American Society of Hematology 2020 guidelines for sickle cell disease: Prevention, diagnosis, and treatment of cerebrovascular disease in children and adults

BACKGROUND: Central nervous system (CNS) complications are among the most common, devastating sequelae of sickle cell disease (SCD) occurring throughout the lifespan.OBJECTIVE: These evidence-based guidelines of the American Society of Hematology are intended to support the SCD community in decisions about prevention, diagnosis, and treatment of the most common neurological morbidities in SCD.METHODS: The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic evidence reviews. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations.RESULTS: The panel placed a higher value on maintaining cognitive function than on being alive with significantly less than baseline cognitive function. The panel developed 19 recommendations with evidence-based strategies to prevent, diagnose, and treat CNS complications of SCD in low-middle- and high-income settings.CONCLUSIONS: Three of 19 recommendations immediately impact clinical care. These recommendations include: use of transcranial Doppler ultrasound screening and hydroxyurea for primary stroke prevention in children with hemoglobin SS (HbSS) and hemoglobin Sβ0 (HbSβ0) thalassemia living in low-middle-income settings; surveillance for developmental delay, cognitive impairments, and neurodevelopmental disorders in children; and use of magnetic resonance imaging of the brain without sedation to detect silent cerebral infarcts at least once in early-school-age children and once in adults with HbSS or HbSβ0 thalassemia. Individuals with SCD, their family members, and clinicians should become aware of and implement these recommendations to reduce the burden of CNS complications in children and adults with SCD.</p

Empirical Comparison of Publication Bias Tests in Meta-Analysis

Background Decision makers rely on meta-analytic estimates to trade off benefits and harms. Publication bias impairs the validity and generalizability of such estimates. The performance of various statistical tests for publication bias has been largely compared using simulation studies and has not been systematically evaluated in empirical data. Methods This study compares seven commonly used publication bias tests (i.e., Begg’s rank test, trim-and-fill, Egger’s, Tang’s, Macaskill’s, Deeks’, and Peters’ regression tests) based on 28,655 meta-analyses available in the Cochrane Library. Results Egger’s regression test detected publication bias more frequently than other tests (15.7% in meta-analyses of binary outcomes and 13.5% in meta-analyses of non-binary outcomes). The proportion of statistically significant publication bias tests was greater for larger meta-analyses, especially for Begg’s rank test and the trim-and-fill method. The agreement among Tang’s, Macaskill’s, Deeks’, and Peters’ regression tests for binary outcomes was moderately strong (most κ’s were around 0.6). Tang’s and Deeks’ tests had fairly similar performance (κ > 0.9). The agreement among Begg’s rank test, the trim-and-fill method, and Egger’s regression test was weak or moderate (κ < 0.5). Conclusions Given the relatively low agreement between many publication bias tests, meta-analysts should not rely on a single test and may apply multiple tests with various assumptions. Non-statistical approaches to evaluating publication bias (e.g., searching clinical trials registries, records of drug approving agencies, and scientific conference proceedings) remain essential

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The effect of crude alcoholic extracted for the Seeds and Leaves of Apium graveolens Var dulce. In the level of some female hormones in albino Mice.

The quantitative determination of the estrogen E2, Progestron P4 & follicle stimulating hormones FSH in the serums of Albino mice used in the experiments & treated by crude alcoholic extracted 95% of the seeds & leaves of Apium graveolens was a significant increase in the concentration of estrogen of different kinds of the extracted in comparison with the values of the coefficient of the control group, that is the study recorded a significant increase of the concentration of estrogen; it was the highest in the mice which was administrated by the methanolic extracted 95%, then it was less in the mouse which was administrated by the ethanolic extracted., and it was the least in the mice which were administrated by the crude ethanolic-methanoloic extracted of the seeds of Apium graveolens; while the increase of the concentration of estrogen of different crude alcoholic extracted leaves of Apium graveolens was the highest than the extracted of the seeds, & it was less concentration in the mice which were administrated by the methanolic extracted 95%, & then it was the least in the mice which were administrated by the crude ethanolic-methanolic extracted leaves of Apium graveolens in comparison with the values of the control group. Further, the plant extracted created a significant increase of the concentration of progestron P4; the statistics analysis recorded that the concentration of progestron was the highest in the mice which were administrated by the methanolic extracted 95%, then it was less in the mice which were administrated by the ethanolic extracted 95%, and the least in the mice which were administrated by the crude ethanolic-methanolic extracted of the seeds of apium graveolens whereas, a significant increase of the concentration of progrstrone was recorded in the leaves of Apium graveolens as follows: it was the highest in the mice which were administrated by the ethanolic extracted 95%, then it was less in the mice which were administrated by the crude methanolic extracted 95%, and it was the least in the mice which were administrated by the crude ethnolic-methanolic extracted in comparison with the coefficient of control group. The study also proved that there was a significant increase of the concentration of the follicle stimulating hormone FSH whose greatest concentration in the mice which was administrated by the crude ethanolic-methanolic for the seeds of Apim graveolens, it was less concentration in the mice which was administrated by crude methanolic extracted 95% of the seeds, and it was the least in the mice which was administrated by the methanolic extracted 95% of the leaves of Apium graveolens in comparison with the concentrations of the coefficient of the control group. While, the results recorded a significant decrease of the FSH in the mice which was administrated by the crude ethanolic extracted of the seeds & leaves of Apium graveolens a highest decrease, it was less concentration in the mice which was administrated by the crude ethanolic-methanolic extracted of the leaves of apium graveolens, in comparison with the concentration in the control group

The effect of disease severity markers on quality of life in autosomal dominant polycystic kidney disease: a systematic review, meta-analysis and meta-regression

Contains fulltext : 174843.pdf (publisher's version ) (Open Access)BACKGROUND: Little is known about determinants of quality of life (QoL) in autosomal dominant polycystic kidney disease (ADPKD). Recent studies suggest that QoL in ADPKD is determined by more factors than mere renal function. We investigated the effect of ADPKD on QoL and evaluated how Qol is affected by disease severity markers renal function, kidney volume and liver volume. METHODS: We performed a systematic review, meta-analysis and meta-regression analyses of cohort studies and randomized controlled trials investigating patient-reported QoL in adult patients with ADPKD not yet on dialysis. EMBASE, MEDLINE, and Web of Science were searched to August 2015 without language restrictions. Two investigators independently reviewed title, abstracts and full text of potentially relevant citations to determine eligibility. We compared pooled QoL summary scores of ADPKD patients using a random-effects meta-analytic model. These scores were compared with mean and age-corrected reference scores of the general population. In a meta-regression analysis, we investigated the univariate effect of renal function, kidney volume and liver volume on QoL. RESULTS: We included nine studies in meta-analysis including 1623 patients who completed the SF-36 questionnaire. Pooled physical (PCS) and mental component scores (MCS) of the SF-36 of individuals with ADPKD were lower than those of the reference population (45.7 vs. 50.0 and 47.8 vs. 50.0 points, both P < 0.001). QoL of ADPKD patients remained lower after comparison with age-corrected reference values (age 35-44 year; PCS 52.2, MCS 49.9 points, both P < 0.05). Larger liver volume negatively impacted PCS (P < 0.001) and MCS (P = 0.001), whereas there was no association with renal function (PCS P = 0.1, MCS P = 0.9) and kidney volume (PCS P = 0.5, MCS P = 0. 5). Total liver and kidney volume had no impact on PCS (P = 0.1), but did have impact on MCS (P = 0.02). CONCLUSIONS: QoL reported by non-dialysis patients with ADPKD is impaired compared to the general population. Large liver volume was the most important factor that diminishes QoL. PROSPERO International Registry number CRD42015026428

Efficacy and Safety of the Woven EndoBridge (WEB) Device for the Treatment of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

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