Sex-based differences in the outcomes of intracerebral haemorrhage: A systematic review and meta-analysis.

INTRODUCTION: To provide updated evidence on the sex-based differences in the risk of mortality and functional outcomes in subjects with intracerebral haemorrhage. METHODS: A systematic search of eligible studies was conducted using three large databases such as PubMed, EMBASE, and Scopus for observational studies that documented the comparative risk of mortality and functional outcomes based on the subjects' sex. Only studies published in the year 2000 and onwards were included. Random effects model was used to pool relevant data and effect sizes were reported as odds ratio (OR) with 95% confidence intervals (CI). RESULTS: The review included 32 studies. In most of the studies, female subjects had a higher mean age compared to males and had a higher rate of neurological deficits at admission. A higher proportion of males had cardiovascular risk factors. The risk of mortality at hospital discharge (OR 0.98, 95% CI: 0.90, 1.06), and one- (OR 0.98, 95% CI: 0.81, 1.18), three- (OR 1.13, 95% CI: 0.95, 1.33) and 12-months (OR 1.04, 95% CI: 0.90, 1.19) follow up was similar in both sexes. Compared to females, males had a lower risk of poor functional outcomes at 3 months (OR 0.83, 95% CI: 0.77, 0.89) and 12 months (OR 0.87, 95% CI: 0.77, 0.98) follow-up. CONCLUSION: There is a similar risk of mortality but better functional outcomes in males with intracerebral haemorrhage compared to females. However, the findings should be interpreted cautiously as there were significant sex-based differences in risk profiles at admission. Further studies that focus on careful and meticulous examination of sex-specific association with survival and functional outcomes are needed.

Prediction of stroke-associated pneumonia by the A2DS2, AIS-APS, and ISAN scores: a systematic review and meta-analysis.

Background: Different scoring systems (A2DS2, AISAPS, ISAN) have been designed to predict the risk of in-hospital stroke-associated pneumonia (SAP). Studies have assessed the accuracy of these scores for predicting SAP. We performed this meta-analysis to consolidate the evidence on the predictive accuracies for SAP of the A2DS2, AISAPS, and ISAN scores.Materials and methods: We conducted a systematic search for all studies reporting the SAP predictive accuracy of A2DS2, AISAPS, or ISAN scores in the databases of PubMed Central, SCOPUS, MEDLINE, Embase, and Cochrane from inception until December 2020. We used the STATA software for the meta-analysis.Results: We included 19 studies with 35 849 patients. The pooled score sensitivities were 78% (95% CI, 71%-83%) for A2DS2, 79% (95% CI, 77%-81%) for AISAPS, and 79% (95% CI, 77%-81%) for ISAN. The pooled score specificities were 73% (95% CI, 65%-80%) for A2DS2, 74% (95% CI, 69%-79%) for AISAPS, and 74% (95% CI, 69%-79%) for ISAN. We found significant heterogeneity for all the scoring systems based on the chi-square test results and an I2 statistic > 75%. We performed meta-regression to explore the source of heterogeneity and found that patient selection (p< 0.05) and reference standards (p< 0.05) in the sensitivity model, index test standards (p< 0.05), flow and timing of tests (p< 0.01) in the specificity model, and mean age (p < 0.001) in the joint model were the source of heterogeneity.Conclusions: To summarize, we found that A2S2, AISAPS and ISAN have moderate predictive accuracy for SAP with A2S2 having a stable cutoff value.

Outcomes Following Percutaneous Coronary Intervention in Saphenous Vein Grafts With and Without Embolic Protection Devices: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aimed to review studies comparing outcomes following percutaneous coronary intervention (PCI) in saphenous vein grafts (SVG) with and without embolic protection devices (EPD). METHODS: Databases including PubMed Central, Cochrane Library, EMBASE, CINAHL, MEDLINE, Google Scholar, ScienceDirect, and Scopus were searched from January 1964 to April 2021. We used the Cochrane risk of bias tool and the Newcastle Ottawa scale to assess the quality of published studies based on study design. From the results, we carried out a meta-analysis with a random-effects model and reported pooled odds ratio (OR) with 95% CI. RESULTS: In total, 11 studies were analyzed that included 79,009 total participants. EPD use had significantly lower odds of mortality (pooled OR = 0.69; 95% CI: 0.5-0.94). There was no significant difference in terms of major adverse cardiovascular events (MACE) (pooled OR = 0.83; 95% CI: 0.67-1.03), target vessel revascularization (pooled OR = 1; 95% CI: 0.95-1.05), periprocedural (pooled OR = 1.12; 95% CI: 0.65-1.9) and late myocardial infarction (MI) (pooled OR = 0.79; 95% CI: 0.55-1.14) with or without EPD for PCI in SVG patients. CONCLUSION: Although not statistically beneficial for MACE, target vessel revascularization, periprocedural, and late MI, EPD use does appear to significantly reduce mortality for the patients undergoing PCI in SVG. Clinicians might consider using EPD for such patients to reduce the burden of post-procedural morbidity and mortality.

Atorvastatin protects BV­2 mouse microglia and hippocampal neurons against oxygen­glucose deprivation­induced neuronal inflammatory injury by suppressing the TLR4/TRAF6/NF­κB pathway.

Atorvastatin is a member of the statin class of drugs, which competitively inhibit the activity of 5­hydroxy­3­methylglutaryl­coenzyme A reductase. The aim of the present study was to assess whether atorvastatin may protect BV­2 microglia and hippocampal neurons against oxygen­glucose deprivation (OGD)­induced neuronal inflammatory injury and to determine the underlying mechanisms by which its effects are produced. Cell viability and apoptotic ability were assessed using an MTT assay and annexin V­fluorescein isothiocyanate/propidium iodide double staining followed by flow cytometry, respectively. The expression of inflammation and apoptosis­associated mRNAs and proteins were assessed using reverse transcription­quantitative polymerase chain reaction and western blotting, and the expression of inflammatory factors was determined using ELISA. The results of the current study revealed that atorvastatin treatment suppressed the viability of OGD BV­2 microglia and hippocampal neurons. Furthermore, atorvastatin treatment reduced the expression of proinflammatory factors in OGD BV­2 microglia. Additionally, it was demonstrated to downregulate the toll­like receptor 4 (TLR4)/tumor necrosis factor receptor­associated factor 6 (TRAF6)/nuclear factor­κB (NF­κB) pathway in OGD BV­2 microglia. Atorvastatin also inhibited the apoptosis of OGD hippocampal neurons by regulating the expression of apoptosis­associated proteins. It was concluded that atorvastatin treatment may protect BV­2 microglia and hippocampal neurons from OGD­induced neuronal inflammatory injury by suppressing the TLR4/TRAF6/NF­κB pathway. This may provide a potential strategy for the treatment of neuronal injury.