The Effect of Chia Seed on Blood Pressure, Body Composition, and Glycemic Control: A GRADE-Assessed Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials.

CONTEXT: Numerous studies have demonstrated the positive effects on metabolic factors of consuming chia seeds. However, the results of clinical trials have been inconsistent. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of available randomized controlled trials to explore the effects of chia seed consumption on body weight (BW), body composition, blood pressure, and glycemic control. DATA SOURCES: A comprehensive search was conducted on the Scopus, PubMed, Medline via Ovid, ISI Web of Science, and Scholar Google databases up to August 2023. DATA EXTRACTION: The outcomes of interest included systolic blood pressure (SBP), diastolic blood pressure (DBP), BW, body mass index (BMI), body fat percentage, waist circumference (WC), fasting blood glucose (FBG), and hemoglobin A1c (HbA1c). DATA ANALYSIS: Weighted mean difference (WMD) and 95% CIs were used to determine the effect size. RESULTS: A total of 8 eligible studies were included in the analysis. The findings revealed a significant reduction in SBP (WMD: -7.19 mmHg; 95% CI, -10.63 to -3.73; P < .001) and DBP (WMD: -6.04 mmHg, 95% CI, -9.58 to -2.49; P = .001). However, no significant effects were observed on BW, body fat percentage, WC, BMI, FBG, and HbA1c. Subgroup analysis indicated that the effect of chia seed on SBP was significant in participants with a baseline SBP of less than 140 mmHg, but the effect was not dependent on the administered dose. CONCLUSION: Chia seed consumption has positive effects on SBP and DBP but does not significantly impact BW, body composition, or glycemic parameters. However, the limited amount of data from included studies should be considered as a limitation while interpreting these findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42023462575.

Effect of dark chocolate/ cocoa consumption on oxidative stress and inflammation in adults: A GRADE-assessed systematic review and dose-response meta-analysis of controlled trials.

BACKGROUND: Oxidative stress and inflammation play critical roles in the pathogenesis of many chronic diseases. Dark chocolate (DC)/cocoa, as a rich source of polyphenols like flavonoids, has anti-inflammatory and antioxidant properties that may confer health benefits, but findings in this context are inconsistent. OBJECTIVE: This systematic review and dose-response meta-analysis aimed to provide a comprehensive overview of the controlled trials (CTs) that have examined the effects of DC/cocoa on oxidative stress and inflammation biomarkers in adults. SEARCH METHODS: Databases including PubMed, Web of Science, and Scopus, were searched for relevant studies through April 2024. SELECTION CRITERIA: Studies assessed C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), nitric oxide (NO), P-selectin, E-selectin and thiobarbituric acid reactive substances (TBARS) in adults were included. DATA ANALYSIS: Based on the random-effects model, we calculated WMDs, SMDs and 95 % confidence intervals (CIs). Sensitivity, sub-group, meta-regression and dose-response analyses were also conducted. RESULTS: Thirty-three eligible CTs with 1379 participants were included. All studies reported the intervention types (cocoa powder, beverages and chocolate bars) and dosage. However, sixteen studies didn't do/report testing for purity and potency by independent groups. Also, none of the studies mentioned the risk of contamination with heavy metals. Another limitation was the lack of blinding assessment in studies. DC/cocoa significantly reduced MDA (SMD: -0.69, 95 %CI: -1.17, -0.2, p = 0.005) and increased NO levels (SMD: 2.43, 95 %CI: 1.11,3.75, p < 0.001); However, it has no significant effects on the other outcomes. Greater anti-inflammatory effects occurred at higher flavonoid doses (>450 mg/day) and for shorter durations (≤4 weeks) in the non-healthy participants. Non-linear dose-response relationships between cocoa dosage and CRP level and also between flavonoid dosage and IL-6 level were observed. Based on the GRADE evaluation, just CRP and MDA results were considered as high certainty evidence and the other outcomes results were categorized as very low to moderate certainty. CONCLUSIONS: DC/cocoa may improve systemic oxidative status and inflammation in adults. However, further studies should be performed to determine its benefits.

The efficacy of curcumin in relieving osteoarthritis: A meta-analysis of meta-analyses.

Osteoarthritis (OA) is one of the most prevalent degenerative joint diseases. Several meta-analyses have shown that curcumin could improve the function of the knee and alleviate pain in OA, while some meta-analyses demonstrate controversial results. Hence, we assessed curcumin's effects on knee OA in an umbrella meta-analysis. PubMed, Scopus, Embase, and Web of Science databases were employed to find English-language meta-analyses of randomized controlled trials investigating the effect of curcumin supplementation on OA outcomes up to September 2023. The visual analog scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, function, and stiffness scales were analyzed. Effect sizes and 95% confidence intervals were utilized to obtain the overall effect size. A random-effects model was applied to perform the meta-analysis. Heterogeneity was determined by I2 statistics and the Cochrane Q-test. The pooled effect of the 11 included meta-analyses showed that curcumin could significantly decrease the VAS score (weighted mean difference [WMD] and standardized mean difference [SMD]), WOMAC-total (SMD and WMD), WOMAC-Function (SMD and WMD), WOMAC-Pain (SMD), and WOMAC-Stiffness scores (SMD) (p ≤ 0.001, ≤0.001, ≤0.001, 0.007, ≤0.001, 0.002, ≤0.001, ≤0.001, respectively). The results strongly support curcuminoid supplementation in relieving pain, improving joint mobility and stiffness, and shortening medication usage of OA patients.

Effect of carotenoid supplementation on blood pressure in adults: a GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials.

CONTEXT: Hypertension (HTN) is regarded as a serious public health issue throughout the world. High blood pressure (BP) may be improved by carotenoid supplementation; however, randomized controlled trials (RCTs) provide conflicting evidence. OBJECTIVE: The aim of this study was to evaluate the effects of carotenoid supplementation on BP in RCTs by systematically review and meta-analysis. DATA SOURCES: A comprehensive literature search was performed in the Scopus, PubMed, and Web of Science databases until October 2023, with no limitation on the date or language of publication. DATA EXTRACTION: Studies that evaluated the net effects of carotenoids in the form of supplements on BP in adults were selected. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated on the basis of a fixed or random-effects model. Sensitivity analysis, meta-regression, publication bias, and heterogeneity were assessed using standard methods. Cochrane quality assessments were used to evaluate the included studies' bias risks. Evidence certainty was calculated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework). DATA ANALYSIS: Reports on a total of 19 RCTs involving 1151 participants were included in this review. Carotenoid supplementation significantly reduced the systolic BP (SBP) (WMD, -2.492 mmHg; 95%CI, -4.52, -0.47; P = 0.016) and diastolic BP (DBP) (WMD, -1.60 mmHg; 95%CI, -2.73, -0.47; P = 0.005). Greater effects were observed in Asian participants, those aged >50 years, nonhealthy participants, and participants with a baseline SBP ≥130 mmHg and DBP ≥80 mmHg, at dose >10 mg. Dose-response analysis showed that carotenoid supplementation decreased SBP and DBP levels at doses of, respectively, 0-25 and 0-20 mg/d. Evidence for all SBP, DBP, and heart rate values was high quality. CONCLUSIONS: Carotenoid supplementation had a beneficial effect on BP parameters, especially in nonhealthy study participants with high BP baseline levels. PROSPERO REGISTRATION NO: CRD42023402740.

Uvulopalatopharyngoplasty with and without modified thyrohyoid suspension for obstructive sleep apnea treatment: a randomized clinical trial.

PURPOSE: This study aims to compare the efficacy of Uvulopalatopharyngoplasty + Tongue Base Radiofrequency (TB-RF) and Uvulopalatopharyngoplasty + modified thyrohyoid suspension techniques + TB-RF which aimed to suspend base of tongue muscles anteriorly toward thyroid cartilage. METHODS: This randomized controlled trial study was conducted on 48 cases of confirmed OSA between Jan, 2019 and Aug, 2022. We divided patients into two groups. One group underwent Uvulopalatopharyngoplasty + modified thyrohyoid suspension + TB-RF technique, and another one underwent Uvulopalatopharyngoplasty + TB-RF. Then, Apnea-Hypopnea Index (AHI), mean and lowest O2 saturation, Drug-Induced Sleep Endoscopy (DISE), Epworth Sleepiness Scale (ESS), Digit Symbol Substitution Test (DSST), Stanford Subjective Snoring Scale (SSSS), and T90 indexes were evaluated before and after each surgery. RESULTS: The mean ± SD age was 39.4 ± 11.17 years. Of the 48 patients, 79.1% (n = 33) were male and 20.9% (n = 15) were female. AHI and SSSS in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group were significantly better than Uvulopalatopharyngoplasty group (P-value; 0.010). Though, there was no significant difference in terms of mean saturation, lowest desaturation, ESS, DSST, and T90 scores. The success rate in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension and Uvulopalatopharyngoplasty groups, according to the Sher criteria: a minimum of 50% reduction with a final AHI less than 20, were 75% (18/24) and 41.7% (10/24), respectively. It was significantly higher in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group (P-value: 0.021). CONCLUSION: The addition of modified thyrohyoid suspension technique to Uvulopalatopharyngoplasty have better surgical outcomes and more success rate than Uvulopalatopharyngoplasty in OSA patients. TRIAL REGISTRATION: IRCT: IRCT20190602043791N2. https://en.irct.ir/trial/53365 .

Effect of supplementation with Chlorella vulgaris on lipid profile in adults: A systematic review and dose-response meta-analysis of randomized controlled trials.

OBJECTIVE: To summarize available findings on the effect of Chlorella vulgaris supplementation on lipid profile in adults. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING: This study followed 2020 PRISMA guideline. We performed a systematic search in the online databases to identify relevant articles and then, extracted required data from each paper for the meta-analysis. Random-effects models were used to obtain overall mean difference (MD) comparing Chlorella vulgaris supplementation with a control group. MAIN OUTCOME MEASURES: Blood lipids including triglyceride (TG), total cholesterol (TC), LDL-C, and HDL-C. RESULTS: In total, 10 RCTs with a total sample size of 539 adults (264 in the Chlorella vulgaris group and 275 in the control group) were included. Of the 10 RCTs, four had a low risk of bias for all aspects of the Cochrane risk of bias tool. Also, only two studies determined the chlorella content, purity, potency, and contamination of the supplements used in the intervention. Combining results from these studies showed a summary MD of -2.11 mg/dL (95% CI: -7.28 to 3.06) for TG, -7.47 mg/dL (95% CI: -12.98 to -1.96) for TC, -7.71 mg/dL (95% CI: -14.05 to -1.37) for LDL-C, and -0.45 mg/dL (95% CI: -0.67 to 1.57) for HDL-C, indicating a beneficial effect of Chlorella vulgaris supplementation on TC and LDL-C levels. Based on the dose-response analysis, the reducing effect of Chlorella vulgaris supplementation on LDL-C levels was seen at the dosages between zero and 1500 mg/d (P for non-linearity= 0.01), whereas in higher amounts, this effect was not significant. CONCLUSION: We found that Chlorella vulgaris supplementation had a beneficial effect on TC and LDL-C levels with no significant effect on TG and HDL-C levels.

Endotracheal tube cuff lidocaine is not superior to intravenous lidocaine in short pediatric surgeries.

BACKGROUND: Instillation of lidocaine into the endotracheal tube cuff is a method with reported efficiency in promoting a smoother emergence from anesthesia with endotracheal intubation. However, whether or not this method is helpful in children and in surgeries with short duration has not been investigated previously. METHODS: 176 ASA I-II children undergoing adenotonsillectomy were enrolled in this prospective, double-blind, randomized clinical trial. Patients were randomly allocated to two groups. Patients in the ECL group (n=88) were injected 2% lidocaine into their endotracheal tube cuff and received saline (1.5mg/kg) intravenously. The IVL group (n=88) received 1.5mg/kg of 2% lidocaine intravenously and saline into the endotracheal tube cuff. In both groups, intra-cuff injections were initiated immediately after insertion of the endotracheal tube and terminated before the cuff pressure reached 20 cmH(2)O. The parameters measured were: coughing (graded by a scale of 3 at the time of extubation), systolic and diastolic blood pressures and heart rate (from the time of extubation up to 5 min after extubation at 1-min intervals), and laryngospasm (defined as the presence of hoarseness or absence of airflow). RESULTS: The groups were not different in sex, age, weight, height, body mass index, anesthesia duration, and baseline hemodynamic parameters. The grade of coughing was significantly higher in the ECL group. The incidence of laryngospasm and hemodynamic trends did not differ between the groups. CONCLUSIONS: Our results indicate that intra-cuff lidocaine may not be beneficial in children and in surgeries with a short duration.

Chronic subdural hematoma outcome prediction using logistic regression and an artificial neural network.

Artificial neural networks (ANN) have not been used in chronic subdural hematoma (CSDH) outcome prediction following surgery. We used two methods, namely logistic regression and ANN, to predict using eight variables CSDH outcome as assessed by the Glasgow outcome score (GOS) at discharge. We had 300 patients (213 men and 87 women) and potential predictors were age, sex, midline shift, intracranial air, hematoma density, hematoma thickness, brain atrophy, and Glasgow coma score (GCS). The dataset was randomly divided to three subsets: (1) training set (150 cases), (2) validation set (75 cases), and (3) test set (75 cases). The training and validation sets were combined for regression analysis. Patients aged 56.5 +/- 18.1 years and 228 (76.0%) of them had a favorable outcome. The prevalence of brain atrophy, intracranial air, midline shift, low GCS, thick hematoma, and hyperdense hematoma was 142 (47.3%), 156 (52.0%), 177 (59.0%), 82 (27.3%), 135 (45.0%), and 52 (17.3%), respectively. The regression model did not show an acceptable performance on the test set (area under the curve (AUC) = 0.594; 95% CI, 0.435-0.754; p = 0.250). It had a sensitivity of 69% and a specificity of 46%, and correctly classified 50.7% of cases. A four-layer 8-3-4-1 feedforward backpropagation ANN was then developed and trained. The ANN showed a remarkably superior performance compared to the regression model (AUC = 0.767; 95% CI, 0.652-0.882; p = 0.001). It had a sensitivity of 88% and a specificity of 68%, and correctly classified 218 (72.7%) cases. Considering that GOS strongly correlates with the risk of recurrence, the ANN model can also be used to predict the recurrence of CSDH.