Stereotactic arrhythmia radioablation (STAR) in patients with ventricular tachycardia: a meta-analysis of efficacy and safety outcomes.

Objectives: The effectiveness and safety of STAR in patients with refractory ventricular tachycardia (VT) to catheter ablation are limited to small series. We performed a meta-analysis of observational studies to summarize existing data about efficacy and toxicity following START for VT. Methods: Eligible studies were identified on Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through March 2020. We followed the PRISMA and MOOSE guidelines. An estimative of % VT burden reduction at 6 months higher than 85% was considered effective. A rate of any grade 3 or higher toxicity lower than 10% and no grade 4 or 5 were considered safe. Results: Four observational studies with a total of 39 patients treated were included. The % of VT burden reduction at 6 months was 91% (CI95% from 83 to 100%). The consumption of lower than 2 anti-arrhythmia drugs (AAD) at 6 months was 81%. The ejection fraction improved in 12.8%, unchanged 82%, and decreased by 5.2%. The overall survival (OS) was 92% and 82 % in 6 and 12 months. The cardiac death and disease-specific survival at 12 months were 12% and 88.5%. Late grade 3 toxicity 5% with no grade 4-5. Conclusion: STAR produced satisfactory % of VT burden reduction, with a significant reduction in the consumption of AAD at 6 months, and no severe toxicity. These findings support the continued work to develop new trials and to adopt STAR as a treatment option for medical practice.

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The efficacy and safety of bamlanivimab treatment against COVID-19: A meta-analysis

10.1101/2021.08.24.21262580 ◽

2021 ◽

Author(s):

Huairong Xiang ◽

Bei He ◽

Yun Li ◽

Xuan Cheng ◽

Qizhi Zhang ◽

...

Keyword(s):

Clinical Trials ◽

Observational Studies ◽

Randomized Clinical Trials ◽

Web Of Science ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Efficacy And Safety ◽

Positive Treatment ◽

The Cochrane Library

Background: Bamlanivimab is routinely used in the treatment of coronavirus disease 2019 (COVID-19) in worldwide. We performed a meta-analysis to investigate the efficacy and safety of bamlanivimab treatment in patients with COVID-19. Methods: We searched articles from Web of Science, PubMed, Embase, the Cochrane Library and MedRxiv between 30 January 2020 and August 5, 2021. We selected randomized clinical trials (RCTs) and observational studies with a control group to assess the efficiency of bamlanivimab in treating patients with COVID-19. Results: Our meta-analysis retrieved 3 RCTs and 7 cohort studies including 14461 patients. Bmlanivimab may help outpatients to prevent hospitalization or emergency department visit (RR 0.41 95%CI 0.29 to 0.58), reduce ICU admission (RR 0.47 95%CI 0.23 to 0.92) and mortality (RR 0.32 95%CI 0.13 to 0.77) from the disease. The combination of bamlanivimab and etesevimab may had a greater potential for positive treatment outcome. Conclusion: Bamlanivimab has demonstrated clinical efficacy on mild or moderate ill patients with COVID-19 to prevent hospitalization, reduce severity and mortality from the disease. Combinations of two or more monoclonal antibody increase the effect. Well-designed clinical trials to identify the clinical and biochemical characteristics in COVID-19 patients'population that could benefit from bamlanivimab are warranted in the future.

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Intravenous dexmedetomidine during spinal anaesthesia for caesarean section: A meta-analysis of randomized trials

Journal of International Medical Research ◽

10.1177/0300060517708945 ◽

2017 ◽

Vol 45 (3) ◽

pp. 924-932 ◽

Cited By ~ 2

Author(s):

Zeqing Bao ◽

Chengmao Zhou ◽

Xianxue Wang ◽

Yu Zhu

Keyword(s):

Caesarean Section ◽

Spinal Anaesthesia ◽

Randomized Trials ◽

Meta Analysis ◽

Relevant Literature ◽

Nausea And Vomiting ◽

Cochrane Library ◽

Control Group ◽

Efficacy And Safety ◽

The Cochrane Library

Objective To evaluate the efficacy and safety of spinal anaesthesia using dexmedetomidine for caesarean section. Methods PubMed, The Cochrane Library, and CNKI were searched for relevant literature. Results The incidence of nausea and vomiting in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.21, 95% CI: 0.12–0.35, P < 0.00001). No difference was found in the incidence of pruritus between the two groups (OR = 1.21, 95% CI: 0.36–4.09, P = 0.76).The dexmedetomidine group had a higher incidence of bradycardia than did the control group (OR = 2.20, 95% CI: 1.02–4.77, P = 0.05). The incidence of shivering in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.20, 95% CI: 0.13–0.32, P < 0.00001). The incidence of hypotension was not different between the two groups (OR = 0.88, 95% CI: 0.49–1.56, P = 0.65). Conclusion Dexmedetomidine can decrease the incidence of nausea, vomiting, bradycardia, and shivering with spinal anaesthesia during caesarean section.

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Efficacy and safety of daratumumab in the treatment of multiple myeloma: a systematic review and meta-analysis

Journal of International Medical Research ◽

10.1177/03000605211038135 ◽

2021 ◽

Vol 49 (8) ◽

pp. 030006052110381

Author(s):

Yin Wang ◽

Yanqing Li ◽

Ye Chai

Keyword(s):

Multiple Myeloma ◽

Meta Analysis ◽

Complete Response ◽

Library Science ◽

Cochrane Library ◽

Control Group ◽

Efficacy And Safety ◽

Risk Patients ◽

Grade 3 ◽

Combination Regimens

Objective To systematically evaluate the efficacy and safety of combination regimens containing daratumumab in patients with multiple myeloma (MM). Methods A systematic search of publications listed on electronic databases (PubMed®, The Cochrane Library, Science Direct and Web of Science) between inception and 13 November 2020 was conducted to find randomized controlled trials (RCTs) that included patients with MM that were treated with combination regimens containing daratumumab. Results A total of seven RCTs were included ( n = 4268 patients). Meta-analysis showed that compared with the control group, the group containing daratumumab showed a significantly better overall response rate and a complete response or better. Daratumumab improved efficacy in both standard-risk and cytogenetically high-risk patients with MM. The prevalence of neutropenia (≥grade 3) and pneumonia was significantly higher in the daratumumab group compared with the control group. Conclusion The available evidence demonstrated that the clinical application of combination regimens containing daratumumab improved the efficacy in patients with MM and had acceptable safety.

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The effect of eye protection on SARS-CoV-2 transmission: a systematic review

10.1101/2021.08.08.21261770 ◽

2021 ◽

Author(s):

Oyungerel Byambasuren ◽

Elaine Beller ◽

Justin Clark ◽

Peter Collignon ◽

Paul Glasziou

Keyword(s):

Observational Studies ◽

Healthcare Workers ◽

Meta Analysis ◽

Cochrane Library ◽

Eye Protection ◽

Before And After ◽

Retrospective Cohort Studies ◽

The One ◽

General Populations ◽

The Cochrane Library

Background: The effect of eye protection to prevent SARS-CoV-2 infection in the real-world remains uncertain. We aimed to synthesize all available research on the potential impact of eye protection on transmission of SARS-CoV-2. Methods: We searched PROSPERO, PubMed, Embase, The Cochrane Library for clinical trials and comparative observational studies in CENTRAL, and Europe PMC for pre-prints. We included studies that reported sufficient data to estimate the effect of any form of eye protection including face shields and variants, goggles, and glasses, on subsequent confirmed infection with SARS-CoV-2. Findings: We screened 898 articles and included 6 reports of 5 observational studies from 4 countries (USA, India, Columbia, and United Kingdom) that tested face shields, googles and wraparound eyewear on 7567 healthcare workers. The three before-and-after and one retrospective cohort studies showed statistically significant and substantial reductions in SARS-CoV-2 infections favouring eye protection with odds ratios ranging from 0.04 to 0.6, corresponding to relative risk reductions of 96% to 40%. These reductions were not explained by changes in the community rates. However, the one case-control study reported odds ratio favouring no eye protection (OR 1.7, 95% CI 0.99, 3.0). The high heterogeneity between studies precluded any meaningful meta-analysis. None of the studies adjusted for potential confounders such as other protective behaviours, thus increasing the risk of bias, and decreasing the certainty of evidence to very low. Interpretation: Current studies suggest that eye protection may play a role in prevention of SARS-CoV-2 infection in healthcare workers. However, robust comparative trials are needed to clearly determine effectiveness of eye protections and wearability issues in both healthcare and general populations.

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Robotic-Assisted vs. Open Simple Prostatectomy for Large Prostates: A Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.695318 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zhongyou Xia ◽

Jinze Li ◽

Xiaoying Yang ◽

Hao Jing ◽

Chao Niu ◽

...

Keyword(s):

Meta Analysis ◽

Similar Efficacy ◽

Prostatic Hyperplasia ◽

Cochrane Library ◽

Efficacy And Safety ◽

Robotic Assisted ◽

Simple Prostatectomy ◽

The Cochrane Library ◽

Large Prostate ◽

Review Manager

Purpose: To compare the efficacy and safety of robotic-assisted simple prostatectomy and open simple prostatectomy for large benign prostatic hyperplasia.Methods: We systematically searched the Cochrane Library, PubMed, Embase, and Science databases for studies published through December 2020. Controlled trials on RASP and OSP for large prostates were included. The meta-analysis was conducted with the Review Manager 5.4 software.Results: A total of seven studies with 3,777 patients were included in the analysis. There were no significant differences in IPSS (WMD, 0.72; 95%CI: −0.31, 1.76; P = 0.17), QoL (WMD, 0.00; 95%CI: −0.39, 0.39; P > 0.99), Qmax (WMD, 1.88; 95% CI: −1.15, 4.91; P = 0.22), or PVR (WMD, −10.48; 95%CI: −25.13, 4.17; P = 0.16) among patients undergoing RASP and OSP. However, compared with patients who underwent OSP, patients who underwent RASP had a shorter LOS (WMD, −2.83; 95%CI: −3.68, −1.98; P < 0.001), less EBL (WMD, −304.68; 95% CI: −432.91, −176.44; P < 0.001), a shorter CT (WMD, −2.61; 95%CI: −3.94, −1.29; P < 0.001), and fewer overall complications (OR, 0.30; 95% CI: 0.16, 0.57; P < 0.001). Nevertheless, RASP was associated with a longer OT (WMD, 59.69, 95% CI: 49.40, 69.98; P < 0.001).Conclusion: The results of the current study demonstrated that RASP provided similar efficacy to those of OSP in the treatment of large prostate, while maintaining better security. Our findings indicate that RASP is a feasible and effective alternative to OSP.

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Efficacy and safety of iron supplementation in patients with heart failure and iron deficiency: a meta-analysis

British Journal Of Nutrition ◽

10.1017/s000711451900014x ◽

2019 ◽

Vol 121 (8) ◽

pp. 841-848 ◽

Cited By ~ 1

Author(s):

Shuo Zhang ◽

Fengxiao Zhang ◽

Meng Du ◽

Kun Huang ◽

Cheng Wang

Keyword(s):

Heart Failure ◽

Fixed Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Efficacy And Safety ◽

Fixed Effects Model ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Randomised Control Trials ◽

The Cochrane Library

AbstractFe therapy can be effective in heart failure patients both with and without anaemia. However, the role of Fe therapy in such patients is still uncertain. In this review, the aim was to evaluate the efficacy and safety of Fe therapy in adult patients with heart failure who have reduced ejection fraction (HFrEF). Multiple databases (PubMed, Medline, EMBASE, the Cochrane Library and Clinical Trials) were searched up to December 2017 and the reference lists of relevant articles obtained from the search were reviewed. Data extracted from randomised control trials (RCT) selected for the review were pooled using a fixed effects model or a random effects model, according to heterogeneity between trials. Nine RCT were included in this meta-analysis which included a total of 789 patients who received Fe therapy and who in turn were compared with 585 controls. There was significant improvement in the 6-min walk test (19·05 m, 95 % CI 10·48, 27·62) and peak VO2/kg (0·93 ml/kg per min, 95 % CI 0·16, 1·69) in the Fe supplementation arm. With Fe therapy, fewer patients were hospitalised for heart failure (OR: 0·42, 95 % CI 0·27, 0·65), but no relationship was found for total re-hospitalisation (OR: 0·70, 95 % CI 0·32, 1·51) or mortality (OR: 0·70, 95 % CI 0·38, 1·28). Fe therapy has the potential to improve exercise tolerance, reduce re-hospitalisations for patients with HFrEF having Fe deficiency. In addition, Fe supplementation was found to be safe, with no increased rate of adverse events.

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Comparative Efficacy and Safety of Sulodexide and Other Extended Anticoagulation Treatments for Prevention of Recurrent Venous Thromboembolism: A Bayesian Network Meta-analysis

TH Open ◽

10.1055/s-0040-1709731 ◽

2020 ◽

Vol 04 (02) ◽

pp. e80-e93 ◽

Cited By ~ 2

Author(s):

Giuseppe Pompilio ◽

Davide Integlia ◽

Joseph Raffetto ◽

Gualtiero Palareti

Keyword(s):

Venous Thromboembolism ◽

Hierarchical Models ◽

Observational Studies ◽

Therapeutic Option ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Cochrane Library ◽

Efficacy And Safety ◽

Comparative Efficacy ◽

Direct Acting

Abstract Objective This network meta-analysis (NMA) assesses the clinical comparative efficacy and safety of sulodexide versus direct-acting oral anticoagulants (DOACs), vitamin K antagonist (VKA), and aspirin in patients with an unprovoked venous thromboembolism (VTE). Methods We conducted a literature search in MEDLINE, Embase, and Cochrane Library using both randomized controlled trials (RCTs) and observational studies. Reduction in recurrent deep venous thrombosis (r-DVT), pulmonary embolism (PE), major bleeding (MB), clinically relevant nonmajor bleeding (CRNMB) were the primary efficacy and safety outcomes. Other secondary end points were also included. We performed a fixed, random effects, and hierarchical models Bayesian NMA for each outcome. Results We identified 18 RCTs and seven observational studies. Random models showed sulodexide is the best treatment compared with DOACs, VKA, and aspirin at reducing the risk of CRNMB, for preventing death from any cause, and VTE/PE/myocardial infarction (MI)/stroke with 0.47, 0.81, and 0.65 probabilities, respectively. In the random model sulodexide was the best treatment for reducing the risk of MB with a 0.50 probability and hierarchical model that confirmed favorable results. Random and hierarchical models showed sulodexide and DOACs to be the best treatments for reducing PE risk. Sulodexide was more effective than aspirin for reducing r-DVT with 0.12 and less of 0.0001 probabilities, respectively. Conclusion Sulodexide is more effective for reducing MB and CRNMB, for preventing deaths from any cause, and from VTE/PE/MI/stroke, than other treatments, for both random and hierarchical models. Sulodexide showed to be more effective than aspirin in reducing the risk of r-DVT and PE. Sulodexide's reduction in bleeding while protecting from recurrent DVT risk makes this therapeutic option an important alternative for extended anticoagulation treatment.

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Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review

npj Precision Oncology ◽

10.1038/s41698-020-00141-4 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Chai Hong Rim ◽

In-Soo Shin ◽

Sunmin Park ◽

Hye Yoon Lee

Keyword(s):

Observational Studies ◽

Meta Analysis ◽

Pooled Analysis ◽

Small Cell ◽

Cochrane Library ◽

Small Cell Lung ◽

Lung Cancers ◽

Randomized Controlled ◽

Grade 3 ◽

Available Information

AbstractWe conducted a meta-analysis of articles published in PubMed, MEDLINE, EMBASE, and Cochrane library to investigate the effectiveness of local consolidative therapy (LCT) against oligometastases. Data from randomized controlled trials (RCTs), balanced studies, and all studies combined were analyzed in a hierarchical manner. Pooled analyses of 31 studies (including seven randomized trials) investigating the effectiveness of LCT on overall survival revealed odds ratios of 3.04, 2.56, and 1.41 for all studies, balanced studies, and RCTs, respectively (all p < 0.05). The benefit of LCT was more prominent in patients with non-small cell lung and colorectal cancers than in those with prostate and small cell lung cancers. Moreover, the benefit of LCT was smaller in patients with high metastatic burdens (p = 0.054). In four of 12 studies with available information, additional grade ≥3 toxicities due to LCTs were reported. Overall, LCT is beneficial for patients with oligometastases, although such benefits are less evident in RCTs than in observational studies. Appropriate LCTs should be carefully selected considering their feasibility, disease type, and metastatic burden.

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Adjuvant Radiotherapy for Extrahepatic Cholangiocarcinoma: A Quality Assessment-Based Meta-Analysis

Liver Cancer ◽

10.1159/000518298 ◽

2021 ◽

Vol 10 (5) ◽

pp. 419-432

Author(s):

Seo Hee Choi ◽

Chai Hong Rim ◽

In-Soo Shin ◽

Won Sup Yoon ◽

Woong Sub Koom ◽

...

Keyword(s):

Sensitivity Analysis ◽

Adjuvant Radiotherapy ◽

Locoregional Recurrence ◽

Meta Analysis ◽

Cochrane Library ◽

Recurrence Rates ◽

Extrahepatic Cholangiocarcinoma ◽

Gastrointestinal Complications ◽

Grade 3 ◽

The Cochrane Library

Introduction: The benefits of adjuvant radiotherapy (ART) for extrahepatic cholangiocarcinoma are uncertain largely because existing publications lack clear comparisons between ART and non-ART arms. Methods: PubMed, Medline, Embase, and the Cochrane library were systematically searched until December 2020. The primary endpoint was overall survival (OS). Sensitivity analysis was performed for studies with reliable comparability (i.e., no favorable prognosticators in the ART arm that could skew the data). Results: Twenty-three studies involving 1,731 patients with extrahepatic cholangiocarcinoma were reviewed. The overall median of all median prescribed doses was 50.4 Gy; brachytherapy or an intraoperative boost of 10–21 Gy was applied in 5 studies. The pooled 1-, 3-, and 5-year OS rates in the non-ART and ART arms were 69.2% versus 81.0%, p = 0.035; 34.3% versus 44.7%, p = 0.025; 25.6% versus 31.7%, p = 0.115, respectively. The corresponding pooled locoregional recurrence rates were 52.1% versus 34.9% (p = 0.014). The pooled rate of grade ≥3 gastrointestinal complications was 9.8%. Sensitivity analysis performed on 14 eligible studies showed that the ART arms had a lower pooled R0 rate (36.8% vs. 63.2%, p = 0.02) and a higher rate of positive lymph nodes (47.4% vs. 34.9%, p = 0.08). The pooled 1-, 3-, and 5-year OS rates in the non-ART versus ART arms of the selected studies were 78.2% versus 84.9%, p = 0.143; 38.5% versus 49.2%, p = 0.026; and 27.8% versus 34.5%, p = 0.11, respectively. Conclusions: ART was shown to improve OS in all studies and in those selected for their reliable comparability.

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Therapeutic outcome and related predictors of stereotactic body radiotherapy for small liver-confined HCC: A systematic review and meta-analysis of observational studies

10.21203/rs.3.rs-37331/v2 ◽

2020 ◽

Author(s):

Yanyan Long ◽

Yan Liang ◽

Shujie Li ◽

Jing Guo ◽

Ying Wang ◽

...

Keyword(s):

Treatment Outcome ◽

Radiation Dose ◽

Tumor Size ◽

Stereotactic Body Radiotherapy ◽

Observational Studies ◽

Meta Analysis ◽

Cochrane Library ◽

Tumor Control ◽

Comparison Results ◽

Grade 3

Abstract Background and purpose: Stereotactic body radiotherapy (SBRT) is a promising ablative modality for hepatocellular carcinoma (HCC) especially for those with small-sized or early-stage tumors. This study aimed to synthesize available data to evaluate efficacy and explore related predictors of SBRT for small liver-confined HCC (≤3 lesions with longest diameter ≤6cm). Materials and methods: A systematic search were performed of the PubMed and Cochrane Library databases. Primary endpoints were overall survival (OS) and local control (LC) of small HCC patients treated with SBRT, meanwhile, to evaluate clinical parameters associated with treatment outcome by two methods including subgroup comparisons and pooled HR meta-analysis. The secondary endpoint was treatment toxicity including grade ≥3 hepatic complication and radiation induced liver disease (RILD). Results: After a comprehensive database review, 14 observational studies with 1238 HCC patients received SBRT were included in qualitative and quantitative analyses. Pooled 1-year and 3-year OS rates were 93.0% (95% confidence interval [CI]: 88.0%-96.0%), and 72.0% (95% CI: 62.0%-79.0%), respectively. Pooled 1-year and 3-year LC rates were 96.0% (95% CI: 91.0%-98.0%), and 91.0% (95% CI: 85.0%-95.0%), respectively. Subgroup comparisons regarding Child-Pugh class (stratified by CP-A percentage 100%, 75-100%, 50-75%) showed there were statistically significant differences for both 1-year OS rate and 3-year OS rate (p < 0.01), while that regarding number of lesions, pretreatment situation, age (median/mean age of 65), macrovascular invasion, tumor size, and radiation dose (median BED10 of 100Gy), there were no differences. In subgroup comparisons for LC rate, it showed number of lesions (1 lesion vs. 1-3 lesions) was significantly associated with 1-year LC rate (p=0.04), though not associated with 3-year LC rate (p=0.72). In subgroup comparisons categorized by other factors including pretreatment situation, age, CP-A percentage, macrovascular invasion, tumor size, and radiation dose, there were no significant differences for 1-year or 3-year LC rate. To further explore the association between CP class (A vs. B) and OS, the second method was applied by combining HR and 95% CIs. Results indicated CP-A was predictive of better OS (p=0.001) with pooled HR was 0.31 (95% CIs: 0.11-0.88), which was consistent with previous subgroup comparison results. Concerning adverse effect of SBRT, pooled rates of grade ≥3 hepatic complications and RILD were 4.0% (95% CI: 2.0%-8.0%) and 14.7% (95% CI: 7.4%-24.7%), respectively. Conclusion: The study showed that SBRT was a potent local treatment for small liver-confined HCC conferring excellent OS and LC persisting up to 3 years, even though parts of included patients were pretreated or with macrovascular invasion. CP-A class was a significant predictor of optimal OS, while number of lesions might affect short term tumor control (1-year LC). Tumor size and radiation dose were not vital factors impacting treatment outcome for such small-sized HCC patients. Because of the low quality of observational studies and heterogeneous groups of patients treated with SBRT, further clinical trials should be prospectively investigated in large sample sizes.

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