Effect of inspiratory muscle training in children with asthma: a systematic review and meta-analysis of randomized controlled trials.

Background: Asthma is a common chronic respiratory disease in children. Alongside pharmacological interventions, inspiratory muscle training (IMT) emerges as a complementary therapeutic approach for asthma management. However, the extent of its efficacy in pediatric populations remains uncertain when compared to its benefits in adults. This systematic review aims to evaluate the effectiveness of IMT with threshold loading in children with asthma. Methods: Randomized controlled trials (RCTs) evaluating the efficacy of inspiratory muscle training in pediatric asthma patients were identified through June 2023 across various literature databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAL), Web of Science, China Knowledge Resource Integrated Database (CNKI), Wei Pu Database, Wan Fang Database, and Chinese Biomedical Database (CBM). These trials compared inspiratory muscle training against sham inspiratory muscle training and conventional care. Eligible studies were assessed in terms of risk of bias and quality of evidence. Where feasible, data were pooled and subjected to meta-analysis, with results reported as mean differences (MDs) and 95% confidence intervals (CIs). Results: Six trials involving 333 patients were included in the analysis. IMT demonstrated significant improvements in maximum inspiratory pressure (MIP) (MD 25.36, 95% CI 2.47-48.26, P = 0.03), maximum expiratory pressure (MEP) (MD 14.72, 95% CI 4.21-25.24, P = 0.006), forced vital capacity in percent predicted values [FVC(% pred)] (MD 3.90, 95% CI 1.86-5.93, P = 0.0002), forced expiratory volume in the first second in percent predicted values [FEV1(% pred)] (MD 4.96, 95% CI 2.60-7.32, P < 0.0001), ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) (MD 4.94, 95% CI 2.66-7.21, P < 0.0001), and asthma control test (ACT) (MD = 1.86, 95% CI: 0.96-2.75, P < 0.0001). Conclusions: Findings from randomized controlled trials indicate that inspiratory muscle training enhances respiratory muscle strength and pulmonary function in pediatric asthma patients. Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023449918, identifier: CRD42023449918.

Risk Factors for Postoperative Permanent Neurological Dysfunction After Stanford Type A Aortic Dissection: A Systematic Review and Meta-Analysis of 11382 Cases.

OBJECTIVE: To systematically evaluate the risk factors for permanent neurological dysfunction (PND) after Stanford type A aortic dissection (TAAD). METHOD: Electronic databases included PubMed, Embase, Web of Science, CNKI, WanFang Data, VIP, and CBM. We collected studies about risk factors for PND after TAAD was published from inception to December 2021. Two authors independently assessed the quality of the studies, and a meta-analysis was performed by RevMan 5.3 Software. RESULTS: A total of 20 studies involved 11382 cases, and among them, 1321 patients suffered PND, including 34 predictive risk factors. The meta-analysis showed that age (OR=1.11, 95% CI (1.06, 1.16), P < 0.0001), preoperative PND (OR=2.95, 95% CI (2.14, 4.07), P < 0.00001), retrograde tear in the ascending aorta (OR=6.67, 95% CI (3.23, 13.79), P < 0.00001) were independent risk factors for PND after TAAD surgery. CONCLUSIONS: Current evidence shows that age, preoperative PND, retrograde tearing in the ascending aorta are risk factors for PND after TAAD. These factors can be used to identify high-risk patients, providing guidance for medical staff to develop perioperative preventive strategies to reduce the incidence of PND. The results should be validated by higher-quality studies.

Advances in the relationship between frailty and cardiac surgery in elderly patients / 中国胸心血管外科临床杂志

@#Frailty is a syndrome characterized by vulnerability to stressors due to loss of physiological reserve. In recent years, many researches have confirmed that frailty is a risk factor for postoperative complications of cardiac surgery, such as readmission, adverse cardiovascular events, and death in elderly patients. This paper reviews the concept of frailty, the relationship between frailty and cardiac surgery, the frailty assessment and intervention strategy in perioperative period, aimed at providing decision making basis for the risk stratification and perioperative management of cardiac surgery in elderly patients.