Ashbyjunker0105

BACKGROUND Tiotropium have been recommended as first-line maintenance therapy for chronic obstructive pulmonary disease (COPD) to reduce the frequency, duration, and severity of exacerbations and improve quality of life. Recently, it was reported that tiotropium use might link to cardiovascular risk in COPD patients. But it is controversial. We aimed to clarify the associations between tiotropium use and cardiovascular risk in patients with COPD. METHODS We searched PubMed, EMBASE, Cochrane Library, and Clinical Trials.gov to identify potentially relevant articles. We included randomized controlled trials of any inhaled tiotropium versus non-anticholinergic treatment for COPD, with reporting of cardiovascular events as an adverse event. We conducted meta-analyses by the Peto and Mantel-Haenszel approaches with corresponding 95% CIs. RESULTS Our work included 20 RCTs with more than 27,699 subjects. Pooled results indicated that tiotropium treatment did not increase the risk of cardiovascular events (Peto OR, 0.97, 95% CI, 0.84-1.12; I2 = 0%), overall mortality (RD, 0.00, 95% CI, - 0.00-0.01; I2 = 68%), and cardiovascular mortality (Peto OR, 1.58, 95% CI, 0.92-2.74; I2 = 0%) compared with controls. Then, subgroup analysis was performed according to the type of controls. The pooled results were consistent with the above (tiotropium vs LABA Peto OR, 0.98, 95% CI, 0.81-1.19; I2 = 17%) (tiotropium vs placebo Peto OR, 0.92, 95% CI, 0.75-1.44; I2 = 15%). In addition, there was also no association between cardiovascular risk and duration of tiotropium treatment. CONCLUSIONS Inhaled tiotropium does not increase the risk of cardiovascular events and cardiovascular mortality in patients with COPD.AIM AND BACKGROUND Postoperative nausea and vomiting (PONV) remains a significant clinical problem for surgical patients. Amisulpride is a well-studied D2/D3 antagonist that has the potential to be used for preventing and treating PONV. Our aim was to assess the efficacy and safety of amisulpride for prevention and treatment of PONV through a systematic review and meta-analysis. METHOD A systematic literature search was performed using MEDLINE, EMBASE, PUBMED, clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials from their inception to Feb 15th, 2019. The efficacy outcome was the incidence of complete response, defined as no emesis and no rescue antiemetic use in a 24-h period after study drug administration. The safety outcomes were the adverse effects associated with amisulpride. RESULTS Five studies comprising 3243 patients met inclusion critieria. Compared with placebo, amisulpride showed a significantly improved incidence of complete response [relative risk (RR) 1.30; 95% confidence interval (CI) 1.20-1.41; P  less then  0.00001, I2 = 0%] with firm evidence from the trial sequential analysis. Particularly, the amisulpride at 5 mg dose indicated a significant benefit than placebo [relative risk (RR) 1.28; 95% confidence interval (CI) 1.18-1.39; P  less then  0.00001, I2 = 4%]. GA-017 manufacturer The adverse event profile of amisulpride was generally similar to the placebo. CONCLUSION Based on our findings, low-dose, intravenous amisulpride is safe and efficacious for the prevention and treatment of PONV compared to placebo. Further studies are needed to explore the optimal dose and timing. CLINICAL TRIAL REGISTRATION PROSPERO CRD42019121483.OBJECTIVE To assess whether 3-dimensional (3D) fractal dimension (FD) and lacunarity features from MRI can predict the meningioma grade. METHODS This retrospective study included 131 patients with meningiomas (98 low-grade, 33 high-grade) who underwent preoperative MRI with post-contrast T1-weighted imaging. The 3D FD and lacunarity parameters from the enhancing portion of the tumor were extracted by box-counting algorithms. Inter-rater reliability was assessed with the intraclass correlation coefficient (ICC). Additionally, conventional imaging features such as location, heterogeneous enhancement, capsular enhancement, and necrosis were assessed. Independent clinical and imaging risk factors for meningioma grade were investigated using multivariable logistic regression. The discriminative value of the prediction model with and without fractal features was evaluated. The relationship of fractal parameters with the mitosis count and Ki-67 labeling index was also assessed. RESULTS The inter-reader reliability wl dimension and higher lacunarity than low-grade meningiomas, suggesting higher complexity and higher rotational variance. • The discriminative value of the predictive model using clinical and conventional imaging features improved when combined with 3D fractal features for predicting the meningioma grade.INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) and low back pain (LBP) are common postnatal problems. We aimed to compare the effects of stabilization exercises focusing on the pelvic floor on postnatal SUI and LBP. METHODS This two-arm, single-blind, parallel, randomized controlled trial was done on 80 women (mean age 30.5, range 20-45 years), with postnatal SUI and LBP. They were randomized into two equal control and intervention groups. The control group received no treatment while the intervention group received home-based stabilization exercises focusing on pelvic floor muscles (PFM) 3 days a week for 12 weeks, three sets a day; each set included three different types of exercise each week. Outcome measures were UI severity, assessed by ICIQ-UI-SF, low back pain functional disability, assessed by the Oswestry Disability Index (ODI), LBP severity, assessed by visual analog scale (VAS), and PFM strength and endurance, assessed by vaginal examination. Transverse abdominis (TrA) muscle strength was assessed by manometric biofeedback. All outcomes were measured directly before and after treatment. RESULTS In the intervention group, PFM strength, TrA muscle strength, functional disability and pain severity were significantly improved (P  less then  0.05). Within-group results showed that all outcomes except pain severity (P = 0.06) had directly improved in the intervention group after treatment (P  less then  0.05), while in the control group only PFM strength and endurance and UI severity had improved (P  less then  0.05). CONCLUSIONS Home-based stabilization exercises focusing on the pelvic floor muscles could be effective for postnatal LBP and SUI. TRIAL REGISTRATION Iranian Registry of Clinical Trials (Code IRCT2017050618760N4).