Sindrom nakon boravka u jedinici intenzivne njege kod kirurških pacijenata – pilot studija

Aim. The retrospective observational study aimed to determine whether there is a defined syndrome after intensive care after less than 14 days of stay in the intensive care unit. Material and methods. Patients who stayed in the intensive care unit of the Clinical Hospital Center “Dr. Dragiša Mišović – Dedinje” in Belgrade during the May 2022 were examined. Data from the health information system and therapeutic lists were used, and the questionnaire on quality of life was filled out during telephone conversations with patients. In the end, the data were statistically processed. Results. Of 16 patients, the average stay in the intensive care unit was 4.7 days (from 2 to 10). In eight of them, a certain level of change in the general state of health was shown in the last year (which includes the period of hospitalization), and in two of them this change was significant. The general health was significantly impaired in four of them, primarily related to male sex, age and ASA status. In these four patients, the length of stay in the intensive care unit was eight days at maximum. Conclusion. The results of this pilot study indicate the occurrence of the syndrome after intensive treatment in our sample of patients. As the sample is small, more extensive studies are needed to confirm or refute the claim that even a stay shorter than 14 days in intensive care units can lead to a significant change in health status and the emergence of post-intensive care syndrome in critically ill patients.Cilj. Retrospektivna opservaciona studija imala je za cilj utvrditi postojanje definiranog sindroma nakon intenzivne njege kod pacijenata sa boravkom kraćim od 14 dana u jedinici intenzivne njege Materijal i metode. Ispitani su pacijenti koji su boravili u jedinici intenzivne njege Kliničkog bolničkog centra “Dr. Dragiša Mišović – Dedinje” u Beogradu tijekom svibnja 2022. godine. Korišteni su podaci iz zdravstvenog informacijskog sustava i terapijskih lista, te je upitnik o kvaliteti života popunjen tijekom telefonskih razgovora sa pacijentima. Na kraju su podaci bili statistički obrađeni. Rezultati. Od 16 pacijenata, prosječan boravak u jedinici intenzivne njege iznosio je 4,7 dana (od 2 do 10). Kod osam pacijenata zabilježena je određena promjena općeg zdravstvenog stanja tijekom posljednje godine (uključujući period hospitalizacije), a kod dvoje je ta promjena bila značajna. Opće zdravlje značajno je bilo narušeno kod četvero pacijenata, uglavnom u vezi sa muškim spolom, dobi i ASA status. U ovih četvero pacijenata, najduže trajanje boravka u jedinici intenzivne njege bilo je osam dana. Zaključak. Rezultati ove pilot studije ukazuju na pojavu sindroma nakon intenzivnog liječenja na našem uzorku pacijenata. S obzirom na malen uzorak, potrebno je provesti opsežnije studije kako bi se potvrdila ili opovrgla tvrdnja da čak i boravak kraći od 14 dana u jedinicama intenzivne njege može dovesti do značajne promjene zdravstvenog stanja i pojave sindroma nakon intenzivne njege kod kritično bolesnih pacijenata

Liječenje i ishod trudnoća kompliciranih infekcijom COVID-19: deskriptivna studija jednog centra

This study aims to describe the clinical characteristics, radiological and laboratory results, therapy and outcome of pregnancies complicated by COVID-19 infection. Methodology. A retrospective descriptive study included all pregnant women with COVID-19 who gave birth in our hospital from April 2020 to January 2022. Exclusion criteria were: incomplete or unclear medical documentation, suspected COVID-19 infection without confirmation by PCR or rapid Ag test, previously diagnosed autoimmune diseases, positive history of malignant diseases, and started oxygen support in another institution before admission to our hospital. Results. Our study included 186 pregnant women who gave birth at KBC “Dr. Dragiša Mišović – Dedinje” in the mentioned period. Of these, 69 had no symptoms of COVID-19 infection, and 67 developed a milder clinical picture. In comparison, 41 pregnant women were diagnosed with bilateral pneumonia. A total of 38 pregnant women were admitted to the intensive care unit, of which 32 pregnant women needed oxygen support, 20 pregnant women were on an oxygen mask, 2 of them on a high-flow nasal canal, four pregnant women on non-invasive mechanical ventilation and six pregnant women on invasive mechanical ventilation. Of the total number of patients, 111 had a natural vaginal delivery, while 75 underwent cesarean section. Of 111 pregnant women who had a vaginal delivery, 92 (83%) received epidural analgesia, while 19 (17%) did not. Among pregnant women undergoing cesarean section, nine pregnant women (12%) received epidural anesthesia, 51 of them (68) received spinal anesthesia, while a cesarean section in 15 pregnant women (20%) was performed under general balanced anesthesia. Of 186 hospitalized and delivered pregnant women, 183 (98.4%) were discharged home in good general condition, while three (1.6%) had a fatal outcome. Conclusion. The clinical manifestations of pregnant women suffering from COVID-19 infection corresponded to the symptoms of the general population to the greatest extent. In contrast, the excessive use of antibiotics, even for asymptomatic patients, is very worrying.Ovo istraživanje ima za cilj opisati kliničke karakteristike, radiološke i laboratorijske nalaze, terapiju i ishod trudnoća kompliciranih infekcijom COVID-19. Metodologija. Retrospektivna deskriptivna studija obuhvatila je sve trudnice s COVID-19 koje su rodile u našoj bolnici od travnja 2020. do siječnja 2022. Kriteriji za isključenje bili su: nepotpuna ili nejasna medicinska dokumentacija, sumnja na infekciju COVID-19 bez potvrde PCR-om ili brzim Ag testom, prethodno dijagnosticirane autoimune bolesti, pozitivna anamneza malignih bolesti, te započeta potpora kisikom u drugoj ustanovi prije prijema u našu bolnicu. Rezultati. Našim istraživanjem obuhvaćeno je 186 trudnica koje su se u navedenom periodu porodile u KBC “Dr. Dragiša Mišović – Dedinje”. Od toga 69 nije imalo simptome infekcije COVID-19, a 67 je razvilo blažu kliničku sliku. Za usporedbu, kod 41 trudnice dijagnosticirana je obostrana upala pluća. Ukupno 38 trudnica primljeno je na jedinicu intenzivne njege, od čega su 32 trudnice trebale kisikovu potporu, 20 trudnica je bilo na kisikovoj maski, od toga 2 na visokoprotočnoj nazalnoj njezi, četiri trudnice na neinvazivnoj. mehaničkom ventilacijom i šest trudnica na invazivnoj mehaničkoj ventilaciji. Od ukupnog broja pacijentica, 111 je imalo prirodni vaginalni porod, a 75 je podvrgnuto carskom rezu. Od 111 trudnica koje su imale vaginalni porod, 92 (83%) dobile su epiduralnu analgeziju, a 19 (17%) nije. Od trudnica podvrgnutih carskom rezu, devet trudnica (12%) dobilo je epiduralnu anesteziju, njih 51 (68) spinalnu anesteziju, dok je carski rez u 15 trudnica (20%) obavljen u općoj uravnoteženoj anesteziji. Od 186 hospitaliziranih i porodilja, 183 (98,4%) otpuštene su kući u dobrom općem stanju, dok su tri (1,6%) imale smrtni ishod. Zaključak. Kliničke manifestacije trudnica oboljelih od infekcije COVID-19 u najvećoj su mjeri odgovarale simptomima opće populacije. Nasuprot tome, pretjerana uporaba antibiotika, čak i kod asimptomatskih pacijenata, vrlo je zabrinjavajuća

Откривање хипотензије током спиналне анестезије за царски рез континуираним неинвазивним праћењем артеријског притиска и интермитентним осцилометријским праћењем крвног притиска код болесница третираних ефедрином или фенилефрином

Introduction/Objective. Despite frequent side effects such as hypotension, spinal anesthesia (SA) is still one of the best anesthetic methods for elective cesarean section (CS). Intermittent, oscillometric, noninvasive blood pressure monitoring (NIBP) frequently leads to missed hypotensive episodes. The objective was to compare continuous non-invasive arterial pressure (CNAP) monitoring with NIBP in the terms of efficiency to detect hypotension. Methods. In this study, we compared CNAP and NIBP monitoring for hypotension detection in 76 patients divided into two groups of 38 patients treated with ephedrine (E) or phenylephrine (P), during threeminute intervals, starting from SA, by the end of the surgery. Results. In E group, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. By monitoring CNAP, we detected 31 (81.6%) hypotensive patients in E group and significantly lower number, 20 (52.6%), with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%) and NIBP only 18 (47.3%), p = 0.001. By monitoring CNAP, we detected significantly higher number of hypotensive intervals in E and P groups (pУвод/Циљ Упркос честим нежељеним ефектима као што је хипотензија, спинална анестезија је и даље техника избора за планирани царски рез. Интермитентно неинвазивно праћење крвног притиска често не детектује хипотензивне епизоде. Циљ ове студије је био да се упореди континуирано неинвазивно праћење артеријског притиска са интермитентним неинвазивним праћењем крвног притиска у смислу ефикасности у откривању хипотензије.Методе Упоређивани су системи за континуирано неинвазивно праћење артеријског притиска и интермитентно неинвазивно праћење крвног притиска ради детекције хипотензије код 76 болесница подељених у две групе од по 38 болесница, третираних ефедрином (Е) или фенилефрином (Ф), на свака три минута, почевши од спиналне анестезије па све до краја операције.Резултати У групи Е су детектоване знатно ниже средње вредности систолног крвног притиска континуираним неинвазивним праћењем артеријског притиска у поређењу са интермитентним неинвазивним праћењем крвног притиска (p = 0,008). Континуираним неинвазивним праћењем артеријског притиска детектована је 31 (81,6%) хипотензивна болесница у групи Е и знатно мањи број, 20 (52,6%) болесница, интермитентним неинвазивним праћењем крвног притиска (p = 0,001), док је у групи Ф континуираним неинвазивним праћењем артеријског притиска детектована хипотензија код 34 болеснице (89,5%), а интермитентним неинвазивним праћењем крвног притиска код 18 (47,3%) болесница, p = 0,001. Континуираним неинвазивним праћењем артеријског притиска детектован је знатно већи број хипотензивних епизода у групама Е и Ф (p < 0,001). pH вредности умбиликалне крви биле су значајно ниже код хипотензивних у односу на нормотензивне болеснице у групама Е и Ф, и са континуираним неинвазивним праћењем артеријског притиска и интермитентним неинвазивним праћењем крвног притиска, респективно (p < 0,001, p = 0,027 у групи Е, и p = 0,009, p < 0,001 у групи Ф).Закључак Континуирано неинвазивно праћење артеријског притиска је много ефикасније у откривању хипотензије током царског реза у спиналној анестезији, што омогућава бржи третман и мање нежељених ефеката код мајке и новорођенчета

Large-scale analysis of structural brain asymmetries in schizophrenia via the ENIGMA consortium

Left-right asymmetry is an important organizing feature of the healthy brain that may be altered in schizophrenia, but most studies have used relatively small samples and heterogeneous approaches, resulting in equivocal findings. We carried out the largest case-control study of structural brain asymmetries in schizophrenia, using MRI data from 5,080 affected individuals and 6,015 controls across 46 datasets in the ENIGMA consortium, using a single image analysis protocol. Asymmetry indexes were calculated for global and regional cortical thickness, surface area, and subcortical volume measures. Differences of asymmetry were calculated between affected individuals and controls per dataset, and effect sizes were meta-analyzed across datasets. Small average case-control differences were observed for thickness asymmetries of the rostral anterior cingulate and the middle temporal gyrus, both driven by thinner left-hemispheric cortices in schizophrenia. Analyses of these asymmetries with respect to the use of antipsychotic medication and other clinical variables did not show any significant associations. Assessment of age- and sex-specific effects revealed a stronger average leftward asymmetry of pallidum volume between older cases and controls. Case-control differences in a multivariate context were assessed in a subset of the data (N = 2,029), which revealed that 7% of the variance across all structural asymmetries was explained by case-control status. Subtle case-control differences of brain macro-structural asymmetry may reflect differences at the molecular, cytoarchitectonic or circuit levels that have functional relevance for the disorder. Reduced left middle temporal cortical thickness is consistent with altered left-hemisphere language network organization in schizophrenia

Evaluation of Intra-Abdominal Hypertension Parameters in Patients with Acute Pancreatitis

Background: Patients with acute pancreatitis develop numerous complications and organ damage due to increased intra-abdominal pressure (IAP). These extrapancreatic complications determine the clinical outcome of the disease. Materials and methods: A total of 100 patients with acute pancreatitis were included in the prospective cohort study. Observed patients were divided into two groups according to their mean values of IAP (normal IAP values and elevated IAP values), which were compared with examined variables. Patients with intra-abdominal hypertension (IAH) were divided into four groups by IAP values, and those groups of patients were also compared with the examined variables. Results: Differences between body mass index (BMI) (p = 0.001), lactates (p = 0.006), and the Sequential Organ Failure Assessment (SOFA) score (p = 0.001) were statistically significant within all examined IAH groups. Differences between the mean arterial pressure (MAP) (p = 0.012) and filtration gradient (FG) (p p = 0.022) showed statistical significance in relation to the first and third groups of IAH patients. Conclusions: Changes in IAP values lead to changes in basic vital parameters MAP, APP, FG, diuresis per hour, and lactate levels in patients with acute pancreatitis. Early recognition of changes in the SOFA score accompanying an increase in the IAP value is essential

“Post-Intensive Care” Syndrome in Patients After Abdominal Surgery – Pilot Study

Aim. The retrospective observational study aimed to determine whether there is a defined syndrome after intensive care after less than 14 days of stay in the intensive care unit. Material and methods. Patients who stayed in the intensive care unit of the Clinical Hospital Center “Dr. Dragiša Mišović – Dedinje” in Belgrade during the May 2022 were examined. Data from the health information system and therapeutic lists were used, and the questionnaire on quality of life was filled out during telephone conversations with patients. In the end, the data were statistically processed. Results. Of 16 patients, the average stay in the intensive care unit was 4.7 days (from 2 to 10). In eight of them, a certain level of change in the general state of health was shown in the last year (which includes the period of hospitalization), and in two of them this change was significant. The general health was significantly impaired in four of them, primarily related to male sex, age and ASA status. In these four patients, the length of stay in the intensive care unit was eight days at maximum. Conclusion. The results of this pilot study indicate the occurrence of the syndrome after intensive treatment in our sample of patients. As the sample is small, more extensive studies are needed to confirm or refute the claim that even a stay shorter than 14 days in intensive care units can lead to a significant change in health status and the emergence of post-intensive care syndrome in critically ill patients

Treatment and outcome of pregnant women with COVID-19: a single-center descriptive study

This study aims to describe the clinical characteristics, radiological and laboratory results, therapy and outcome of pregnancies complicated by COVID-19 infection. Methodology. A retrospective descriptive study included all pregnant women with COVID-19 who gave birth in our hospital from April 2020 to January 2022. Exclusion criteria were: incomplete or unclear medical documentation, suspected COVID-19 infection without confirmation by PCR or rapid Ag test, previously diagnosed autoimmune diseases, positive history of malignant diseases, and started oxygen support in another institution before admission to our hospital. Results. Our study included 186 pregnant women who gave birth at KBC “Dr. Dragiša Mišović – Dedinje” in the mentioned period. Of these, 69 had no symptoms of COVID-19 infection, and 67 developed a milder clinical picture. In comparison, 41 pregnant women were diagnosed with bilateral pneumonia. A total of 38 pregnant women were admitted to the intensive care unit, of which 32 pregnant women needed oxygen support, 20 pregnant women were on an oxygen mask, 2 of them on a high-flow nasal canal, four pregnant women on non-invasive mechanical ventilation and six pregnant women on invasive mechanical ventilation. Of the total number of patients, 111 had a natural vaginal delivery, while 75 underwent cesarean section. Of 111 pregnant women who had a vaginal delivery, 92 (83%) received epidural analgesia, while 19 (17%) did not. Among pregnant women undergoing cesarean section, nine pregnant women (12%) received epidural anesthesia, 51 of them (68) received spinal anesthesia, while a cesarean section in 15 pregnant women (20%) was performed under general balanced anesthesia. Of 186 hospitalized and delivered pregnant women, 183 (98.4%) were discharged home in good general condition, while three (1.6%) had a fatal outcome. Conclusion. The clinical manifestations of pregnant women suffering from COVID-19 infection corresponded to the symptoms of the general population to the greatest extent. In contrast, the excessive use of antibiotics, even for asymptomatic patients, is very worrying

Increased power by harmonizing structural MRI site differences with the ComBat batch method in ENIGMA

A common limitation of neuroimaging studies is their small sample sizes. To overcome this hurdle, the Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) Consortium combines neuroimaging data from many institutions worldwide. However, this introduces heterogeneity due to different scanning devices and sequences. ENIGMA projects commonly address this heterogeneity with random-effects meta-analysis or mixed-effects mega -analysis. Here we tested whether the batch adjustment method, ComBat, can further reduce site-related het-erogeneity and thus increase statistical power. We conducted random-effects meta-analyses, mixed-effects mega -analyses and ComBat mega-analyses to compare cortical thickness, surface area and subcortical volumes between 2897 individuals with a diagnosis of schizophrenia and 3141 healthy controls from 33 sites. Specifically, we compared the imaging data between individuals with schizophrenia and healthy controls, covarying for age and sex. The use of ComBat substantially increased the statistical significance of the findings as compared to random - effects meta-analyses. The findings were more similar when comparing ComBat with mixed-effects mega-analysis, although ComBat still slightly increased the statistical significance. ComBat also showed increased statistical power when we repeated the analyses with fewer sites. Results were nearly identical when we applied the ComBat harmonization separately for cortical thickness, cortical surface area and subcortical volumes. Therefore, we recommend applying the ComBat function to attenuate potential effects of site in ENIGMA projects and other multi-site structural imaging work. We provide easy-to-use functions in R that work even if imaging data are partially missing in some brain regions, and they can be trained with one data set and then applied to another (a requirement for some analyses such as machine learning)

Increased power by harmonizing structural MRI site differences with the ComBat batch adjustment method in ENIGMA

Altres ajuts: SRB: The Australian Schizophrenia Research Bank (ASRB) was supported by the National Health and Medical Research Council of Australia (NHMRC) (Enabling Grant, ID 386500), the Pratt Foundation, Ramsay Health Care, the Viertel Charitable Foundation and the Schizophrenia Research Institute. Chief Investigators for ASRB were Carr, V., Schall, U., Scott, R., Jablensky, A., Mowry, B., Michie, P., Catts, S., Henskens, F., Pantelis, C. We thank Loughland, C., the ASRB Manager, and acknowledge the help of Jason Bridge for ASRB database queries. CP was supported by NHMRC Senior Principal Research Fellowships (IDs: 628386 & 1105825); GC was supported by the Schizophrenia Research Institute utilizing infrastructure funding from the New South Wales Ministry of Health and New South Wales Ministry of Trade and Investment (Australia); JMF was supported by NHMRC project grant (1063960) and the Janette Mary O'Neil Research Fellowship; MJG was supported by NHMRC as an R.D. Wright Biomedical Career Development Fellow (1061875). MJC was supported by NHMRC Senior Research Fellowship (1121474). CASSI: CSW is funded by the NSW Ministry of Health, Office of Health and Medical Research. CSW is a recipient of a National Health and Medical Research Council (Australia) Principal Research Fellowship (PRF) (#1117079). CIAM: The CIAM study (FMH - PI) was supported by the University Research Committee, University of Cape Town and South African funding bodies National Research Foundation and Medical Research Council. COBRE: The COBRE dataset and investigators were supported by NIH grants R01EB006841 & P20GM103472, as well as NSF grant 1539067. JT (senior author) and VDC are supported by 5R01MH094524. JMS is supported by R01 AA021771 and P50 AA022534. EONCKS: This work was supported by a New Partnership for Africa's Development (NEPAD) grant through the Department of Science and Technology of South Africa, the Medical Research Council of South Africa (grant number 65174). ESO: The ESO study was funded by NPU I - LO1611 and Ministry of Health, Czech Republic - Conceptual Development of Research Organization 00023001 (IKEM). FIDMAG/Project: This work was supported by the Catalan Government and several grants from the Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, 'Investing in your future'): Miguel Servet Research Contracts and Research Project Grants. FOR2107 Marburg: The FOR2107 Marburg study was funded by the German Research Foundation (DFG), Tilo Kircher (speaker FOR2107; DFG grant numbers KI588/14-1, KI588/14-2), Axel Krug (KR 3822/5-1, KR 3822/7-2), Igor Nenadic (NE 2254/1-2), Carsten Konrad (KO 4291/3-1). FOR2107 Muenster: The FOR2107 Muenster study was funded by the German Research Foundation (DFG, grant FOR2107 DA1151/5-1 and DA1151/5-2 to UD) and the Interdisciplinary Center for Clinical Research (IZKF) of the medical faculty of Münster (grant Dan3/012/17 to UD). TH was supported by grants from the German Research Foundation (DFG grants HA7070/2-2, HA7070/3, HA7070/4). Frankfurt: MRI was performed at the Frankfurt Brain Imaging Center, supported by the German Research Council (DFG) and the German Ministry for Education and Research (BMBF; Brain Imaging Center Frankfurt/Main, DLR 01GO0203). GIPSI: This study was supported by Colciencias PRISMA-U.T. Huilong1 & Huilong2: This study was funded by the National Natural Science Foundation of China (81761128021; 31671145; 81401115; 81401133), Beijing Municipal Science and Technology Commission grant (Z141107002514016) and Beijing Natural Science Foundation(7162087, Beijing Municipal Administration of Hospitals Clinical medicine Development of special funding (XMLX201609; zylx201409). IGP: This study was funded by Project Grants from the Australian National Health and Medical Research Council of Australia (NHMRC; APP630471 and APP1081603), the Macquarie University's Australian Research Council Centre of Excellence in Cognition and its Disorders (CE110001021). Johns Hopkins: Supported by National Institutes of Health Grant Nos. MH-092443, MH-094268 (Silvio O. Conte Center), MH-105660, and MH-107730; foundation grants from Stanley, RUSK/S-R, and NARSAD/Brain and Behavior Research Foundation. Madrid: Supported by the Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III, co-financed by ERDF Funds from the European Commission, "A way of making Europe", CIBERSAM. Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds and European Union Seventh Framework Program and H2020 Program; Fundación Familia Alonso, Fundación Alicia Koplowitz and Fundación Mutua Madrileña. MPRC1 & MPRC2: Support was received from NIH grants U01MH108148, 2R01EB015611, R01MH112180, R01DA027680, R01MH085646, P50MH103222 and T32MH067533, a State of Maryland contract (M00B6400091) and NSF grant (1620457). OLIN: The Olin study was supported by NIH grants R37MH43375 and R01MH074797. Oxford: The Oxford study MRC G0500092. SLF Rome: Support from the Italian Ministry of Health grants RC-12-13-14-15-16-17-18-19/A. RSCZ: RSCZ data collection was supported by RFBR 15-06-05758 grant. SCORE: This study was supported in part by grant 3232BO_119382 from the Swiss National Science Foundation. We thank the FePsy (Frueherkennung von Psychosen; early detection of psychosis) Study Group from the University of Basel, Department of Psychiatry, Switzerland, for the recruitment of the study participants. The FePsy Study was supported in part by grant No. SNF 3200-057216/1, ext./2, ext./3. Singapore: This study was supported by research grants from the National Healthcare Group, Singapore (SIG/05004; SIG/11003), and the Singapore Bioimaging Consortium (RP C-009/2006) research grants awarded to KS. SNUH: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (Grant no. 2013R1A2A1A03071089 and 2017M3C7A1029610). UCISZ: The UCISZ study was supported by the National Institutes of Mental Health grant number R21MH097196 to TGMvE. UCISZ data were processed by the UCI High Performance Computing cluster supported by Joseph Farran, Harry Mangalam, and Adam Brenner and the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR000153. UNIBA: The UNIBA study was supported by grant funding from the Italian Ministry of Health (PE-2011-02347951). UNIMAAS: The study was supported by Dutch Organization for Health Research and Development (ZonMw 91112002) and a personal grant to Thérèse van Amelsvoort (ZonMw-VIDI: 91712394). The data was collected in a clinical trial registered in the Dutch clinical trial registry under ID: NTR5094 (http://www.trialregister.nl). UPenn: This study was supported by the National Institute of Mental Health grants MH064045, MH 60722, MH019112, MH085096 (DHW), and R01MH112847 (RTS and TDS). Zurich: This study was supported by the Swiss National Science Foundation (105314_140351 to S.K.). Matthias Kirschner acknowledges support from the National Bank Fellowship (McGill University) and the Swiss National Foundation (P2SKP3_178175). Research reported in this publication was also supported by the following National Institutes of Health grants: U54 EB020403 to PMT, R01 MH116147, U24 RR21992, R21MH097196, and TR000153 to TGMvE, S10 OD023696 and R01EB015611 to PK, T32 AG058507and 5T32 MH073526 to CRKC, R01 MH117601 to NJ, ENIGMA's NIH Big Data to Knowledge (BD2K) initiative U54 EB020403, ENIGMA Sex Differences R01MH116147, and ENIGMA-COINSTAC: Advanced World-wide Transdiagnostic Analysis of Valence System Brain Circuits R01MH121246.A common limitation of neuroimaging studies is their small sample sizes. To overcome this hurdle, the Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) Consortium combines neuroimaging data from many institutions worldwide. However, this introduces heterogeneity due to different scanning devices and sequences. ENIGMA projects commonly address this heterogeneity with random-effects meta-analysis or mixed-effects mega-analysis. Here we tested whether the batch adjustment method, ComBat, can further reduce site-related heterogeneity and thus increase statistical power. We conducted random-effects meta-analyses, mixed-effects mega-analyses and ComBat mega-analyses to compare cortical thickness, surface area and subcortical volumes between 2897 individuals with a diagnosis of schizophrenia and 3141 healthy controls from 33 sites. Specifically, we compared the imaging data between individuals with schizophrenia and healthy controls, covarying for age and sex. The use of ComBat substantially increased the statistical significance of the findings as compared to random-effects meta-analyses. The findings were more similar when comparing ComBat with mixed-effects mega-analysis, although ComBat still slightly increased the statistical significance. ComBat also showed increased statistical power when we repeated the analyses with fewer sites. Results were nearly identical when we applied the ComBat harmonization separately for cortical thickness, cortical surface area and subcortical volumes. Therefore, we recommend applying the ComBat function to attenuate potential effects of site in ENIGMA projects and other multi-site structural imaging work. We provide easy-to-use functions in R that work even if imaging data are partially missing in some brain regions, and they can be trained with one data set and then applied to another (a requirement for some analyses such as machine learning)