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Background: Previous studies have shown inconclusive effects of target organ damage from white-coat hypertension (WCHT). Arterial stiffness is involved in the atherosclerotic processes in the setting of sustained hypertension. This meta-analysis aimed to compare arterial stiffness in subjects with diagnosis of WCHT to subjects with normotension (NT) and SHT. Methods: A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through May 2016. The inclusion criterion was the observational studies’ assessment of the association between WCHT and NT or SHT in adult subjects. European Society of Hypertension practice guidelines for ambulatory blood pressure (BP) monitoring was used to define WCHT (office BP≥140/90mmHg and daytime BP Results: Data were extracted from 4 observational studies involving 2,413 subjects. PWV is not different in patients with WCHT compared with SHT (pooled MD= -0.25 m/sec; 95% CI, -0.81 to 0.30; P-value=0.37, I 2 =74%). PWV in WCHT is also not different when compared with PWV in NT (MD= 0.86 m/sec; 95% CI, -0.30 to 2.03; P-value=0.15, I 2 =97%). Conclusion: In a meta-analysis, we observe that arterial stiffness measured by pulse wave velocity is not different in patients with white-coat hypertension when compared with sustained hypertension or normotension.

Background: Whether nonalcoholic fatty liver disease (NAFLD) is related to subclinical artherosclerosis is unclear. Coronary artery calcium scanning (CAC) is the robust predictor of coronary events in the asymptomatic individuals. Several recent studies have investigated the association between NAFLD and this surrogate marker. Thus, we conducted a systematic review and meta-analysis to better characterize the association between NAFLD and CAC. Methods: A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through May 2016. The inclusion criterion was the observational studies’ assessment of the association between NAFLD and CAC in adult subjects. Pooled odds ratio (OR) and 95% confidence interval (CI) from multivariate model with confounders adjustment were calculated using a random-effect, generic inverse variance method. The between-study heterogeneity of effect-size was quantified using the Q statistic and I 2 . Results: Data were extracted from 15 studies (all cross-sectional studies) involving 35,409 subjects. NAFLD is significantly associated with CAC > 0 and CAC > 100 with pooled OR of 1.41 (95% CI 1.24-1.61, P heterogeneity = 0.01, I 2 =57%) (Figure 1) and 1.24 (95% CI 1.02-1.52, P heterogeneity = 0.09, I 2 =42%). The association between NAFLD and CAC > 0 was stronger in women than men (P between sex = 0.017). Conclusions: NAFLD is also associated with coronary calcification independent of traditional risk factors, obesity and metabolic syndrome in asymptomatic individuals and this association was appeared to be stronger in women.

Background: Studies have shown that patients with psoriasis have higher risk of CVD, independent of traditional CVD risk factors. However, pathophysiology of the development of CVD in psoriasis is not well known. Arterial stiffness has been recognized as an independent predictor of cardiovascular risk. It is controversial whether psoriasis and arterial stiffness is associated. In this systematic review and meta-analysis, we sought to assess the hypothesis that patients with psoriasis have increased arterial stiffness compared with controls. Methods: Systematic literature search was performed using MEDLINE and EMBASE databases from inception to May 2016. We included original research publications that contained data on arterial stiffness and psoriasis. Aortic pulse wave velocity (aPWV) is the non-invasive marker for assessment of arterial stiffness. We compared aPWV between patients with psoriasis and controls and estimated the pooled mean difference (MD) and 95% confidence interval (CI) of aPWV using a random-effects model meta-analysis. Results: Data from five observational studies involving 438 participants (233 with psoriasis) were extracted and included in the meta-analysis. Pooled MD of aPWV was 1.17 m/sec higher in patients with psoriasis compared with controls (95% CI: 0.78-1.55, P-value2 = 69%). There is no change in the direction or statistical significance of MD of aPWV after removing each study at a time in the sensitivity analysis. Conclusion: Psoriasis is associated with increased arterial stiffness. Assessment of arterial stiffness parameters may be important for early detection of cardiovascular deterioration in psoriasis patients.

Context: Hypoxia reduces osteoblast growth resulting in bone thinning and osteoporosis. Although obstructive sleep apnea (OSA) with recurrent hypoxia might be a contributing factor for osteoporosis development, whether OSA is a risk or protective factor for osteoporosis has not been demonstrated. Objectives: This systematic review and meta-analysis evaluated the association between OSA and osteoporosis using published observational studies. Data Sources: PubMed/MEDLINE and EMBASE databases Study Selection: We completed a systematic review and meta-analysis of published observational studies that evaluated incidence or prevalence of osteoporosis or bone mineral density in obstructive sleep apnea compared with controls. Severity of OSA was char- acterized using the apnea-hypopnea index (AHI). Data Extraction: Primary outcomes were incidence, prevalence, or odds ratio of having osteoporosis, defined as bone mineral density T-score < -2.5 SD. Results: Of 353 articles, 344 articles were excluded, 9 underwent full-length review and data were extracted from 7 studies consisting of 113,558 patients. Finally, 3 extracted studies were included in the meta-analysis of osteoporosis. Among cohort studies, the pooled odds ratio of osteoporosis in patients with OSA was 1.92 (95% confidence interval (CI): 1.24 - 2.97) compared with controls. Among cross-sectional studies, odds of osteoporosis was higher in controls compared with patients with OSA (OR = 0.60, 95% CI: 0.42 - 0.87). In subgroup analysis by gender and study design, in both sexes, only cohort studies had higher odds of osteoporosis compared with controls. Conclusions: There was significant association between OSA and osteoporosis in studies with cohort design. Further prospec- tive studies with large numbers of patients adjusted for the eects of age, sex, or BMI are required to comprehensively determine whether OSA is a risk factor for osteoporosis.

To determine if the reduction of visceral adipose tissue (VAT) volume by lifestyle intervention improved risk factors for cardiovascular disease (CVD) independent of weight loss amount.Ancillary study of randomized-controlled trial.Data analysis using multivariable regression models.Participants of the Look AHEAD (Action for HEAlth in Diabetes) Fatty Liver Ancillary Study.Correlations between changes in VAT and in CVD risk factors, while adjusting for weight loss and treatment (intensive lifestyle intervention [ILI] vs. diabetes support and education [DSE]).Of 100 participants analyzed, 52% were women, and 36% were black, with a mean age of 61.1 years. In the DSE group, mean weight and VAT changed by 0.1 % (p=0.90) and 4.3% (p=0.39), respectively. In the ILI group, mean weight and VAT decreased by 8.0% (p0.001) and 7.7% (p=0.01), respectively. Across both groups, mean weight decreased by 3.6% (p0.001), and mean VAT decreased by 1.2% (p=0.22); the decrease in VAT was correlated with the increase in HDL-cholesterol (HDL-C; R=-0.37; p=0.03). There were no correlations between changes in VAT and blood pressure, triglycerides, LDL-C, glucose, or HbA1c. After adjusting for age, race, gender, baseline metabolic values, fitness, and treatment group, changes in HDL-C were not associated with changes in VAT, while weight changes were independently associated with decrease in glucose, HbA1c, and increase in HDL-C.VAT reduction was not correlated with improvements of CVD risk factors in a sample of overweight and obese adults with type 2 diabetes after adjusting for weight loss.

Background Nonalcoholic fatty liver disease (NAFLD) is associated increased cardiovascular events and mortality. Coronary artery calcium scanning (CAC) is the robust predictor of coronary events in the asymptomatic individuals. Several recent studies have investigated the association between NAFLD and this surrogate marker. Thus, we conducted a systematic review and meta-analysis to better characterize the association between NAFLD and CAC. Methods MEDLINE and EMBASE were searched through May 2016. Primary outcome was the association between NAFLD and CAC. Pooled odds ratio (OR) and 95% confidence interval (CI) from multivariable-adjusted estimates were calculated using a random-effects model. The between-study heterogeneity of effect-size was quantified using the Q statistic and I 2 . Results Data were extracted from 16 studies (all cross-sectional studies) involving 16,433 NAFLD patients and 41,717 controls. NAFLD is significantly associated with CAC score >0 and CAC score >100 with pooled OR of 1.41 (95%CI 1.26–1.57, P heterogeneity = 0.07, I 2 = 66%) and 1.24 (95%CI 1.02–1.52, P heterogeneity = 0.10, I 2 = 42%). Conclusions NAFLD is associated with increased coronary artery calcification independent of traditional risk factors. The assessment of coronary artery calcium may be useful in identifying NAFLD patients at risk of future cardiovascular events.

Objectives: Gallstone disease shares certain risk factors with cardiovascular disease, particularly metabolic risk factors. Patients with gallstone disease may be at increased risk of cardiovascular disease. Several recent studies exploring the effect of gallstone disease on cardiovascular disease outcomes demonstrated inconsistent results. Design: We conducted a systematic review and meta-analysis of cohort, case–control, and cross-sectional studies that compared the risk of developing cardiovascular disease events in patients with gallstone disease versus non-gallstone disease controls. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the pooled hazard ratio, odd ratio, and 95% confidence interval. Results: Data were extracted from six studies involving 176,734 cases and 803,714 controls. The pooled hazard ratio of cardiovascular events in patients with gallstone disease was 1.28 (95% confidence interval: 1.23–1.33, I2 = 42%). The pooled odd ratio of cardiovascular events in patients with gallstone disease was 1.82 (95% confidence interval: 1.47–2.24, I2 = 68%). Conclusions: Our study demonstrated a statistically significant increase in the risk of cardiovascular disease among patients with gallstone disease.

Background and Aim Diverticular disease and colorectal neoplasia are common digestive disorders worldwide. Both diseases share epidemiological trends and certain risk factors including advancing age, physical inactivity, and Western diet and lifestyle. Studies assessing the association between these diseases reported inconsistent results. Thus, we conducted a systematic review and meta-analysis to determine the association between diverticular disease and colorectal adenomas, advanced adenomas and cancer. Methods A comprehensive search of the databases MEDLINE and EMBASE was done from inception through March 2016. Inclusion criterion was the observational studies’ assessment of the association between diverticular disease and colorectal neoplasia in adult participants. Pooled OR and 95% confidence interval (CI) were calculated using a random effect. Results Data were extracted from 14 observational studies (11 cross-sectional studies, one case–control study and two cohort studies). Diverticular disease was associated with increased odds of adenomas (OR = 1.67, 95% CI 1.27–2.21, 10 studies), but not associated with advanced adenomas (OR = 1.19, 95% CI 0.88–1.62, I2 = 52%, four studies) or colorectal cancer (OR = 1.36, 95% CI 0.47–3.92, I2 = 98%, seven studies). Conclusions Our meta-analysis demonstrated that diverticular disease was associated with colorectal adenomas. Colonoscopists should be aware of this association and carefully examine the entire large bowel in individuals with diverticulosis.

Systemic autoimmune disorders may interfere with normal reproductive function resulting in negative outcome of pregnancy. Primary Sjogren’s syndrome (pSS) is a common rheumatic disease that mostly affects females. There are many reports that this condition may increase risk of pregnancy complications and fetal loss. However, data regarding these adverse outcomes are scarce and inconclusive. We performed a systematic review and meta-analysis of available articles that assess the association between pSS and adverse pregnancy outcome. We comprehensively searched the databases of MEDLINE and EMBASE from their dates of inception to March 2016 and reviewed papers with validity criteria. A random-effects model was used to evaluate pregnancy complications in patients with pSS and healthy controls. From 20 full-text articles, 7 studies involving 544 patients and 1586 pregnancies were included in the meta-analysis. Fetal complications included spontaneous abortion, stillbirth, neonatal deaths, and intrauterine growth retardation. Compared with healthy pregnancy, patients with pSS had significantly higher chance of neonatal deaths (pooled odds ratio (OR) = 1.77, 95 % confidence interval (CI) 1.28 to 1.46, p = 0.01). However, there were no significant associations between pSS and premature birth (OR = 2.10, 95 % CI 0.59–7.46, p = 0.25), spontaneous abortion (OR = 1.46, 95 % CI 0.72–2.93, p = 0.29), artificial abortion (OR = 1.12, 95 % CI 0.52–2.61, p = 0.71), or stillbirth (OR = 1.05, 95 % CI 0.38–2.97, p = 0.92). There is an increased risk of fetal loss in pregnant patients with pSS. The presented evidence further supports multidisciplinary care for these patients to prevent complications during pregnancy.

Summary Background/objectives Hepatitis C virus (HCV) infection is a major cause of cirrhosis worldwide. Several studies have linked HCV infection to a higher risk of developing intrahepatic cholestasis of pregnancy (ICP), but some data demonstrates contradictory results. To further investigate the association and estimated risk of ICP in patients with HCV infection, we conducted this meta-analysis to summarize all available evidence. Methods This study consists of two meta-analyses. A literature search was performed using MEDLINE and EMBASE from inception to January 2016. The first study included observational studies that reported relative risks, odds ratios, or hazard ratios of the associations between HCV infection and risk of ICP. The second analysis included studies comparing the risk of later HCV infection in ICP patients with those without ICP. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effect, generic inverse variance method. Results Three studies were included in the first analysis. The pooled OR of ICP in HCV-infected pregnant women compared to non-HCV pregnant women was 20.40 (95% CI, 9.39–44.33, I 2 = 55%). Two studies were included in the second analysis. The pooled OR of later HCV infection among ICP patients compared to non-ICP patients was 4.08 (95% CI, 3.13–5.31, I 2 = 0%). Conclusions Our meta-analysis demonstrates not only a higher risk of ICP among HCV-infected pregnant women but also an increased risk of later HCV infection among ICP patients. These findings suggest potential benefits of screening for hepatitis C in women with signs of ICP.

Background: Previous studies have suggested that osteoporosis and coronary heart disease have shared common risk factors. Some studies also suggested that low bone mineral density (BMD) also increased risk of peripheral vascular disease (PVD) or stroke. However, few longitudinal studies did not find significant association between these two conditions. We performed a systematic review and meta-analysis to explore association between low BMD and risk of PVD or stroke from prospective studies. Methods: We comprehensively searched the databases of PubMed/MEDLINE, EMBASE, and Cochrane Databases from their dates of inception to December 2015. The inclusion criteria were published prospective observational studies of PVD, stroke, BMD, osteoporosis, or fractures. Two authors independently assessed the quality of the articles and extracted the data. The primary outcome of interest was risk of new PVD or stroke events comparing between low BMD and normal BMD groups. Results: From 36 full-text articles, five observational studies involving 3,287 participants were included in the meta-analysis based on the random-effects model. There was increased risk of new peripheral vascular disease or stroke events in groups with low BMD compared with normal BMD controls with pooled hazard risk (HR) of 3.10 (95% CI: 1.32-7.23). In the subgroup analysis of fracture as a risk factor, there was no significant difference in risk of PVD or stroke in group with pooled HR of 1.17 (95% CI: 0.78-1.75). Conclusions: Low BMD is associated with increased risk of PVD and stroke from the meta-analysis of prospective observational studies. Clinicians should be aware of the close association between these two conditions. Early identification of PVD in patients with low BMD should be performed.

Vitamin D deficiency increases risk of cardiovascular diseases, arterial stiffness, and endothelial dysfunction. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the impact of vitamin D supplementation on arterial stiffness.A comprehensive search of the databases of the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE was performed from inception through November 2015. The inclusion criterion was RCTs that assessed the impact of cholecalciferol supplementation in adults on the surrogate markers of arterial stiffness (aortic pulse wave velocity (PWV) and augmentation index (AIx)). Outcome was the pooled mean difference (MD) of PWV and AIx between the vitamin D supplementation (intervention) group and placebo.The initial search yielded 1164 articles. Twenty-eight articles underwent full-length review and data were extracted from seven RCTs involving totally 547 participants. Dose of cholecalciferol supplementation varied from 1000 IU/day to 120,000 IU/month of cholecalciferol. Duration of treatment ranged from 2 to 12 months. There was no significant difference in the change of PWV (pooled MD = 0.18, 95% CI: -0.17 to 0.52 or AIx (pooled MD = 2.39, 95% CI: -4.43 to 4.92) between the intervention group and placebo.There was no improvement of markers of arterial stiffness after vitamin D supplementation.

SummaryBackground Vitamin D deficiency is associated with a number of autoimmune diseases. We completed a meta-analysis of observational studies to establish whether there was a relationship between hypovitaminosis D and the autoimmune skin disease vitiligo. Methods Comprehensive search was applied in the MEDLINE and EMBASE databases from their inception to December 2015. Inclusion criteria were observational studies that assessed 25-hydroxyvitamin D (25(OH)D) levels in adults with vitiligo. The main outcome was the mean difference in serum 25(OH)D level between patients with vitiligo and controls. Results Our search strategy identified 383 articles; seventeen studies met the criteria for full-length review and seven studies, containing the data of 1200 patients, were included in a random-effects model meta-analysis. The pooled mean difference in serum 25-hydroxyvitamin D concentration between patients with vitiligo and controls was −7.45 ng/ml (95% confidence interval, −12.99 to −1.91, P-value = 0.01). The between-study heterogeneity (I2) was 96%, P = value

Current approaches to determine the cause of acute kidney injury (AKI) in patients with cirrhosis are suboptimal. The aim of this study was to determine the utility of fractional excretion of urea (FEUrea) for the differential diagnosis of AKI in cirrhotic patients. A retrospective analysis was performed in patients (n=50) with cirrhosis and ascites admitted with AKI. Using adjudicated etiology assessment as the reference standard, receiver operating curves (ROC) and optimal cutoff, sensitivity (Sn) and specificity (Sp) for the diagnosis of prerenal azotemia (PRA), type 1 hepatorenal syndrome (HRS) and acute tubular necrosis (ATN) was derived. Validation was performed in an independent cohort (n=50) and by bootstrap analysis. The causes of AKI (derivation:validation cohorts) were: PRA 21:21, HRS 18:15, ATN: 11:14. Median FEUrea were statistically different across all etiologies of AKI in the derivation cohort (PRA 30.1 vs HRS 20.2 vs ATN 43.6, p=

Introduction Both estrogen and testosterone are important in maintaining bone health. It is known that those in the transsexual population undergo significant changes in their body composition and bone mass due to the hormonal changes, either from male-to-female or female-to-male after sex reassignment surgery. Objective This meta-analysis aimed to explore the bone mineral changes in transsexual female individuals before and after following either genital reassignment surgery or cross-sex hormonal therapy or both. We additionally performed a systemic review of the bone mineral change in transsexual male individuals. Method A comprehensive search of the MEDLINE and EMBASE databases was performed from inception through October 2017. The inclusion criterion was observational studies evaluating the bone mineral density change in transsexual persons. The pooled mean difference (MD) of bone mineral density (BMD) and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare the changes between transsexual persons and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. Result Data were extracted from 5 observational studies involving 322 subjects. Pooled results from trans women compared to age-matched male controls demonstrated a statistically significant lower BMD at the lumbar spine (MD= -0.08; 95% CI: -0.14 to -0.01, p-value=0.02, I2 =87%) and hip (MD= -0.16; 95% CI: -0.20 to -0.12, p-value Conclusion To the best of our knowledge, this is the first systematic review and meta-analysis investigating the bone mineral density change in transsexual persons. We found a statistically significant decrease in BMD at hip and spine among transsexual female individuals compared to the male control groups. The result of our meta-analysis suggested that low bone mineral density could be found in transsexual female individuals.

Objective Studies have shown that the association between weight and BMD is primarily due to lean mass. Our objective was to determine whether the age-related decline in BMD was associated with changes in body composition (lean/fat mass) and whether it is influenced by sex and race/ethnicity. Study design This is a cross-sectional study of 76,780 adult participants (age 20-85 years) from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 who had whole body dual energy X-ray absorptiometry (DXA) that provided soft tissue measurements for the total body lean and fat mass and bone measurements for the lumbar spine (LS), total hip (TH) and femoral neck (FN). We performed a multivariate linear regressions stratified by sex with BMD of the 3 skeletal sites as outcome, age as predictor and total body lean and fat mass, and race categories [African American (AA), Caucasian American (CA) and Mexican American (MA)] as covariates. For all data presented p-values were Results In both sexes and across age groups BMD was higher in AA than in other groups. In males, LS BMD did not change significantly with age. TH BMD was stable until age 40 and declined thereafter at a rate of approximately 5% per five years. There was a positive correlation between decline in BMD and lean mass (3% decrease in BMD per 10 kg decrease in lean mass), while adding fat mass did not have significant effect. Findings were similar at the FN (3.3% decrease in BMD per 10 kg decrease in lean mass) but the decline started at age 20. In females, the rate of decline in BMD and lean mass did not differ between perimenopause (45-60 years) and post menopause (over 60 years). LS did not change significantly with age. TH BMD was stable until age 45 and declined thereafter at a rate of approximately 5.1% per five years. There was a positive correlation between the decline in BMD and lean mass (3.2% decrease in BMD per 10 kg decrease in lean mass), while adding fat mass did not have a significant effect. The observation was similar in FN with approximately 5% decrease in BMD per five years after age 45 and 3.5% decrease in BMD per 10 kg decrease in lean mass. Conclusion Decline in BMD with age was associated with the decrease in lean mass in both sexes and all 3 racial/ethnic groups. Based on this cross-sectional study we cannot determine whether the decline in lean mass causes decrease in BMD or whether the reduction in both BMD and lean mass are due to other factors associated with aging. Nevertheless, when designing interventions for optimizing bone health in the elderly it may be prudent to preferentially consider those that also improve total body lean mass.

Hyponatremia is the most common electrolyte disorder. Recent research shows that it may associate with osteoporosis and fracture. However, whether it directly associates or is a surrogate marker of other causes is still unclear.To explore the hypothesis of an association of osteoporosis or fracture with hyponatremia.MEDLINE and EMBASE databases from inception to October 2015.The inclusion criteria were published studies evaluating bone mineral density, risk or prevalence of osteoporosis or fracture in patients with hyponatremia.Both authors independently reviewed titles and abstracts of all citations that were identified.A meta-analysis using a random-effects model comparing between hyponatremia and normal serum sodium groups was performed. We calculated pooled mean difference in bone mineral density, pooled hazard ratio (HR) or odds ratio (OR) of fracture and osteoporosis. Factors that may predict these associations were evaluated in subgroup analysis and meta-regression. From 29 full-text articles, 15 observational studies involving 212 889 participants met our inclusion criteria. Twelve studies were included in the meta-analysis. There was a significant association with fracture and osteoporosis in patients with hyponatremia with OR of fracture = 1.99 (95% confidence interval, 1.50–2.63; p.001) for studies that reported OR, and increase risk of fracture with HR = 1.62 (95% confidence interval, 1.28–2.05; P.001) for studies that reported HR.Hyponatremia significantly associates with osteoporosis and fracture. More prospective studies evaluating osteoporosis and fracture risk reduction after hyponatremia correction should be performed.

Many studies have found an association between abnormal body mass index (BMI) and poor outcomes among lung transplant recipients. We performed a systematic review and meta-analysis to identify outcomes associated with an abnormal pretransplant BMI after lung transplantation (LTx). The MEDLINE and EMBASE databases were searched from inception to May 2015 with focus on original observational studies with post-transplant survival data in candidates with abnormal BMI (underweight, overweight, or obese). We performed meta-analyses examining survival and primary graft dysfunction after LTx. We identified 866 citations; 13 observational cohort studies involving 40 742 participants met our inclusion criteria for systematic review. Seven of the 13 were included in the meta-analysis. There was a significant risk of mortality after LTx in candidates with underweight and obesity (underweight versus normal, relative risk [RR] 1.36, 95% confidence interval [CI] 1.11-1.66, I(2) = 0%; obesity vs. normal, RR 1.90, 95% CI 1.45-2.56, I(2) = 0%; overweight vs. normal, RR 1.36, 95% CI 1.11-1.66, I(2) = 0). There was also a significant risk of primary graft dysfunction in obese (RR 1.92, 95% CI 1.39-2.65, I(2) = 0%) and overweight (RR 1.72, 95% CI, 1.32-2.24, I(2) = 0%) candidates. Lung transplant candidates who are underweight or obese have a higher risk of post-transplant mortality than recipients with a normal BMI.

Bariatric surgery is found to prevent type 2 diabetes, improve glycemic control, and decrease long-term incidence of microvascular and macrovascular complications in obese persons. However, its effect on urinary albumin excretion (UAE) in patients with diabetic nephropathy (DN) is still unknown. This is a systematic review and meta-analysis of observational studies on bariatric surgery and change in UAE in patients with diabetes.To explore whether there is improvement in UAE after bariatric surgery.We comprehensively searched the databases of MEDLINE, Embase, and Cochrane. The inclusion criteria were published studies evaluating effects of bariatric surgery in patients with DN at baseline. The primary outcome was the pre- and postbariatric surgery UAE as characterized by urinary albumin-to-creatinine ratio and albuminuria. A meta-analysis comparing pre- and postsurgery UAE was performed.From 65 full-text articles, 15 observational studies met our inclusion criteria, and 11 studies were included in the meta-analysis based on the random effects model. There was a significant reduction in urinary albumin-to-creatinine ratio after bariatric surgery with a mean difference of -6.60 mg/g of creatinine (95% CI -9.19 to -4.02; P.001). There was also a reduction in albuminuria with a mean difference of -55.76 mg/24 hours (95% CI -92.11 to -19.41; P.001) after bariatric surgery.Bariatric surgery significantly decreases urinary albumin excretion in DN. However, studies comparing bariatric surgery and conventional or intensive care of diabetes on UAE outcome should be done.

Background A number of observational studies have found an association between low vitamin D levels and risk of sepsis. We conducted a systematic review and meta-analysis to determine the overall estimate of risk. Methods This was a systematic review and meta-analysis conducted by online searches (CENTRAL, PubMed/MEDLINE, and EMBASE) was registered in PROSPERO (CRD42014014767). Primary outcome was incidence, prevalence, relative risk or odds ratio of having sepsis or bloodstream infection between patients with vitamin D deficiency and controls. Results The initial search yielded 647 articles. Twenty-one articles underwent full-length review and data were extracted from 10 observational studies. Pooled odds ratio of sepsis in participants with vitamin D deficiency was 1.78 (95 % confidence interval [CI] = 1.55 to 2.03, p

Objective. Clostridium difficileinfection is a leading cause of nosocomial diarrhea in developed countries. Studies evaluating the associations of increased risk of community-acquired CDAD and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have yielded inconclusive results. We conducted a systematic review and meta-analysis to compare the odds of NSAID exposure in patients with CDAD versus patients without CDAD in both community-based and healthcare-associated settings.Methods.Relevant observational studies indexed in PubMed/MEDLINE and EMBASE up to February 2015 were analyzed and data were extracted from nine studies. Of these, eight studies were included in the meta-analysis.Results.A search of the databases resulted in 987 articles. The nine studies from which data were extracted involved over 39,000 subjects. The pooled odds ratio for history of NSAID use in participants with CDAD compared with controls was 1.41 (95% CI 1.06–1.87;p<0.01), indicating a significant increased odds of CDAD among patients exposed to NSAIDs.Conclusions.To the best of our knowledge, this is the first study of its nature to demonstrate the association between the use of NSAIDs and increased risk of CDAD. Further studies to evaluate if any specific types of NSAIDs can increase the risk of CDAD are warranted.

Background: Metabolic syndrome (Mets) is documented to increase mortality in the general population. However, there are reports of lower mortality in end stage renal disease (ESRD) patients with obesity. We conducted a meta-analysis to determine the association of all-cause and cardiovascular disease (CVD) mortality, and residual renal function with Mets in ESRD subjects. Objectives: PubMed/MEDLINE, EMBASE, and CENTRAL from their inception to September 2014 were comprehensively searched for eligible studies assessing the effects of the metabolic syndrome in ESRD subjects. Inclusion criterion was ESRD participants who had hemodialysis (HD or peritoneal dialysis (PD). Renal transplant subjects were excluded. Two authors independently assessed article quality and extracted the data. The primary outcome was all-cause mortality and secondary outcomes were CVD death and residual renal function. Results: From 23 full-text articles, 7 studies involving 613 (all-cause mortality), 284 (CVD death) and 383 (residual renal function) participants were included in the meta-analysis that was based on the random effects model. Compared with the non-Mets, ESRD subjects with Mets had no significant difference in risk of all-cause mortality (pooled odds ratio= 1.65; 95% CI, 0.86, 3.17) (figure 1) or CVD death (pooled odds ratio= 1.67; 95% CI, 0.75, 3.69). There was also no difference in residual renal function between the two groups with pooled standard mean difference of -0.26 ml/min/1.73 m2 (95% CI: -0.62, 0.10). Conclusion: Metabolic syndrome is not associated with an increased risk of all-cause or CVD mortality in ESRD patients who underwent HD or PD.

Background. Several chronic inflammatory disorders, such as rheumatoid arthritis and idiopathic inflammatory myositis, have been shown to increase risk of ischemic stroke but the data on systemic sclerosis (SSc) remains unclear.Methods. We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of ischemic stroke in patients with SSc versus non-SSc participants. Pooled risk ratio and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird.Results. Four retrospective cohort studies were identified and included in our data analysis. We found a statistically significant elevated ischemic stroke risk in patients with SSc with a pooled risk ratio of 1.68 (95% CI, 1.26–2.24). The statistical heterogeneity was moderate with an I2 of 69%.Conclusions. Our study demonstrated a statistically significant increased ischemic stroke risk among patients with SSc.

Objective: The aim of this study is to compare the prevalence of diabetes mellitus (DM) in patients who are recently diagnosed with giant cell arteritis (GCA) with age- and sex-matched controls. Methods: We conducted a systematic review and meta-analysis of observational studies that (1) consisted of GCA cohort and non-GCA cohort that was randomly selected from the same population and (2) provided prevalences of DM at the time of diagnosis for patients with GCA and at the index date for controls. Pooled odds ratios and 95% confidence intervals (CIs) were calculated using a random-effect, Mantel–Haenszel analysis. Results: Five studies with 903 patients with GCA and 1064 controls were identified and included in our data analysis. We demonstrated a statistically significant lower prevalence of DM among patients with GCA with the pooled OR of 0.74 (95% CI, 0.57–0.97). Conclusion: At diagnosis, patients with GCA had a lower prevalence of DM. Whether DM could be a protective factor against the development of GCA needs further investigations.

Background: HMG CoA reductase inhibitors (statins) are known to prevent cardiovascular disease and improve lipid profiles. However, the effects of statins on renal outcomes, including decline in estimated glomerular filtration rate (eGFR) and proteinuria in patients with chronic kidney disease (CKD), are controversial. This meta-analysis evaluated the impact of statins on renal outcomes in patients with CKD. Materials and Methods: We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane Databases. The inclusion criteria were published RCT and cohort studies comparing statin therapy to placebo or active controls in patients with CKD (eGFR

Psoriasis is a chronic inflammatory disease of the skin with joint manifestations. Greater psoriasis severity and lower response to treatment have been linked to obesity. However, the effect of weight reduction by non-pharmacologic intervention on disease severity is still questionable. This is a systematic review and meta-analysis of randomized controlled trials (RCTs) on the effect of dietary and lifestyle weight loss interventions on psoriasis severity.We comprehensively searched PubMed/MEDLINE, EMBASE and CENTRAL from their inception to August 2014. Inclusion criteria were RCTs that examined lifestyle intervention by diet or exercise in overweight or obese patients with psoriasis and measured the severity of psoriasis as an outcome compared with controls. Two authors independently assessed article quality and extracted the data.Out of 12 full-text articles, 7 RCTs involving 878 participants met our inclusion criteria. Five of these RCTs were included in the meta-analysis, which was based on the random-effects model. There was a greater reduction in the Psoriasis Area Severity Index (PASI) score in patients receiving weight loss intervention than in controls, with a pooled mean difference of -2.49 (95% confidence interval (CI), -3.90 to -1.08; P=0.004). More participants in the intervention group than in the control group achieved a 75% reduction in the PASI score, with a pooled odds ratio of 2.92 (95% CI, 1.39-6.13; P=0.005).Nonpharmacologic, nonsurgical weight loss intervention is associated with reduction in the severity of psoriasis in overweight or obese patients. However, more RCTs with more participants are needed to provide better quality of evidence.

Alcoholic hepatitis (AH) frequently progresses to multiple organ failure (MOF) and death. However, the driving factors are largely unknown. At admission, patients with AH often show criteria of systemic inflammatory response syndrome (SIRS) even in the absence of an infection. We hypothesize that the presence of SIRS may predispose to MOF and death. To test this hypothesis, we studied a cohort including 162 patients with biopsy-proven AH. The presence of SIRS and infections was assessed in all patients, and multivariate analyses identified variables independently associated with MOF and 90-day mortality. At admission, 32 (19.8%) patients were diagnosed with a bacterial infection, while 75 (46.3%) fulfilled SIRS criteria; 58 patients (35.8%) developed MOF during hospitalization. Short-term mortality was significantly higher among patients who developed MOF (62.1% versus 3.8%, P