Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis

BackgroundHepatic encephalopathy (HE) is defined as brain dysfunction that occurs because of acute liver failure or liver cirrhosis and is associated with significant morbidity and mortality. Lactulose is the standard of care till this date; however, polyethylene glycol (PEG) has gained the attention of multiple investigators.MethodsWe screened five databases namely PubMed, Scopus, Web of Science, Cochrane Library and Embase from inception to 10 February 2021. Dichotomous and continuous data were analysed using the Mantel-Haenszel and inverse variance methods, respectively, which yielded a meta-analysis comparing PEG versus lactulose in the treatment of HE.ResultsFour trials with 229 patients were included. Compared with lactulose, the pooled effect size demonstrated a significantly lower average HE Scoring Algorithm (HESA) Score at 24 hours (Mean difference (MD)=−0.68, 95% CI (−1.05 to –0.31), p<0.001), a higher proportion of patients with reduction of HESA Score by ≥1 grade at 24 hours (risk ratio (RR)=1.40, 95% CI (1.17 to 1.67), p<0.001), a higher proportion of patients with a HESA Score of grade 0 at 24 hours (RR=4.33, 95% CI (2.27 to 8.28), p<0.0010) and a shorter time to resolution of HE group (MD=−1.45, 95% CI (−1.72 to –1.18), p<0.001) in favour of patients treated with PEG.ConclusionPEG leads to a higher drop in the HESA Score and thus leads to a faster resolution of HE compared with lactulose.

Download Full-text

Brain-Derived Exosomal Proteins as Effective Biomarkers for Alzheimer’s Disease: A Systematic Review and Meta-Analysis

Biomolecules ◽

10.3390/biom11070980 ◽

2021 ◽

Vol 11 (7) ◽

pp. 980

Author(s):

Ka-Young Kim ◽

Ki-Young Shin ◽

Keun-A. Chang

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Web Of Science ◽

Meta Analysis ◽

Cochrane Library ◽

Blood Biomarkers ◽

Cell Lineages ◽

The Central Nervous System ◽

New Biomarkers ◽

T Tau

Alzheimer’s disease (AD), a progressive neurodegenerative disease, affects approximately 50 million people worldwide, which warrants the search for reliable new biomarkers for early diagnosis of AD. Brain-derived exosomal (BDE) proteins, which are extracellular nanovesicles released by all cell lineages of the central nervous system, have been focused as biomarkers for diagnosis, screening, prognosis prediction, and monitoring in AD. This review focused on the possibility of BDE proteins as AD biomarkers. The articles published prior to 26 January 2021 were searched in PubMed, EMBASE, Web of Science, and Cochrane Library to identify all relevant studies that reported exosome biomarkers in blood samples of patients with AD. From 342 articles, 20 studies were selected for analysis. We conducted a meta-analysis of six BDE proteins and found that levels of amyloid-β42 (standardized mean difference (SMD) = 1.534, 95% confidence interval [CI]: 0.595–2.474), total-tau (SMD = 1.224, 95% CI: 0.534–1.915), tau phosphorylated at threonine 181 (SMD = 4.038, 95% CI: 2.312-5.764), and tau phosphorylated at serine 396 (SMD = 2.511, 95% CI: 0.795–4.227) were significantly different in patients with AD compared to those in control. Whereas, those of p-tyrosine-insulin receptor substrate-1 and heat shock protein 70 did not show significant differences. This review suggested that Aβ42, t-tau, p-T181-tau, and p-S396-tau could be effective in diagnosing AD as blood biomarkers, despite the limitation in the meta-analysis based on the availability of data. Therefore, certain BDE proteins could be used as effective biomarkers for AD.

Download Full-text

The value of lncRNAs as prognostic biomarkers on clinical outcomes in osteosarcoma: a meta-analysis

BMC Cancer ◽

10.1186/s12885-021-07882-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenchao Zhang ◽

Xiaolei Ren ◽

Lin Qi ◽

Chenghao Zhang ◽

Chao Tu ◽

...

Keyword(s):

Web Of Science ◽

Meta Analysis ◽

Positive Outcome ◽

Clinical Applications ◽

Clinicopathological Features ◽

Cochrane Library ◽

Human Osteosarcoma ◽

Non Coding Rna ◽

The Cochrane Library ◽

Long Non Coding Rna

Abstract Background In recent years, emerging studies have demonstrated critical functions and potential clinical applications of long non-coding RNA (lncRNA) in osteosarcoma. To further validate the prognostic value of multiple lncRNAs, we have conducted this updated meta-analysis. Methods Literature retrieval was conducted by searching PubMed, Web of Science and the Cochrane Library (last update by October 2, 2019). A meta-analysis was performed to explore association between lncRNAs expression and overall survival (OS) of osteosarcoma patients. Relationships between lncRNAs expression and other clinicopathological features were also analyzed respectively. Results Overall, 4351 patients from 62 studies were included in this meta-analysis and 25 lncRNAs were identified. Pooled analyses showed that high expression of 14 lncRNAs connoted worse OS, while two lncRNAs were associated with positive outcome. Further, analysis toward osteosarcoma clinicopathologic features demonstrated that overexpression of TUG1 and XIST indicated poor clinical parameters of patients. Conclusions This meta-analysis has elucidated the prognostic potential of 16 lncRNAs in human osteosarcoma. Evidently, desperate expression and functional targets of these lncRNAs offer new approaches for prognosis and therapy of osteosarcoma.

Download Full-text

Comparative diagnostic accuracy of EUS needles in solid pancreatic masses: a network meta-analysis

Endoscopy International Open ◽

10.1055/a-1381-7301 ◽

2021 ◽

Vol 09 (06) ◽

pp. E853-E862

Author(s):

Samuel Han ◽

Furqan Bhullar ◽

Omar Alaber ◽

Ayesha Kamal ◽

Puanani Hopson ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Meta Analysis ◽

Sampling Technique ◽

Standard Of Care ◽

Needle Aspiration ◽

Cochrane Library ◽

Pancreatic Masses ◽

Quantitative Synthesis ◽

Made In

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided tissue sampling is the standard of care for diagnosing solid pancreatic lesions. While many two-way comparisons between needle types have been made in randomized controlled trials (RCTs), it is unclear which size and type of needle offers the best probability of diagnosis. We therefore performed a network meta-analysis (NMA) to compare different sized and shaped needles to rank the diagnostic performance of each needle. Methods We searched MEDLINE, EMBASE and Cochrane Library databases through August, 2020 for RCTs that compared the diagnostic accuracy of EUS fine-needle aspiration (FNA) and biopsy (FNB) needles in solid pancreatic masses. Using a random-effects NMA under the frequentist framework, RCTs were analyzed to identify the best needle type and sampling technique. Performance scores (P-scores) were used to rank the different needles based on pooled diagnostic accuracy. The NMA model was used to calculate pairwise relative risk (RR) with 95 % confidence intervals. Results Review of 2577 studies yielded 29 RCTs for quantitative synthesis, comparing 13 different needle types. All 22G FNB needles had an RR > 1 compared to the reference 22G FNA (Cook) needle. The highest P-scores were seen with the 22G Medtronic FNB needle (0.9279), followed by the 22G Olympus FNB needle (0.8962) and the 22G Boston Scientific FNB needle (0.8739). Diagnostic accuracy was not significantly different between needles with or without suction. Conclusions In comparison to FNA needles, FNB needles offer the highest diagnostic performance in sampling pancreatic masses, particularly with 22G FNB needles.

Download Full-text

S-1 and Capecitabine for the Treatment of Colorectal Cancer: A Meta-Analysis

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2021.2673 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1144-1152

Author(s):

Ping Huang ◽

Zhenfen Wang ◽

Qian Liu ◽

Guohao Cai

Keyword(s):

Colorectal Cancer ◽

Web Of Science ◽

Advanced Colorectal Cancer ◽

Meta Analysis ◽

Cochrane Library ◽

Therapeutic Effects ◽

Chemotherapeutic Drugs ◽

The Third ◽

Hand Foot Syndrome ◽

The Cochrane Library

Colorectal cancers common tumors that develop in the large intestines. The incidence of colorectal cancer is second only to gastric and esophageal cancers. Both S-1 and capecitabine are the third-generation fluorouracil-based chemotherapeutic drugs. We hope to summarize the therapeutic effects of tecotae and capecitabine in patients with colorectal cancer through this Meta-analysis. We performed a meta-analysis of the findings in the current literature. We performed a systematic review of outcomes associated with S-1 and capecitabine used to treat advanced colorectal cancer based on findings from both English and Chinese publications listed in PubMed, Embase, CNKI, Wanfang, EBSCO, Web of Science and the Cochrane Library. End-points included ORR, DCR, OS, and PFS; adverse events (grades 1–2 and 3–4) were also evaluated. Statistical analysis was performed using RevMan 5.3. A total of 12 studies were eventually included, involving a total of 3,375 patients. Of this group, 1,683 and 1,692 patients underwent treatment with S-1 or capecitabine, respectively. There were no greatly differences with respect to ORR, DCR, or OS; however, PFS was bettered in the group of S-1 compared to those treated with capecitabine. The incidence of leukopenia, diarrhea and anorexia were all higher among those in S-1 group compared to the capecitabine group, but a higher incidence of hand-foot syndrome was linked with use of capecitabine. Use of S-1 for the treatment of colorectal cancer may result in superior outcomes when compared to use of capecitabine.

Download Full-text

Pooled analysis of T2 Candida for rapid diagnosis of candidiasis

BMC Infectious Diseases ◽

10.1186/s12879-019-4419-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Dong-Lan Tang ◽

Xiao Chen ◽

Chang-Guo Zhu ◽

Zhong-wei Li ◽

Yong Xia ◽

...

Keyword(s):

Likelihood Ratio ◽

Web Of Science ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Pooled Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Research Subjects

Abstract Background The present meta-analysis examined the diagnostic accuracy of T2 Candida for candidiasis. Methods The literature databases, such as PubMed, Embase, DVIO, Cochrane library, Web of Science, and CNKI, were searched on T2 Candida detection. Results A total of 8 articles, comprising of 2717 research subjects, were included in the study. The pooled sensitivity and specificity were 0.91 (95% confidence interval (CI): 0.88–0.94) and 0.94 95% CI: 0.93–0.95), respectively. The pooled positive likelihood ratio and negative likelihood ratio was 10.16 (95% CI: 2.75–37.50) and 0.08 (95% CI: 0.02–0.35), respectively. The combined diagnostic odds ratio is 133.65 95% CI: 17.21–1037.73), and the AUC of SROC is 0.9702 [(SE = 0.0235), Q* = 0.9201(SE = 0.0381)]. Conclusions The current evidence supported that T2 Candida has high accuracy and sensitivity and is of major clinical significance in the diagnosis of Candida infection.

Download Full-text

The Role of L-ornithine-L-aspartate in the Management of Minimal Hepatic Encephalopathy among Patients with Liver cirrhosis: a Systemic review and Meta-analysis

Acta Medica Philippina ◽

10.47895/amp.v52i1.487 ◽

2018 ◽

Vol 52 (1) ◽

Author(s):

Henry Winston C. Li ◽

Maria Ana Louise M. Naidas ◽

Karen Anjela M. Mondragon ◽

Ruter M. Maralit

Keyword(s):

Liver Cirrhosis ◽

Hepatic Encephalopathy ◽

Meta Analysis ◽

Block Design ◽

Cochrane Collaboration ◽

Minimal Hepatic Encephalopathy ◽

Systemic Review ◽

Cochrane Library ◽

P Value ◽

Picture Completion

Objective. To evaluate the efficacy of L-ornithine-L-aspartate (LOLA) in improving minimal hepatic encephalopathy in adult patients with liver cirrhosis. Methods. A search in PubMed, Cochrane Library, Google Scholar, and Medline was made obtaining four qualified randomized controlled trials. Studies included adult cirrhotic patients with minimal hepatic encephalopathy measured by the number connection test (NCT-A, B), figure connection test (FCT-A, B), picture completion, block design test, and critical flicker frequency (CFF) testing with a cut-off score of <39Hz. Methodologic assessment of studies was performed using Cochrane Collaboration Risk of Bias Tool and Review Manager (RevMan) version 5.3 for statistical analysis. Results. Of the 29 studies identified, 4 fulfilled the inclusion criteria, which entailed analysis of 238 participants (LOLA: 116, Control: 122). Three out of the four studies were used in meta-analysis and one study was analyzed separately due to a difference in the neuropsychometric measure. The metaanalysis favored experimental group (LOLA), with a mean difference of 2.29 (95% CI 0.72 – 3.86), p-value = 0.004, and an I2 of 18%. Conclusion. LOLA provided great potential in managing encephalopathy since treating earlier related to better survival and prevention of disease progression. The results of our study supported such evidence and its use may be encouraged.

Download Full-text

Association between early mobilization or rehabilitation and intensive care unit acquired weakness: A systematic review and meta-analysis of randomized controlled trials.

10.21203/rs.3.rs-125436/v1 ◽

2020 ◽

Author(s):

Minghang Li ◽

Mingyue Ding ◽

Huanzhang Shao ◽

Bingyu Qin ◽

Xingwei Wang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Meta Analysis ◽

Early Mobilization ◽

Standard Of Care ◽

Cochrane Library ◽

Care Group ◽

China National Knowledge Infrastructure ◽

Number Of Patients ◽

Icu Discharge

Abstract Background The prognosis of intensive care unit acquired weakness (ICUAW) is poor and the treatment effect is not ideal. At present, some effective and safe early prevention means are urgently needed to reduce its incidence.This study evaluated the effectiveness and safety of early activities or rehabilitation in the prevention of ICUAW. Methods We searched for articles in five electronic databases, including PubMed, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) and Wanfang Med Online. All publications until June, 2020 were searched. We have selected trials investigating early mobilization or rehabilitation as compared to standard of care in critically ill adults.The extracted data included adverse events, the number of patients with ICUAW, the length of stay in the ICU (ICU-LOS) the length of mechanical ventilation (MV) etc. Results The final results showed that compared with the usual care group, early mobilization or rehabilitation reduced the prevalence of ICUAW (RR, 0.73; [0.61, 0.87]; I2 = 44%; P = 0.0006), ICU-LOS (MD, − 1.47;[2.83, 0.10]; I2 = 56%; P = 0.04), length of MV (MD, − 1.96; [2.41, 1.51]; I2 = 0%; P = 0.00001), but the mortality (RR, 0.90; [0.62, 1.32]; I2 = 3%; P = 0.60) at ICU discharge was not associated. The subgroup analysis of ICUAW prevalence and ICU-LOS based on the intervention methods showed that early combined rehabilitation could reduce the prevalence of ICUAW (RR, 0.56; [0.43, 0.74]; I2 = 34%; P = 0.0001) and shorten the ICU-LOS (MD, − 2.21; [3.28, 0.97]; I2 = 23%; P = 0.0003). EGDM was not associated with a decrease in ICUAW prevalence (RR, 0.85; [0.65, 1.09]; I2 = 26%; P = 0.20), but it reduced the ICU-LOS (MD, − 2.27; [3.86, 0.68]; I2 = 0%; P = 0.005).Early in-bed cycling was not associated with reduced ICUAW prevalence(RR, 1.25; [0.73, 2.13]; I2 = 0%; P = 0.41) and ICU-LOS(MD, 2.27; [0.27, 4.80]; I2 = 0%; P = 0.08) . Conclusions Early mobilization or rehabilitation was associated with a shorter length of MV and ICU-LOS, but not mortality. Of course, not all early activities or forms of rehabilitation are effective. The early combined rehabilitation model is effective for the prevention of ICUAW. However, EGDM and early in-bed cycling were not effective in preventing ICUAW.

Download Full-text

Comparative efficacy and safety of β-lactam/β-lactamase inhibitors versus cabapenems for febrile neutropenia empiric therapy: A systematic review and meta analysis

10.21203/rs.3.rs-62389/v1 ◽

2020 ◽

Author(s):

Haiyang Meng ◽

Jingyi ZHANG ◽

Ailing ZHANG ◽

Jie YANG ◽

Jingli LU ◽

...

Keyword(s):

Febrile Neutropenia ◽

Web Of Science ◽

Meta Analysis ◽

Treatment Success ◽

Empiric Therapy ◽

Cochrane Library ◽

Efficacy And Safety ◽

Comparative Efficacy ◽

All Cause Mortality ◽

Adults And Children

Abstract Background The efficacy and safety of β-lactam/β-lactamase inhibitors (BL/BLIs) versus carbapenems for febrile neutropenia empiric therapy are controversial. Methods PubMed, Embase, Cochrane library databases, Web of Science and Google scholar were searched up to 1 April 2020. Studies were included if they compared BL/BLIs versus carbapenem for febrile neutropenia patients undergoing chemotherapy for either solid tumours or haematological malignancies among adults and children. We pooled the treatment success rate, mortality and adverse events. Results Nine RCTs were included. There was no differences between carbapenems and BL/BLIs were observed in terms of treatment success without modification (RR 1.04, 95% CI 0.93–1.15), no differences were observed in the subgroups of BL/BLIs, adults and children. No significant differences were found in all-cause mortality (RR 1.15, 95% CI 0.64–2.06). Our study shows that gastrointestinal events are the most common adverse effects, nausea/vomiting were significantly more common with carbapenems (RR 2.83, 95% CI 1.35–5.92, P = 0.006), however, diarrhea were more common with BL/BLIs (RR 0.47, 95% CI 0.27–0.80, P = 0.006). Conclusions The efficacy and safety of BL/BLIs with carbapenems were comparable in empiric treatment of febrile neutropenia.

Download Full-text

Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature

Acta Otorhinolaryngologica Italica ◽

10.14639/0392-100x-1195 ◽

2017 ◽

Vol 37 (1) ◽

pp. 1-8

Author(s):

J. Liang ◽

Z. Li ◽

F. Fang ◽

T. Yu ◽

C. Leone

Keyword(s):

Thyroid Cancer ◽

Cancer Patients ◽

Differentiated Thyroid Cancer ◽

Web Of Science ◽

Meta Analysis ◽

Central Neck Dissection ◽

Cochrane Library ◽

Central Neck ◽

Sono Stati ◽

Prophylactic Central Neck Dissection

Le metastasi ai linfonodi del compartimento centrale del collo sono comuni nei pazienti affetti da carcinoma differenziato della tiroide (DTC). La gestione dei pazienti con stadiazione preoperatoria cN0 è ancora dibattuta. Lobiettivo di questo lavoro è stato quello di analizzare le differenze in merito a ricorrenza e complicanze chirurgiche tra tiroidectomia (TT) isolata e TT associata a svuotamento linfonodale profilattico del compartimento centrale del collo (pCND) come trattamenti iniziali di pazienti con DTC cN0, e di valutare limportanza clinica del pCND per questi pazienti. I database PubMed, Ovid, Cochrane Library e Web of Science sono stati analizzati scrupolosamente, e sono stati identificati ventitré articoli per un totale di 6823 pazienti. La qualità di evidenza è stata valutata tramite lo score di Jadad e tramite la Newcastle-Ottawa Quality assessment scale. I risultati hanno mostrato che i pazienti sottoposti a TT e pCND, se paragonati ai pazienti sottoposti a TT isolata, hanno avuto un tasso significativamente più alto di lesioni transitorie del nervo laringeo inferiore (p = 0,023), di ipocalcemia transitoria (p < 0,01) e di ipocalcemia permanente (p < 0,01). Inoltre è stato rilevato un trend in diminuzione per quel che riguarda il tasso di ricorrenza nei pazienti sottoposti a TT e pCND (p < 0,01). La tiroidectomia totale associata allo svuotamento del compartimento centrale del collo come trattamento iniziale per quei pazienti con cN0 potrebbe ridurre il rischio di ricorrenza di malattia, ma aumenta lincidenza di alcune complicanze. Si rendono necessari ulteriori studi di maggior qualità metodologica.

Download Full-text

2513. The Effect of Treatment Supporter Interventions on ART Adherence in Eastern and Southern Africa: a systematic review and meta-analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2191 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S872-S873

Author(s):

Ya Haddy Sallah ◽

Thabani Nyoni ◽

Kim Lipsey

Keyword(s):

Cohort Studies ◽

Southern Africa ◽

Meta Analysis ◽

Standard Of Care ◽

Cochrane Library ◽

Virologic Suppression ◽

Art Adherence ◽

Meta Regression ◽

Eastern And Southern Africa ◽

Study Type

Abstract Background Access to ART has significantly reduced morbidity and mortality and improved quality of life in people living with HIV (PLWH). Treatment supporter interventions (TSIs) utilize patient or facility selected individuals to increase optimal ART adherence through home visits, peer support and medication management. This aim of this meta-analysis is to evaluate the effectiveness of TSIs in improving optimal ART adherence among PLWH in SSA using process- and outcome-oriented measures. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science (WOS), Cochrane Library, and ClinicalTrials.gov for randomized controlled trials or cohort studies comparing treatment supporter interventions to the standard of care conducted in Eastern and Southern Africa. The primary outcomes were ART adherence measured by pill counts and virologic suppression. Pooled risk ratios with 95% confidence intervals were calculated using random-effects models. Stratified analyses and meta-regression were conducted to determine the effect of study type and patient nomination of treatment supporters on ART adherence. Results Sixteen studies, 10 RCTs and 6 cohort studies, were selected for inclusion. Virologic suppression was reported in 14 studies with 12,457 individuals in TSIs and 23,592 receiving the standard of care. Optimal ART adherence was reported in 7 RCTs only (2,185 individuals in TSI and 1,545 receiving SOC). Optimal ART adherence was 7.6% higher in TSIs compared with SOC (pooled RR 1.076, 95% CI 1.005–1.151, p = 0.035). Heterogeneity of these studies was high (I2 = 91.1%). Virologic suppression was 5% higher in TSIs compared with the standard of care (pooled RR 1.05, 95% CI 1.019–1.081, P = 0.001). Meta-regression demonstrated that virologic suppression did not significantly vary by study type (b = −0.042, 95% CI −0.09–0.001, P = 0.057) and patient selection of the treatment supporter (b = 0.026, 95% CI −0.07–0.12, P = 0.554). Conclusion Optimal ART adherence is marginally higher in treatment supporter interventions compared with the standard of care. Patient-nominated supporters achieve similar rates of virologic suppression to facility-selected supporters, and could play a critical role in addressing disparities in health outcomes among PLWH. Disclosures All authors: No reported disclosures.

Download Full-text