Comparative efficacy of non-invasive brain stimulation for post-stroke cognitive impairment: a network meta-analysis.

BACKGROUND: Non-invasive brain stimulation (NIBS) is a burgeoning approach with the potential to significantly enhance cognition and functional abilities in individuals who have undergone a stroke. However, the current evidence lacks robust comparisons and rankings of various NIBS methods concerning the specific stimulation sites and parameters used. To address this knowledge gap, this systematic review and meta-analysis seek to offer conclusive evidence on the efficacy and safety of NIBS in treating post-stroke cognitive impairment. METHODS: A systematic review of randomized control trials (RCT) was performed using Bayesian network meta-analysis. We searched RCT in the following databases until June 2022: Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, and EMBASE. We compared any active NIBS to control in terms of improving cognition function and activities of daily living (ADL) capacity following stroke. RESULTS: After reviewing 1577 retrieved citations, a total of 26 RCTs were included. High-frequency (HF)-repetitive transcranial magnetic stimulation (rTMS) (mean difference 2.25 [95% credible interval 0.77, 3.66]) was identified as a recommended approach for alleviating the global severity of cognition. Dual-rTMS (27.61 [25.66, 29.57]) emerged as a favorable technique for enhancing ADL function. In terms of stimulation targets, the dorsolateral prefrontal cortex exhibited a higher ranking in relation to the global severity of cognition. CONCLUSIONS: Among various NIBS techniques, HF-rTMS stands out as the most promising intervention for enhancing cognitive function. Meanwhile, Dual-rTMS is highly recommended for improving ADL capacity.

Global and local fat effects on bone mass and quality in obesity.

Aims: The aim of this study was to investigate the global and local impact of fat on bone in obesity by using the diet-induced obese (DIO) mouse model. Methods: In this study, we generated a diet-induced mouse model of obesity to conduct lipidomic and 3D imaging assessments of bone marrow fat, and evaluated the correlated bone adaptation indices and bone mechanical properties. Results: Our results indicated that bone mass was reduced and bone mechanical properties were impaired in DIO mice. Lipidomic sequencing and bioinformatic analysis identified 373 differential lipids, 176 of which were upregulated and 197 downregulated. Functional enrichment analysis revealed a significant downregulation of the pathways: fat digestion and absorption (ko04975) and lipolysis regulation in adipocytes (ko04923) in DIO mice, leading to local fat accumulation. The use of 3D imaging confirmed the increase in fat accumulation within the bone marrow cavity of obese mice. Conclusion: Our study sheds light on the intricate interplay between fat and bone, and provides a non-toxic and non-invasive method for measuring marrow adipose tissue.

Comparative Muscle Tolerability of Different Types and Intensities of Statins: A Network Meta-Analysis of Double-Blind Randomized Controlled Trials.

PURPOSE: The benefits of statins for ischemic cardio-cerebrovascular diseases are well known. However, concerns around muscle adverse events still exist. We therefore aimed to compare the muscle safety of individual statins in adults. METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials and Web of Science were searched to include double-blind randomized controlled trials (RCTs) comparing one statin with another or with control treatment. Pairwise meta-analyses and network meta-analyses were undertaken with Stata 14.0 software. Relative risk (RR) with 95% confidence intervals (CIs) was adopted for each outcome. RESULTS: A total of 83 RCTs were included. In the pairwise meta-analysis, statins were significantly associated with only a slight increase in muscle symptoms compared with control (RR=1.05; 95% CI=1.01-1.09). In the drug-level network meta-analyses, no statistically significant difference was found between individual statins in the incidence of muscle symptoms, myalgia, myopathy, rhabdomyolysis, creatine kinase (CK) >10 times the upper limit of normal (ULN) or discontinuation due to muscle adverse events. In the dose-level network meta-analyses, there were no statistically significant dose-dependent effects on any outcomes except that moderate-intensity statins had a higher incidence of muscle symptoms than control (RR=1.13; 95% CI=1.01-1.27). Moderate simvastatin (RR=6.57; 95% CI=1.26-34.41) and moderate pravastatin (RR=5.96; 95% CI=1.00-35.44) had a statistically significantly higher incidence of CK >10×ULN compared with moderate atorvastatin. Lipophilic statins and statins metabolized by liver cytochrome P450 3A4 were not associated with an increased risk of muscle adverse events. CONCLUSION: Statins may be generally safe on muscle. Moderate atorvastatin may be superior to equivalent simvastatin and pravastatin in muscle tolerability.

Development and validation of a risk model for cognitive impairment in the older Chinese inpatients: An analysis based on a 5-year database.

Early diagnosis of cognitive impairment is important but difficult. Prediction models may work as an efficient way to identify high risk individuals for this disease. This study aimed to develop a simple and convenient model to identify high-risk individuals of cognitive impairment in the older Chinese inpatients. We enrolled 1300 inpatients aged 60 years or above from the department of geriatrics of the First Affiliated Hospital of Chongqing Medical University during 2013 to 2017. The model for cognitive impairment was established in the developing cohort of 1100 participants and tested in another validating cohort of 200 participants. Logistic regression analyses were used to identify the candidate variables of cognitive impairment. Receiver operating curve was adopted to validate the model. Logistic regression analyses showed that increasing age, diabetes, depression and low educational level were independently associated with cognitive impairment. The model was generated in the following way: Pmodel = ey/(1 + ey), where y = -6.874 + 0.088 * age + 0.317 * diabetes + 0.647 * depression + 0.345 * education level. The value of Pmodel indicates the probability of cognitive impairment for each patient. The present model proved to be a reliable marker for identifying people at high risk of cognitive impairment (area under curve = 0.790, 95% CI = 0.728-0.852, p < 0.001). It had a high sensitivity (86.2%) but a relatively low specificity (59.4%). It may be helpful to "recognize" those at high risk of cognitive impairment rather than "rule out" those at low risk of this disease.

Association Between Vitamin D and Statin-Related Myopathy: A Meta-analysis.

BACKGROUND: Myopathy is the most widely reported statin-associated adverse event. Several studies have linked vitamin D deficiency with statin-related myopathy. OBJECTIVE: This meta-analysis aimed to investigate whether adult patients with statin-related myopathy have a lower 25-hydroxyvitamin D (25OHD) level than patients without myopathy and whether statin-related myopathy in vitamin D-deficient patients can be improved by vitamin D supplementation. METHODS: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until 28 September 2020. Original studies comparing the 25OHD levels of patients with and without myopathy or detecting the impact of vitamin D supplementation on statin-related muscular intolerance were included. Subgroup analyses based on the sample size and baseline 25OHD level were conducted. RESULTS: This meta-analysis, based on nine cohort studies with a total of 2906 patients, revealed that the 25OHD level of patients with statin-related myopathy was significantly lower than that of patients without myopathy [weighted mean difference - 4.17 ng/mL; 95% confidence interval (CI) - 7.70 to - 0.63; p = 0.021]. The overall analysis from another four studies with 446 patients who were previously vitamin D deficient and reported statin-related muscular intolerance showed that the pooled tolerance rate of statins improved to 89% (95% CI 8692; p < 0.001) after vitamin D supplementation. CONCLUSIONS: The present meta-analysis provides evidence that low 25OHD level is associated with statin-related myopathy and that exogenous vitamin D supplementation can improve statin-related muscular intolerance associated with low 25OHD level in most cases. Our findings may provide useful insight for the prevention and treatment of statin-related myopathy.

Chest computed tomography as a primary tool in COVID-19 detection: an update meta-analysis.

PURPOSE: A growing number of publications have paid close attention to the chest computed tomography (CT) detection of COVID-19 with inconsistent diagnostic accuracy, the present meta-analysis assessed the available evidence regarding the overall performance of chest CT for COVID-19. METHODS: 2 × 2 diagnostic table was extracted from each of the included studies. Data on specificity (SPE), sensitivity (SEN), negative likelihood ratio (LR-), positive likelihood ratio (LR+), and diagnostic odds ratio (DOR) were calculated purposefully. RESULTS: Fifteen COVID-19 related publications met our inclusion criteria and were judged qualified for the meta-analysis. The following were summary estimates for diagnostic parameters of chest CT for COVID-19: SPE, 0.49 (95% CI 46-52%); SEN, 0.94 (95% CI 93-95%); LR-, 0.15 (95% CI 11-20%); LR+, 1.93 (95% CI 145-256%); DOR, 17.14 (95% CI 918-3199%); and the area under the receiver operating characteristic curve (AUC), 0.93. CONCLUSION: Chest CT has high SEN, but the SPE is not ideal. It is highly recommended to use a combination of different diagnostic tools to achieve sufficient SEN and SPE. It should be taken into account as a diagnostic tool for current COVID-19 detection, especially for patients with symptoms. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40336-021-00434-z.

Associations between obesity and cognitive impairment in the Chinese elderly: an observational study.

PURPOSE: The aim of this study was to investigate the relationship between obesity and cognitive impairment in the Chinese elderly. PATIENTS AND METHODS: Patients aged 60 years or above were enrolled from the Department of Geriatrics of The First Affiliated Hospital of Chongqing Medical University from March 2013 to May 2017. Mini-Mental State Examination scale was used to assess the cognitive function. Body mass index (BMI) and waist-hip ratio were used to classify obesity. Student's t-test, Mann-Whitney U-test, or chi-squared test was used to compare the data between participants with normal cognition and participants with cognitive impairment as appropriate. Univariate logistic regression models and multivariate logistic regression models were performed to explore the relationship between BMI or abdominal obesity and cognitive impairment. RESULTS: A total of 1,100 patients including 568 men and 532 women aged 60-98 years (median age 79 years) were enrolled. After adjusting for age, gender, smoking, drinking, education level, hypercholesterolemia, hypertension, and diabetes, overweight was significantly associated with a decreased risk of cognitive impairment (OR=0.458, 95% CI=0.298-0.703, P<0.001). After adjustment for age, education level, hypercholesterolemia, hypertension, and diabetes, abdominal obesity remained significantly associated with an increased risk of cognitive impairment (OR=1.532, 95% CI=1.037-2.263, P=0.032). CONCLUSION: Overweight is associated with a decreased risk of cognitive impairment in the Chinese elderly, while abdominal obesity is associated with an increased risk of cognitive impairment independent of conventional sociodemographic, lifestyle, and health-related comorbid factors.

Characteristics of lipid profiles and lipid control in patients with diabetes in a tertiary hospital in Southwest China: an observational study based on electronic medical records.

BACKGROUND: Diabetes is often accompanied by dyslipidemia. Lipid control is very important in the management of diabetes. There are limited real world data on the lipid control in diabetic inpatients in southwest China. METHODS: An observational study was conducted to assess the characteristics of lipid profiles and lipid control. Diabetic patients from February 2009 to December 2013 at West China Hospital of Sichuan University were identified. RESULTS: A total of 56,784 inpatients were included and 85.9% of them had at least one lipid panel. The proportions of inpatients with optimal low-density lipoprotein cholesterol (LDL-C) level (< 2.59 mmol/L), optimal triglyceride (TG) level (< 1.70 mmol/L), optimal high-density lipoprotein cholesterol (HDL-C) level (men ≥1.04 mmol/L; women ≥1.30 mmol/L) and optimal non-high-density lipoprotein cholesterol (non-HDL-C) level (< 3.37 mmol/L) were 61.1, 64.6, 49.9 and 64.5%, respectively. Only 23.1% of inpatients obtained optimal levels for all the above four lipid parameters. Of diabetic inpatients with ischemic heart disease, the proportions of inpatients with optimal LDL-C level (< 1.81 mmol/L), optimal TG level (< 1.70 mmol/L), optimal HDL-C level (men ≥1.04 mmol/L; women ≥1.30 mmol/L) and optimal non-HDL-C level (< 2.59 mmol/L) were 38.0, 66.3, 48.1 and 48.7%, respectively. Of diabetic inpatients with cerebrovascular disease, the proportions were 28.3, 64.8, 49.9 and 38.1%, respectively. Older people and men were more likely to obtain optimal lipid levels. However, inpatients between 46 and 64 years were least likely to obtain optimal LDL-C levels. CONCLUSIONS: The lipid control of diabetic inpatients in southwest China is worrisome. Individualized strategies of lipid management should be taken to bridge the gap between the recommendations of clinical guidelines and the real situation of clinical practice.

Relations of lipid parameters, other variables with carotid intima-media thickness and plaque in the general Chinese adults: an observational study.

BACKGROUND: It has been reported that non-high-density lipoprotein cholesterol (non-HDL-C) and lipid ratios, including total cholesterol (TC) / high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) / HDL-C, are better predictors for atherosclerosis than conventional lipid profiles. However, there have been few studies comparing the predictive values of different lipid parameters for early atherosclerosis. The aim of this study was to determine the relevant factors of carotid intima-media thickness (IMT) and plaque in the general Chinese adults and analyze the predictive values of different lipid parameters for carotid IMT and plaque. METHODS: We collected the demographics, anthropometrics, and laboratory data of 311 Chinese adults without the diagnoses of acute myocardial infarction, stroke, heart failure, peripheral arterial disease, end-stage renal disease or malignant tumor. The carotid IMT and the presence of carotid plaque were evaluated by high-resolution color Doppler ultrasonography. RESULTS: Based on the cutoff level of 0.9 mm, the percentage of people with a thickened IMT was 8.4%. And the percentage of people with carotid plaque was 15.8%. Among the lipid parameters, the levels of TC, non-HDL-C and LDL-C were more closely related to carotid IMT and plaque compared with other lipid parameters in the univariate analyses. In multivariate analyses, age, gender and systolic blood pressure (SBP) remained significantly with carotid IMT, whereas age, gender, diastolic blood pressure (DBP) and the TC level remained significantly with carotid plaque. Non-HDL-C level remained significantly with carotid plaque after adjusting for age, gender, waist-hip ratio (WHR), smoking, drinking, SBP and fasting plasma glucose (FPG). CONCLUSIONS: Age, gender, SBP are important predictors for carotid IMT. Age, gender, DBP and TC are important predictors for carotid plaque. TC, LDL-C and non-HDL-C have greater predictive values for IMT and the presence of carotid plaque compared with other lipid parameters, among which TC has the greatest predictive value for the presence of carotid plaque. The predictive value of non-HDL-C for carotid IMT and plaque is not inferior to that of LDL-C.

Study design and baseline characteristics of inpatients with diabetes mellitus in a tertiary hospital in China: A database study based on electronic medical records.

AIM: To describe the characteristics of inpatients with diabetes in a tertiary hospital in China using an electronic medical record (EMR)-based database. METHODS: We identified the medical records of all patients with diabetes from nonpediatric departments of West China Hospital, Sichuan University (from February 2009 to December 2013), and extracted information on demographic, diagnosis, discharge outcome, department of discharge, laboratory test, and prescription from the EMR system. The quality of the database was assessed by analyzing missing data and extreme data and by reviewing the International Classification of Diseases 10th Revision (ICD-10) coding. RESULTS: Among 683,267 discharged patients, 56,784 (8.3%) patients diagnosed with diabetes were identified from all departments. Among the patients with diabetes, the average age was 63.5 ± 13.1 years and the overall death in hospital was 2.2%. Laboratory test results were highly completed in our database with no extreme or discrepant value identified. Anthropometric parameters were of a relatively low quality as 62.2% body-mass index data were missing. HbA1c levels at admission were available for 36.7% patients with diabetes. The ICD-10 coding of the diagnosis of diabetes was accurate in 88.6% records reviewed. Dyslipidemia (76.5%), hypertension (51.3%), chronic kidney disease (22.1%), and hyperuricemia (16.2%) were the most commonly presented comorbidities among inpatients with diabetes. CONCLUSIONS: Our study indicated a wide distribution of diabetes throughout the inpatients in a tertiary hospital in southwest China. This EMR-based database of diabetes could be potentially useful in further investigations.

The Metabolic Effects of Oats Intake in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis.

The present study aimed to comprehensively assess if oats intake is beneficial for diabetic patients. The literature search was conducted in PubMed database up to 23 August 2015. Fourteen controlled trials and two uncontrolled observational studies were included. Compared with the controls, oats intake significantly reduced the concentrations of glycosylated hemoglobin A1c (HbA1c) (MD, -0.42%; 95% CI, -0.61% to -0.23%), fasting blood glucose (FBG) (MD, -0.39 mmol/L; 95% CI, -0.58 to -0.19 mmol/L), total cholesterol (TC) (MD, -0.49 mmol/L; 95% CI, -0.86 to -0.12 mmol/L), low-density lipoprotein cholesterol (LDL-C) (MD, -0.29 mmol/L; 95% CI, -0.48 to -0.09 mmol/L). Oatmeal significantly reduced the acute postprandial glucose and insulin responses compared with the control meal. The present study has revealed a beneficial effect of oats intake on glucose control and lipid profiles in type 2 diabetic patients. Further investigations of oats intake in patients with type 1 diabetes and the safety of oats consumption are required.

Association Between SLCO1B1 Gene T521C Polymorphism and Statin-Related Myopathy Risk: A Meta-Analysis of Case-Control Studies.

Statin-related myopathy is an important adverse effect of statin which is classically unpredictable. The evidence of association between solute carrier organic anion transporter 1B1 (SLCO1B1) gene T521C polymorphism and statin-related myopathy risk remained controversial. This study aimed to investigate this genetic association. Databases of PubMed, EMBASE, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database, and Wanfang Data were searched till June 17, 2015. Case-control studies investigating the association between SLCO1B1 gene T521C polymorphism and statin-related myopathy risk were included. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of included studies. Data were pooled by odds ratios (ORs) and their 95% confidence intervals (CIs). Nine studies with 1360 cases and 3082 controls were included. Cases of statin-related myopathy were found to be significantly associated with the variant C allele (TC + CC vs TT: OR = 2.09, 95% CI = 1.27-3.43, P = 0.003; C vs T: OR = 2.10, 95% CI = 1.43-3.09, P < 0.001), especially when statin-related myopathy was defined as an elevation of creatine kinase (CK) >10 times the upper limit of normal (ULN) or rhabdomyolysis (TC + CC vs TT: OR = 3.83, 95% CI = 1.41-10.39, P = 0.008; C vs T: OR = 2.94, 95% CI = 1.47-5.89, P = 0.002). When stratified by statin type, the association was significant in individuals receiving simvastatin (TC + CC vs TT: OR = 3.09, 95% CI = 1.64-5.85, P = 0.001; C vs T: OR = 3.00, 95% CI = 1.38-6.49, P = 0.005), but not in those receiving atorvastatin (TC + CC vs TT: OR = 1.31, 95% CI = 0.74-2.30, P = 0.35; C vs T: OR = 1.33, 95% CI = 0.57-3.12, P = 0.52). The available evidence suggests that SLCO1B1 gene T521C polymorphism is associated with an increased risk of statin-related myopathy, especially in individuals receiving simvastatin. Thus, a genetic test before initiation of statins may be meaningful for personalizing the treatment.