Conduct and Interpretation of Systematic Reviews and Meta-analyses in Urology

ane Introduction

Psoriasis is a common, chronic inflammatory skin disease that affects approximately ranging from 2% to 4% of the world's population.^[i–three] It impairs patients' physical and psychologic well-being, leading to reduced health-related quality of life.^[four] In recent years, a big number of studies in abroad have confirmed that psoriasis was associated with metabolic syndrome, cardiovascular disease, and it is believed that the concurrence of psoriasis, metabolic syndrome, and cardiovascular disease may exist due to the nature of psoriasis itself every bit a chronic inflammatory procedure.^[5]

Hypertension is an extremely common finding in the community, which is a major take chances factor for myocardial infarction, stroke, peripheral vascular diseases, and cardiovascular expiry.^[6] Nevertheless, there is yet a huge controversy most the clan between psoriasis and hypertension, and elevated levels of endothelin-ane, dysregulation of the renin–angiotensin arrangement, and increased oxidative stress amidst patients with psoriasis are possible etiologic links.^[7–nine] Some studies showed that the prevalence of hypertension in psoriasis patients is higher than that in nonpsoriasis patients.^[10–xiii] But the studies such as Huerta et al^[xiv] and Chen et al^[15] suggested that there was relation between psoriasis and hypertension. So far, the controversy about the human relationship between psoriasis and hypertension has non been completely ended.

A great understanding about the association between psoriasis and hypertension in epidemiology would assist in screening of cardiovascular risk factors in patients with psoriasis, and would assistance direct future clinical researches. A recent systematic review and meta-assay by Armstrong et al^[16] found the pooled odds ratio (OR) for hypertension among patients with psoriasis was 1.58 compared with the controls. Even so, such upshot has exhibited high heterogeneity (I ⁱⁱ = 98.4%) and has included few adjusted-for-covariates studies, to a sure extent, the consequence would be biased. All the same, no meta-analysis has been restricted to studies that adjusted for confounders heretofore in the literature. Considering the forcefulness of the clan betwixt these 2 diseases is influenced by confounders (e.m., age, sex activity, smoking, booze, trunk mass alphabetize), nosotros performed the systematic review and meta-assay that every included written report had adjusted-for-covariates to improve empathize the association between psoriasis and hypertension and provide more convincing evidence about that.

2 Methods

The meta-analysis was conducted and reported co-ordinate to Preferred Reporting Items for Systematic Reviews and Meta-assay (PRISMA) statement.^[17]

2.1 Data sources and searches

A systematic literature search in the MEDLINE, Embase, Cochrane databases, and Google Scholar was conducted to identify relevant studies which reported the clan of psoriasis with the run a risk of hypertension published up to Nov 2018 in English. The Medical Subject Heading (Mesh) terms and/or fundamental words and/or gratuitous words were psoriasis AND (hypertension OR high blood pressure). Additional manual searches were made using the reference lists from relevant studies to recall other papers relevant to our topic. We accept tried to contact all respective authors when data were missing.

2.2 Written report selection

Two reviewers (XD and JL) reviewed the full texts of the included studies which met the post-obit inclusion criteria were included in the meta-assay: Participants were female and male adults with psoriasis diagnosed with specific criteria and controls (participants without psoriasis). Studies had to evaluate the prevalence or incidence of hypertension past diagnostic codes, billing codes, clinician diagnosis, patient-self report, claret force per unit area measurement, or medical nautical chart review; The take a chance approximate was reported equally an adjusted OR or hazard ratio (AOR/AHR) with the 95% confidence interval (CI); The report had a cohort blueprint or retrospective case–command blueprint or cross-exclusive or randomized control pattern; The study evaluated psoriasis with hypertension; The study language was published in English. Nosotros excluded studies lack of crude data after exhausting efforts to contact the authors for complete data. Overlapping studies were included subsequently discarding the written report with the smaller written report population. Studies that did not meet the in a higher place criteria were excluded.

2.3 Data extraction and quality assessment

Data were extracted via a standardized information extraction form, collecting data on the yr of publication, land, study design, number of cases and controls, AOR/AHR, adapted factors, and diagnosis arroyo of hypertension, when available. Each included article was appraised by 2 reviewers (MY And TL), who assessed the methodologic quality of selected studies independently with the quality of included studies using Newcastle–Ottawa scale (NOS) to assess the methodologic quality of selected studies independently. Nosotros divers scores as vi to nine being loftier methodologic quality and <6 existence depression quality. NOS quality scores were presented as office of descriptive summaries for each study and did not influence decisions to puddle studies in meta-analysis.

two.4 Data synthesis and meta-analysis

The results of the meta-assay are presented in wood plots. Heterogeneity, that is, the proportion of variability across studies was assessed using Cochran Q statistic and quantified using the I ² statistic. If high heterogeneity (I ^two > 50) was found, subgroup analysis or influence analysis (sensitivity analysis) would be performed. Information assay was performed with Stata 5.12 (StataCorp, College Station, TX). Subgroup analysis was also used to evaluate the heterogeneity by dividing the group co-ordinate to the patient geographic location and severity of psoriasis. We used Begg adjusted rank correlation exam and Egger regression disproportion test to detect publication bias, and P < .05 for both tests was considered to correspond significant statistical publication bias.

3 Results

3.1 Literature search and study election

A PRISMA flow chart of screening and selection results is shown as Figure ane. Using prespecified search strategy, our initial search identified 1573 manufactures, and after awarding of the criteria selection, from 234 studies initially identified, 79 were considered potentially suitable. Later a total-text review, 16 adjusted-for-covariates studies^{[five,10–13,eighteen–28]} were included in this meta-assay. Table 1 provides a clarification of the 16 studies.^{[v,10–13,eighteen–28]} There are fifty,291 cases with hypertension in 255,132 psoriasis patients and 76,547 cases with hypertension in 814,631 controls (no psoriasis). Among all sixteen studies,^{[v,x–thirteen,18–28]} 2 was cohort written report,^[24,28] 10 were example–control studies,^{[10–12,xviii–21,23,25,26]} and the rest 4 studies were cross-sectional.^[v,13,22,27] Amid the 16 studies,^{[5,10–13,18–28]} 1 was performed in S America,^[23] 10 in Europe,^{[5,10,11,18,20,22,24–26,28]} and 5 in Asia.^{[12,13,19,21,27]} The number of stars of studies assessed by NOS ranged from half-dozen to 9 (Table 1).

Figure 1:

Flowchart for records option process of the meta-assay.

Table i:

Characteristics of the 16 eligible studies.

3.ii Overall analysis

The relationship betwixt psoriasis and the take a chance of hypertension using data from 16 studies^{[5,10–xiii,18–28]} was examined, and total AOR/AHR reported by the fourteen adjusted-for-covariates studies^{[five,10,12,13,xviii–27]} were used to assess the associations between them. Overall, there was statistically significant clan between psoriasis and hypertension risk (OR 1.43; 95% CI 1.25–1.64; P = .000; I ² = 94.1%) (Fig. 2). Despite the random effects model used, the studies appeared loftier heterogeneous (I ² = 94.1%).

Figure 2:

Pooled approximate of association between psoriasis and the risk of hypertension. CI = confidence interval, OR = odds ratio.

3.iii Subgroup analysis

Nosotros performed subgroup analysis to attempt to explain the high heterogeneity. Based on the different the severity of illness and geographic locations of these trials, 2 subgroup analyses were performed.

Amid the xvi studies,^{[v,x–xiii,18–28]} 4 studies^{[eleven,xiii,22,27]} reported associations between hypertension and mild psoriasis and 5 reported associations betwixt hypertension and severe psoriasis^{[11,xiii,22,27,28]} (Fig. iii). The heterogeneity was acceptable amid those studies with severe psoriasis (I ² = 49.five%) (Fig. 3). At that place was no pregnant association for studies betwixt psoriasis and hypertension risk observed in the group with mild psoriasis (OR 1.09; 95% CI 0.98–1.22; P = .118; I ² = 51.5%) (Fig. 3), just a meaning clan between psoriasis and hypertension risk observed in the group with severe psoriasis (OR 1.xiii; 95% CI ane.03–ane.25; P = .011; I ^two = 49.five%) (Fig. iii). In addition, a significant association for studies between psoriasis and hypertension chance was observed basing on overall issue (OR 1.xi; 95% CI one.04–ane.18; P = .002; I ^two = 59.2%) (Fig. 3).

Figure 3:

Pooled estimate of the subgroup assay on the clan between psoriasis and the hazard of hypertension according to the severity of psoriasis. CI = confidence interval, OR = odds ratio.

With regard to geographic location, we grouped the studies, but the heterogeneous was still high, so the random effects model was used. And we observed European studies (OR 1.46; 95% CI 1.20–1.77; P = .000; I ² = 96.0%; random-effects model) and Asian studies (OR ane.46; 95% CI 1.26–1.68; P = .000; I ² = 73.nine% random-effects model) exhibiting significant clan between psoriasis and hypertension adventure (Fig. 4), respectively. However, we found that the OR of S American written report was 0.ix (95% CI 0.59–1.37; P = .626) (Fig. 4).

Figure four:

Pooled estimate of the subgroup analysis on the clan betwixt psoriasis and the risk of hypertension according to regional differences. CI = conviction interval, OR = odds ratio.

3.four Sensitivity analysis

To further assess the heterogeneity in these pooled studies, a sensitivity analysis was performed to thereby evaluate the influence of private studies on the overall gamble of psoriasis and hypertension. The results are shown in Figure 5. Nosotros found that when each one or each 2 trials were excluded, the heterogeneity has not yet decreased from high to the level that nosotros could take. Finally, the heterogeneity was significantly reduced (I ² = 23.0%) when v trials^{[5,thirteen,18,20,22]} were excluded from the meta-analysis (Supplemental Table 1, https://links.lww.com/MD/D851). Consequently, after analyzing the existing information, we finally attributed the high heterogeneity to the departure in diagnostic criteria for hypertension and psoriasis, instruments for measuring claret pressure, case source, and and then on.

Figure 5:

Forest plot for sensitivity analysis. CI = confidence interval.

3.v Publication bias

There was no prove of publication bias to be observed past visual inspection of the funnel plots (Fig. vi) or past the application of Begg test (P = .743) or Egger test (P = .072).

Figure 6:

Funnel plot to detect publication bias.

4 Word

The present meta-assay results demonstrated that psoriasis was positively associated with an increased take a chance of hypertension compared to those without psoriasis. Our study was the 1st meta-assay to examine the relationship between psoriasis and risk of hypertension with adjustment for covariates in the literature to appointment with 255,132 psoriasis patients and 814,631 controls. Over the included studies in our meta-analysis, 16 were all of high quality based on NOS quality scores.

There were many confounding factors betwixt psoriasis and hypertension. First of all, psoriasis itself might lead to stress, anxiety, depression, more likely to smoke, beverage, lack of exercise, and pb to aberrant blood pressure level, and moreover, drugs for psoriasis, such equally cyclosporine and compound glycyrrhizin, might touch on blood pressure,^[29] and diabetes mellitus and metabolic syndrome were besides confounding factors associated with psoriasis and hypertension.^[30] In the literature, in that location was ane previous meta-analysis ^[16] assessing the event of psoriasis on hypertension, they identified 24 observational studies with a full of approximately 2.7 million study participants fulfilling their inclusion criteria in that meta-analysis. However, the meta-analysis ^[16] had some limitations. In that meta-analysis,^[16] only some studies adjusted for confounders and most studies did not completely adjust for important confounders such every bit obesity and smoking. Given that observational studies might have a loftier potential for bias due to confounding variables, adjusted-for-covariates ORs were preferred to avert the heterogeneity and bias.^[31,32] Therefore, it is more possible to get a disarming outcome after more thorough adjustment for confounders of the association between psoriasis and hypertension. All studies adjusted for confounders to get more convincing evidence, in our study, to illustrate the link betwixt both.

At present, the etiology of psoriasis is unclear, and information technology is considered as an inflammatory skin disease mediated by T lymphocyte, and psoriasis is a mutual and frequently occurring affliction in dermatology, which cannot be absolutely cured.^[33] Hypertension is a clinical syndrome caused past many factors, such as heredity and surround, characterized past persistent summit of systemic and circulatory arterial blood pressure, which is also a major run a risk factor for cardiovascular and cerebrovascular diseases such as coronary heart disease and stroke, and it is one of the well-nigh common cardiovascular diseases.^[34] Hypertension and psoriasis are chronic diseases with high incidence, which seriously impact the quality of life and health of patients. These findings accept led to the recommendation that all patients with psoriasis should undergo detailed screening and management of hypertension. However, the biologic mechanism underlying the association of psoriasis and adventure of hypertension are uncertain.

The study of the correlation between psoriasis and hypertension has been a hot topic in dermatology and internal medicine in recent years, and many literatures accept elucidated the correlation from the epidemiologic signal of view and the biologic mechanism by means of basic research, accomplice studies, cross-exclusive studies, and case–command studies.^{[5,seven,9–13,18–28,35]} Some people^[7,9,35] have done basic researches on the human relationship between psoriasis and hypertension, and their conclusions indicated that shared pathways including systemic endothelial dysfunction, increased oxidative stress, and the altered renin–angiotensin organization in psoriasis patients might link the pathogenesis of psoriasis with the development of hypertension. The consequence of a meta-analysis performed by Armstrong et al^[16] indicated that psoriasis was associated with greater prevalence of hypertension, and it was put forward that both of mild and astringent psoriasis were associated with hypertension. In add-on, the result of Al-Metairie'south report^[36] supported that the correlation betwixt severe psoriasis and hypertension was significantly higher than that of mild psoriasis, suggesting that the more than severe the psoriasis was, the higher the risk of hypertension might be. Meanwhile, Langan's report^[22] suggested that this trend was not obvious. Five of the articles^{[11,thirteen,22,27,28]} that nosotros included studied the human relationship between psoriasis and hypertension based on the severity of psoriasis, and our result, that the prevalence of hypertension in astringent psoriasis patients was higher than that in mild psoriasis patients, was roughly the same equally that of Al-Metairie's report.^[36] But our result was somewhat different from that of previous study,^[sixteen] therefore, information technology was necessary to further study the correlation between the severity of psoriasis and hypertension and its related mechanisms in the future.

The prevalence of hypertension in the earth ranged from 10% to 20%.^[37] Generally speaking, hypertension was more common among white people, followed by yellow race and less black race, moreover the morbidity and prevalence of hypertension are often higher in economically developed areas, high altitude areas, and high common salt diet areas.^[38] At present, there was no related research virtually the effect of the incidence of hypertension in psoriasis based on regional difference. Fourteen of the studies^{[5,10,12,thirteen,eighteen–27]} that we included studied the relationship between psoriasis and hypertension based on regional difference, and our result showed that psoriasis was associated with hypertension, and the risk of hypertension in psoriasis patients was higher than that in nonpsoriasis patients in Europe and Asia. Because the included literature of our meta-analysis did non classify the population's ethnic origins, we could not practice the analysis of the correlation between psoriasis and hypertension among different ethnic groups. The better well-designed studies should exist carried out to obtain more than evidence in this regard in the future.

There were several limitations in our meta-analysis. First, we did not obtained missing data despite repeated attempts to contact the authors. Secondly, the included studies of our meta-analysis were generally case–control studies and cross-exclusive studies, which had some limitations attributable to its weakness to determine crusade and effects,^[39] and we recorded the information on each participant only once. Thirdly, this was a heterogeneous trial. The difference in diagnostic criteria for hypertension and psoriasis, instruments for measuring blood pressure, and case source might contribute to the heterogeneity. In an attempt to reduce or explain the high heterogeneity, nosotros performed subgroup analysis and sensitivity assay. When 5 trials^{[v,13,18,20,22]} were excluded from the meta-analysis, the heterogeneity was within acceptable. And in the future, the better well-designed, large-calibration nationwide and the sufficient power studies will be needed to offering the more than comprehensive evidence to analyze the clan of psoriasis and hypertension.

5 Conclusion

We conducted this meta-analysis using the adjusted-for-covariates OR, demonstrating that psoriasis was associated with an increased risk of hypertension compared to those without psoriasis. Based on this upshot, we propose that, in our clinical work, physicians should pay attention to screening whether psoriasis patients suffered from hypertension, and bear out appropriate intervention and health pedagogy for patients with hypertension or loftier blood force per unit area. It non just helps to improve the prognosis of primary diseases, but as well prevents adverse events such as coronary heart illness and stroke.

Author contributions

Conceptualization: Xi Duan, Junbo Liu.

Data curation: Yunzhu Mu, Ting Liu, Yujuan Chen, Ruichao Yu, Xincai Xiong.

Formal analysis: 11 Duan, Junbo Liu, Yunzhu Mu, Ting Liu, Yujuan Chen.

Funding acquisition: Tao Wu.

Investigation: Xi Duan, Junbo Liu.

Methodology: Xi Duan, Junbo Liu, Tao Wu.

Resources: Xi Duan, Junbo Liu, Ruichao Yu, Xincai Xiong.

Writing – original draft: Xi Duan, Junbo Liu.

Writing – review & editing: Tao Wu.

Junbo Liu orcid: 0000-0003-2442-0950.

References

[1]. Christophers Eastward. Psoriasis: epidemiology and clinical spectrum. Clin Exp Dermatol 2001;26:314–20.

[two]. Gelfand JM, Weinstein R, Porter SB, et al. Prevalence and treatment of psoriasis in the United Kingdom: a population-based written report. Arch Dermatol 2005;141:1537–41.

[3]. Parisi R, Symmons DP, Griffiths CE, et al. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol 2013;133:377–85.

[4]. Schmitt J, Ford DE. Understanding the relationship between objective disease severity, psoriatic symptoms, affliction-related stress, wellness-related quality of life and depressive symptoms in patients with psoriasis - a structural equations modeling approach. Gen Hosp Psychiatry 2007;29:134–xl.

[5]. Sommer DM, Jenisch S, Suchan Grand, et al. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Curvation Dermatol Res 2006;298:321–viii.

[6]. Chobanian AV, Bakris GL, Black 60 minutes, et al. Seventh written report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Claret Pressure level. Hypertension 2003;42:1206–52.

[7]. Huskić J, Alendar F. Tissue angiotensin-converting enzyme in patients with various clinical forms of psoriasis. Bosn J Bones Med Sci 2007;vii:103–six.

• Cited Here |
• PubMed

[8]. Ryder KW, Epinette WW, Jay SJ, et al. Serum angiotensin converting enzyme activeness in patients with psoriasis. Clin Chim Acta 1985;153:143–6.

[9]. Ena P, Madeddu P, Glorioso North, et al. Loftier prevalence of cardiovascular diseases and enhanced activity of the reninangiotensin system in psoriatic patients. Acta Cardiol 1985;40:199–205.

• Cited Here |
• PubMed

[10]. Armesto Due south, Coto-Segura P, Osuna CG, et al. Psoriasis and hypertension: a case-control study. J Eur Acad Dermatol Venereol 2011;26:785–eight.

[11]. Neimann AL, Shin DB, Wang Ten, et al. Prevalence of cardiovascular run a risk factors in patients with psoriasis. J Am Acad Dermatol 2006;55:829–35.

[12]. Shapiro J, Cohen Advertizing, Weitzman D, et al. Psoriasis and cardiovascular risk factors: a instance-command study on inpatients comparison psoriasis to dermatitis. J Am Acad Dermatol 2011;66:252–8.

[13]. Xiao J, Chen LH, Tu YT, et al. Prevalence of myocardial infarction in patients with psoriasis in cardinal China. J Eur Acad Dermatol Venereol 2009;23:1311–v.

[fourteen]. Huerta C, Rivero E, Rodri'guez LA. Incidence and take chances factors for psoriasis in the general population. Arch Dermatol 2007;143:1559–65.

[15]. Chen YJ, Shen JL, Wu CY, et al. Elevated plasma osteopontin level is associated with occurrence of psoriasis and is an unfavorable cardiovascular hazard gene in patients with psoriasis. J Am Acad Dermatol 2009;60:225–thirty.

[16]. Armstrong AW, Harskamp CT, Armstrong EJ. The association betwixt psoriasis and hypertension: a systematic review and meta-assay of observational studies. J Hypertens 2013;31:433–42.

[17]. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62:1006–12.

[18]. Brauchli YB, Jick SS, Miret M, et al. Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case-command analysis. Br J Dermatol 2009;160:1048–56.

[19]. Cohen Ad, Sherf M, Vidavsky 50, et al. Association betwixt psoriasis and the metabolic syndrome. A cross-sectional written report. Dermatology 2008;216:152–five.

[twenty]. Gerdes Southward, Zahl VA, Knopf H, et al. Comedication related to comorbidities: a study in 1203 hospitalized patients with severe psoriasis. Br J Dermatol 2008;159:1116–23.

[21]. Itani S, Arabi A, Harb D, et al. High prevalence of metabolic syndrome in patients with psoriasis in Lebanese republic: a prospective written report. Int J Dermatol 2016;55:390–5.

[22]. Langan SM, Seminara NM, Shin DB, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the Uk. J Invest Dermatol 2012;132:556–62.

[23]. Menegon DB, Pereira AG, Camerin Ac, et al. Psoriasis and comorbidities in a southern Brazilian population: a example-control study. Int J Dermatol 2014;53:e518–25.

[24]. Parisi R, Rutter MK, Lunt M, et al. Psoriasis and the risk of major cardiovascular events: accomplice written report using the clinical do research datalink. J Invest Dermatol 2015;135:2189–97.

[25]. Schmitt J, Ford DE. Psoriasis is independently associated with psychiatric morbidity and adverse cardiovascular risk factors, just not with cardiovascular events in a population-based sample. J Eur Acad Dermatol Venereol 2010;24:885–92.

[26]. Warnecke C, Manousaridis I, Herr R, et al. Cardiovascular and metabolic hazard profile in High german patients with moderate and severe psoriasis: a example control study. Eur J Dermatol 2011;21:761–seventy.

[27]. Yang YW, Keller JJ, Lin HC. Medical comorbidity associated with psoriasis in adults: a population-based report. Br J Dermatol 2011;165:1037–43.

[28]. Wakkee Yard, Meijer W, Neumann HA, et al. Psoriasis may not exist an independent predictor for the apply of cardiovascular and antidiabetic drugs: a 5-year prevalence study. Acta Derm Venereol 2010;89:476–83.

[29]. Qureshi AA, Choi HK, Setty AR, et al. Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses. Arch Dermatol 2009;145:379–82.

[30]. Sanz LP. Psoriasis, a systemic disease? Actas Dermo-Sifiliográficas (English language Edition) 2007;98:396–402.

• Cited Here

[31]. Rodriguez-Zuniga MJM, Garcia-Perdomo HA. Systematic review and meta-analysis of the association between psoriasis and metabolic syndrome. J Am Acad Dermatol 2017;77:657–66.

[32]. Voils CI, Crandell JL, Chang Y, et al. Combining adjusted and unadjusted findings in mixed research synthesis. J Eval Clin Pract 2011;17:429–34.

[33]. Gaspari AA. Innate and adaptive immunity and the pathophysiology of psoriasis. J Am Acad Dermatol 2006;54:S67–80.

[34]. Sowers JR. Hypertension, angiotensin 2, and oxidative stress. N Engl J Med 2002;346: 1999-1200a.

• Cited Here

[35]. Armstrong AW, Voyles SV, Armstrong EJ, et al. Angiogenesis and oxidative stress: common mechanisms linking psoriasis with atherosclerosis. J Dermatol Sci 2011;63:1–9.

[36]. Al-Mutairi N, Al-Farag Southward, Al-Mutairi A, et al. Comorbidities associated with psoriasis: an feel from the Centre East. J Dermatol 2010;37:146–55.

[37]. Rasmussen CB, Glisson JK, Minor DS. Dietary supplements and hypertension: potential benefits and precautions. J Clin Hypertens (Greenwich) 2012;14:467–71.

[38]. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA 2011;305:1777–85.

[39]. Sedgwick P. Cross sectional studies: advantages and disadvantages. BMJ 2014;348:g2276.

Keywords:

psoriasis; hypertension; adjusted-for-covariates; meta-assay

Supplemental Digital Content

Copyright © 2020 the Author(southward). Published by Wolters Kluwer Wellness, Inc.

deeseeale1964.blogspot.com

Source: https://journals.lww.com/md-journal/Fulltext/2020/02280/A_systematic_review_and_meta_analysis_of_the.49.aspx

Share this post