pain" in Lumbar Radiculopathy and Trigeminal Neuralgia and Ideas Concerning Its Neural Substrates


مجله:
Pain

تاریخ انتشار:
Oct, 2019

چکیده:
Patients with radicular low back pain (radicular LBP, sciatica) frequently describe their pain as "shooting" or "radiating". The dictionary meaning of these words implies rapid movement, and indeed, many sufferers report feeling pain moving rapidly from the lower back or buttock into the leg. But others do not. Moreover, the sensation of movement is paradoxical; it is neither predicted nor accounted for by current ideas about the pathophysiology of radicular LBP. We have employed a structured questionnaire to evaluate the sensory qualities associated with "shooting" and "radiating" in 155 patients, 98 with radicular LBP and 57 with trigeminal neuralgia (TN), a second chronic pain condition in which shooting/radiating are experienced. Results indicated a spectrum of different sensations in different people. While many sciatica patients reported rapid downward movement of their pain, even more reported downward expansion of the area of pain, some reported upward movement and for some there was no spatial dynamic at all. The velocity of movement or expansion was also variable. By cross-referencing sensations experienced in the sciatica and TN cohorts with known signal processing modes in the somatosensory system, we propose testable hypotheses concerning the pathophysiology of the various vectorial sensations reported, their direction and velocity, and the structures in which they are generated. Systematic evaluation of qualitative features of "shooting" and "radiating" pain at the time of diagnosis can shed light on the pain mechanism in the individual patient and perhaps contribute to a better therapeutic outcomes.

DOI: 10.1097/j.pain.0000000000001729


🔎 @Meditorha

مقاله شماره ۲۸
#Oncology
#Gynecology
عنوان:
Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer

مجله:
The New England Journal of Medicine

تاریخ انتشار:
Nov, 2019

سایتیشن:
Coleman et al.

چکیده:

BACKGROUND

Secondary surgical cytoreduction in women with platinum-sensitive, recurrent epithelial ovarian, primary peritoneal, or fallopian-tube ("ovarian") cancer is widely practiced but has not been evaluated in phase 3 investigation.

METHODS

We randomly assigned patients with recurrent ovarian cancer who had received one previous therapy, had an interval during which no platinum-based chemotherapy was used (platinum-free interval) of 6 months or more, and had investigator-determined resectable disease (to no macroscopic residual disease) to undergo secondary surgical cytoreduction and then receive platinum-based chemotherapy or to receive platinum-based chemotherapy alone. Adjuvant chemotherapy (paclitaxel-carboplatin or gemcitabine-carboplatin) and use of bevacizumab were at the discretion of the investigator. The primary end point was overall survival.

RESULTS

A total of 485 patients underwent randomization, 240 to secondary cytoreduction before chemotherapy and 245 to chemotherapy alone. The median follow-up was 48.1 months. Complete gross resection was achieved in 67% of the patients assigned to surgery who underwent the procedure. Platinum-based chemotherapy with bevacizumab followed by bevacizumab maintenance was administered to 84% of the patients overall and was equally distributed between the two groups. The hazard ratio for death (surgery vs. no surgery) was 1.29 (95% confidence interval [CI], 0.97 to 1.72; P = 0.08), which corresponded to a median overall survival of 50.6 months and 64.7 months, respectively. Adjustment for platinum-free interval and chemotherapy choice did not alter the effect. The hazard ratio for disease progression or death (surgery vs. no surgery) was 0.82 (95% CI, 0.66 to 1.01; median progression-free survival, 18.9 months and 16.2 months, respectively). Surgical morbidity at 30 days was 9%; 1 patient (0.4%) died from postoperative complications. Patient-reported quality of life decreased significantly after surgery but did not differ significantly between the two groups after recovery.

CONCLUSIONS

In this trial involving patients with platinum-sensitive, recurrent ovarian cancer, secondary surgical cytoreduction followed by chemotherapy did not result in longer overall survival than chemotherapy alone.

DOI: https://www.nejm.org/doi/10.1056/NEJMoa1902626

توضیحات:

The authors of this multinational, randomized, phase III clinical trial compared outcomes of secondary surgical cytoreduction followed by platinum-based chemotherapy versus platinum-based chemotherapy alone in 485 women with resectable, platinum-sensitive, recurrent ovarian cancer. The median overall survival was 50.6 months following surgery compared with 64.7 months without surgery. The hazard ratio for death was 1.29 with surgery compared with platinum-based chemotherapy alone (P=.08). Surgery was not associated with improved outcomes even when comparing only 67% of surgical patients who achieved complete gross resection with the chemotherapy-alone cohort.

🔎 @Meditorha

مقاله شماره ۲۹
#Cardiology
#VascularSurgery
#Internal_medicine
#Pharmacology
#Rheumatology
عنوان:
Use of direct oral anticoagulants in antiphospholipid syndrome.

مجله:
Journal of Thromb Haemost

نوع مطالعه:
Review
تاریخ انتشار:
2018

سایتیشن:
Cohen et al.

چکیده:
The direct oral anticoagulants (DOACs) are therapeutic alternatives to warfarin and other vitamin K antagonists (VKAs), and constitute the standard of care for many indications. VKAs constitute the conventional therapy for the treatment and secondary thromboprophylaxis of thrombotic antiphospholipid syndrome (APS), but are often problematic, owing to the variable sensitivity of thromboplastins to lupus anticoagulant. Thus, the International Normalized Ratio may not accurately reflect anticoagulation intensity, or be clinically effective. Definition of the current role of DOACs in the treatment of APS is based on limited clinical trial data and information from other sources, including manufacturers' data, case series or cohort studies, and expert consensus. The Rivaroxaban in Antiphospholipid Syndrome (RAPS) randomized controlled trial (RCT), which had a laboratory surrogate primary outcome measure, suggests that rivaroxaban has the potential to be an effective and convenient alternative to warfarin in thrombotic APS patients with a single venous thromboembolism event requiring standard-intensity anticoagulation. However, further studies, in particular to provide better long-term efficacy and safety data, are needed before it can be widely recommended. APS patients are clinically heterogeneous, with the risk of recurrent thrombosis and the intensity of anticoagulation being influenced by their clinical phenotype and risk profile. DOAC trials involving homogeneous thrombotic APS populations, with the antiphospholipid antibody status well defined, will help to optimize the appropriate treatment in APS patient subgroups. Ongoing and emerging DOAC RCTs should provide further information to guide the use of DOACs in APS patients. Optimal identification of APS patients is a key step in working towards improved therapeutic strategies in these individuals.

DOI: https://doi.org/10.1111/jth.14017


🔎 @Meditorha

مقاله شماره ۳۰
#Gynecology
#Oncology
عنوان:
Supplemental MRI Screening for Women With Extremely Dense Breast Tissue

مجله:
The New England Journal of Medicine

نوع مطالعه:
RCT
تاریخ انتشار:
Nov, 2019

سایتیشن:
Bakker et al.

چکیده:
BACKGROUND

Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients.

METHODS

In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period.

RESULTS

The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P<0.001). Of the women who were invited to undergo MRI, 59% accepted the invitation. Of the 20 interval cancers that were diagnosed in the MRI-invitation group, 4 were diagnosed in the women who actually underwent MRI (0.8 per 1000 screenings) and 16 in those who did not accept the invitation (4.9 per 1000 screenings). The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1000 screenings (95% CI, 13.3 to 20.5). The positive predictive value was 17.4% (95% CI, 14.2 to 21.2) for recall for additional testing and 26.3% (95% CI, 21.7 to 31.6) for biopsy. The false positive rate was 79.8 per 1000 screenings. Among the women who underwent MRI, 0.1% had either an adverse event or a serious adverse event during or immediately after the screening.

CONCLUSIONS

The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period. 

DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa1903986

توضیحات مهم:

✅ در این مطالعه، ۴۰۳۷۳ زن در محدودع سنی ۵۰ تا ۷۵ سال با بافت پستان extremely dense و نتایج غربالگری نرمال ماموگرافی بصورت رندوم به دو گروه supplemental MRI و فقط ماموگرافی تقسیم شدند.

✔️ The interval cancer rate was significantly lower in the MRI-invitation group compared with the mammography-only group.

✔️ Among the 20 interval cancers diagnosed in the MRI-invitation group, 4 were diagnosed in women who underwent MRI and 16 were diagnosed in those who did not accept the invitation.

✔️Among the women who underwent MRI screening, the cancer-detection rate was 16.5 per 1000 screenings.

✔️ The positive predictive value was 17.4% for recall for additional testing and 26.3% for biopsy, whereas the false-positive rate was 79.8 per 1000 screenings.

✔️✔️ نتایج این مطالعه نشان می دهد که supplemental MRI در زنان با بافت پستان extremely dense و ماموگرافی نرمال منجر به تشخیص کمتر قابل توجهی از کنسرهای interval در مقایسه با ماموگرافی به تنهایی می شود.

🔎 @Meditorha

مقاله شماره ۳۱
#Internal_medicine
#Surgery
#Gastroenterology
عنوان:
Rituximab Is Ineffective for Treatment of Fatigue in Primary Biliary Cholangitis

مجله:
Hepatology

نوع مطالعه:
single‐center phase 2 randomized controlled trial

تاریخ انتشار:
May, 2018

سایتیشن:
Khanna et al.

چکیده:
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease. Half of patients experience debilitating fatigue, which is currently untreatable. Previous studies have shown muscle bioenergetic abnormalities in PBC, including increased muscle acidosis with exercise linked to the antimitochondrial antibody (AMA) diagnostic of the disease, and reduced anaerobic threshold. In this study we addressed the hypothesis that fatigue in PBC is driven by muscle bioenergetic abnormality related to AMA, and that AMA reduction with B-cell depletion therapy will improve fatigue. In our single-center phase 2 randomized controlled trial, 57 participants aged 18 years or older with PBC and moderate to severe fatigue were randomized to receive two doses of either rituximab (1000 mg) or saline (placebo). The primary outcome measure was fatigue severity assessed using the PBC-40 fatigue domain at 3 months. Secondary outcome measures included patient-reported outcomes and immunological and bioenergetics disease parameters. Experimental outcomes included biochemical markers of disease severity. Improvement in fatigue score at 3 months was seen in both arms, with no significant difference (adjusted mean difference -0.9 [95% confidence interval -4.6 to 3.1]). Little difference was observed in other patient-reported outcomes or physical activity. Significant anaerobic threshold improvement was seen in the rituximab group, only but this was not associated with fatigue improvement. No treatment-emergent serious adverse events were seen. Conclusions: Rituximab was safe over the 12-month study period but showed no evidence of effectiveness for the treatment of fatigue in PBC. Anaerobic threshold improvement was seen, potentially linking AMA with muscle bioenergetics dysfunction; however, this was not related to improvement in fatigue. Rituximab had some evidence of a beneficial effect on alkaline phosphatase levels in this largely ursodeoxycholic acid (UDCA)-responding, early-disease stage cohort.

DOI: https://dx.doi.org/10.1002/hep.30099

توضیحات مهم:

✅ هدف اصلی این مطالعه بهبود Fatigue ناشی از کلانژیت صفراوی اولیه (PBC) بود.

✔️ فرضیه این بود که Fatigue توسط آنتی بادی ضد میتوکندری (AMA) موجود در PBC هدایت می شود.

✔️ نتایج نشان داد که کاهش AMA از طریق کاهش سلول B باعث خستگی بیماران مبتلا به PBC می شود. اما تفاوت معنی داری در خستگی بین گروه ریتوکسیماب در مقایسه با دارونما مشاهده نشد.

🔎 @Meditorha

مقاله شماره ۳۲
#Cardiology
#Pharmacology
عنوان:
Selenium Deficiency Associated With Worse Outcomes in Patients With Heart Failure

مجله:
European Journal of Heart Failure

نوع مطالعه:
cohort study

تاریخ انتشار:
06 December 2019

سایتیشن:
Bomer et al.

چکیده:
AIMS

Severe deficiency of the essential trace element selenium can cause myocardial dysfunction although the mechanism at cellular level is uncertain. Whether, in clinical practice, moderate selenium deficiency is associated with worse symptoms and outcome in patients with heart failure is unknown.

METHODS AND RESULTS

BIOSTAT-CHF is a multinational, prospective, observational cohort study that enrolled patients with worsening heart failure. Serum concentrations of selenium were measured by inductively coupled plasma mass spectrometry. Primary endpoint was a composite of all-cause mortality and hospitalization for heart failure; secondary endpoint was all-cause mortality. To investigate potential mechanisms by which selenium deficiency might affect prognosis, human cardiomyocytes were cultured in absence of selenium, and mitochondrial function and oxidative stress were assessed. Serum selenium concentration (deficiency) was <70 μg/L in 485 (20.4%) patients, who were older, more often women, had worse New York Heart Association class, more severe signs and symptoms of heart failure and poorer exercise capacity (6-min walking test) and quality of life (Kansas City Cardiomyopathy Questionnaire). Selenium deficiency was associated with higher rates of the primary endpoint [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.06-1.42] and all-cause mortality (HR 1.52; 95% CI 1.26-1.86). In cultured human cardiomyocytes, selenium deprivation impaired mitochondrial function and oxidative phosphorylation, and increased intracellular reactive oxygen species levels.

CONCLUSIONS

Selenium deficiency in heart failure patients is independently associated with impaired exercise tolerance and a 50% higher mortality rate, and impaired mitochondrial function in vitro, in human cardiomyocytes. Clinical trials are needed to investigate the effect of selenium supplements in patients with heart failure, especially if they have low plasma concentrations of selenium.



DOI: https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.1644

توضیحات مهم:

✅ این مطالعه آینده نگر با استفاده از داده های مطالعه کوهورت بین المللی BIOSTAT-CHF، به بررسی ارتباط بین غلظت سلنیوم و پیامدهای آن در 2516 بیمار با بدتر شدن نارسایی قلبی پرداخته است.

✔️ از بین شرکت کنندگان ، ۲۰/۴٪ غلظت سرمی سلنیوم کمتر از حد نرمال بود (<70 میکروگرم بر لیتر).

✔️ در مقایسه با بیمارانی که سطح سلنیوم بالاتری دارند ، این بیماران بیشتر در زنان و افراد مسن بود. علاوه بر این ، آنها علائم و نشانه های شدیدتری از نارسایی قلبی ، بدتر شدن کلاس NYHA ، کیفیت پایین تر زندگی داشتند.

✔️ مرگ و میر (mortality) در بیماران مبتلا به کمبود سلنیوم بیشتر بود.

👈 اگر چه آزمایشات بالینی بیشتری برای تعیین اینکه آیا مکمل سلنیوم نتایج بیماران مبتلا به نارسایی قلبی را بهبود می بخشد ، لازم است ، اما این داده ها نشان می دهد که بیماران با سطح سلنیوم پایین پیامدهای بدتری دارند (از جمله نرخ مرگ و میر بالاتر).

🔎 @Meditorha

مقاله شماره ۳۳
#Internal_medicine
#Diabete
عنوان:
Preventing Foot Ulceration in Diabetes

مجله:
Diabetologia

نوع مطالعه:
systematic review and meta-analyses of RCT data

تاریخ انتشار:
27 November 2019

سایتیشن:
Crawford et al.

چکیده:
AIMS/HYPOTHESIS

Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data.

METHODS

We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses.

RESULTS

Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions.

CONCLUSIONS/INTERPRETATION

Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit.

https://link.springer.com/article/10.1007%2Fs00125-019-05020-7

توضیحات مهم:

✅ نویسندگان این مرور ساختارمند و متاآنالیز، اثربخشی مداخلات طراحی شده برای جلوگیری از زخم پای دیابتی را در بین مبتلایان به دیابت ارزیابی کردند.

✔️ در میان 22 مطالعه RCT که 8 مداخله را ارزیابی می کند ، مداخلات نشان داده دماسنج dermal infrared، مداخلات پیچیده و کفش custom-made و offloading insole موثر بوده است.

✔️ یک آزمایش واحد از دستگاه های دیجیتالی سیلیکون نیز از مزیت متوسطی برخوردار بود.

✔✔ اگرچه 4 مداخله در پیشگیری از زخم پای دیابتی در بین مبتلایان به دیابت مؤثر شناخته شده است ، اما مطالعات آینده لازم است تا مشخص شود که کدام مداخلات مؤثرتر هستند و استفاده از این راهکارها در کدام جمعیت هدف پیشگیرانه بیشتر است.

🔎 @Meditorha

مجموعه مدیتورها شما را به مطالعه این مقاله ارزشمند دعوت می کند.

در سال ۲۰۰۹ کریگ بنت مطالعه‌ای بر روی یک ماهی آزاد به وسیله fMRI انجام داد و در آن به ماهی آزاد تعدادی تصویر انسان نشان داد و از ماهی خواست که احساسات افراد را بیان کند!
پس از آنالیز اطلاعات، بنت به این نتیجه رسید که مغز ماهی آزاد میتواند احساسات بشر را تشخیص دهد.

مشکل اینجا بود که ماهی مورد مطالعه مرده بود!!

این مطالعه برای نشان دادن مشکلات آنالیز آماری و p value طراحی شده بود.
فیلم در مورد تاریخچه و کاربرد p value در دانش امروزی است و اهمیتی که کاربرد درست آن دارد.

Bennett, et al "Neural correlates of interspecies perspective taking in the post-mortem Atlantic Salmon: an argument for multiple comparisons correction." Neuroimage 47.Suppl 1 (2009): S125.


در کانال مجموعه علمی پژوهشی #مدیتورها در تلگرام عضو شوید.

http://www.tgoop.com/meditorha

مقاله شماره ۳۴

#Internal_medicine
#Diabete
#Cardiology
عنوان:

2019 ADA and EASD Guidelines for the Management of Hyperglycemia in Type 2 Diabetes

مجله:
Diabetes Care

نوع مطالعه:
Original Research

تاریخ انتشار:
October 15, 2019

سایتیشن:
Buse et al.

چکیده:
The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min–1 [1.73 m]–2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.

https://doi.org/10.2337/dci19-0066

توضیحات مهم:

✔ The ADA and EASD have updated their guidelines for the management of hyperglycemia in type 2 diabetes to include the use of GLP-1 receptor agonists or SGLT2 inhibitors in high-risk patients.
✔ The update also includes the consideration of GLP-1 receptor agonist use in those diabetic patients without cardiovascular disease and the use of SGLT2 inhibitors in type 2 diabetes patients with heart failure and chronic kidney disease.


🔎 @Meditorha