Association between ß2-Adrenoreceptor Medications and Risk of Parkinson's Disease: A Meta-Analysis.

Background and Objective: Parkinson's disease (PD) is a progressive neurological disorder characterized by an accumulation of Lewy bodies and degeneration of dopaminergic neurons in the substantia nigra. The treatment options currently available are only partly effective and fail to restore the lost dopaminergic neurons or slow the progression. ß2-adrenoceptors (ß2AR) are widely expressed in various human tissues and organs, regulate many important metabolic functions, and are targeted for treatment of various diseases. Studies have reported a link between chronic use of the ß2AR antagonist propranolol and an increased risk of PD, and chronic use of ß2AR agonists has been associated with a decreased risk of PD. We conducted a meta-analysis on the association between both ß2AR agonist level and ß2AR antagonist level and the risk of PD. Materials and Methods: A comprehensive electronic search was conducted on the databases of PubMed, ScienceDirect, ProQuest, Cochrane Library, and ClinicalKey from the start of each database until 30 June 2021. The objective was to identify prospective cohort and case-control studies that have reported on the association between ß-adrenoceptor agonist level, antagonist level, and PD risk. Results: A meta-analysis of the data extracted from eight studies revealed that ß2AR agonist use was associated with reduced PD risk (RR = 0.859, 95% confidence interval [CI] 0.741-0.995. p = 0.043). Compared with the control group, ß2AR antagonist use was associated with an increased risk of PD (RR = 1.490, 95% CI, 1.195 to 1.857. p < 0.005). Propranolol, a type of ß2AR antagonist, was related to an increased risk of PD (RR = 2.820, 95% CI, 2.618 to 3.036. p < 0.005). Conclusions: In this meta-analysis, ß2AR agonists were associated with a decreased risk of PD, and ß2AR antagonists were related with an increased risk of PD. However, further studies with larger sample sizes and an evaluation of the long-term effects of varying dosages of medications are needed.

Ergotamine Use and Overuse in Taiwan: A Retrospective Cohort Study.

OBJECTIVE: The aim of this study was to investigate the pattern of ergotamine prescription and overuse in Taiwan. BACKGROUND: Ergotamine is a frequently prescribed medication for the treatment of migraine, although excessive use may lead to medication-overuse headache. METHODS: We conducted a retrospective cohort study by using the Longitudinal Health Insurance Database 2005 in Taiwan. Patients enrolled in the study were between the ages of 18 and 80 years, received at least two prescriptions of ergotamine, and follow-up for more than 1 year at outpatient clinics during 1999 to 2013. Each ergotamine prescription was converted into a defined daily dose (DDD) and patients were sorted into two groups: occasional users, having fewer than 3 consecutive months of use, and regular users, with 3 consecutive months of use or more. Regular users were further divided into overusers (DDDs ≥ 10 per month) and non-overusers. RESULTS: A total of 41,023 migraine patients were enrolled in the study; 5803 patients were classified as regular users, with 859 of those being overusers. Of the ergotamine overusers, around 698/859 (82%) continued to use, and 443/859 (52%) remained overusers of ergotamine in the subsequent year after the index date. The most frequently prescribed prophylactic medications were propranolol and flunarizine, which were prescribed in 30.4% and 20.0% of overuse patients, respectively. CONCLUSIONS: Ergotamine overuse remains common in Taiwan, while prophylactic medicine is still underutilized. More education on ergotamine-overuse headache is needed to improve awareness.

Predicting fetal growth restriction with liver volume by three-dimensional ultrasound: efficacy evaluation.

It is well-documented that fetal growth restriction (FGR) may have increased risks of perinatal morbidity and mortality. Early detection of FGR is crucial in prenatal care and daily practice. We undertook a prospective and cross-sectional study using quantitative 3-D ultrasound (US) to assess the efficacy of fetal liver volume (LV) in predicting FGR. During the study period, 42 fetuses with FGR and 375 fetuses without FGR were included for the LV assessment in utero by 3-D US. All the fetuses were singletons and had follow-up to delivery to ensure whether they were complicated with FGR or not. Our results revealed that fetal LV assessed by 3-D US can differentiate well fetuses with FGR from those without FGR. The sensitivity of fetal LV in predicting FGR was 97.6%, with specificity 93.6%, predictive value of positive test 63%, predictive value of negative test 99.7% and accuracy 94%. In conclusion, fetal LV assessed by quantitative 3-D US can be used to predict fetuses with FGR antenatally. Our data support that fetal LV assessment by 3-D US would be a useful test in detecting fetuses with FGR.

Fetal upper arm volume in predicting intrauterine growth restriction: a three-dimensional ultrasound study.

As fetuses with intrauterine growth restriction (IUGR) may have increased risks with perinatal morbidity and mortality, prenatal diagnosis of IUGR is a very important issue in perinatology. To assess the efficacy of fetal upper arm volume in predicting IUGR, we undertook a prospective, cross-sectional study using quantitative three-dimensional (3D) ultrasound (US). In total, 40 fetuses with IUGR and 442 fetuses without IUGR were included for the upper arm volume assessment in utero by 3D US. All the fetuses were singletons and were followed up to delivery to establish whether they were complicated with IUGR or not. Our results showed that fetal upper arm volume assessed by 3D US can differentiate fetuses with IUGR from fetuses without IUGR well. The best predicting threshold for IUGR is at the 10th percentile by upper arm volume. Using the 10th percentile as the cutoff, the sensitivity of fetal upper arm volume in predicting IUGR was 97.5%, with specificity 92.8%, predictive value of positive test 54.9%, predictive value of negative test 99.8% and accuracy 93.1%. Furthermore, upper arm volume is the best parameter for detecting IUGR among the common fetal biometric indices, such as biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW). In conclusion, fetal upper arm volume assessed by quantitative 3D US can be used to predict fetuses with IUGR antenatally. We believe fetal upper arm volume assessment by 3D US would be a useful test in detecting fetuses with IUGR.

The efficacy assessment of thigh volume in predicting intrauterine fetal growth restriction by three-dimensional ultrasound.

Intrauterine growth restriction (IUGR) is an important issue in perinatology. To assess the efficacy of fetal thigh volume (ThVol) in predicting IUGR, we undertook a prospective cross-sectional study using quantitative 3-D ultrasound (US). During the study period, 30 fetuses with IUGR and 282 fetuses with non-IUGR were included for the ThVol assessment in utero by 3-D US. All the fetuses were singletons and had follow-up to the delivery to determine whether they were complicated with IUGR or not. Our results showed fetal ThVol assessed by 3-D US can differentiate fetuses with IUGR from fetuses with non-IUGR well. Using the 10th percentile as the screening threshold, the sensitivity of fetal ThVol in predicting IUGR was 86.6%, with specificity 91.1%, predictive value of positive test 51.0%, predictive value of negative test 98.5% and accuracy 90.7%. In conclusion, fetal ThVol assessed by quantitative 3-D US can be used to predict fetuses with IUGR antenatally. We believe fetal ThVol assessment by 3-D US would be a useful test in detecting fetuses with IUGR.

Three-dimensional power Doppler ultrasound for the assessment of the fetal brain blood flow in normal gestation.

Early identification of the abnormal fetal brain vascularization and blood flow is very important, because the deficient perfusion of the fetal brain may be related to a poor prognosis of the central nervous system (CNS) development. To assess the fetal brain vascularization and the blood flow in normal gestation, we measured the fetal brain vascularization and the brain blood flow in normal fetuses using three-dimensional (3-D) power Doppler ultrasound (US) and the quantitative 3-D power Doppler histogram analysis. This study was undertaken by a prospective and cross-sectional design. In total, 155 normal singletons with gestational age (GA) between 21 and 40 weeks were included. The 3-D power Doppler US and the quantitative 3-D histogram analyses were used to assess the fetal brain vascular indexes, i.e., vascularization index (VI), flow index (FI) and vascularization-flow index (VFI), in each case. Our results revealed that all the fetal brain VI, FI and VFI increased significantly with GA (all p<0.001). In addition, the fetal brain VI, FI and VFI were all significantly correlated with the common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight. Our study indicates that fetal brain vascularization and blood flow increase significantly with the advancement of GA as well as the fetal common growth indices during normal gestation. We believe our data may serve as a reference for further studies of the fetal brain blood flow in abnormal conditions.