[show abstract][hide abstract] ABSTRACT: The incidence of hepatocellular carcinoma (HCC) varies widely by sex and geographical area, for example from approximately 5 per 100,000 women and 8 per 100,000 men in northern Europe in 2010 to 12 per 100,000 women and 30 cases per 100,000 men in eastern Asia in 2008; 82% of liver cancers are estimated to occur in less developed countries. Liver cancer incidence in developed countries has increased over time since the 1970s. The variability by sex, place and time partly reflects difference in prevalence of hepatitis B and C infection but also relates to changing patterns of other risk factors including ageing populations, alcohol consumption, obesity and diabetes.
Jamie Anderson, Yun Lin Ang, Shaoyun Chen, Kevin C.C. Choy, Muhamed M.H. Farhan-Alanie, Ewan D. Kennedy, Sam A. MacKenzie, Deborah E. Moore, Robert A. Sykes, R. Peter Alston
[show abstract][hide abstract] ABSTRACT: Background:
In the last two decades, coronary artery bypass grafting (CABG) surgery has increasingly been performed without cardiopulmonary bypass (CPB) that is ‘off-pump’. A strong motivation for performing CABG surgery off-pump was to avoid CPB which has been believed to cause of cognitive decline. However, accumulating evidence from systematic reviews and meta-analyses comparing on- and off-pump CABG surgery indicate that CPB may not be the cause of cognitive decline . Several additional randomised controlled trials (RCTs) comparing cognition after on- and off-pump CABG surgery have been published since the last meta-analyses.
The aim of this study was to undertake a systematic review the literature and meta-analysis to compare cognition following on- and off-pump CABG surgery.
RCTs comparing continuous measures of cognitive outcome after on- and off-pump CABG surgery were identified by literature searching. Data extraction enabled data from seven psychometric tests (Auditory Verbal Learning Test, Grooved Pegboard, Trail-Making A and B, Digit Symbol, Digit Span, and Stroop Colour Word Test) to be amalgamated. Data was grouped into early (< six months) and late (≥ six months) postoperative periods and analysed using Revman 5.
A systematic literature search conducted in Medline, Embase, PsychINFO and The Cochrane Library yielded 13 studies totalling 2285 patients that could be included in the meta-analysis. No significant differences were found between on- and off-pump groups in any of the psychometric tests in either early or late postoperative periods.
To-date, this is the largest meta-analysis comparing cognition following on- and off-pump CABG surgery and the absence of difference is consistent with previous systematic reviews and meta-analyses. The results are highly suggestive that CPB may not be the cause cognitive decline associated with CABG surgery.