Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis

BackgroundThe importance of patient-reported outcome measurement in chronic kidney disease (CKD) populations has been established. However, there remains a lack of research that has synthesised data around CKD-specific symptom and health-related quality of life (HRQOL) burden globally, to inform focused measurement of the most relevant patient-important information in a way that minimises patient burden. The aim of this review was to synthesise symptom prevalence/severity and HRQOL data across the following CKD clinical groups globally: (1) stage 1–5 and not on renal replacement therapy (RRT), (2) receiving dialysis, or (3) in receipt of a kidney transplant.Methods and findingsMEDLINE, PsycINFO, and CINAHL were searched for English-language cross-sectional/longitudinal studies reporting prevalence and/or severity of symptoms and/or HRQOL in CKD, published between January 2000 and September 2021, including adult patients with CKD, and measuring symptom prevalence/severity and/or HRQOL using a patient-reported outcome measure (PROM). Random effects meta-analyses were used to pool data, stratified by CKD group: not on RRT, receiving dialysis, or in receipt of a kidney transplant. Methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data, and an exploration of publication bias performed. The search identified 1,529 studies, of which 449, with 199,147 participants from 62 countries, were included in the analysis. Studies used 67 different symptom and HRQOL outcome measures, which provided data on 68 reported symptoms. Random effects meta-analyses highlighted the considerable symptom and HRQOL burden associated with CKD, with fatigue particularly prevalent, both in patients not on RRT (14 studies, 4,139 participants: 70%, 95% CI 60%–79%) and those receiving dialysis (21 studies, 2,943 participants: 70%, 95% CI 64%–76%). A number of symptoms were significantly (p < 0.05 after adjustment for multiple testing) less prevalent and/or less severe within the post-transplantation population, which may suggest attribution to CKD (fatigue, depression, itching, poor mobility, poor sleep, and dry mouth). Quality of life was commonly lower in patients on dialysis (36-Item Short Form Health Survey [SF-36] Mental Component Summary [MCS] 45.7 [95% CI 45.5–45.8]; SF-36 Physical Component Summary [PCS] 35.5 [95% CI 35.3–35.6]; 91 studies, 32,105 participants for MCS and PCS) than in other CKD populations (patients not on RRT: SF-36 MCS 66.6 [95% CI 66.5–66.6], p = 0.002; PCS 66.3 [95% CI 66.2–66.4], p = 0.002; 39 studies, 24,600 participants; transplant: MCS 50.0 [95% CI 49.9–50.1], p = 0.002; PCS 48.0 [95% CI 47.9–48.1], p = 0.002; 39 studies, 9,664 participants). Limitations of the analysis are the relatively few studies contributing to symptom severity estimates and inconsistent use of PROMs (different measures and time points) across the included literature, which hindered interpretation.ConclusionsThe main findings highlight the considerable symptom and HRQOL burden associated with CKD. The synthesis provides a detailed overview of the symptom/HRQOL profile across clinical groups, which may support healthcare professionals when discussing, measuring, and managing the potential treatment burden associated with CKD.Protocol registrationPROSPERO CRD42020164737.

In a systematic review and meta analysis, Benjamin R. Fletcher and colleagues study patient-reported symptom prevalence, severity, and health related quality of life among individuals with different stages of chronic kidney disease in 62 countries.     

Integrated system approach to dark fermentative biohydrogen production for enhanced yield,energy efficiency and substrate recovery

The challenges of climate change, dwindling fossil reserves, and environmental pollution have fuelled the need to search for clean and sustainable energy resources. The process of biohydrogen has been highlighted as a propitious alternative energy of the future because it has many socio-economic benefits such as non-polluting features, the ability to use diverse feedstocks including waste materials, the process uses various microorganisms, and it is the simplest method of producing hydrogen. However, the establishment of a biohydrogen driven economy has been hindered by low process yields due to the accumulation of inhibitory products. Over the past few years, various optimization methods have been used in literature. Among these, integration of bioprocesses is gaining increasing prominence as an effective approach that could be used to achieve a theoretical yield of 4 mol H₂ mol^?1 glucose. In batch integrated systems, dark fermentation is used as a primary process for conversion of substrates into biohydrogen, carbon dioxide, and volatile fatty acids. This is followed by a secondary anaerobic process for further biohydrogen conversion efficiency. This review discusses the current challenges facing scale-up studies in dark fermentation process. It elucidates the potential of batch integrated systems in biohydrogen process development. Furthermore, it explores the various integrated fermentation techniques that are employed in biohydrogen process development. Finally, the review concludes with recommendations on improvement of these integrated processes for enhanced biohydrogen yields which could pave a way for the establishment of a large-scale biohydrogen production process.     

Are Individual and Community Acceptance and Witnessing of Intimate Partner Violence Related to Its Occurrence? Multilevel Structural Equation Model

Background

Intimate partner violence against women (IPVAW) is a serious and widespread problem worldwide. Much of the research on IPVAW focused on individual-level factors and attention has been paid to the contextual factors. The aim of this study was to develop and test a model of individual- and community-level factors associated with IPVAW.

Methods and Findings

We conducted a (multivariate) multilevel structural equation analysis on 8731 couples nested within 883 communities in Nigerian Demographic and Health Survey 2008. Variables included in the model were derived from respondents'' answers to the experience of IPVAW, attitudes towards wife beating and witnessing physical violence in childhood. We found that women that witnessed physical violence were more likely to have tolerant attitudes towards IPVAW and women with tolerant attitudes were more likely to have reported spousal IPVAW abuse. Women with husbands with tolerant attitudes towards IPVAW were more likely to have reported spousal abuse. We found that an increasing proportion of women in the community with tolerant attitudes was significantly positively associated with spousal sexual and emotional abuse, but not significantly associated with spousal physical abuse. In addition, we found that an increasing proportion of men in the community with tolerant attitudes and an increasing proportion of women who had witnessed physical violence in the community was significantly positively associated with spousal physical abuse, but not significantly associated with spousal sexual and emotional abuse. There was a positive correlation between all three types of IPVAW at individual- and community-level.

Conclusions

We found that community tolerant attitudes context in which people live is associated with exposure to IPVAW even after taking into account individual tolerant attitudes. Public health interventions designed to reduce IPVAW must address people and the communities in which they live in order to be successful.     

Stinkbug complex of soybean glycine max (l.) Merrill and the importance of insecticidal control in the northern guinea savanna area of Nigeria

Field experiments were conducted in Samara for a two year period (1996 and 1997) to identify the major pod sucking bugs of soybean and to determine the effect of insecticides and frequency of application on the bugs and soybean yield. Nezara viridula L. Halydicoris ventralis Dall. Sphaerocoris annulus Fab. and Agonoscelis versicolor Fab. were the major bugs and their population were less than two bugs per plot. Also, insecticides and frequency of spray application had no significant effect on the pod sucking bugs population, percentage damage pods, seed damage index, 100 seed weight and seed yield per hectare. Hence, except the status of the pod sucking bugs population in this area of study changes significantly (possibly due to the influence of environmental factors and cropping patterns) soybean may be grown in this area with no insecticidal protection.     

The EMBL sequence version archive

SUMMARY: The EMBL Nucleotide Sequence Database, maintained at the European Bioinformatics institute, is Europe's primary nucleotide sequences database. Its entries are subject to changes, but only the most recent versions are preserved in the database. The EMBL Sequence Version Archive is a new publicly available database retaining also the earlier versions of these entries. AVAILABILITY: http://www.ebi.ac.uk/embl/sva/     

Citation Classics in Systematic Reviews and Meta-Analyses: Who Wrote the Top 100 Most Cited Articles?

Background

Systematic reviews of the literature occupy the highest position in currently proposed hierarchies of evidence. The aims of this study were to assess whether citation classics exist in published systematic review and meta-analysis (SRM), examine the characteristics of the most frequently cited SRM articles, and evaluate the contribution of different world regions.

Methods

The 100 most cited SRM were identified in October 2012 using the Science Citation Index database of the Institute for Scientific Information. Data were extracted by one author. Spearman’s correlation was used to assess the association between years since publication, numbers of authors, article length, journal impact factor, and average citations per year.

Results

Among the 100 citation classics, published between 1977 and 2008, the most cited article received 7308 citations and the least-cited 675 citations. The average citations per year ranged from 27.8 to 401.6. First authors from the USA produced the highest number of citation classics (n=46), followed by the UK (n=28) and Canada (n=15). The 100 articles were published in 42 journals led by the Journal of the American Medical Association (n=18), followed by the British Medical Journal (n=14) and The Lancet (n=13). There was a statistically significant positive correlation between number of authors (Spearman’s rho=0.320, p=0.001), journal impact factor (rho=0.240, p=0.016) and average citations per year. There was a statistically significant negative correlation between average citations per year and year since publication (rho = -0.636, p=0.0001). The most cited papers identified seminal contributions and originators of landmark methodological aspects of SRM and reflect major advances in the management of and predisposing factors for chronic diseases.

Conclusions

Since the late 1970s, the USA, UK, and Canada have taken leadership in the production of citation classic papers. No first author from low or middle-income countries (LMIC) led one of the most cited 100 SRM.     

Predicting the expression of recombinant monoclonal antibodies in Chinese hamster ovary cells based on sequence features of the CDR3 domain

Despite the development of high‐titer bioprocesses capable of producing >10 g L^?1 of recombinant monoclonal antibody (MAb), some so called “difficult‐to‐express” (DTE) MAbs only reach much lower process titers. For widely utilized “platform” processes the only discrete variable is the protein coding sequence of the recombinant product. However, there has been little systematic study to identify the sequence parameters that affect expression. This information is vital, as it would allow us to rationally design genetic sequence and engineering strategies for optimal bioprocessing. We have therefore developed a new computational tool that enables prediction of MAb titer in Chinese hamster ovary (CHO) cells based on the recombinant coding sequence of the expressed MAb. Model construction utilized a panel of MAbs, which following a 10‐day fed‐batch transient production process varied in titer 5.6‐fold, allowing analysis of the sequence features that impact expression over a range of high and low MAb productivity. The model identified 18 light chain (LC)‐specific sequence features within complementarity determining region 3 (CDR3) capable of predicting MAb titer with a root mean square error of 0.585 relative expression units. Furthermore, we identify that CDR3 variation influences the rate of LC‐HC dimerization during MAb synthesis, which could be exploited to improve the production of DTE MAb variants via increasing the transfected LC:HC gene ratio. Taken together these data suggest that engineering intervention strategies to improve the expression of DTE recombinant products can be rationally implemented based on an identification of the sequence motifs that render a recombinant product DTE. © 2013 American Institute of Chemical Engineers Biotechnol. Prog., 30:188–197, 2014