Background: Increasing use of extended-criteria donors (ECD) set higher requirements for graft preservation. Machine perfusion (MP) improves orthotopic liver transplantation (OLT) outcomes but its effects on different donor types remains unclear. Our aim was to assess the effects of hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), or normothermic regional perfusion (NRP) versus static cold storage (SCS) on different donor types. Materials and Methods: A literature search comparing the efficacy of MP versus SCS in PubMed, Cochrane and EMBASE database was conducted. Meta-analysis was performed to obtain pooled effects of MP on extended criteria donors (ECD), donation after circulatory death (DCD), donor after brainstem death. Results: 39 studies were included (9 RCTs and 30 cohort studies). Compared with SCS, HMP significantly reduced the risk of non-anastomotic biliary stricture (NAS) (OR 0.43, 95%CI 0.26-0.72), major complications (OR 0.55, 95%CI 0.39-0.78), early allograft dysfunction (EAD) (OR 0.46, 95%CI 0.32-0.65) and improve one-year graft (OR 2.36, 95%CI 1.55-3.62) in ECD-OLT. HMP also reduced primary nonfunction (PNF) (OR 0.40, 95%CI 0.18-0.92) and acute rejection (OR 0.62, 95%CI 0.40-0.97). NMP only reduced major complications in ECD-OLT (OR 0.56, 95%CI 0.34-0.94), without favorable effects on other complications and survival. NRP lower the overall risk of NAS (OR 0.27, 95%CI 0.11-0.68), PNF (OR 0.43, 95%CI 0.22-0.85), EAD (OR 0.58, 95%CI 0.42-0.80) and meanwhile improved one-year graft survival (OR 2.40, 95%CI 1.65-3.49) in control DCD-OLT. Conclusions: HMP might currently be considered for marginal livers as it comprehensively improves ECD-OLT outcomes. NMP assists some outcomes in ECD-OLT but more evidence regarding NMP-ECD is warrant. NRP significantly improves DCD-OLT outcomes and is recommended where longer non-touch periods exist.
Background: Myopia is increasing in prevalence and developing at a younger age, a trend exacerbated by the COVID-19 pandemic. To combat the epidemic of myopia, eye exercises have been promoted in recent national efforts in mainland China, continuing a compulsory national school policy for over 50 years. We aimed to evaluate the efficacy of eye exercises in preventing and controlling myopia. Methods: In this systemic review and meta-analysis, we searched nine major Chinese and English databases from their inception to December 15, 2022. We included studies that compared the effects of eye-exercise interventions with controls (no eye exercises) on at least one myopia-related indicator. Studies could be either randomized or non-randomized controlled trials. Two coders independently screened records for eligibility; extracted study-level data (study information, sample sizes, interventions, and myopia indicators); and assessed the risk of bias (Cochrane Risk of Bias Tool 2.0) and study heterogeneity. Using random-effect models and sensitivity analysis, we estimated the effects of eye exercises compared to control on changes in visual acuity, diopter, and curative effects (axial length was not reported). We used standardized mean differences (SMDs) to evaluate visual acuity and diopter outcomes, and risk ratios (RRs) to assess curative effects. This study is registered on the Open Science Framework (https://osf.io/dr5jk). Findings: Of the 1765 records identified, 1754 were excluded: 423 were duplicates, 1223 did not have a control group, 16 did not have full-text, and 92 did not fulfill other inclusion criteria. In total, 11 studies were included in the meta-analysis, with 921 participants (399 in eye-exercise interventions and 522 in control groups). Nine studies had some concerns of bias in at least two domains, and two studies had a high risk of bias in two domains. Seven studies used visual acuity to measure myopia; visual acuity declined after eye-exercise interventions (SMD=-0.67, 95% CI -1.28 to -0.07, Z=2.17, p=0.03) and the effect was not better than control (SMD=-0.50, 95% CI -1.16 to 0.16, Z=1.49, p=0.14). Two studies used diopter to measure myopia; the effect of eye-exercise interventions did not differ from control (SMD=-1.74, 95% CI -6.27 to 2.79, Z=0.75, p=0.45). Seven studies reported curative effects; eye exercises had a higher curative effect than control (RR=0.40, 95% CI 0.23-0.71, Z=3.13, p<0.01). Interpretation: Eye exercises are not effective in preventing or controlling the progression of myopia, as measured by changes in visual acuity and diopter. A small positive effect is observed in curative effects, but the studies have high heterogeneity and potential publication bias, with major weaknesses in design (inadequate measures, small sample sizes, biases, failure to consider side effects, and failure to include established effective interventions as control). There is little evidence to support the continued use of eye exercises to manage myopia in schoolchildren. Funding: Guangdong Basic and Applied Basic Research Foundation (2019A1515110574) and Shenzhen Fundamental Research Program (JCYJ20210324134603010).
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