Fecal Microbiota Transplantation as a Novel Therapy for Ulcerative Colitis
Da‐Li SunWei‐Ming LiShumin LiYunyun CenQingwen XuYijun LiYanbo SunYu‐Xing QiYueying LinTing YangPeng-Yuan XuQiping Lu
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Variation in clinical evidence has prevented the adoption of fecal microbiota transplantation (FMT) in patients with ulcerative colitis (UC). We aimed to conduct a systematic review and meta-analysis to determine the efficacy and safety of FMT in UC. A systematic literature search was performed in 5 electronic databases from inception through September 2015. Inclusion criteria were reports of FMT in patients with UC. Studies were excluded if they did not report clinical outcomes or included patients with infections. Clinical remission (CR) was defined as the primary outcome. Eleven studies (2 randomized controlled trials (RCTs), 1 open-label case-control study, and 8 cohort studies) with a total of 133 UC patients were included in the analysis. In 11 studies (including 8 noncontrol cohort studies and the treatment arms of 3 clinical control trials), the pooled proportion of patients who achieved CR was 30.4% (95% CI 22.6–39.4%), with a low risk of heterogeneity (Cochran Q test, P = 0.139; I2 = 33%). A subgroup analysis suggested that no difference in CR was detected between upper gastrointestinal delivery versus lower gastrointestinal delivery. Furthermore, subgroup analysis revealed that there was no difference in CR between single infusion versus multiple infusions (>1) of FMT. All studies reported mild adverse events. FMT is potentially useful in UC disease management but better-designed RCTs are still required to confirm our findings before wide adoption of FMT is suggested. Additionally, basic guidelines are needed imminently to identify the right patient population and to standardize the process of FMT.Keywords:
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The aim of the study was to examine how well aggregate data meta-analyses (ADMAs) and individual patient data meta-analyses (IPDMAs) agree in their overall results and how frequently interactions are detected in IPDMAs and ADMAs.ADMA articles immediately published before the IPDMA and matching the research topic were identified. Agreement in the overall result was achieved if the estimate was in the same direction. The number of subgroup analyses, in particular that of significant interactions, was compared between the 2 types of meta-analyses.A total of 829 IPDMA articles were identified; 129 (15.6%) were found to have a matched ADMA article and 204 paired meta-analyses were identified. Agreement in the overall effect was observed in 187 (91.7%) of the 204 paired meta-analyses. Fifty-three (26.0%) ADMAs and 121 (59.3%) IPDMAs conducted subgroup analyses and presented 150 and 634 subgroup analyses, respectively. The IPDMAs conducted 7 times more subgroup analyses on interaction (544 in IPDMAs vs 68 in ADMAs) and identified 14 times more potential interactions (44 in IPDMAs vs 3 in ADMAs).ADMAs will almost always agree with their corresponding IPDMAs in the overall result if greater efforts are made to improve the methodology in conducting ADMAs. The IPDMA is required mostly if interactions are suspected.
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To explore the role and application of Meta-regression and subgroup analyses to recognize and control the heterogeneity in Meta-analysis, Meta-regression models were established by secondary data to screen the factors resulting heterogeneity,and subgroup analyses were used to compare the change of heterogeneity before and after.The heterogeneity was found in the Meta-analysis(Q=44.71,df=27,P=0.017).Sample size and region were selected(P=0.012 and P=0.091,respectively)by Meta-regression from many possible factors such as sample size,year,region and case/contml ratio.The Q values were lowered from 44.71 to 32.11 after subgroup analyses.Thus,Metaregression method was convenient and reliable to screen the affected factors of heterogeneity,and subgroup analyses based on the hypothesis that could significantly lower the heterogeneity.It was recommended to a combined use when an obvious heterogeneity existed but was in need to get an overall result in Metaanalysis.We could correctly judge and lower the heterogeneity to increase the robustness and rationality of results from Meta-analysis.
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Atrial fibrillation (AF) is one of the most common persistent arrhythmia, and its complications include cerebral embolism, arterial embolism and heart failure. Some studies have found that elevated Homocysteine (HCY) levels is a new risk factor for AF. Currently, there is no meta-analysis to explore whether the HCY levels is related to AF. Therefore, a meta-analysis was conducted to evaluate the relationship between the HCY levels and AF, in order to draw the attention of clinicians to the HCY levels. A meta-analysis was performed in the study to evaluated the association between the HCY levels and AF. In order to identify eligible original articles, The EMBASE, PubMed, and web of science were systematically searched until November 2020. All data were analyzed with Review Manager 5.3. The meta-analysis results were evaluated depending on standardized mean differences (SMD) with 95% confidence intervals (CI). Moreover, the subgroup analysis and sensitivity analysis were also analyzed. The HCY levels was significantly associated with AF (WMD = 0.81, 95% CI: 0.58 to 1.03; P < .00001). In the analysis, there was a medium degree of heterogeneity (I2 = 73%). Subgroup analysis showed that female < 60, BMI≥25, BMI <25, age ≥60 and publication year ≥2010 were identified as possible sources of heterogeneity. Sensitivity analysis showed that the main results remained unchanged after omitting any single study or converting the random effects model (REM) to fixed effects model (FEM). The meta-analysis showed that there is a significant correlation between the HCY levels and AF, and the role of HCY in AF patients should not be ignored in clinical.
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Abstract Current reports on the changes in peripheral blood regulatory T cell (Tregs) to CD4 + T cell ratio in systemic sclerosis (SSc) patients are varied in their conclusions. We therefore performed a meta-analysis to identify the actual change in the proportion of peripheral Tregs in SSc. Three databases, namely EMBASE, ISI web of knowledge, and Pubmed were systematically searched for relevant literature. Approximately 250 SSc patients and controls from several studies were included in this analysis. Comprehensive Meta Analysis Version 2.0 software was used to conduct the meta-analysis. Six studies were included in the meta-analysis. Results of the meta-analysis showed high degree of heterogeneity ( I 2 = 96.98), and a random-effect model was used in the subsequent analysis. The ratio of circulating Tregs to CD4 + T cell in SSc was lower than in controls, but not statistically significantly so (−0.61 ± 0.94, P = 0.52). Subgroup analysis did not identify any potential source of heterogeneity. This meta-analysis indicated that Tregs might play a less prominent immunosuppressive role in the immune system in SSc patients, but needs further confirmation.
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Many studies suggest that the Gln261Arg polymorphism in 12-lipoxygenase gene is assicated with cancer susceptibility, but the results are inconclusive. This meta-analysis aimed to investigate the overall association between the Gln261Arg polymorphism in 12-lipoxygenase gene and cancer risk.Literature search was performed in Pubmed, Embase and other databases for studies evaluating the association between the Gln261Arg polymorphism in 12-lipoxygenase gene and cancer risk. Data were extracted and statistical analysis was performed using STATA 12.0 software.A total of eight publications involving 8,379 subjects were included in this meta-analysis. Combined analysis revealed a significant association between this polymorphism and cancer susceptibility with an OR of 1.19 (95% CI: 1.09-1.31, P=0.000 for Gln/Gln vs. Arg/Gln + Arg/Arg). Subgroup analysis by ethnicity showed that the cancer risk associated with the Gln261Arg polymorphism in 12-lipoxygenase gene was significantly elevated among Asians (OR=1.21, 95% CI: 1.10-1.34, P=0.000 for Gln/Gln vs. Arg/Gln + Arg/Arg), but not among Caucasians. Subgroup analysis by cancer type suggested that the Gln261Arg polymorphism in 12-lipoxygenase gene is not a risk factor for colon cancer or rectal cancer.This meta-analysis suggests that the Gln261Arg polymorphism in 12-lipoxygenase gene contributes to cancer susceptibility, specifically in Asian populations. More studies are needed to validate our findings.
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To perform a systematic review and meta-analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands.
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Objectives: Individual patient data (IPD) meta-analyses have been proposed as a major improvement in meta-analytic methods to study subgroup effects. Subgroup effects of conventional and IPD meta-analyses using identical data have not been compared. Our objective is to compare such subgroup effects using the data of six trials ( n = 1,643) on the effectiveness of antibiotics in children with acute otitis media (AOM). Methods: Effects (relative risks, risk differences [RD], and their confidence intervals [CI]) of antibiotics in subgroups of children with AOM resulting from (i) conventional meta-analysis using summary statistics derived from published data (CMA), (ii) two-stage approach to IPD meta-analysis using summary statistics derived from IPD (IPDMA-2), and (iii) one-stage approach to IPD meta-analysis where IPD is pooled into a single data set (IPDMA-1) were compared. Results: In the conventional meta-analysis, only two of the six studies were included, because only these reported on relevant subgroup effects. The conventional meta-analysis showed larger (age < 2 years) or smaller (age ≥ 2 years) subgroup effects and wider CIs than both IPD meta-analyses (age < 2 years: RD CMA -21 percent, RD IPDMA-1 -16 percent, RD IPDMA-2 -15 percent; age ≥2 years: RD CMA -5 percent, RD IPDMA-1 -11 percent, RD IPDMA-2 -11 percent). The most important reason for these discrepant results is that the two studies included in the conventional meta-analysis reported outcomes that were different both from each other and from the IPD meta-analyses. Conclusions: This empirical example shows that conventional meta-analyses do not allow proper subgroup analyses, whereas IPD meta-analyses produce more accurate subgroup effects. We also found no differences between the one- and two-stage meta-analytic approaches.
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Background The evidence for association between Epstein-Barr virus (EBV) infection and risk of oral squamous cell carcinoma (OSCC) is inconsistent in the literature. Therefore, this meta-analysis was conducted to clarify this association. Methods A literature search was conducted in electronic databases for English- and Chinese-language publications until March 31, 2017 to include eligible case-control studies. The pooled odds ratio (OR) and 95% confidence interval (95% CI) were estimated to determine the association between EBV infection and OSCC risk using a fixed- or random-effects model based on heterogeneity. Publication bias was assessed using funnel plot analysis. Results A total of 13 case-control studies with 686 OSCC patients and 433 controls were included based on predetermined inclusion and exclusion criteria. The pooled OR with 95% CI between EBV infection and OSCC risk was 5.03 (1.80–14.01) with significant heterogeneity observed (I2 = 87%). The subgroup analysis indicates that the year of publication, study location, economic level, sample size, tissue type, detection method and marker, control type, and language might explain potential sources of heterogeneity. Publication bias was not observed, and sensitivity analysis showed stable results. Conclusions The results of the current meta-analysis suggest that EBV infection is statistically associated with increased risk of OSCC. However, additional high-quality studies with larger sample sizes are needed to further confirm the relationship between EBV and OSCC.
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