Effects of telmisartan on fat distribution: a meta-analysis of randomized controlled trials

<p><b>Objectives</b>: Several meta-analyses have confirmed the positive metabolic effects of telmisartan, an angiotensin II receptor blocker that can also act as a partial peroxisome proliferator-activated receptor-γ agonist, compared to those of other angiotensin II receptor blockers. These effects include decreased fasting glucose, glycosylated hemoglobin, interleukin-6, and tumor necrosis factor-α levels. However, no systemic analysis of telmisartan’s effects on body fat distribution has been performed. We performed a meta-analysis of randomized controlled telmisartan trials to investigate its effects on body weight, fat distribution, and visceral adipose reduction. <b>Research design and methods</b>: A literature search was performed using Embase, MEDLINE, and the Cochrane Library between January 1966 and November 2013. Randomized controlled trials in English and meeting the following criterion were included: random assignment of hypertensive participants with overweight/obesity, metabolic syndrome, or glucose intolerance to telmisartan or control therapy group. <b>Results</b>: Of 651 potentially relevant reports, 15 satisfied the inclusion criterion. While visceral fat area was significantly lower in the telmisartan group than in the control group (weighted mean difference = −18.13 cm², 95% C.I. = −27.16 to −9.11, <i>P_χ</i>² = 0.19, <i>I</i>² = 41%), subcutaneous fat area was similar (weighted mean difference =2.94 cm², 95% C.I. = −13.01 to 18.89, <i>P_χ</i>² = 0.30, <i>I</i>² = 17%). Total cholesterol levels were significantly different between the groups (standardized mean difference = −0.24, 95% C.I. = −0.45 to −0.03, <i>P_χ</i>² = 0.0002, <i>I</i>² = 67%). <b>Limitations</b>: Limitations include: (1) limited number of studies, especially those evaluating fat distribution; (2) different imaging modalities to assess visceral fat area (V.F.A.) and subcutaneous fat area (S.F.A.); (3) observed heterogeneity. <b>Conclusion</b>: The findings suggest that telmisartan affected fat distribution, inducing visceral fat reduction, and thus could be useful in hypertensive patients with obesity/overweight, metabolic syndrome, or glucose intolerance.</p

Comparison of the I-Gel and the Laryngeal Mask Airway Proseal during General Anesthesia: A Systematic Review and Meta-Analysis

<div><p>Objectives</p><p>Conflicting results have been reported for the i-gel and the laryngeal mask airway proseal (LMA-P) during general anesthesia. The objective of the current investigation was to compare the efficacy and safety of the i-gel vs. the LMA-P during general anesthesia.</p><p>Methods</p><p>Two authors performed searches of MEDLINE, EMBASE, CENTRAL, and Google Scholar to identify randomized clinical trials that compared the LMA-P with the i-gel during general anesthesia. A meta -analysis was performed using both random and fixed-effect models. Publication bias was evaluated using Begg's funnel plot and Egger's linear regression test.</p><p>Results</p><p>Twelve randomized clinical trials met the eligibility criteria. There were no significant differences in insertion success rate at the first attempt (risk ratio [RR] 1.01, 95% confidence interval [CI] 0.97, 1.06), ease of insertion (RR 1.14, 95% CI 0.93, 1.39), oropharyngeal leak pressure (OLP) (MD -1.98, 95% CI -5.41, 1.45), quality of fiberoptic view (RR 1.00, 95% CI 0.91, 1.10) and success rate of gastric tube insertion (RR 1.07, 95% CI 0.98, 1.18) between the i-gel and the LMA-P, respectively. The i-gel had a shorter insertion time than the LMA-P (MD -3.99, 95% CI -7.13, -0.84) and a lower incidence of blood staining on the device (RR 0.26, 95% CI 0.14, 0.49), sore throat (RR 0.28, 95% CI 0.15, 0.50) and dysphagia (RR 0.27, 95% CI 0.10, 0.74).</p><p>Conclusions</p><p>Both devices were comparable in ease of insertion to insert and both had sufficient OLP to provide a reliable airway. Only a few minor complications were reported. The i-gel was found to have fewer complications (blood staining, sore throat, dysphagia) than the LMA-P and offers certain advantages over the LMA-P in adults under general anesthesia.</p></div

Funnel showing the incidence of blood staining on the devices: i-gel versus LMA-P.

<p>White circles: comparisons included. Black circles: inputted comparisons using the trim-and-fill method. White diamond: pooled observed log risk ratio. Black diamond: pooled inputted log risk ratio.</p

Forest plot showing oropharyngeal leak pressure: i-gel versus LMA-P.

<p>Subgroup analysis according to overall and using of neuromuscular blocking agents (paralyzed vs. non-paralyzed)</p

Flow diagram showing the number of abstracts and articles identified and evaluated during the review

<p>Flow diagram showing the number of abstracts and articles identified and evaluated during the review</p

Forest plot showing insertion time: i-gel versus LMA-P.

<p>Subgroup analysis according to using of neuromuscular blocking agents (paralyzed vs. non-paralyzed).</p

Microscopic Adhesion Score System.

<p>Microscopic Adhesion Score System.</p

Example of image design for CT evaluation (left panel), and a schematic of a CT scan of four pericardial segments (right panel).

<p>A, anterior; P, posterior; L, left; R, right.</p

Picture of a container with the PACM and dye mixture (left panel).

<p>The containers with the mixture were scanned at a distance of 2.5ⅹ10⁻² m. A total of 27 circles (nine circles on each of three sections) with 1.0ⅹ10⁻² m diameter were drawn on each scanned image (right panel). Hounsfield units were recorded in each circle.</p

Macroscopic evaluation.

<p>A rabbit with macroscopic adhesion score 0 in group PD (left panel) and score 4 in group CO (right panel).</p