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BACKGROUND: Using continuous glucose monitoring (CGM) in critically ill adult patients requiring insulin therapy has increased with inconsistent results. Thus, we conducted a meta-analysis to assess the effect of CGM and frequent point-of-care (POC) measurements in such a patient population. METHODS: We searched PubMed, Embase, Cochrane Library, China national knowledge infrastructure, and Wanfang for relevant articles from inception to Jan 15, 2022. Randomized controlled trials (RCTs) were considered if they focused on critically ill patients who required insulin and were treated with CGM or any POC measurements. We used the Cochrane risk evaluating tool to assess study quality. Subgroup analysis and publication bias were also conducted. RESULTS: We finally included 19 RCTs with 1,852 participants. The quality of the included studies were at a low to moderate levels. Overall, CGM devices significantly reduced hypoglycemia incidence (Risk ratio (RR) 0.35; 95% CI, 0.25-0.49; P<0.00001) than the POC measurement. Further subgroup and sensitivity analyses confirmed this result. The CGM group also had lower overall mortality (RR 0.54; 95% CI, 0.34-0.86; P=0.01), lower glucose variability, and nosocomial infection. The time in, below, or above target blood glucose range, insulin use, and length of stay in the ICU were comparable between the two groups. In addition, few studies provided data in favor of decreased nursing workload and medical costs in the CGM group. CONCLUSIONS: The CGM technique could significantly reduce hypoglycemia incidence, overall mortality, and glucose variability compared to POC measurement in critically ill patients. However, further large, well-designed RCTs are required to confirm our results.
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Introduction: Serum phosphate level is often deranged during critical illness. Hyperphosphatemia, as a marker of disease severity, attracts more and more attention. This study aimed to evaluate the impact of hyperphosphatemia on clinical outcomes in critically ill patients. Methods: We searched for relevant studies in PubMed, EMBASE, and the Cochrane database up to Jan 10, 2022. Two authors independently screened studies, extracted data, and assessed the study quality. Meta-analyses were performed to determine hyperphosphatemia prevalence and evaluate its relationship with prognosis and important clinical outcomes. We also conducted subgroup analysis and sensitivity analyses to explore the sources of heterogeneity. Results: Ten studies with 60,358 patients met the inclusion criteria. These studies were moderate to high quality. The median prevalence of hyperphosphatemia was 30% (range from 5.6 to 45%). Patients with hyperphosphatemia had a significantly higher risk of all-cause mortality than those without (OR 2.85; 95% CI, 2.35 to 3.38, P < 0.0001). Subgroup analyses, sensitivity analyses, and regression analyses further confirmed these results. In addition, patients with hyperphosphatemia required more CRRT (OR 4.96; 95% CI, 2.43 to 10.2, P < 0.0001) but not significantly increased duration of mechanical ventilation (mean difference, MD 0.13, 95% CI -0.04 to 0.30; P = 0.138), length of stay in intensive care unit (ICU) (SMD 0.164 day, 95% CI -0.007 to 0.335; P = 0.06), and length of stay in hospital (SMD 0.005 day, 95% CI -0.74 to 0.75; P = 0.99). Conclusions: Our results indicated that hyperphosphatemia was associated with all-cause mortality in critically ill patients. However, due to the retrospective design of the included studies, more prospective, well-designed research is required in the future. Systematic Review Registration: [https://doi.org/10.37766/inplasy2021.12.0130], identifier [INPLASY2021120130].
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Objective: Bioelectrical impedance-derived phase angle (PA) has exhibited good prognostic values in several non-critical illnesses. However, its predictive value for critically ill patients remains unclear. Thus, we aimed to perform a systematic review and meta-analysis to investigate the relationship between PA and survival in such a patient population. Materials and methods: We searched for relevant studies in PubMed, Embase, and the Cochrane database up to Jan 20, 2022. Meta-analyses were performed to determine the association between the baseline PA after admission with survival. We further conducted subgroup analyses and sensitivity analyses to explore the sources of heterogeneity. Results: We included 20 studies with 3,770 patients. Patients with low PA were associated with a significantly higher mortality risk than those with normal PA (OR 2.45, 95% CI 1.97-3.05, P < 0.00001). Compared to survivors, non-survivors had lower PA values (MD 0.82°, 95% CI 0.66-0.98; P < 0.00001). Similar results were also found when pooling studies reported regression analyses of PA as continuous (OR = 0.64; 95% CI 0.52-0.79, P < 0.00001) or categorical variable (OR = 2.42; 95% CI 1.76-3.34; P < 0.00001). These results were further confirmed in subgroup analyses and sensitivity analyses. Conclusion: Our results indicated that PA may be an important prognostic factor of survival in critically ill patients and can nicely complement the deficiencies of other severity scoring systems in the ICU setting.
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Objective: Sarcopenia is a syndrome of decreased muscle mass and deficits in muscle strength and physical function. We aimed to investigate the relationship between creatinine/cystatin C ratio (CCR) and sarcopenia and the prognostic value of CCR in hospitalized patients. Materials and methods: We searched for relevant studies in PubMed, EMBASE, and the Cochrane Database up to August 25, 2022. Meta-analyses were performed to evaluate the relationship between CCR and skeletal muscle [computed tomography-assessed skeletal muscle (CTASM), muscle strength, and physical performance], prognosis and important clinical outcomes in hospitalized adults. The pooled correlation coefficient, the area under the receiver operating characteristic (ROC) curves, and hazard ratio (HR) together with their 95% confidence intervals (CIs) were calculated. We also conducted subgroup analyses to explore the sources of heterogeneity. Results: A total of 38 studies with 20,362 patients were eligible. These studies were of moderate to high quality. Our results showed that CCR was significant correlations with all CTASM types (Fisher's Z ranged from 0.35 to 0.5; P values ranged from < 0.01 to 0.01), handgrip strength (Fisher's Z = 0.39; 95% CI, 0.32-0.45; P < 0.001) and gait speed (Fisher's Z = 0.25; 95% CI, 0.21-0.30; P < 0.001). The ROC curves suggested that CCR had good diagnostic efficacy (0.689; 95% CI, 0.632-0.746; P < 0.01) for sarcopenia. CCR can reliably predict mortality in hospitalized patients, which was confirmed by regression analysis of CCR as both continuous (HR 0.78; 95% CI, 0.72-0.84; P < 0.01) and categorical variables (HR 2.05; 95% CI, 1.58-2.66; P < 0.0001). In addition, less evidence showed that higher CCR was independently associated with a shorter duration of mechanical ventilation, reduced length of stay in the intensive care unit and hospital, less nutritional risk, and decreased complications in hospitalized patients. Conclusion: CCR could be a simple, economical, and effective screening tool for sarcopenia in hospitalized patients, and it is a helpful prognostic factor for mortality and other important clinical outcomes. Systematic review registration: https://inplasy.com/inplasy-2022-9-0097/, identifier INPLASY202290097.
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Background: Cardiopulmonary support, as extracorporeal membrane oxygenation (ECMO) or mechanical ventilation (MV), is crucial for ICU patients. However, some of these patients are difficult to wean. Therefore, we aimed to assess the efficacy and safety of levosimendan in facilitating weaning from cardiorespiratory support in this patient population. Methods: We searched for potentially relevant articles in PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and the Cochrane database from inception up to Feb 30, 2021. Studies focusing on weaning data in MV/ECMO adult patients who received levosimendan compared to controls were included. We used the Cochrane risk of bias tool or the Newcastle-Ottawa Quality Assessment Scale to evaluate the study quality. The primary outcome was the weaning rate from MV/ECMO. Secondary outcomes were mortality, duration of MV, and ICU stay. Subgroup analysis, sensitivity analysis, and publication bias were also conducted. Results: Eighteen studies with 2,274 patients were included. The quality of the included studies was low to moderate. Overall, levosimendan effectively improved weaning rates from MV/ECMO [odds ratio (OR) = 2.32; 95%CI, 1.60-3.36; P < 0.00001, I 2 = 68%]. Subgroup analyses confirmed the higher successful weaning rates in ventilated patients with low left ventricular ejection fractions (OR = 4.06; 95%CI, 2.16-7.62), patients with ECMO after cardiac surgery (OR = 2.04; 95%CI, 1.25-3.34), and patients with ECMO and cardiogenic shock (OR = 1.98; 95%CI, 1.34-2.91). However, levosimendan showed no beneficial effect on patients with MV weaning difficulty (OR = 2.28; 95%CI, 0.72-7.25). Additionally, no differences were found concerning the secondary outcomes between the groups. Conclusions: Levosimendan therapy significantly increased successful weaning rates in patients with cardiopulmonary support, especially patients with combined cardiac insufficiency. Large-scale, well-designed RCTs will be needed to define the subgroup of patients most likely to benefit from this strategy.
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BACKGROUND: The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population. METHODS: We searched PubMed, EMBASE, and Cochrane library databases up to October 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. RESULTS: Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio = 0.77; 95% CI 0.60 to 0.98; I2 = 3%, P = 0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD] = 0.61 days; 95% CI - 1.08 to 2.29; P = 0.48), length of stay in ICU (MD = 0.32 days; 95% CI - 2.51 to 3.16; P = 0.82) and hospital (MD = 0.30 days; 95% CI - 3.23 to 3.83; P = 0.87). Additionally, adverse events were similar between the two groups. CONCLUSIONS: This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings.
Subject(s)
Calorimetry, Indirect/methods , Nutritional Support/methods , Critical Illness/therapy , Energy Metabolism , Humans , Length of Stay/trendsABSTRACT
Objective To investigate the knowledge and practice of residents about schistosomiasis prevention and control in endemic areas of Jingzhou City,Hubei Province after the disease transmission being controlled,so as to provide the valuable in-formation for formulating an efficient health education and intervention strategy.Methods The residents were selected by using the cluster sampling method and investigated with questionnaires in Jiangling County and Gong'an County,Jingzhou City,Hu-bei Province,and the data were analyzed by using the descriptive analysis method,Chi-square tests and logistic regression.Re-sults In a total,826 available questionnaires were obtained with 100% of valid rate.Among them,97.0% of the interviewee knew schistosomiasis,and 86.3% knew that the infection happened by contacting water containing cercariae.The residents in el-der age(41-84 years)had higher awareness rates than the residents in lower age(6-17 years),about the regions of epidemic area(χ 2=57.860),infection route of schistosomiasis(χ 2=87.045),advanced schistosomiasis symptoms(χ 2=27.268)and On-comelania hupensis being as intermediate host(χ 2=55.856)(all P<0.05).The males had higher awareness rates of epidemic areas than the females(χ2=13.442,P<0.05).For personal behavior,36.6% of the interviewee had experience of contacting lake or pond water many times a day,and 66.5% had the willingness to participate in schistosomiasis health education.Conclu-sion In the investigation areas,Jiangling County and Gong'an County,the awareness rates of the residents about schistosomia-sis prevention and control are higher,and we should strengthen the health education and behavior intervention,especially in the students of middle and primary schools to help them have the self-protection ability efficiently.
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OBJECTIVE: To investigate the knowledge and practice of residents about schistosomiasis prevention and control in endemic areas of Jingzhou City, Hubei Province after the disease transmission being controlled, so as to provide the valuable information for formulating an efficient health education and intervention strategy. METHODS: The residents were selected by using the cluster sampling method and investigated with questionnaires in Jiangling County and Gong'an County, Jingzhou City, Hubei Province, and the data were analyzed by using the descriptive analysis method, Chi-square tests and logistic regression. RESULTS: In a total, 826 available questionnaires were obtained with 100% of valid rate. Among them, 97.0% of the interviewee knew schistosomiasis, and 86.3% knew that the infection happened by contacting water containing cercariae. The residents in elder age (41-84 years) had higher awareness rates than the residents in lower age (6-17 years), about the regions of epidemic area (χ2 = 57.860), infection route of schistosomiasis (χ2 = 87.045), advanced schistosomiasis symptoms (χ2 = 27.268) and Oncomelania hupensis being as intermediate host (χ2 = 55.856) (all P < 0.05) . The males had higher awareness rates of epidemic areas than the females (χ2 = 13.442, P < 0.05) . For personal behavior, 36.6% of the interviewee had experience of contacting lake or pond water many times a day, and 66.5% had the willingness to participate in schistosomiasis health education. CONCLUSIONS: In the investigation areas, Jiangling County and Gong'an County, the awareness rates of the residents about schistosomiasis prevention and control are higher, and we should strengthen the health education and behavior intervention, especially in the students of middle and primary schools to help them have the self-protection ability efficiently.
Subject(s)
Health Knowledge, Attitudes, Practice , Schistosomiasis/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Child , China , Disease Vectors , Female , Humans , Lakes , Male , Middle Aged , Snails , Surveys and Questionnaires , Young AdultABSTRACT
<p><b>BACKGROUND</b>Over-expression of P-glycoprotein (P-gp), encoded by the MDR1 gene, confers multidrug resistance (MDR) in renal cell carcinoma (RCC) and is a major reason for unsuccessful chemotherapy. This study aimed to determine the effct of RNA interference (RNAi) on the reversal of MDR in human RCC.</p><p><b>METHODS</b>We designed and selected one short hairpin RNA (shRNA) targeting MDR1 gene, which is stably expressed from integrated plasmid and transfected by lentivirus fluid in human RCC A498 cell.</p><p><b>RESULTS</b>The MDR1-targeted RNAi resulted in decreased MDR1 gene mRNA level (P < 0.001), almost abolished P-gp expression and reversed MDR to different chemotherapy drugs in the RCC A498 cell line.</p><p><b>CONCLUSION</b>MDR could be reversed by RNAi in human RCC A498 cell line, which may be used for clinical application in future.</p>
