scholarly journals Comparative efficacy and safety of transurethral laser surgery with holmium laser, KTP laser, 2-micron laser or thulium laser for the treatment of non-muscle invasive bladder carcinoma: a protocol of network meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055840
Author(s):  
Jinfeng Yu ◽  
Junbiao Zheng
Keyword(s):  
Laser Surgery ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Holmium Laser ◽  
Cochrane Library ◽  
Ktp Laser ◽  
Efficacy And Safety ◽  
Thulium Laser ◽  
Comparative Efficacy ◽  
Muscle Invasive

IntroductionThe potential of transurethral laser surgery in treating non-muscle invasive bladder cancer (NMIBC) has been confirmed, however which types of lasers may be preferentially prescribed remains a debate. The aim of this network meta-analysis is to investigate the comparative efficacy and safety of transurethral laser surgery with four common types of laser including holmium laser, potassium titanylphosphate (KTP) laser, 2-micron laser or thulium laser for the treatment of NMIBC.Methods and analysisA systematic search will be conducted to search all potentially eligible randomised controlled trials comparing different transurethral laser surgeries with each other or with standard transurethral resection among patients with NMIBC in PubMed, Embase, the Cochrane library, China National Knowledge Infrastructure, Wanfang database and Chongqing VIP from their inception until 31 May 2021. Two reviewers will be asked to independently select eligible studies, and assess the risk of bias of individual study with Cochrane risk of bias assessment tool. A random-effects network meta-analysis based on Markov chain Monte Carlo method will be carried out. Ranking probabilities will be considered to rank all laser types. Quantitative analysis will be carried out by using WinBUGS V.1.4.3.Ethics and disseminationEthical approval is not required because this is a network meta-analysis of published data. We will submit all findings to some conferences for preliminary communication and to a peer-reviewed journal for publication.Trial registration number10.17605/OSF.IO/TD9MW.

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

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.

scholarly journals Comparative efficacy and safety of intra-articular analgesics after knee arthroscopy: a Bayesian network meta-analysis protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e035346
Author(s):  
Yuchen He ◽  
Hongyi He ◽  
Dong-Xing Xie ◽  
Xiaoxiao Li ◽  
Yilun Wang
Keyword(s):  
Single Dose ◽  
Pain Relief ◽  
Bayesian Network ◽  
Knee Arthroscopy ◽  
Meta Analysis ◽  
Arthroscopic Surgery ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Comparative Efficacy ◽  
Number Of Patients

IntroductionMost of the patients who received arthroscopic knee surgery will suffer moderate to severe pain, which can delay the rehabilitation process and increase the risk of postoperative complications. Therefore, seeking a safe and effective postoperative analgesia is necessary for promoting the application of arthroscopic surgery. This protocol aims to detail a planned systematic review and meta-analysis on the comparative efficacy and safety of single-dose intra-articular injection of analgesics for pain relief after knee arthroscopy.Method and analysisPubMed, Embase, Web of Science and Cochrane Library will be searched from inception to 1 June 2020 to retrieve randomised controlled trials (RCTs) that compared the commonly used single-dose intra-articular analgesics (ie, morphine; bupivacaine (including levobupivacaine); ropivacaine and magnesium alone or in combination) with placebo or between each other for postoperative pain relief among patients who had received knee arthroscopy. The primary outcome is pain intensity at 2-hour and 24-hour postoperatively; the secondary outcomes include side effects (eg, knee effusion, nausea, vomiting and flushing), the number of patients requiring supplementary analgesia and the time to first analgesic request. The methodological quality of the included RCTs will be assessed based on the Cochrane risk of bias table. The Bayesian network meta-analysis will be conducted using WinBUGS V.1.4.3.Ethics and disseminationSince no private or confidential patient data will be contained in the reporting, approval from an ethics committee is not required. Our study raises no ethical issue, and the results will be published in a peer-reviewed journal.PROSPERO registration numberCRD42019130876.

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

TH Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e80-e93 ◽  
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.

scholarly journals Efficacy and Safety of Keluoxin Capsule in the Treatment of Diabetic Kidney Disease

2021 ◽  
Author(s):  
Jingxin Zhou ◽  
Wenhua Zhang ◽  
Jie Yang ◽  
Qiaoqiao Liu ◽  
Yizhen Lu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Biomedical Literature ◽  
Health Concern ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Diabetic Kidney

Abstract Background: Diabetic kidney disease (DKD), which is a serious complication of diabetes and the leading cause of end-stage renal disease, becomes a major health concern worldwide. Keluoxin capsule, a Chinese patent medicine used for DKD, has been widely used in diabetic kidney disease, but its efficacy and safety have not yet been clarified. Therefore, the aim of this systematic review and meta-analysis is to summarize the efficacy and safety of Keluoxin capsule in the treatment of DKD. Methods: A systematic literature search will be conducted in PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, WANFANG database, VIP, SinoMED, and Chinese Biomedical Literature Database (CBM) to ensure all possible randomized controlled trials (RCT) studies on K eluoxin capsule to November 1, 2021. The primary outcome to be assessed will include the change in albuminuria and estimated glomerular filtration rate (eGFR), while secondary outcomes will be serum creatinine, blood urea nitrogen, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol, and triglycerides, etc and adverse events. The quality of the included studies and the risk of bias will be independently assessed by two reviewers using the risk of bias assessment tool from Cochrane Handbook. We will conduct random-effects model meta-analysis using Review Manager software (Revman5.3). Discussion: This systematic review and meta-analysis will objectively evaluate the effect of Keluoxin capsule for DKD, and provide evidence for Keluoxin capsule in the treatment of DKD. Ethics and dissemination : Ethics approval is not required for this study. We aim to publish the results of this systematic review in a peer-reviewed journal. INPLASY registration number: INPLASY 2021110067.

scholarly journals The efficacy and safety of thulium laser resection of bladder tumor versus standard transurethral resection in patients with non muscle-invasive bladder cancer: a systematic review and meta-analysis

2021 ◽  
Keyword(s):  
Bladder Cancer ◽  
Recurrence Rate ◽  
Bladder Tumor ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Thulium Laser ◽  
Muscle Invasive Bladder Cancer ◽  
Laser Resection ◽  
Significant Difference ◽  
Muscle Invasive

Purpose: This study was to analyze the efficacy and safety of thulium laser resection of bladder tumor (Tm-TURBT) versus TURBT for patients with non-muscle-invasive bladder cancer (NMIBC). Materials and Methods: Randomized controlled trial data were retrieved using the MEDLINE, Embase, Web of Science, and the Cochrane Library. We also searched Chinese databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang data and VIP data. Results: A total of sixteen articles including 1662 participants were enrolled into our meta-analysis. We found no significant difference in terms of operation time, urethral stricture, 1-year recurrence rate, overall 1-year recurrence rate and overall 3-year recurrence rate between the two groups. Less intraoperative blood loss and a lower incidence of obturator nerve reflex (ONR), bladder perforation and bladder irritation were identified in Tm-TURBT group than in TURBT group in our analysis. The analysis also demonstrated faster postoperative recovery in terms of the catheterization, bladder irrigation and hospitalization time in Tm-TURBT group. The subgroup analysis was conducted based on different postoperative chemotherapy (epirubicin and non-epirubicin) concerning recurrence rate whereas no significant difference was noted. Conclusion: Tm-TURBT is an efficient and safe treatment for NMIBC and it could be an alternative choice for TURBT. Given that some limitations are clearly identified, more large-scale and well-designed RCTs are needed to confirm our findings.

scholarly journals The Efficacy and Safety of Levamisole in African Children With Idiopathic Nephrotic Syndrome: A Protocol for Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Christie Divine Akwaowo ◽  
Emmanuel Okechukwu Nna ◽  
Henrietta Uchenna Okafor ◽  
Adanze Onyenonachi Asinobi ◽  
Ann Ebele Aronu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nephrotic Syndrome ◽  
Adverse Events ◽  
Idiopathic Nephrotic Syndrome ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
African Children ◽  
Steroid Sensitive

Abstract BackgroundNephrotic syndrome (NS) is one of the most common childhood renal disorders globally, with an incidence of 2 to 7 cases per 100,000 children. A characteristic feature is massive proteinuria which may rapidly progress to end stage kidney failure, if uncontrolled. Most of the cases in children are steroid sensitive but associated with frequent relapses. Levamisole, a cheap antihelminthic has been used as steroid sparing agent in steroid sensitive NS (SSNS). This study assesses the efficacy and safety of Levamisole in African children with idiopathic nephrotic syndrome.MethodsWe will conduct a systematic review and meta-analysis of all Randomised controlled trials which reported African children with Idiopathic nephrotic syndrome who were on Levamisole compared to other drugs. Ten databases including PubMed, African Journals Online, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Cochrane Library, Web of Science, Scopus, Clinicaltrial.gov and Research Gate will be searched using a search strategy. The search will have no time restrictions, but studies must have been conducted among African children residing in Africa and are retrievable in the English Language. Studies will be selected based on inclusion and exclusion criteria by two independent reviewers without blinding. The study quality will be assessed using the Pedro scale and risk of bias evaluated using the Cochrane Risk of Bias tool. Eligible screened studies will be inlcuded for meta-analysis using the CMA Software. Statistical, clinical and methodological heterogeneity will be tested. Subgroup analyses and meta-regression will be performed on rate of relapses, adverse event and drug dose.DiscussionThe primary outcome will be the proportion of children with remissions and or relapses within 6 -12 months post initiation of levamisole or comparators with effect size being the relative risk. Safety of Levamisole will be measured using reported adverse events. Moderating effects of age, gender, duration of illness, and dosage of Levamisole on the duration of remission, frequency of relapses and adverse events will be examined.Systematic Review RegistrationThis protocol has been registered in PROSPERO, with registration number CRD42020213327.

Warming Acupuncture in the Treatment of Cervical Spondylotic Radiculopathy: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Wang Zuqing ◽  
Li Yan
Keyword(s):  
Systematic Review ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Effective Rate ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Vas Score ◽  
Cervical Spondylotic Radiculopathy ◽  
The Cochrane Library

Background: Warming acupuncture (WA) is widely used in the management of Cervical spondylotic radiculopathy (CSR)in China and obtains desirable efficacy. Therefore, the aim of this study is to systematically assess the efficacy and safety whether using WA alone or combined with traditional Chinese medicine (TCM) therapy for the treatment of CSR. <br><br> Methods: PubMed, EMBASE, Sinomed, the Cochrane Library, CNKI, VIP and Wangfang databases were searched from their inception through 30 September 2020. All the retrieved records were screened or excluded based on the criteria that were pre-established, and the results that meet the criteria were assessed by the Cochrane risk of bias tool and Meta-analysis was conducted by using RevMan5.3 software. <br><br> Results: Fourteen RCTs (1021patients) were included in the meta-analysis. The effective rate of WA alone or combination with TCM therapy was analyzed in comparison with the treatment of regular therapy. The results indicated that compared with regular therapy, WA alone or in combination with TCM therapy increased clinical effective rate (Odds ratio (OR)=4.43,95%CI 2.85 to 6.90, P<0.01). Additionally decreased VAS score (mean difference (MD)=-1.21,95%CI -1.68 to -0.73, P<0.01), PPI (MD=-1.34, 95% CI -2.08 to -0.61) and PRI (MD=-0.55,95% CI -0.72 to -0.37, P<0.001). However, adverse events of WA were not specially reported in all studies. <br> Conclusions: WA as the main treatment for CSR can improve the clinical effective rate and reduce the level of VAS score, PPI and PRI. Further research is needed to determine the effectiveness of WA for CSR treatment, rigorously and unambiguously.

scholarly journals Efficacy and Safety of Duhuo Jisheng Decoction for Postmenopausal Osteoporosis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jinyu Li ◽  
Wei Wang ◽  
Guiyu Feng ◽  
Jian Du ◽  
Shengqian Kang ◽  
...  
Keyword(s):  
Postmenopausal Osteoporosis ◽  
Medication Safety ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Curative Effect ◽  
Randomized Controlled

Aim. To evaluate the effects and medication safety of Duhuo Jisheng Decoction (DHJSD) alone or as a combination therapy with other interventions on the related clinical index in postmenopausal osteoporosis condition. Methods. Search in CNKI, WanFang, CBM, VIP, PubMed, EMBASE, and Cochrane Library databases and randomized controlled trials where at least one group received any form of DHJSD for postmenopausal osteoporosis condition. Risk of bias was based on the Cochrane handbook, the quality of evidence was assessed by the GRADEpro online, and analyses were performed by RevMan 5.3 software. Results. Eight studies were enrolled with 650 participants. DHJSD alone or with other interventions had a significant effect on BMD of the lumbar spine (MD = 0.46, 95%CI (0.24, 0.68), P<0.0001), E2 (SMD = 0.49, 95%CI (0.30, 0.68), P<0.0001), and clinical effectiveness (OR = 5.07, 95%CI (3.07, 8.35), P<0.0001). However, no effect at BGP (MD = −0.84, 95%CI (−1.69, 0.00), P=0.05) was seen. Conclusion. The pooled estimate suggested that DHJSD combined with conventional medical therapies has a certain clinical curative effect on postmenopausal osteoporosis. However, considering the unsatisfactory quality of included trials, more high-quality trials are needed to elucidate this issue.

scholarly journals Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110266
Author(s):  
Zhongcheng Liu ◽  
Qiong Yi ◽  
Liangzhi He ◽  
Changjiang Yao ◽  
Lanfang Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patellar Dislocation ◽  
Revision Rate ◽  
Meta Analysis ◽  
Nonoperative Treatment ◽  
Risk Of Bias ◽  
Mpfl Reconstruction ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Obvious Benefit

Background: Medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, and nonoperative treatment are important treatments for patients with patellar dislocation. However, it is unclear which treatment leads to better outcomes. Purpose: To determine the efficacy and safety of the 3 treatments in the treatment of patellar dislocation and compare the effect of MPFL reconstruction with MPFL repair, MPFL reconstruction with nonoperative treatment, and MPFL repair with nonoperative treatment. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Web of Science, Cochrane Library, Embase, CNKI (China National Knowledge Infrastructure), and Wanfang databases were searched from inception to December 2020. Included were clinical studies that described the efficacy and safety of 2 of the 3 treatments, studies directly comparing the clinical effects of the 2 operative techniques, or studies comparing the effects of reconstruction or repair with nonoperative treatment. Two reviewers independently extracted data and assessed the quality of the included studies with the Cochrane risk-of-bias tools. The outcomes evaluated were postoperative redislocation rate, revision rate, complications, and Kujala score. We used traditional direct pairwise meta-analysis as well as network meta-analysis for comprehensive efficacy of all 3 treatment measures. Results: Twelve studies were included: 5 compared MPFL reconstruction with MPFL repair, 2 compared MPFL reconstruction with nonoperative treatment, and 5 compared MPFL repair with nonoperative treatment. The risk of bias was serious in 4, moderate in 4 and low in 4 articles. MPFL reconstruction led to significantly reduced redislocation and improved Kujala scores compared with MPFL repair and nonoperative treatment. MPFL repair led to reduced redislocation rates compared with nonoperative treatment but did not show an obvious benefit in primary dislocations. There was no significant difference among the 3 treatments in terms of revision rate and incidence of complications, although we found that treatment-related complications were least likely to occur in nonoperative treatment. Conclusion: The results of this review indicate that MPFL reconstruction decreases recurrent dislocation compared with MPFL repair or nonoperative treatment, but it has a higher possibility of complications. MPFL repair resulted in less postoperative redislocation than nonoperative treatment but did not show an obvious benefit in primary dislocation.

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