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Development of donor specific antibodies after SARS-CoV-2 vaccination: What do we know so far? 接种 SARS-CoV-2 疫苗后供体特异性抗体的产生:我们目前了解多少?
Pub Date : 2024-06-18 DOI: 10.13105/wjma.v12.i2.91264
Ahmed Daoud, Karim M. Soliman, M. A. Posadas Salas, Sakshi Vaishnav, Genta Uehara, Ahmed Abdelkader, Tibor Fulop, Michael J. Casey
Vaccination against Coronavirus disease-19 (COVID-19) was pivotal to limit spread, morbidity and mortality. Our aim is to find out whether vaccines against COVID-19 lead to an immunological response stimulating the production of de novo donor specific antibodies (DSAs) or increase in mean fluorescence intensity (MFI) of pre-existing DSAs in kidney transplant recipients (KTRs). This study involved a detailed literature search through December 2nd, 2023 using PubMed as the primary database. The search strategy incorporated a combination of relevant Medical Subject Headings terms and keywords: "COVID-19", "SARS-CoV-2 Vaccination", "Kidney, Renal Transplant", and "Donor specific antibodies". The results from related studies were collated and analyzed. A total of 6 studies were identified, encompassing 460 KTRs vaccinated against COVID-19. Immunological responses were detected in 8 KTRs of which 5 had increased MFIs, 1 had de novo DSA, and 2 were categorized as either having de novo DSA or increased MFI. There were 48 KTRs with pre-existing DSAs prior to vaccination, but one study (Massa et al ) did not report whether pre-existing DSAs were associated with post vaccination outcomes. Of the remaining 5 studies, 35 KTRs with pre-existing DSAs were identified of which 7 KTRs (20%) developed de novo DSAs or increased MFIs. Overall, no immunological response was detected in 452 (98.3%) KTRs. Our study affirms prior reports that COVID-19 vaccination is safe for KTRs, especially if there are no pre-existing DSAs. However, if KTRs have pre-existing DSAs, then an increased immunological risk may be present. These findings need to be taken cautiously as they are based on a limited number of patients so further studies are still needed for confirmation.
接种冠状病毒病-19(COVID-19)疫苗对于限制传播、发病率和死亡率至关重要。我们的目的是了解针对 COVID-19 的疫苗是否会导致免疫反应,刺激肾移植受者(KTR)产生新的供体特异性抗体(DSAs)或增加原有 DSAs 的平均荧光强度(MFI)。本研究使用 PubMed 作为主要数据库,对截至 2023 年 12 月 2 日的文献进行了详细检索。搜索策略结合了相关的医学主题词和关键词:"COVID-19"、"SARS-CoV-2 疫苗接种"、"肾脏、肾移植 "和 "供体特异性抗体"。对相关研究的结果进行了整理和分析。共确定了 6 项研究,涉及 460 名接种了 COVID-19 疫苗的 KTR。在 8 例 KTR 中检测到了免疫反应,其中 5 例 MFI 增加,1 例为新生 DSA,2 例被归类为新生 DSA 或 MFI 增加。有 48 例 KTR 在接种疫苗前已存在 DSA,但其中一项研究(Massa 等人)没有报告接种疫苗前已存在 DSA 是否与接种疫苗后的结果有关。在其余 5 项研究中,发现了 35 名接种前已存在 DSA 的 KTR,其中 7 名 KTR(20%)出现了新的 DSA 或 MFIs 增加。总体而言,452 例(98.3%)KTR 未检测到免疫反应。我们的研究证实了之前的报道,即 COVID-19 疫苗接种对 KTR 是安全的,尤其是在没有预先存在 DSA 的情况下。但是,如果 KTR 预先存在 DSA,则可能会增加免疫风险。由于这些研究结果是基于有限的患者数量得出的,因此还需要进一步的研究来证实,因此需要谨慎对待。
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引用次数: 0
Exploring influences and risk of bias of studies on return to sport and work after lateral ankle sprain: A systematic review and meta-analysis 探讨有关外侧踝关节扭伤后恢复运动和工作的研究的影响因素和偏倚风险:系统回顾和荟萃分析
Pub Date : 2024-03-18 DOI: 10.13105/wjma.v12.i1.87026
Priscilla A Maria, G. Vuurberg, Gino M. Kerkhoffs
BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity, with an incidence rate of 15%-20%. The high incidence and prevalence highlights the economic impact of this injury. Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses. Up to 40% of patients who suffer from an ankle sprain develop chronic ankle instability. Chronic instability can lead to prolonged periods of pain, immobility and injury recurrence. Identification of factors that influence return to work (RTW) and return to sports (RTS) after a lateral ankle sprain (LAS) may help seriously reduce healthcare costs. AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS. METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023. Inclusion criteria were as follows: (1) Injury including LAS or chronic ankle instability; (2) Described any form of treatment; (3) Assessment of RTW or RTS; (4) Studies published in English; and (5) Study designs including randomized controlled clinical trials, clinical trials or cohort studies. Exclusion criteria were: (1) Studies involving children (age < 16 year); or (2) Patients with concomitant ankle injury besides lateral ankle ligament damage. A quality assessment was performed for each of the included studies using established risk of bias tools. Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis. A best evidence synthesis was performed in cases of qualitative outcome analysis. For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS. RESULTS A total of 8904 patients were included in 21 studies, 10 randomized controlled trials, 7 retrospective cohort studies and 4 prospective cohort studies. Fifteen studies were eligible for meta-analysis. The overall RTS rate ranged were 80% and 83% in the all treatments pool and surgical treatments pool, respectively. The pooled mean days to RTS ranged from 23-93 d. The overall RTW rate was 89%. The pooled mean time to RTW ranged from 5.8-8.1 d. For patients with chronic ankle instability, higher preoperative motivation was the sole factor significantly and independently (P = 0.001) associated with the rate of and time to RTS following ligament repair or reconstruction. Higher body mass index was identified as a significant factor (P = 0.04) linked to not resuming sports or returning at a lower level (median 24, range 20-37), compared to those who resumed at the same or higher level (median 23, range 17-38). Patients with a history of psychological illness or brain injury, experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains. The extent of the delayed rehabilitation was directly proportional to the increased likel
背景脚踝外侧扭伤是下肢最常见的创伤性肌肉骨骼损伤,发病率为 15%-20%。高发病率和高患病率凸显了这种损伤对经济的影响。踝关节扭伤因其高发率和高额医疗费用而造成沉重的社会经济负担。多达 40% 的踝关节扭伤患者会发展成慢性踝关节不稳定。慢性不稳可导致长期疼痛、活动不便和损伤复发。找出影响外侧踝关节扭伤(LAS)后重返工作岗位(RTW)和重返运动场地(RTS)的因素,可能有助于大幅降低医疗成本。目的 探讨哪些因素可能会影响外侧踝关节扭伤后的恢复工作和恢复运动。方法 系统检索 EMBASE 和 PubMed 上截至 2023 年 6 月发表的相关研究。纳入标准如下(1) 损伤包括 LAS 或慢性踝关节不稳;(2) 描述了任何形式的治疗;(3) 对 RTW 或 RTS 进行了评估;(4) 以英语发表的研究;(5) 研究设计包括随机对照临床试验、临床试验或队列研究。排除标准包括(1) 涉及儿童(年龄小于 16 岁)的研究;或 (2) 除外侧踝关节韧带损伤外,还合并有踝关节损伤的患者。我们使用既定的偏倚风险工具对每项纳入研究进行了质量评估。此外,如果定量分析中包含结果,则使用 GRADEpro 工具对证据质量进行评估。对定性结果分析进行了最佳证据综合。对于所有适合定量分析的研究结果,均绘制了森林图,以计算对 RTW 和 RTS 的影响。结果 21 项研究共纳入了 8904 名患者,其中包括 10 项随机对照试验、7 项回顾性队列研究和 4 项前瞻性队列研究。其中 15 项研究符合荟萃分析条件。所有治疗方法和手术治疗方法的总RTS率分别为80%和83%。总体复工率为 89%。对于慢性踝关节不稳的患者来说,术前动机越高是唯一一个与韧带修复或重建后的RTS率和RTS时间显著且独立相关的因素(P = 0.001)。与恢复到相同或更高水平的患者(中位数为23,范围为17-38)相比,体重指数较高是与不恢复运动或恢复到较低水平(中位数为24,范围为20-37)相关的一个重要因素(P = 0.04)。有心理疾病或脑损伤病史的患者在骨折扭伤和不明扭伤的康复过程中会出现延迟。康复延迟的程度与踝关节扭伤复发的可能性增加以及与踝关节相关的就诊次数成正比。我们还观察到,10% 的运动员在外侧踝关节扭伤但没有骨折的情况下重返运动场,他们所描述的未重返运动场的原因与踝关节无关。结论 所有治疗方法的效果相当,每种治疗方法都可能具有独特的优势或益处。术前动机可能会影响 LAS 术后的康复。由于纳入的患者之间缺乏可比性,因此无法对影响较大的因素进行分级。
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引用次数: 0
Transient elastography (FibroScan) in critical care: Applications and limitations 重症监护中的瞬态弹性成像(FibroScan):应用和局限性
Pub Date : 2023-12-18 DOI: 10.13105/wjma.v11.i7.340
Sahil Kataria, D. Juneja, O. Singh
FibroScan® is a non-invasive device that assesses the ‘hardness’ (or stiffness) of the liver via the technique of transient elastography. Because fibrous tissue is harder than normal liver, the degree of hepatic fibrosis can be inferred from the liver hardness. This technique is increasingly being employed to diagnose liver fibrosis, even in critically ill patients. It is now being used not only for diagnosis and staging of liver cirrhosis, but also for outcome prognostication. However, the presence of several confounding factors, especially in critically ill patients, may make interpretation of these results unreliable. Through this review we aim to describe the indications and pitfalls of employing FibroScan in patients admitted to intensive care units.
FibroScan® 是一种无创设备,可通过瞬态弹性成像技术评估肝脏的 "硬度"(或刚度)。由于纤维组织比正常肝脏更硬,因此可以从肝脏硬度推断肝纤维化的程度。这项技术越来越多地被用于诊断肝纤维化,甚至是重症患者。现在,它不仅被用于肝硬化的诊断和分期,还被用于预后判断。然而,由于存在多种混杂因素,尤其是在危重病人身上,这些结果的解释可能并不可靠。通过这篇综述,我们旨在描述在重症监护病房住院患者中使用纤维扫描的适应症和误区。
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引用次数: 0
Comprehensive analysis of sodium polystyrene sulfonate-induced colitis: A systematic review 全面分析聚苯乙烯磺酸钠诱发的结肠炎:系统综述
Pub Date : 2023-12-18 DOI: 10.13105/wjma.v11.i7.351
Gabriel Peixoto Aver, Guilherme Ferreira Ribeiro, V. R. Ballotin, Francisco Souza dos Santos, L. G. Bigarella, F. Riva, Eduardo Brambilla, Jonathan Soldera
BACKGROUND Sodium polystyrene sulfonate (SPS) is commonly prescribed for the management of hyperkalemia, a critical electrolyte imbalance contributing to over 800000 annual visits to emergency departments. AIM To conduct a systematic review of documented cases of SPS-induced colitis and assess its associated prognosis. METHODS Following the PRISMA-P guidelines, our study employed Medical Subject Headings and Health Sciences Descriptors, skillfully combined using Boolean operators, to conduct comprehensive searches across various electronic databases, including Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase, and Opengray.eu. Language criteria were confined to English, Spanish, and Portuguese, with no limitations on the publication date. Additionally, we manually scrutinized the reference lists of retrieved studies. To present our findings, we utilized simple descriptive analysis. RESULTS Our search strategy yielded a total of 442 references. After rigorous evaluation, we included 51 references, encompassing 59 documented cases of colitis. Predominant clinical presentations included abdominal pain, observed in 35 (60.3%) cases, and bloating, reported in 18 (31%) cases. The most frequently affected sites of inflammation were the cecum, rectum, and small intestine, accounting for 31%, 25.8%, and 22.4% of cases, respectively. Colonoscopy findings were described in 28 (48.2%) cases, and 29 (50%) of patients required surgical intervention. Among the subset of patients for whom outcome data was available, 39 (67.2%) experienced favorable outcomes, while 12 (20.6%) unfortunately succumbed to the condition. The mean time required for resolution was 36.7 d, with a range spanning from 1 to 120 d. CONCLUSION SPS demonstrates the capacity to effectively lower serum potassium levels within 24 h. However, this benefit is not without the risk of bowel injury. Our study highlights the absence of high-quality data pertaining to the incidence of adverse events associated with SPS usage, making it challenging to determine whether the potential risks outweigh the benefits. However, a significant mortality rate related to SPS-induced colitis was noted. Future investigations should prioritize randomized controlled trials with a sufficiently large patient cohort to ascertain the true utility and safety profile of this medication.
背景 聚苯乙烯磺酸钠(SPS)是治疗高钾血症的常用处方药,高钾血症是一种严重的电解质失衡,每年导致 80 多万人到急诊科就诊。 目的 对 SPS 引起的结肠炎病例进行系统回顾,并评估其相关预后。 方法 按照 PRISMA-P 指南,我们的研究采用了医学主题词和健康科学描述符,并巧妙地结合使用布尔运算符,在各种电子数据库中进行了全面检索,包括 Scopus、Web of Science、MEDLINE (PubMed)、BIREME (Biblioteca Regional de Medicina)、LILACS (Latin American and Caribbean Health Sciences Literature)、SciELO (Scientific Electronic Library Online)、Embase 和 Opengray.eu。语言标准仅限于英语、西班牙语和葡萄牙语,出版日期不限。此外,我们还人工仔细检查了检索到的研究的参考文献列表。为了呈现研究结果,我们采用了简单的描述性分析。 结果 我们的检索策略共获得 442 篇参考文献。经过严格评估,我们纳入了 51 篇参考文献,其中包括 59 例有记录的结肠炎病例。主要临床表现包括腹痛(35 例,占 60.3%)和腹胀(18 例,占 31%)。最常受影响的炎症部位是盲肠、直肠和小肠,分别占 31%、25.8% 和 22.4%。28例(48.2%)病例有结肠镜检查结果,29例(50%)患者需要手术治疗。在有结果数据的患者子集中,39 例(67.2%)患者的结果良好,而 12 例(20.6%)患者不幸病逝。SPS 能在 24 小时内有效降低血清钾水平。我们的研究突出表明,缺乏与使用 SPS 相关的不良事件发生率的高质量数据,因此很难确定潜在风险是否大于益处。不过,我们注意到与 SPS 引起的结肠炎相关的死亡率很高。未来的研究应优先考虑进行随机对照试验,以足够大的患者群来确定这种药物的真正效用和安全性。
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引用次数: 0
Burnout syndrome and anxiety among healthcare workers during global pandemics: An umbrella review 全球流行病期间医护人员的职业倦怠综合征和焦虑:综述
Pub Date : 2023-12-18 DOI: 10.13105/wjma.v11.i7.368
Clayton Yang Teng Bey, Jin-Uu Koh, Christopher Wai Keung Lai
BACKGROUND Burnout syndrome and anxiety are two mental health symptoms experienced by healthcare workers (HCWs) that can be exacerbated during pandemics due to increased job demands and the global health workforce crisis. AIM To provide a comprehensive review and summary of evidence on burnout and anxiety in HCWs during previous global pandemics. METHODS A systematic search on electronic databases such as PubMed Central and MEDLINE was conducted to identify high-quality systematic review studies that reported on the prevalence of burnout and/or anxiety in HCWs during any previous global pandemic. RESULTS Twenty-four high quality systematic review articles were found to be suitable for inclusion. Twenty articles focused merely on Coronavirus disease 2019, while four articles examined multiple pandemics. Burnout was examined in nine articles, while anxiety was examined in the remaining 21 articles. Female HCWs and nurses were identified to be at a higher risk of developing burnout and anxiety during pandemic. We also observed a variation in the prevalence of burnouts and anxiety across different studies due to different mental health instruments were used in different studies. CONCLUSION Nurses and females HCWs had a high prevalence of burnout syndrome and anxiety during pandemic. More emphasis and attention should be paid to safeguarding the psychological well-being of these at-risk populations in the future pandemics.
背景倦怠综合征和焦虑是医护人员(HCWs)经历的两种心理健康症状,在流行病期间,由于工作要求的增加和全球卫生劳动力危机,这两种症状可能会加剧。 目的 全面回顾和总结以往全球大流行期间医护人员职业倦怠和焦虑的相关证据。 方法 对 PubMed Central 和 MEDLINE 等电子数据库进行了系统性检索,以确定高质量的系统性综述研究,这些研究报告了以往任何一次全球大流行期间医护人员职业倦怠和/或焦虑的发生率。 结果 发现有 24 篇高质量的系统性综述文章适合纳入研究。20 篇文章仅关注了 2019 年冠状病毒疾病,4 篇文章研究了多种流行病。9篇文章研究了职业倦怠问题,其余21篇文章研究了焦虑问题。研究发现,女性医护人员和护士在大流行期间出现职业倦怠和焦虑的风险较高。由于不同的研究使用了不同的心理健康工具,我们还观察到不同研究中职业倦怠和焦虑的发生率存在差异。 结论 护士和女性人道主义工作者在大流行期间的职业倦怠综合征和焦虑症发生率较高。在未来的大流行中,应更加重视和关注这些高危人群的心理健康。
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引用次数: 0
Evidence relating cigarettes, cigars and pipes to cardiovascular disease and stroke: Meta-analysis of recent data from three regions 香烟、雪茄和烟斗与心血管疾病和中风有关的证据:对三个地区最新数据的元分析
Pub Date : 2023-09-18 DOI: 10.13105/wjma.v11.i6.290
Peter Nicholas Lee, K. J. Coombs, Jan S Hamling
Neoplasms can be considered as a group of aberrant cells that need more vascular supply to fulfill all their functions. Therefore, they promote angiogenesis through the same neovascularization pathway used physiologically. Angiogenesis is a process characterized by a heterogeneous distribution of oxygen caused by the tumor and oxidative stress; the latter being one of the most powerful stimuli of angiogenesis. As a result of altered tumor metabolism due to hypoxia, acidosis occurs. The angiogenic process and oxidative stress can be detected by measuring serum and tissue biomarkers. The study of the mechanisms underlying angiogenesis and oxidative stress could lead to the identification of new biomarkers, ameliorating the selection of patients with neoplasms and the prediction of their response to possible anti-tumor therapies. In particular, in the treatment of patients with similar clinical tumor phenotypes but different prognoses, the new biomarkers could be useful. Moreover, they may lead to a better understanding of the mechanisms underlying drug resistance. Experimental studies show that blocking the vascular supply results in antiproliferative activity in vivo in neuroendocrine tumor cells, which require a high vascular supply.
肿瘤可被视为一组异常细胞,它们需要更多的血管供应来实现其所有功能。因此,它们会通过与生理学上相同的新生血管生成途径促进血管生成。血管生成过程的特点是由肿瘤和氧化应激引起的氧气分布不均;氧化应激是血管生成的最强刺激因素之一。由于缺氧导致肿瘤新陈代谢改变,酸中毒也随之发生。血管生成过程和氧化应激可通过测量血清和组织生物标记物来检测。研究血管生成和氧化应激的内在机制可以确定新的生物标志物,从而更好地选择肿瘤患者,并预测他们对可能的抗肿瘤疗法的反应。特别是,在治疗临床肿瘤表型相似但预后不同的患者时,新的生物标志物可能非常有用。此外,新的生物标志物还能帮助人们更好地了解抗药性的内在机制。实验研究表明,阻断血管供应可在体内对需要大量血管供应的神经内分泌肿瘤细胞产生抗增殖活性。
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引用次数: 0
期刊
World Journal of Meta-Analysis
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