Prognostic and Predictive biomarkers in a Mediterranean cohort (Review from Atena Project)

Abstract Background Atena project involved 5,062 women aged 30 to 69 years living in the area of Naples. The purpose of this study is to investigate the causes of those chronic diseases that have a major impact on the female population. As a part of the design (scheduled in 2002-2004). After 10 years, in 228 women, some biochemical measurements were performed. Methods This systematic review and meta-analysis biomarkers were evaluated in studies nested into the Atena cohort. Studies were searched using MEDLINE/PubMed. The search was performed by entering individually or in combination: Atena, Mediterranean woman, biomarkers. The preferred reporting of systematic reviews and meta-analysis (PRISMA) guidelines were used for the review. Studies selected for this review are conducted in the Atena project Cohort and reported the study of biomarkers. Disagreements on data extractions between the two investigators were solved by consensus. The extracted data were entered and analyzed using REVMAN software. The original articles were described using forest plot and table. Heterogeneity was computed by Cochran’s Q test. Results The search strategy retrieved 13 potential articles, 11 were screened as full text articles and 6 were included in the pooled estimates. Among the articles included, biomarkers chosen as predictors were Lipids, Hcrp, as prognostic where predictive of IMT; and cycle length and LPa as predictive of an augmented LDL cholesterol mean. According to the comparability of data presented, for the first comparison we selected 3 of the 5 studies that assed IMT, for the second we selected 2 of the three studies that analyzed for LDL mean. Results were shown into forrest plots. The pooled estimates verified the potential of biomarkers as predictor of IMT, the significance seemed lower for prediction of LDL cholesterol. Conclusions Both results, consistent with the multifactor profile of the CV risk, identify the impact of secondary prevention according to biochemical profiles. Key messages Biomarkers studied in nested cohort stufies have predictive potential. pooled estimates may identify the impact of secondary prevention according to biochemical profiles.

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P2641Renal and cardiovascular benefits of treatment with angiotensin receptor blockers in patients with hypertension and chronic kidney disease: A systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.0962 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Burnier ◽

L R Ruilope ◽

G B Bader ◽

S D Durg ◽

P B Brunel

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Meta Analysis ◽

Risk Of Bias ◽

Forest Plot ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Receptor Blockers ◽

The Impact

Abstract Background Blood pressure (BP) control is critical in delaying the progression of chronic kidney disease (CKD), which otherwise results in an increased risk of cardiovascular morbidity and mortality. Angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors, are recommended by several guidelines as first-line treatment for patients with hypertension and CKD. Purpose We reviewed and analysed the effect of ARB treatment on BP and renal outcomes (estimated glomerular filtration rate (eGFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria) in patients with hypertension and CKD with or without diabetes, including large clinical trials such as RENAAL and IDNT. Methods MEDLINE, EMBASE, and BIOSIS databases were searched for literature from the earliest available date to July 2017. Randomised (parallel-group) controlled trials of ≥8 weeks assessed the impact of ARBs on systolic/diastolic BP (SBP/DBP), eGFR, SCr, CrCl or proteinuria were included in the analysis. Meta-analysis (post- versus pre-treatment) and meta-regression were conducted in R-statistical software (v3.4.1) using meta- and metafor-packages. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) was used to pool data for an outcome in a single forest plot. The risk of bias (quality) of included studies was assessed by the six items of the Cochrane instrument. Results Of the 165 articles assessed for eligibility, 24 studies were included in the analysis (19 evaluated ARBs as monotherapy, 4 evaluated ARBs in combination with other antihypertensives and 1 evaluated ARBs both as mono- and combination therapy). Treatment with ARBs as monotherapy for ≥8 weeks to <1 year significantly reduced mean office SBP (MD, −12.60 mmHg; 95% CI, −18.53 to −6.67)/DBP (−6.52 mmHg; −11.27 to −1.77) (p<0.01). BP reduction was also significant (p<0.01) with ARB monotherapy for ≥1 year SBP (−14.84 mmHg; −17.82 to −11.85)/DBP (−10.27 mmHg; −12.26 to −8.27). ARBs also significantly reduced SBP/DBP when combined with other antihypertensive treatments for ≥8 weeks to <1 year as well as for ≥1 year (Figure). Moreover, ARBs induced significant reductions (p<0.01) in proteinuria (≥8 weeks to <1 year [MD, −0.6 g/L; 95% CI, −0.93 to −0.26; ≥1 year [−0.9 g/L; −1.22 to −0.59]), but no significant changes in eGFR, CrCl or SCr levels. The beneficial effect of ARBs was maintained overtime with no significant additional impact on SBP change (estimate: 0.025; 95% CI, –0.14 to 0.19) or eGFR (estimate: 0.068; 95% CI, −0.14 to 0.28; p=0.53). The overall risk of bias was judged to be low. Effect of ARBs on blood pressure changes Conclusion Treatment with ARBs effectively and sustainably lowered BP and proteinuria with no significant change in eGFR in patients with hypertension and CKD with or without diabetes.

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Meta-analysis of the impact of human papillomavirus on cancer risk and overall survival in head and neck squamous cell carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.6080 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 6080-6080

Author(s):

F. Dayyani ◽

C. Etzel ◽

M. Liu ◽

C. Ho ◽

S. M. Lippman ◽

...

Keyword(s):

Overall Survival ◽

Human Papillomavirus ◽

Meta Analysis ◽

Local Therapy ◽

Forest Plot ◽

Etiologic Factor ◽

Hpv Dna ◽

Hpv Status ◽

Increased Risk ◽

The Impact

6080 Background: Human papillomavirus (HPV) is an important etiologic factor in HNSCC and its prevalence has been reported in several independent studies. We conducted a meta-analysis to determine the prevalence of HPV, its impact on risk of developing HNSCC and overall survival (OS). Methods: Pubmed search terms “HPV” and “HNSCC” were used to identify 40 clinical and translational studies between the years 1980–2008 that reported the prevalence of HPV in HNSCC. Statistical software STATA 10.0 was used in the meta-analyses to identify the association of HPV and HNSCC risk and OS. Pooled adjusted odds ratio (OR) or hazard ratio (HR) were obtained using a random-effects model. The amount of heterogeneity between studies was estimated with both the Chi-squared based Q test and the I2 statistic model. Potential sources of publication bias were detected using funnel plots. OS between the trials was compared in forest plot. Results: A total of 6,794 patients (pts) were included. The prevalence of HPV among HNSCC pts was 24.2%; and 86.8% of all HPV(+) tumors were HPV16. Thirteen studies (n = 1933 pts) determined HPV status by serology and the remainder detected HPV DNA in tumor tissue by PCR. Overall, HPV positivity conferred an increased risk for HNSCC (OR = 1.43; 95% CI 1.04–1.82). Risk for HNSCC among HPV16(+) pts was 4.47 times that of HPV16(-) pts. The OS was improved in HPV(+) pts compared to HPV(-) pts (HR = 0.40; 0.27–0.53). In HPV16(+) pts the HR for OS was 0.41 and the survival benefit was even more pronounced in the subgroup of HPV16(+) oropharyngeal cancers (HR = 0.38;0.17–0.58). Conclusions: This meta-analysis provides further evidence supporting the role of HPV as an important causative agent in HNSCC and supports HPV(+) HNSCC as a separate biologic entity which likely should be treated differently than HPV(-) HNSCC. Additional analysis on treatment outcomes to systemic and local therapy is ongoing. No significant financial relationships to disclose.

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Covid-19-induced fear in infoveillance studies: a meta-analysis (Preprint)

10.2196/preprints.21156 ◽

2020 ◽

Author(s):

Styliani Geronikolou ◽

George Chrousos

Keyword(s):

Social Media ◽

Meta Analysis ◽

World Health ◽

Forest Plot ◽

Health Authorities ◽

Prophylactic Measures ◽

The Social ◽

Public Health Authorities ◽

Health Organization ◽

The Impact

UNSTRUCTURED The World Health Organization named the phenomenon of misinformation spread through the social media “infodemics”, and recognized the need to curb it. Misinformation infodemics undermine not only population safety, but also compliance to the suggestions/prophylactic measures recommended in pandemics. The aim of this study was to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic. PRISMA protocol was followed and six out of twenty studies were retrieved, meta-analyzed, and had their findings presented in the form of a Forest plot. The summary random and significant event rate was 0.298, 95% CI respectively 0.213 and 0.400, suggesting that social media-circulated misinformation related to COVID-19 triggered public fear and other manifestations. These findings merit special attention by public health authorities. Thus, “infodemiology” and Infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, with potentially damaging effects.

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Association between Toxoplasma gondii infection and headache: a systematic review and meta-analysis

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666200617135851 ◽

2020 ◽

Vol 20 ◽

Author(s):

Tooran Nayeri ◽

Shahabeddin Sarvi ◽

Mahmood Moosazadeh ◽

Zahra Hosseininejad ◽

Afsaneh Amouei ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Forest Plot ◽

Cross Sectional ◽

Effect Model ◽

Toxoplasma Gondii Infection ◽

And Control ◽

The Impact

Background: The impact of infectious agents, such as Toxoplasma gondii (T. gondii), on human behavior and mental disorders has recently attracted the attention of researchers. T. gondii has emerged as a suitable candidate for such disorders due to its neural nature. Therefore, the current study aimed at investigating the possible relationship between T. gondii infection and headache. Methods: Five databases were thoroughly searched (up to October 4, 2019) for articles on the prevalence of T. gondii in headache sufferer. In this study, the odds ratio (OR) and corresponding 95% confidence interval (CI) were estimated using a random effect model and forest plot to gauge effect size and effect of each study. Results: A total number of four articles, including three case-controls and one cross-sectional studies with 2517 participants entered the meta-analysis out of whom 1205 subjects were afflicted with headache or migraine (17.67% positive for toxoplasmosis) and 1312 participants were not (18.29% for toxoplasmosis). The results of the meta-analysis indicated a common OR of 1.59 (95% CI: 1.03-2.47) by the random effect model. Conclusion: The obtained results of several studies have linked toxoplasmosis and headache. Therefore, more quality studies with larger sample sizes are needed to determine the detailed association between headache and T. gondii infection for the prevention and control of toxoplasmosis among headache sufferers.

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1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1291 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S640-S641

Author(s):

Ashley Shiyuan Lim ◽

Jun Jie Benjamin Seng ◽

Tao Tao Magdeline Ng ◽

Hui Ting Chng ◽

Zhe Han

Keyword(s):

Systematic Review ◽

Area Under Curve ◽

Selection Process ◽

Meta Analysis ◽

Repeated Measurements ◽

Cochrane Library ◽

Therapeutic Drug ◽

Forest Plot ◽

The Impact ◽

Trough Levels

Abstract Background Trough levels have been used for Vancomycin (VAN) therapeutic drug monitoring (TDM) historically due to its practicality. A paradigm shift towards the use of area under curve (AUC)-guided dosing TDM has been made due to availability of advanced pharmacokinetics software, variability between trough levels and AUC values and the potential for reducing toxicity. This review aims to evaluate the impact of AUC-guided vs trough-guided vancomycin TDM on nephrotoxicity-related outcomes. Methods A systematic review was conducted using PubMed®, Embase®, Web of Science®, CINAHL®, Google scholar and Cochrane library® up till 1st January 2021 and was reported according to the PRISMA checklist. Studies which evaluated AUC-guided or trough-guided VAN TDM and vancomycin-associated nephrotoxicity were included. Random effects models were used to compare differences in nephrotoxicity between trough level or AUC based vancomycin TDM due to expected heterogeneity in study designs. PRISMA Flowchart PRISMA flow chart depicting the selection process of studies included in the meta-analysis Results Of 1191 records retrieved, 57 studies were included. Majority of studies included adult and elderly patients (n=47, 82.5%). The pooled prevalence of nephrotoxicity was lower using the AUC-guided TDM [6.2%, 95% confidence interval (CI): 2.9 – 9.5%] compared to trough-guided TDM [17.0%; 95% CI: 14.7 – 19.2%]. The risk of nephrotoxicity was lower with the AUC-guided approach as compared with the trough-guided approach [OR: 0.53, 95% CI: 0.32–0.89]. AUC thresholds correlated with risk of nephrotoxicity only for the first 96 hours of therapy. A frequency analysis of significant multivariable factors showed that concomitant use of nephrotoxins, VAN trough levels and duration of VAN therapy were most commonly associated with nephrotoxicity. Forest plot comparing the risk of nephrotoxicity of AUC-guided vs trough-guided Forest plot comparing the risk of nephrotoxicity of AUC-guided vs trough-guided Pooled nephrotoxicity rates from AUC-guided monitoring Pooled nephrotoxicity rates from AUC-guided monitoring Pooled nephrotoxicity rates from trough-guided monitoring Pooled nephrotoxicity rates from trough-guided monitoring Conclusion The AUC-guided approach appeared to have lower risk of nephrotoxicity which supports the updated American Society of Health-System Pharmacists recommendations. More studies should be performed to evaluate the optimal derivation of AUC and clinical utility of repeated measurements of vancomycin AUC and trough levels. Disclosures All Authors: No reported disclosures

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Impact of single and dual neoadjuvant HER2-directed therapy on clinical outcomes among patients with HER2-positive breast cancer (BC).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.647 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 647-647 ◽

Cited By ~ 1

Author(s):

Kerry Lynn Reynolds ◽

Ashmeet Bhatia ◽

XingXing Cheng ◽

Barbara Lynn Smith ◽

Michelle Connolly Specht ◽

...

Keyword(s):

Meta Analysis ◽

Single Agent ◽

Disease Free Survival ◽

Predictive Biomarkers ◽

Standard Of Care ◽

Complete Response ◽

Breast Conserving Surgery ◽

Her2 Positive ◽

Improve Patient Selection ◽

The Impact

647 Background: While the addition of trastuzumab to neoadjuvant chemotherapy (CTX) is well established for HER2+ BC, the use of dual agent HER2 blockade in the preoperative setting is not considered standard of care. We conducted a comprehensive systematic review and meta-analysis to evaluate the impact of neoadjuvant dual and single agent HER2 blockade on breast conserving surgery (BCS), pathological complete response (pCR) for estrogen receptor (ER)+ and ER- tumors, and impact of pCR on disease-free survival (DFS) and overall survival (OS) for HER2+ BC. Methods: Based on QUORUM guidelines, MEDLINE and Cochrane Controlled Clinical Trials Register databases were queried to identify eligible trials. Inclusion criteria were prospective, neoadjuvant trials that had at least one arm with HER2 directed therapy, and reported pCR. Pooled relative risk ratios (RRs) and 95% confidence intervals (CIs) were estimated for endpoints using the random effects model. Results: We identified 34 trials (N = 4064). High pCR rates (> 40%) were seen with anthracycline-based CTX and trastuzumab, as well as taxane based CTX alone with dual HER2 blockade. The addition of trastuzumab to CTX did not improve BCS rate (RR 1.40, CI: 0.89-2.22, p=.15), but significantly increased rates of pCR (RR 1.91, CI: 1.38-2.64, p=.0001). Similarly, dual HER2 blockade compared to trastuzumab alone did not improve BCS rate (RR 1.03, CI: 0.77-1.38, p=.84), but significantly increased rates of pCR overall (RR 1.38, CI: 1.24-1.53, p<0.00001), in both ER+ (RR 1.72, CI: 1.14-2.61, p=.01) and ER- subsets (RR 1.91, CI: 1.38-2.64, p=.0001). Higher pCR was associated with improved DFS (RR 2.29, CI: 1.27-4.12, p=.006) and OS (RR 4.61, CI: 1.46-14.56, p=.009). Conclusions: Neither the addition of trastuzumab to CTX, nor the dual-HER2 blockade compared to trastuzumab, improves rates of BCS, but both significantly improve rates of pCR, which is associated with improved DFS and OS. A subgroup of HER2+ BC patients can achieve pCR with dual HER2 blockade without dependence on anthracycline-based therapy. Predictive biomarkers are needed to improve patient selection and personalize the optimal regimen for HER2+ BC.

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The Impact of Opium Abuse on Lipid Profile in Patients with Diabetes: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234795 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4795

Author(s):

Omorogieva Ojo ◽

Xiao-Hua Wang ◽

Osarhumwese Osaretin Ojo ◽

Jude Ibe

Keyword(s):

Systematic Review ◽

Body Mass Index ◽

Lipid Profile ◽

Ldl Cholesterol ◽

Meta Analysis ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Patients With Diabetes ◽

Opium Abuse ◽

The Impact

There is an increasing prevalence of diabetes worldwide and substance abuse has been observed as a problem among some people with diabetes. Therefore, there is an urgent need to understand the association between unhealthy drug use including the abuse of opium and clinical outcomes including its impact on lipid profile in patients with diabetes as the presence of these conditions can increase the risk of cardiovascular morbidity and mortality. Aim: This was a systematic review and meta-analysis which evaluated the impact of opium abuse on lipid profile in patients with diabetes. Method: This systematic review was conducted in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Three databases (Embase, PubMed, and PsycINFO) plus Google Scholar were searched for relevant articles from database inception to 18 July 2019 based on the Population, Intervention, Comparator, and Outcomes (PICO) framework. The studies included were based on a set of inclusion and exclusion criteria including patients with diabetes who abused opium. Articles were evaluated for risk of bias and the meta-analysis was conducted using Revman. Results: Six articles that met the criteria were included in the systematic review and meta-analysis. The type of substance abused was opium in all the studies. The results of the meta-analysis showed that opium abuse significantly (P = 0.01) lowered total cholesterol compared to control with a mean difference of −0.17 (95% CI, −0.29, −0.04) in patients with diabetes. With respect to high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and body mass index, the differences were not statistically significant (P > 0.05) between those who abused opium compared with the control. Nutritional deficiencies, weight loss and lipid dysregulation due to liver dysfunction which are found in people who abuse substances may explain the findings of the current review with respect to lipid profile in patients with diabetes who abuse opium compared with the control. Conclusion: The findings of this systematic review and meta-analysis have shown that opium abuse significantly decreased total cholesterol (P < 0.05) in patients with diabetes. However, the effect of opium abuse on HDL cholesterol, triglycerides, body mass index (BMI) and LDL cholesterol in these patients were not statistically significant (P > 0.05) compared with the control. This result has public health significance in terms of ensuring the promotion of adequate nutritional intake in patients with diabetes who abuse opium.

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Irreversible electroporation versus chemotherapy with or without radiation for locally advanced pancreatic adenocarcinoma: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.408 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 408-408

Author(s):

Kavin Sugumar ◽

Jonathan J. Hue ◽

Luke Rothermel ◽

Jeffrey Hardacre ◽

John Brian Ammori ◽

...

Keyword(s):

Meta Analysis ◽

Locally Advanced ◽

Irreversible Electroporation ◽

Advanced Pancreatic Cancer ◽

Standard Of Care ◽

Morbidity And Mortality ◽

Cochrane Library ◽

Mortality Data ◽

Forest Plot ◽

The Impact

408 Background: Multi-agent chemotherapy (CT) with or without radiotherapy (RT) is the standard of care for non-metastatic Type B locally advanced pancreatic cancer (LAPC). Irreversible electroporation (IRE) has been described as a treatment modality in patients with LAPC but published postoperative morbidity and mortality rates are high for a non-curative procedure. There have been few studies that have compared directly IRE with standard of care CT ± RT. We performed a meta-analysis of the available literature to compare the outcomes between these treatment groups in LAPC. Methods: A systematic literature search was performed in Medline, Embase, and the Cochrane Library in September 2020. Studies that focused on comparing outcomes between IRE and CT ± RT for LAPC were selected for further study. The impact of IRE versus CT ± RT was evaluated using forest plot analysis. Overall survival (OS) and progression free survival (PFS) served as the primary endpoints. As a secondary objective, short term morbidity and mortality data in both groups was evaluated. Results: Our search yielded 326 papers. After excluding duplicates, 3 studies met inclusion criteria. All were retrospective. Combined, these studies included clinical data on 3,862 patients. The meta-analysis indicated that patients with LAPC who underwent IRE had better OS (HR = 0.46, 95% CI: 0.28-0.74) and PFS (HR = 0.38, 95% CI: 0.24-0.60) compared to patients who received CT ± RT. Due to incomplete morbidity, 30-, and 90- day mortality information reported in the included studies, further analysis was not performed for the same. Conclusions: There is a striking paucity of studies comparing IRE with the standard of care treatment approaches for LAPC. Our meta-analysis reveals that IRE has been associated with longer OS and PFS compared to CT ± RT. However, these studies are limited by retrospective study design, heterogeneity of population and chemotherapy regimens, and incomplete morbidity data, precluding any conclusions. Until higher quality, comparative retrospective studies, or more importantly, prospective studies with standardized indications are conducted, IRE should be used with caution and remains experimental in the treatment of PDAC.

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