Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases:A Systematic Review and Meta-Analysis

To assess safety and outcome of radiofrequency ablation (RFA) and microwave ablation (MWA) as compared to systemic chemotherapy and partial hepatectomy (PH) in the treatment of colorectal liver metastases (CRLM). MEDLINE, Embase and the Cochrane Library were searched. Randomized trials and comparative observational studies with multivariate analysis and/or matching were included. Guidelines from National Guideline Clearinghouse and Guidelines International Network were assessed using the AGREE II instrument. The search revealed 3530 records; 328 were selected for full-text review; 48 were included: 8 systematic reviews, 2 randomized studies, 26 comparative observational studies, 2 guideline-articles and 10 case series; in addition 13 guidelines were evaluated. Literature to assess the effectiveness of ablation was limited. RFA + systemic chemotherapy was superior to chemotherapy alone. PH was superior to RFA alone but not to RFA + PH or to MWA. Compared to PH, RFA showed fewer complications, MWA did not. Outcomes were subject to residual confounding since ablation was only employed for unresectable disease. The results from the EORTC-CLOCC trial, the comparable survival for ablation + PH versus PH alone, the potential to induce long-term disease control and the low complication rate argue in favour of ablation over chemotherapy alone. Further randomized comparisons of ablation to current-day chemotherapy alone should therefore be considered unethical. Hence, the highest achievable level of evidence for unresectable CRLM seems reached. The apparent selection bias from previous studies and the superior safety profile mandate the setup of randomized controlled trials comparing ablation to surgery

Living with disabling chronic pain: results from a face-to-face cross-sectional population-based study.

To estimate the prevalence of disabling chronic pain (DCP) in Spanish adults, to analyse its characteristics, to determine its multimorbidity and to identify its associated factors. 2011 Andalusian Health Survey, a cross-sectional population survey based on face-to-face home interviews. 6507 people aged 16 years or older and living in Andalusia, Spain. The response variable was disabling chronic pain. Multivariate multinomial logistic regression models were used to analyse the association of factors with disabling chronic pain. The sample design was considered throughout the statistical analysis. The prevalence of disabling chronic pain in the Spanish adult population was 11.36% (95% CI 11.23 to 11.49), while that of non-disabling chronic pain was 5.67% (95% CI 5.57 to 5.77). Disabling chronic pain was associated with high multimorbidity (especially in women (51%) and in the elderly (70%) with three or more additional chronic diseases), as well as with disadvantaged social status (such as female gender (OR=2.12), advanced age (OR10-year increase=1.28), unemployment (OR=1.33), manual work (OR=1.26), low income (OR=1.14) and reduced emotional social support (OR=1.04)). Other influential factors were tobacco consumption (OR=1.42), sleeping ≤7 hours (OR=1.2)], environmental or work conditions (OR=1.16) and quality of life (ORmental=1.21, ORphysical=2.37). The population with disabling chronic pain was associated with multimorbidity, vulnerable social status and an impaired quality of life. In contrast, the population with non-disabling chronic pain showed almost no differences when compared with the population without chronic pain. The association between DCP and mental disorders highlights the need for psychosocial services in the management of chronic pain

Maternal Diabetes and Cognitive Performance in the Offspring: A Systematic Review and Meta-Analysis.

Diabetes during gestation is one of the most common pregnancy complications associated with adverse health effects for the mother and the child. Maternal diabetes has been proposed to negatively affect the cognitive abilities of the child, but experimental research assessing its impact is conflicting. The main aim of our study was to compare the cognitive function in children of diabetic and healthy pregnant women.A systematic review and meta-analysis was conducted through a literature search using different electronic databases from the index date to January 31, 2015. We included studies that assessed the cognitive abilities in children (up to 14 years) of diabetic and non-diabetic mothers using standardized and validated neuropsychological tests.Of 7,698 references reviewed, 12 studies involving 6,140 infants met our inclusion criteria and contributed to meta-analysis. A random effect model was used to compute the standardized mean differences and 95% confidence interval (CI) were calculated. Infants (1-2 years) of diabetic mothers had significantly lower scores of mental and psychomotor development compared to control infants. The effect size for mental development was -0.41 (95% CI -0.59, -0.24; p<0.0001) and for psychomotor development was -0.31 (95% CI -0.55, -0.07; p = 0.0125) with non-significant heterogeneity. Diabetes during pregnancy could be associated with decreased intelligence quotient scores in school-age children, although studies showed significant heterogeneity.The association between maternal diabetes and deleterious effects on mental/psychomotor development and overall intellectual function in the offspring must be taken with caution. Results are based on observational cohorts and a direct causal influence of intrauterine hyperglycemia remains uncertain. Therefore, more trials that include larger populations are warranted to elucidate whether gestational diabetes mellitus (GDM) has a negative impact on offspring central nervous system (CNS)

Study flowchart showing the number of studies identified, screened, assessed for eligibility and included in the qualitative and quantitative analysis [17].

<p>*Further information regarding the excluded studies can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0142583#pone.0142583.s010" target="_blank">S2 Text</a>.</p

Characteristics of the cohort studies included in the systematic review and meta-analysis (<i>n</i> = 12).

<p>Studies list is ordered by date and by type of outcome (Most recent studies and “support” are showed first).</p><p>ALSPAC, Avon Longitudinal Study of Parents and Children; ND, Not defined; GDM, Gestational Diabetes Mellitus; PGDM, Pre-gestational Diabetes Mellitus; Ctrl, Control; BMI, Body Mass Index; WISC-III/R, Wechsler Intelligence Scale for Children-3^rd Edition, R, revised; IQ, Intelligence Quotient; ADHD, Attention Deficit Hyperactivity Disorder; WPPSI-III/R, Wechsler Preschool and Primary Scale of Intelligence–3^rd Edition, R, Revised; SES, Socio Economic Status; T1DM, Type 1 Diabetes Mellitus; T2DM, Type 2 Diabetes Mellitus; BSID-I/II, Bayley Scales of Infant Development- 1^st/2^nd Edition; MDI, Mental Development Index; PDI, Psychomotor Development Index; OGTT, Oral Glucose Tolerance Test; DIEP, Diabetes in Early Pregnancy; FA, Fatty Acids.</p><p>Risk of bias classification (GRADE): L, Low; M, Medium; H, High.</p><p>Quality score (Newcastle-Ottawa): from 0 (lowest) to 9 (highest).</p><p>^† Number of children included in the studies.</p><p>*All values refer to mean (Standard Deviation), otherwise it is stated.</p><p>^§ Three references are related to the same subjects, so only the oldest study was included.</p><p>Characteristics of the cohort studies included in the systematic review and meta-analysis (<i>n</i> = 12).</p

Effect of pregnancy diabetes on the mental and psychomotor development and intelligence quotient.

<p>Forest plots comparing the difference in the (A) Mental Development Index and (B) Psychomotor Development Index subscales of the BSID between children of diabetic and non-diabetic mothers. (C) Forest plots comparing the difference in the intelligence quotient yielded by combined data from the Wechsler scales and the Stanford-Binet intelligence scale between children of diabetic and non-diabetic mothers.</p

Effectiveness of a Hand Hygiene Program at Child Care Centers:A Cluster Randomized Trial

Respiratory infections (RIs) are an important cause of morbidity and excessive antibiotic prescriptions in children attending day care centers (DCCs). We aimed to assess the effectiveness of an educational and hand hygiene program in DCCs and homes in reducing RI incidence and antibiotic prescriptions in children. A cluster, randomized, controlled, and open study of 911 children aged 0 to 3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up. Two intervention groups of DCC families performed educational and hand hygiene measures, 1 with soap and water (SWG; n = 274), another with hand sanitizer (HSG; n = 339), and the control group (CG; n = 298) followed usual hand-washing procedures. RI episode rates were compared through multilevel Poisson regression models. The percentage of days missed were compared with Poisson exact tests. There were 5211 RI episodes registered. Children in the HSG had less risk of RI episodes (incidence rate ratio [IRR]: 0.77; 95% confidence interval [CI]: 0.68-0.88) and antibiotic prescriptions (IRR: 0.69; 95% CI: 0.57-0.84) compared with the those in the CG. Children in the SWG had a higher risk of RI episodes (IRR: 1.21; 95% CI: 1.06-1.39) and antibiotic prescriptions (IRR: 1.31; 95% CI: 1.08-1.56) than those in the HSG. Pupils missed 5186 DCC days because of RIs, and the percentage of days absent was significantly lower in the HSG compared with the CG (P Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents, reduce absent days, RIs, and antibiotic prescriptions for these infections in children at DCCs