The transforming growth factor beta (TGFβ) pathway could modulate the Duchenne muscular dystrophy (DMD) phenotype. This meta-analysis aims to estimate the association of genetic variants involved in ...the TGFβ pathway, including the latent transforming growth factor beta binding protein 4 (LTBP4) and secreted phosphoprotein 1 (SPP1) genes, among others, with age of loss of ambulation (LoA) and cardiac function in patients with DMD. Meta-analyses were conducted for the hazard ratio (HR) of LoA for each genetic variant. A subgroup analysis was performed in patients treated exclusively with glucocorticoids. Eight studies were included in the systematic review and four in the meta-analyses. The systematic review suggests a protective effect of LTBP4 haplotype IAAM (recessive model) for LoA. It is also suggested that the SPP1 rs28357094 genotype G (dominant model) is associated with early LoA in glucocorticoids-treated patients. The meta-analysis of the LTBP4 haplotype IAAM showed a protective association with LoA, with an HR = 0.78 (95% CI: 0.67–0.90). No association with LoA was observed for the SPP1 rs28357094. The LTBP4 haplotype IAAM is associated with a later LoA, especially in the Caucasian population, while the SPP1 rs28357094 genotype G could be associated with a poor response to glucocorticoids. Future research is suggested for SPP1 rs11730582, LTBP4 rs710160, and THBS1 rs2725797.
Abstract
Background
Short peripheral catheters (SPC) insertion technique has a high failure rate, one of the reasons why the ultrasound (US)-guided method has been proposed as a valid alternative to ...traditional technique in SPC insertion. This umbrella review aims to synthesize the available evidence comparing the US-guided method with the traditional method on SPC insertion in terms of effectiveness, safety and patient satisfaction.
Methods
An umbrella review addressing the comparison between US-guided versus traditional method for SPC insertion in which only systematic reviews of all comparative study designs were eligible was carried out. Previous systematic reviews and meta-analyses were systematically searched in MEDLINE, EMBASE, Web of Science and Cochrane Library. Methodological quality was assessed with AMSTAR-2 tool. The quality of evidence per association was assessed using the GRADE criteria and was stablished as high, moderate, low and very low.
Results
Twelve systematic reviews with a range of 75–1860 patients were included. Moderate certainty evidence supports the positive effect of US-guided method on first-attempt success rate and number of attempts. There is moderate certainty evidence that US-guided method does not reduce the time spent in SPC insertion. Low certainty evidence supports that US-guided method improves both overall success rates and patient satisfaction. Emergency department was the main hospital department where these findings were reported.
Conclusions
The best current evidence indicates that US-guided method for SPC insertion is postulated as a valid alternative for both adult and pediatric population, especially in patients with difficult venous access and in hospital departments where optimal vascular access in the shortest time possible is critical.
Trial registration
PROSPERO: CRD42021290824.
Aims:
To synthesize and evaluate the available scientific evidence on the efficacy of antihypertensive drugs on arterial stiffness in patients with hypertension by using a network meta-analysis ...approach.
Methods:
A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different antihypertensive drugs on arterial stiffness parameters (pulse wave velocity PWV and augmentation index AIx) in adults with hypertension. Comparative evaluation of the effect of antihypertensive drugs was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between antihypertensive drugs and placebo/other antihypertensive drugs. Analyses were performed including studies of any duration and only studies longer than 6 months length.
Results:
Seventy-six studies were included in the main analysis and considering only studies longer than 6 months length, thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination showed a higher effect on reducing PWV, and ACEIs and ARBs on reducing AIx.
Conclusion:
Our research provides evidence that antihypertensive medications are an effective way to treat arterial stiffness in adults with hypertension. Based on our findings, patients with hypertension who have greater levels of arterial stiffness may benefit from using thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination.
Systematic Review Registration:
PROSPERO (CRD42021276360).
A balanced diet can help in the prevention of chronic diseases. The aim of this study was to evaluate the effect of an mHealth intervention on the distribution of macronutrients and the intake of ...food groups. A total of 650 participants were included in this multi-center, clinical, randomized, controlled trial (Evident 3 study). All participants were given brief advice about diet and exercise. The intervention group received, in addition, an app (Evident 3) for the self-recording of their diet and an activity tracker wristband for 3 months. Follow-up visits were performed at 3 and 12 months to collect the diet composition using the Food Frequency Questionnaire. There were decreases in the intake of total calories, fat, protein and carbohydrates in both groups throughout the study, without significant differences between them. The intervention group reduced the intake of cholesterol (-30.8; 95% CI -59.9, -1.7) and full-fat dairies (-23.3; 95% CI -42.8, -3.8) and increased the intake of wholemeal bread (3.3; 95% CI -6.7, 13.3) and whole-grain cereals (3.4; 95% CI -6.8, 13.7) with respect to the control group. No differences were found in the rest of the nutritional parameters. The brief advice is useful to promote a healthier diet, and the app can be a support tool to obtain changes in relevant foods, such as integral foods, and the intake of cholesterol. Trial registration: ClinicalTrials.gov with identifier NCT03175614.
Background
Heart diseases, particularly heart failure, significantly impact patient quality of life and mortality rates. Functional capacity assessment is vital for predicting prognosis and risk in ...these patients. While the cardiopulmonary exercise test is considered the gold standard, the 6-minute walk test has emerged as a more accessible alternative. However, the screening accuracy and optimal cut-off points of the 6-minute walk test for detecting severely reduced functional capacity in cardiac pathologies, including heart failure with preserved ejection fraction, are unclear. The study aimed to analyse the diagnostic accuracy of the 6-minute walk test for detecting reduced functional capacity, defined as VO
2max
< 14 ml/kg/min, compared with the cardiopulmonary exercise test in participants with heart failure with preserved ejection fraction using data from the “Ejercicio en Insuficiencia Cardiaca con Fracción de Eyección Preservada” (ExIC-FEp) trial; and to compare these results with previous studies investigating the screening accuracy for assessing functional capacity of the 6-minute walk test in participants with other chronic cardiac pathologies through a meta-analysis.
Results
The ExIC-FEp trial involved 22 participants with heart failure with preserved ejection fraction, who were not treated with beta-blockers, using the cardiopulmonary exercise test, specifically VO
2max,
as the reference test. The 6-minute walk test had a sensitivity of 70%, a specificity of 80%, and an area under the curve of 76% in the ExIC-FEp trial. Five studies were included in the meta-analysis showing a sensitivity of 79%, a specificity of 78%, and an area under the curve of 85%.
Conclusion
In conclusion, the 6-minute walk test holds promise as a screening tool for assessing functional capacity in heart failure with preserved ejection fraction and chronic heart diseases, with a VO
2max
< 14 ml/kg/min as a reference point. It demonstrates moderate to good screening accuracy. However, the screening accuracy and optimal cut-off points of the 6-minute walk test for detecting severely reduced functional capacity, regardless of aetiology, are unclear.
Trial Registration
NCT05726474. Registered 16 February 2023,
https://clinicaltrials.gov/study/NCT05726474
.
Key Points
• The 6-minute walk test (6MWT) shows promise as a screening tool for assessing functional capacity in participants with heart failure with preserved ejection fraction (HFpEF) and other chronic cardiac pathologies.
• The screening accuracy of the 6MWT was analysed in comparison to the gold standard cardiopulmonary exercise test (CPET) in participants with HFpEF from the ExIC-FEp trial. The 6MWT demonstrated a sensitivity of 70%, specificity of 80%, and an area under the curve (AUC) of 76%.
• A meta-analysis comparing the screening accuracy of the 6MWT for detecting severely reduced functional capacity across various cardiac pathologies revealed consistent results. The pooled estimates showed a sensitivity of 79%, a specificity of 78%, and an AUC of 85%.
• The 6MWT offers a cost-effective and easily implementable alternative to the CPET for assessing functional capacity. Its moderate to good screening accuracy and widespread availability make it a valuable screening tool in the screening evaluation of participants with HFpEF and other chronic cardiac pathologies.
: Spasticity is a motor disorder characterised by exaggerated movements of the tendons and accompanied by hyperreflexia and hypertonia. Extracorporeal shock wave therapy (ESWT) is used as a treatment ...for spasticity, although more evidence is needed on the effectiveness of this therapy in the treatment of spasticity. Therefore, the aim of this study was to assess the effectiveness ESWT in the treatment of upper and lower limbs spasticity in both children and adults through different aetiologies.
: A systematic search was performed in different databases from inception to December 2023. Random-effects meta-analysis was used to estimate the efficacy of ESWT on spasticity using the Modified Ashworth Scale.
: Sixteen studies were included in the systematic review and meta-analysis. The effect of ESWT on spasticity measured with the Modified Ashworth Scale shows a significant decrease in spasticity in the upper limbs and in the lower limbs in adults with chronic stroke and in children with cerebral palsy, is more effective immediately after application, and maintains its effect up to 12 weeks post treatment.
: These findings are important for clinical practice since they show evidence that ESWT is effective in reducing spasticity in both children and adults.
(1) Background: Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for approximately 50% of all patients with HF. In the absence of pharmacological treatments that have been ...successful in reducing mortality or morbidity in this pathology, physical exercise is recognized as an important adjunct in the treatment of HF. Therefore, the objective of this study is to compare the efficacy of combined training and high intensity interval training (HIIT) on exercise capacity, diastolic function, endothelial function, and arterial stiffness in participants with HFpEF. (2) Methods: The ExIC-FEp study will be a single-blind, 3-arm, randomized clinical trial (RCT) conducted at the Health and Social Research Center of the University of Castilla-La Mancha. Participants with HFpEF will be randomly assigned (1:1:1) to the combined exercise, HIIT or control group to evaluate the efficacy of physical exercise programs on exercise capacity, diastolic function, endothelial function, and arterial stiffness. All participants will be examined at baseline, at three months and at six months. (3) Results: The findings of this study will be published in a peer-reviewed journal. (4) Conclusions: This RCT will represent a significant advance in the available scientific evidence on the efficacy of physical exercise in the treatment of HFpEF.
This study aimed to examine the associations between physical fitness components and health-related quality of life (HRQoL) among adults stratified by sex and age. In addition, we aimed to examine ...whether these associations change based on socioeconomic, clinical, and biochemical characteristics.
A total of 297 participants aged 47.41 (standard deviation: 9.08) years from the "Validity of a Model of Accelerated Vascular Aging as a Cardiovascular Risk Index in Healthy Adults: the EVasCu cross-sectional study" were included in this analysis. HRQoL, physical fitness, socioeconomic status (SES), waist circumference, and blood pressure were measured. Additionally, blood samples were extracted to determine cholesterol, triglyceride, and glycated hemoglobin A1c (HbA1c) levels. Analyses of covariance (ANCOVAs) were estimated to test mean differences in physical and mental health-related health measures (HRQoL) between fitness categories (fixed factors) by sex and age categories.
The physical HRQoL was related to the levels of fitness parameters among women, independent of age, while for men, it was related to better levels of general fitness and cardiorespiratory fitness among men aged < 50 and men aged ≥ 50, respectively. In contrast, mental HRQoL was related to cardiorespiratory fitness only among women aged < 50 years; speed/agility and flexibility among men aged < 50 years; and general fitness, strength, and flexibility among men aged ≥ 50 years. These data did not change when SES, clinical variables, or biochemical determinations were included in the analyses, neither for the physical nor for the mental HRQoL.
Gender and age are important factors to be considered when analysing health indicators and influences in the population. In addition, SES, clinical characteristics, and biochemical parameters do not seem to influence the relationship between HRQoL and fitness.
Low-to-moderate alcohol consumption appears to have potential health benefits. Existing evidence concludes that wine may be associated with a lower incidence of certain diseases. This systematic ...review and meta-analysis aim to examine evidence on the association between wine consumption and cognitive decline and to analyze whether this association varies depending on the wine consumption level or is affected by individual and study characteristics, including mean age, percentage of women participants, and follow-up time.
In this systematic review and meta-analysis, we undertook a search in MEDLINE (
PubMed), Scopus, Cochrane, and Web of Science databases for longitudinal studies measuring the association between wine consumption and cognitive decline from their inception to May 2021. Effect sizes were calculated using the DerSimonian and Laird and Hartung-Knapp-Sidik-Jonkman methods.
The search retrieved 6,055 articles, 16 of which were included in this systematic review. In total, 12 studies were included in the meta-analysis. The studies were published between 1997 and 2019. They were conducted in nine different countries. The sample size of the included studies ranged from 360 to 10,308 with a mean age of 70 years old. Using the DerSimoniand and Laird method, the pooled RR for the effect of wine consumption on cognitive decline was 0.72 (95% CI 0.63-0.80;
= 82.4%; τ
: 0.0154). Using the Hartung-Knapp-Sidik-Jonkman method, the RR was 0.65 (95% CI 0.52-0.79;
= 94,531%; τ
: 0.057).
This study may show a protective effect of wine consumption against cognitive decline. However, it would be important for future research to differentiate the types of wine within consumption.
Arterial stiffness is an independent predictor of cardiovascular and all-cause mortality that is classically regarded as a consequence of arterial hypertension. However, a growing number of studies ...have shown that arterial stiffness is involved in the pathogenesis and prognosis of arterial hypertension. Thus, in this systematic review and meta-analysis, we aimed to assess whether arterial stiffness, as measured by pulse wave velocity, systolic blood pressure and diastolic blood pressure are associated with incident hypertension.
The Scopus, PubMed, Web of Science and Cochrane Library databases were searched from inception to March 30, 2021. The DerSimonian and Laird method was used to compute pooled relative risk estimates and their respective 95% confidence intervals of association between incident hypertension with pulse wave velocity, systolic blood pressure and diastolic blood pressure.
Our findings provide a synthesis of the evidence supporting that the higher arterial stiffness (RR: 1.09; 95% CIs: 1.05, 1.12), systolic blood pressure (RR: 1.08; 95% CIs: 1.05, 1.10) and diastolic blood pressure (RR: 1.08; 95% CIs: 1.04, 1.12) are associated with incident hypertension in normotensive adult subjects, with similar independent predictive values. However, our results should be interpreted with caution because the meta-analyses performed showed considerable heterogeneity.
Our results showed that higher pulse wave velocity, systolic blood pressure and diastolic blood pressure are associated with incident hypertension. These findings are of clinical importance, supporting arterial stiffness as an additional tool for the prevention of arterial hypertension and being a fundamental component to reduce cardiovascular morbidity and mortality.
This study was registered in PROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=236435 (Registration number: CRD42021236435).
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