Carotid endarterectomy with primary closure versus patch angioplasty in patients with symptomatic and significant stenosis:protocol for a systematic review with meta-analyses and trial sequential analysis of randomised clinical trials

Introduction Use of patch angioplasty in carotid endarterectomy (CEA) is suggested to reduce the risk of restenosis and recurrent ipsilateral stroke. The objective is to conduct a systematic review with meta-analysis and trial sequential analysis as well as Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments comparing the benefits and harms of CEA with primary closure of the arterial wall versus CEA with patch angioplasty in patients with a symptomatic and significant carotid stenosis.Methods and analysis The review shall be conducted according to this published protocol following the recommendations of the ` Cochrane' and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Randomised clinical trials comparing CEA with primary closure of the arterial wall versus CEA with patch angioplasty (regardless of used patch materials) in human adults with a symptomatic and significant carotid stenosis will be included. Primary outcomes are all-cause mortality at maximal follow-up, health-related quality of life and serious adverse events. Secondary outcomes are symptomatic or asymptomatic arterial occlusion or restenosis, and non-serious adverse events. We will primarily base our conclusions on meta-analyses of trials with overall low risk of bias. However, if pooled point estimates of all trials are similar to pooled point estimates of trials with overall low risk of bias and there is lack of a statistical significant interaction between estimates from trials with overall high risk of bias and trials with overall low risk of bias we will consider the precision achieved in all trials as the result of our meta-analyses.Ethics and dissemination The proposed systematic review will collect and analyse secondary data from published studies therefor ethical approval is not required. The results of the systematic review will be disseminated by publication in a peer-review journal and submitted for presentation at relevant conferences.</p

Molecular Basis of Hb H Disease in Southwest Iran

International audienceAlthough alpha(0)-thalassemia (thal) defects are not very frequent in the Iranian population, Hb H disease does occur in the country. We have analyzed the alpha gene cluster of 13 patients showing the presence of Hb H to establish the molecular background of this disease in southwest Iran (Shiraz and Hormozgan provinces). Using gap-polymerase chain reaction (gap-PCR) and direct DNA sequencing we have found the ―(MED-I) deletion, the polyadenylation signal (poly A) mutations alpha(T-Saudi)alpha and alpha(T-Turkish)alpha, and Hb Constant Spring (Hb CS) in association with the common -alpha(3.7) deletion. This study has revealed that: 1) at least six genotypes are responsible for Hb H disease in the area: -alpha(3.7)/ ―(MED-I); -alpha(3.7)/alpha(T-Saudi)alpha; alpha(T-Saudi)alpha/alpha(T-Saudi)alpha; alpha(CS)alpha/―(MED-I); ―(MED-I)/alpha(T-Turkish)alpha; and the atypical forms of Hb H disease -alpha(3.7)/alpha(CS)alpha. 2) The molecular background of Hb H disease in the southwest area of Iran is more similar to the Mediterranean type than to the Southeast Asian. 3) Hb Bart's hydrops fetalis syndrome and mild, intermediate or severe postnatal Hb H disease conditions can be expected, but at a relatively low incidence. 4) The diagnostic flowchart for patients with microcytic hypochromic anemia should include iron deficiency, beta-thal, alpha(+)- and alpha(0)-thal analyses