British journal of anaesthesia
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Meta Analysis
Convalescent plasma for COVID-19: a meta-analysis, trial sequential analysis, and meta-regression.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies, particularly those preventing interaction between the viral spike receptor-binding domain and the host angiotensin-converting enzyme 2 receptor, may prevent viral entry into host cells and disease progression. ⋯ CRD42021234201 (PROSPERO).
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Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. ⋯ Postoperative change trajectories for cognition and CSF Aβ, tau or p-tau levels did not differ between community dwelling older APOE4 carriers and non-carriers. APOE4 carriers showed greater preoperative functional connectivity and greater postoperative decreases in functional connectivity in key Alzheimer's disease-risk regions, which occur via Aβ-independent mechanisms.
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Terms such as prospective, interventional, and controlled are redundant in the context of randomised trials, and are therefore distracting. Pragmatic should probably be reserved for trials that intentionally control little except the exposure. The term pilot should be reserved for trials that were designated to a priori and registered as pilot trials, and have appropriate pilot outcomes. 'Pragmatic' and 'real-world' should not be inserted to excuse poor trial design; and similarly, 'pilot' should not be appended to excuse inadequate power.
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Accurate preoperative risk prediction for perioperative complications such as acute kidney injury (AKI) may serve to better inform patients and families of risk before surgery, assist with resource requirement planning, and aid with cohort enrichment for enrolment into clinical trials. Where a specific risk factor is modifiable, it may offer a potential therapeutic target for risk reduction. The report by Wang and colleagues describes the modest incremental benefit of N-terminal pro brain natriuretic peptide levels when added to almost 20 other variables for the preoperative prediction of AKI after cardiac surgery. This is consistent with previous smaller studies, but there are important additional questions still to be answered before this biomarker might be used for this purpose in clinical practice.