Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis

2019 ◽  
Vol 11 (12) ◽  
pp. 1266-1272 ◽  
Author(s):  
Krishnan Ravindran ◽  
Lauren A Dalvin ◽  
Jose S Pulido ◽  
Waleed Brinjikji
Keyword(s):  
Metastatic Disease ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
First Line ◽  
Short Term ◽  
Systemic Complications ◽  
Substantial Heterogeneity ◽  
Insight Into

Background and purposeIntra-arterial chemotherapy for retinoblastoma has been adopted as a first-line treatment option by numerous tertiary centers. The effect of intra-arterial chemotherapy on future rates of metastatic disease as well as on globe salvage in advanced eyes remains relatively unknown.MethodsA search of PubMED, MEDLINE, EMBASE, and Web of Science electronic databases was conducted from inception until January 2019 for studies with a minimum of 10 patients reporting outcomes and complications following intra-arterial chemotherapy for retinoblastoma.ResultsA total of 20 studies met the inclusion criteria for analysis, comprising 873 patients and 1467 eyes. Only one study was comparative; there was substantial heterogeneity in reported outcomes and several overlapping patient cohorts that were published. Across all studies, 174 of 1467 eyes were enucleated (11.8%). Metastatic disease occurred in 8 of 513 patients (1.6%). Globe salvage was achieved in 318 of 906 (35.6%) cases of advanced retinoblastoma. The most common ocular complication was retinal detachment, occurring in 23% of eyes, and the most common systemic complications were transient fever and nausea/vomiting.ConclusionsThere is a paucity of higher-level evidence with adequate follow-up surrounding the long-term safety of intra-arterial chemotherapy and effect on metastasis in retinoblastoma. Studies to date have been limited by short-term follow-up. Longitudinal prospective studies could provide greater insight into the ability of intra-arterial chemotherapy to reduce the risk of retinoblastoma metastasis.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

The Effects of Corpus Use on Second Language Vocabulary Learning: A Multilevel Meta-analysis

2018 ◽  
Vol 40 (5) ◽  
pp. 721-753 ◽  
Author(s):  
Hansol Lee ◽  
Mark Warschauer ◽  
Jang Ho Lee
Keyword(s):  
Second Language ◽  
Vocabulary Learning ◽  
Meta Analysis ◽  
Vocabulary Knowledge ◽  
Effect Sizes ◽  
Short Term ◽  
Different Dimensions ◽  
L2 Vocabulary

Abstract This study investigates the effects of corpus use on second language (L2) vocabulary learning as well as the influence of moderators on effectiveness. Based on 29 studies representing 38 unique samples, all of which met several criteria for inclusion (e.g. with control groups), we found an overall positive medium-sized effect of corpus use on L2 vocabulary learning for both short-term (77 posttest effect sizes; Hedges’ g = 0.74, SE = 0.09, p < .001) and long-term periods (34 follow-up effect sizes; Hedges’ g = 0.64, SE = 0.17, p < .001). Furthermore, large variation in adjusted mean effect sizes across moderators was revealed. Above all, for the different dimensions of L2 vocabulary knowledge, in-depth knowledge (i.e. referential meanings as well as syntactic features of vocabulary) was associated with a large effect size. Moreover, the results revealed that learners’ L2 proficiency and several features of corpus use (i.e. interaction types, corpus types, training, and duration) influence the magnitude of the effectiveness of corpus use in improving L2 vocabulary learning.

scholarly journals Incidence of Long-term Post-acute Sequelae of SARS-CoV-2 Infection Related to Pain and Other Symptoms: A Living Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Hiroshi Hoshijima ◽  
Takahiro Mihara ◽  
Hiroyuki Seki ◽  
Shunsuke Hyuga ◽  
Norifumi Kuratani ◽  
...  
Keyword(s):  
Data Extraction ◽  
Meta Analysis ◽  
Persistent Symptoms ◽  
Initial Stage ◽  
Study Selection ◽  
Inverse Variance ◽  
Meta Regression ◽  
Substantial Heterogeneity

Importance: Persistent symptoms are reported in patients who survive the initial stage of COVID-19, often referred to as ″long COVID″ or ″post-acute sequelae of SARS-CoV-2 infection″ (PASC); however, evidence on incidence is still lacking, and symptoms relevant to pain are yet to be assessed. Objective: To determine long-term symptoms in COVID-19 survivors after infection. Data Sources: A literature search was performed using the electronic databases PubMed, EMBASE, Scopus, and CHINAL and preprint servers MedRχiv and BioRχiv through January 15, 2021. Study Selection: Eligible studies were those reporting patients with a confirmed diagnosis of SARS-CoV-2 and who showed any symptoms persisting beyond the acute phase. Data Extraction and Synthesis: Incidence rate of symptoms were pooled using inverse variance methods with a DerSimonian-Laird random-effects model. Main Outcomes and Measures: The primary outcome was pain-related symptoms such as headache or myalgia. Secondary outcomes were symptoms relevant to pain (depression or muscle weakness) and symptoms frequently reported (anosmia and dyspnea). Heterogeneity among studies and publication bias for each symptom were estimated. The source of heterogeneity was explored using meta-regression, with follow-up period, age and sex as covariates. Results: In total, 35 studies including 18,711 patients were eligible. Eight pain-related symptoms and 26 other symptoms were identified. The highest pooled incidence among pain-related symptoms was chest pain (17%, 95% CI, 12%-25%), followed by headache (16%, 95% CI, 9%-27%), arthralgia (13%, 95% CI, 7%-24%), neuralgia (12%, 95% CI, 3%-38%) and abdominal pain (11%, 95% CI, 7%-16%). The highest pooled incidence among other symptoms was fatigue (45%, 95% CI, 32%-59%), followed by insomnia (26%, 95% CI, 9%-57%), dyspnea (25%, 95% CI, 15%-38%), weakness (25%, 95% CI, 8%-56%) and anosmia (19%, 95% CI, 13%-27%). Substantial heterogeneity was identified (I2, 50-100%). Meta-regression analyses partially accounted for the source of heterogeneity, and yet, 53% of the symptoms remained unexplained. Conclusions and Relevance: The current meta-analysis may provide a complete picture of incidence in PASC. It remains unclear, however, whether post-COVID symptoms progress or regress over time or to what extent PASC are associated with age or sex.

Abstract 19824: Percutaneous Mitral Balloon Comissurotomy versus Surgical Comissurotomy in the Treatment of Severe Symptomatic Mitral Stenosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rhanderson N Cardoso ◽  
Mohammad Ansari ◽  
Daniel Garcia ◽  
Eduardo De Marchena ◽  
Cesar E Mendoza
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Meta Analysis ◽  
Clinical Results ◽  
Short Term ◽  
Stage D ◽  
Valve Area

Introduction: Percutaneous mitral balloon comissurotomy (PMBC) and surgical comissurotomy can be used for treatment of stage D mitral stenosis. Randomized controlled trials (RCTs) comparing PMBC and surgery have shown inconsistent results. Hypothesis: PMBC is associated with better hemodynamic and clinical results for the treatment of stage D mitral stenosis. Methods: Databases were searched for RCTs that compared double-balloon PMBC to surgical comissurotomy. Inclusion criteria were no left atrial clot, a favorable valve morphology and absence of significant mitral regurgitation. Clinical and hemodynamic outcomes were evaluated within short-term (less than 6 months) and long-term (over 6 months) follow up. Random-effects model was used due to anticipated heterogeneity. Results: A total of 6 RCTs with 474 patients were included, of whom 222 (46.8%) underwent PBMC. In short-term follow up, PMBC was associated with a larger mitral valve area (MVA) compared to surgical comissurotomy (mean difference 0.41 cm2; 95% CI 0.16-0.67; p=0.002; figure 1A), but also a higher incidence of moderate to severe mitral regurgitation (MR; OR 2.63; 95% CI 1.04-6.70; p=0.04; figure 1B). Short-term symptomatic (NYHA II-IV) heart failure (p=0.40) and new MR (p=0.32), as well as long-term MVA (p=0.23), restenosis (p=0.39), symptomatic heart failure (p=0.11), new MR (p=0.64) and need for reintervention (p=0.21) were not significantly different between groups. Conclusions: Our meta-analysis of RCTs suggests that PMBC is associated with an increased MVA as well as a higher incidence of moderate to severe MR when compared to surgery in the treatment of stage D MS. Therefore, the decision to proceed with PMBC or surgery in patients suitable for both procedures must rely on patient preferences, physician experience and risk of procedure-specific complications, such as left-to-right shunt with PMBC and wound infection/dehiscence with surgical comissurotomy.

scholarly journals Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis

2011 ◽  
Vol 199 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Falk Leichsenring ◽  
Sven Rabung
Keyword(s):  
Mental Disorders ◽  
Psychodynamic Psychotherapy ◽  
Meta Analysis ◽  
Dose Effect ◽  
Effect Sizes ◽  
Inclusion Criteria ◽  
Comparative Efficacy ◽  
Short Term ◽  
Prospective Design

BackgroundDose–effect relationship data suggest that short-term psychotherapy is insufficient for many patients with chronic distress or personality disorders (complex mental disorders).AimsTo examine the comparative efficacy of long-term psychodynamic psychotherapy (LTPP) in complex mental disorders.MethodWe conducted a meta-analysis of controlled trials of LTPP fulfilling the following inclusion criteria: therapy lasting for at least a year or 50 sessions; active comparison conditions; prospective design; reliable and valid outcome measures; treatments terminated. Ten studies with 971 patients were included.ResultsBetween-group effect sizes in favour of LTPP compared with less intensive (lower dose) forms of psychotherapy ranged between 0.44 and 0.68.ConclusionsResults suggest that LTPP is superior to less intensive forms of psychotherapy in complex mental disorders. Further research on long-term psychotherapy is needed, not only for psychodynamic psychotherapy, but also for other therapies.

Feline pantarsal arthrodesis using pre-contoured dorsal plates applied according to the principles of percutaneous plate arthrodesis

2013 ◽  
Vol 26 (05) ◽  
pp. 399-407 ◽  
Author(s):  
D. Sajik ◽  
M. Farrell ◽  
N. Fitzpatrick
Keyword(s):  
Wound Dehiscence ◽  
Normal Activity ◽  
Radiographic Evaluation ◽  
Dorsal Plate ◽  
Inclusion Criteria ◽  
Medium Term ◽  
Short Term ◽  
Plate Breakage

SummaryObjective: To describe the surgical technique for pantarsal arthrodesis (PTA) in cats according to the principles of percutaneous plate arthrodesis with application of a pre-contoured dorsal plate, without external coaptation and to report the long-term clinical outcome.Materials and methods: Retrospective review was performed of all cats treated by percutaneous plate application using a new pre-contoured dorsal plate for PTA between 2008 and 2011. Inclusion criteria were clinical and radiographic records plus clinical follow-up to at least six weeks. Data recorded included signalment, indication for surgery, postoperative care, and complications encountered. Radiographs were assessed for arthrodesis progression and complications. Outcome was assessed using an owner questionnaire.Results: Eleven cats were treated for tarsal injuries and met the inclusion criteria. Mean age was 86 ± 45 months, weight 4.50 ± 0.92 kg. The only major short-term complication encountered was wound dehiscence requiring sedation and re-suturing. In the medium-term (23.3 months ± 11.6 months) eight out of nine cats returned to normal activity and one cat showed intermittent lameness. Long-term (34.3 months ±17.5 months) radiographic evaluation was performed in seven out of nine cats; six manifested complete arthrodesis and one sustained plate breakage. Based on owner questionnaire, all nine cats returned to normal activity in the long-term, even the case with plate breakage.Conclusion: Based on our results, PTA using a custom pre-contoured dorsal plate is a suitable salvage surgery for treatment of severe tarsal injuries in cats.

Long-term efficacy and safety of newer generation ultrathin strut drug-eluting stents: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Lattuca ◽  
X Odorico ◽  
B.V Occean ◽  
L Cornillet ◽  
L Schmutz ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Target Vessel ◽  
Efficacy And Safety ◽  
Short Term ◽  
Term Efficacy ◽  
Drug Eluting

Abstract Background Recent trials have demonstrated that short-term efficacy and safety of ultrathin strut drug-eluting stents (DES) were non-inferior to contemporary stents but long-term benefit remains uncertain. Purpose The main objective of this meta-analysis was to evaluate efficacy and safety of ultrathin strut DES with an extended follow-up in comparison to 2nd and 3rd generations DES. Methods A double-blind review of randomized controlled trials (RCT) comparing ultrathin strut DES to contemporary DES was performed from MEDLINE and CENTRAL databases and from cardiological congresses. The primary efficacy endpoint was target vessel failure (TLF) defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI) and target lesion revascularization (TLR) and the primary safety endpoint was occurrence of stent thrombosis (ST). Short (1 year) and long term (≥2 years) effects were estimated separately. This analysis was pre-specified in PROSPERO (CRD42019142206). Results The meta-analysis included 13 RCT including 19,490 patients. In short term, we found TLF decrease with ultrathin strut DES (RR 0.85, CI [0.75–0.97], p=0.01), driven by lower TV-MI (RR 0.83, CI [0.66–1.03], p=0.1) and TLR (RR 0.77, CI [0.58–1.01], p=0.1) rates, and a non-significant downward trend in ST (RR 0.85 CI [0.64–1.14]). In long term, from the 5 trials with extended follow-up, there was no significant difference between ultrathin strut DES and thicker strut stents in rate of TLF at the longest available follow-up (RR 0.90, CI [0.76–1.06], p=0.2), despite a numerically reduction of TV-MI (RR 0.81, CI [0.61–1.08], p=0.05) and TLR (RR 0.85, CI [0.69–1.04], p=0.1) in favor of ultrathin strut stents. However, we observed a persistent numerically reduction in ST (RR 0.79, CI [0.61–1.02], p=0.01). Conclusion Ultrathin strut DES was associated with a lower target lesion failure rate at one year but not beyond 2-years follow-up. Nevertheless, the safety of the ultrathin strut stents was sustained over time with a numerically reduction of ST. Funding Acknowledgement Type of funding source: None

scholarly journals POS1099 EFFICACY OF INTRA-ARTICULAR CORTICOSTEROID INJECTIONS IN KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 829.2-830
Author(s):  
A. Najm ◽  
A. Alunno ◽  
C. Weill ◽  
J. Gwinnutt ◽  
F. Berenbaum
Keyword(s):  
Knee Osteoarthritis ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Medium Term ◽  
Short Term ◽  
Knee Oa ◽  
Randomized Controlled ◽  
And Function

Background:Knee osteoarthritis (OA) is a frequent degenerative disease representing an important health and economic burden. Symptomatic medical treatments available include intra-articular (IA) injections of corticosteroids (GC) but their efficacy is debated. In addition, safety signals regarding cartilage damage with IA GC have been highlighted in a few studies.Objectives:To perform a meta-analysis of studies assessing IA GC efficacy and safety in knee OA.Methods:A systematic literature review and a meta-analysis of randomized controlled trials (RCTs) assessing the effect of GC IA injections versus other interventions (IA Hyaluronic Acid, IA placebo, IA NSAID, oral NSAID or physiotherapy) in knee OA was performed. The effect of the interventions on pain and function were extracted from the single studies and pooled and are presented as short term (<6weeks), medium term (6-24 weeks) and long term (>24 weeks) follow-up period. Standardized mean differences (SMD) are reported.Results:Of 520 studies screened, 23 were included in the SLR and 14 subsequently included in the MA. While IA GC showed a superior effect compared to control on both pain (SMD -0.61 (95% CI -1,25, 0.03)) and function (SMD -1.02 (95% CI -2.14, 0.10)) in short term follow-up; long term follow-up analysis favored controls (IA HA, IA NSAID, physiotherapy) for both pain (SMD 0.68 (95% CI -0.11, 1.47)) and function (SMD 0.88 (95% CI -0.36, 2.12) outcomes (Figure 1). No difference was found between interventions in the medium term. Safety data were reported in 18/23 studies (n= 1936/2314 patients); and side effects were reported as follows: arthralgia (69 IA GC patients, 146 IA HA patients, and 20 saline patients); site injection pain (7 in the IA GC group, 2 in the IA saline group, 14 in the IA HA group); 16 post injection knee swelling without signs of septic arthritis in the IA GC group and 24 in the IA HA group. In one study assessing cartilage effects of GCs, the rate of cartilage loss was greater in the GC group with a reduction of cartilage thickness at 2 year compared to placebo group. No difference was observed in the progression of cartilage denudation or bone marrow lesion. On the contrary, another study showed no effect of injections on the cartilage structure.Conclusion:We demonstrate in this work that IA GC injections reduce pain and improve function in the early phase (≤6 weeks) of treatment. In the long term (≥24 weeks), other intervention such as IA HA injections or physiotherapy seem to be more efficient, but this effect was largely driven by single studies with large effect sizes and the comparators were heterogeneous.Figure 1.Knee pain outcome at short term (≤6weeks) (A), medium term (>6 & <24 weeks) (B), and long term (≥24 weeks) (C) follow up.Disclosure of Interests:None declared.

Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis

2018 ◽  
Vol 47 (4) ◽  
pp. 1001-1018 ◽  
Author(s):  
Luca Andriolo ◽  
Sante Alessandro Altamura ◽  
Davide Reale ◽  
Christian Candrian ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Eccentric Exercise ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Patellar Tendinopathy ◽  
Study Quality ◽  
Short Term ◽  
Long Term Follow Up

Background: Patellar tendinopathy is a condition characterized by anterior knee activity–related pain. It has a high incidence among athletes engaged in jumping sports and may become a chronic condition. Nonoperative management is the first choice in these patients, and several nonsurgical treatment options have been proposed. Nonetheless, clear indications on the most effective approach to address patellar tendinopathy are still lacking. Purpose: To analyze the evidence on nonoperative options to treat chronic patellar tendinopathy through a systematic review of the literature and to perform a meta-analysis to identify the most effective nonsurgical option. Study Design: Systematic review and meta-analysis. Methods: The search was conducted with the PubMed and Cochrane databases on January 4, 2017. All clinical English-language reports of any level of evidence on nonsurgical treatment of patellar tendinopathy were included. The quality of each article was assessed by use of the Coleman score. A meta-analysis was performed on all articles reporting the Victorian Institute of Sport Assessment scale for patellar tendinopathy to evaluate the results of the most described treatments. Results: A total of 70 studies involving 2530 patients were included in the qualitative data synthesis. The Coleman score showed an overall poor study quality. The most described treatment groups that could be included in the meta-analysis were reported in 22 studies on eccentric exercise, extracorporeal shockwave therapy (ESWT), and platelet-rich plasma (PRP). Single and multiple PRP injections were evaluated separately. Eccentric exercise therapies obtained the best results ( P < .05) at short-term (<6 months, mean 2.7 ± 0.7 months). However, multiple injections of PRP obtained the best results ( P < .05), followed by ESWT and eccentric exercise, at long-term follow-up (≥6 months, mean 15.1 ± 11.3 months). Conclusion: The literature documents several nonsurgical approaches for the treatment of chronic patellar tendinopathy with important limitations in terms of study quality. The available evidence showed an overall positive outcome, but some differences have been highlighted. Eccentric exercises may seem the strategy of choice in the short-term, but multiple PRP injections may offer more satisfactory results at long-term follow-up and can be therefore considered a suitable option for the treatment of patellar tendinopathy.

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