Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Objectives. Unknown onset stroke (UOS) is usually excluded from intravenous thrombolysis concerning the unclear symptom onset time. Attempts have been done to use thrombolytic therapy in these patients. The current meta-analysis was done to examine the efficacy and safety of intravenous thrombolysis in UOS. Methods. PubMed, Web of Science, and Cochrane Library were searched for studies comparing thrombolysis with conservative therapy among UOSs. Data of good outcome (mRS, 0-2), mortality, and intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) were extracted and analyzed using the Revman 5.2 software. Results. In total, 8 studies with 1271 subjects (542 with thrombolysis and 729 with conservative therapy) were included in this meta-analysis. The data showed that patients receiving thrombolysis had a higher incidence of 90-day good outcome (P=0.0005) than conservative therapy. The comparison of discharge (P=0.89) and 90-day mortality (P=0.10) in both groups did not find any significances. The incidences of ICH (P=0.42) and sICH (P=0.06) were relatively comparable between the two therapies. Conclusions. Intravenous thrombolysis is a better choice for UOS patients for its efficacy and safety. In addition, pretreatment imaging assessment is beneficial for improving the efficacy of thrombolytic therapy. However, it needs more supporting evidences for clinical use in the future.

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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.

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Efficacy of four hollow nail rhombic fixation for the treatment of patients with femoral neck fractures: A protocol of systematic review and meta-analysis

10.21203/rs.3.rs-27662/v1 ◽

2020 ◽

Author(s):

Qing-hui Ji ◽

Yu Xue ◽

Jie Miao ◽

Zhi-xin Reng ◽

Yu-fei Yuan ◽

...

Keyword(s):

Systematic Review ◽

Femoral Neck ◽

Web Of Science ◽

Meta Analysis ◽

Femoral Neck Fractures ◽

Cochrane Library ◽

Publication Date ◽

Study Quality ◽

Efficacy And Safety ◽

Randomized Controlled

Abstract Background : This study aims to assess the efficacy of four hollow nail rhombic fixation (FHNRF) for the treatment of patients with femoral neck fractures (FNF). Methods : A literature search in MEDLINE, Scopus, Web of Science, EMBASE, Cochrane Library, ProQuest, Thesis and Dissertation Catalog, Cumulative Index to Nursing and Allied Health Literature, and China National Knowledge Infrastructure will be performed from inception through February 29, 2020. This study will not apply limitations to the language and publication date. All potential randomized controlled trials (RCTs) that identify the efficacy and safety of FHNRF for the treatment of patients with FNF. Two contributors will separately examine searched records, extract essential data, and assess study quality using Cochrane risk of bias tool. Any opposition between two authors will be settled by a third contributor. We will employ RevMan 5.3 software for statistical analysis. Discussion : This study will summarize high quality RCTs to assess the efficacy and safety of FHNRF for the treatment of patients with FNF. It will help to determine whether or not FHNRF is effective and safety for the treatment of patients with FNF. Systematic review registration CRD42020168378.

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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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Efficacy and safety of ledipasvir/sofosbuvir for hepatitis C among drug users: a systematic review and meta-analysis

Virology Journal ◽

10.1186/s12985-021-01625-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Xue Yang ◽

Yang Tang ◽

Di Xu ◽

Guang Zhang ◽

Peng Xu ◽

...

Keyword(s):

Hepatitis C ◽

Drug Users ◽

Web Of Science ◽

Meta Analysis ◽

Cochrane Library ◽

Efficacy And Safety ◽

Limited Data ◽

Svr12 Rate ◽

Funnel Plots ◽

Direct Acting

Abstract Background and aims Limited data is available on the efficacy of direct acting anti-viral drugs on hepatitis C in drug users. The aim of this meta-analysis was to comprehensively analyze the efficacy and safety of LDV/SOF in drug users infected with the hepatitis C virus (HCV). Methods The PubMed, Cochrane library, Embase and Web of Science databases were searched for articles published till April 2021 on HCV-positive drug users who were treated with ledipasvir/sofosbuvir (LDV/SOF). The primary endpoint was pooled sustained virological response at 12 weeks (SVR12) with 95% confidence interval (95% CI). Funnel plots and Egger’s test were used to assess the publication bias. Results A total of 12 studies and 711 subjects treated with LDV/SOF-based regimen for HCV were included, and the pooled SVR12 rate was 89.8% (95% CI 85.9–92.7). The pooled SVR12 rate of genotype 1 drug users was 92.4% (95% CI 88.6–95.0). Subgroup analysis showed that pooled SVR12 rates of patients treated with LDV/SOF and LDV/SOF ± RBV were 89.2% (95% CI 83.4–93.1), 90.4% (95% CI 83.6–94.5) respectively. In addition, the SVR12 rates were 88% (95% CI 70.7–95.7) for 8 weeks, 89.9% (95% CI 81.0–94.9) for 12 weeks and 82.2% (95% CI 24.9–98.5) for 24 weeks of treatment. Conclusion LDV/SOF is a safe and relatively effective treatment for hepatitis C in drug users.

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The Comparison of Intrathecal Ropivacaine with Bupivacaine for Knee Arthroscopy: A Meta-analysis of Randomized Controlled Trials

The Journal of Knee Surgery ◽

10.1055/s-0039-3402795 ◽

2020 ◽

Author(s):

Zhiwei Xie ◽

Xiaoying Nie ◽

Linlin Pan ◽

Na Zhang ◽

Huiqin Xue

Keyword(s):

Randomized Controlled Trials ◽

Motor Block ◽

Web Of Science ◽

Knee Arthroscopy ◽

Meta Analysis ◽

Onset Time ◽

Sensory Block ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled

AbstractThe comparison of intrathecal ropivacaine with bupivacaine for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the efficacy of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2019 for randomized controlled trials (RCTs) assessing the effect of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. This meta-analysis is performed using the random effects model. Five RCTs are included in the meta-analysis. Overall, compared with intrathecal bupivacaine for knee arthroscopy, intrathecal ropivacaine is associated with increased onset time of motor block (mean difference [MD] = 2.05, 95% CI: 1.43–2.67, p < 0.00001) and decreased duration of sensory block (MD = −26.82, 95% CI: −31.96 to −21.67, p < 0.00001) but shows no remarkable influence on onset time of sensory block (MD = −0.09; 95% CI: −1.89 to 1.70, p = 0.92), duration of motor block (MD = −59.76; 95% CI: −124.44 to 4.91, p = 0.07), time to maximum block (MD = 2.35; 95% CI: –0.16 to 4.86, p = 0.07), first urination time (MD = −26.42, 95% CI: −57.34 to 4.51, p = 0.09), or first ambulation time (MD = 3.63, 95% CI: −25.20 to 32.47, p = 0.80).Intrathecal ropivacaine can substantially increase onset time of motor block and decrease the duration of sensory block than intrathecal bupivacaine for knee arthroscopy.

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Efficacy of ondansetron for spinal anesthesia during cesarean section: a meta-analysis of randomized trials

Journal of International Medical Research ◽

10.1177/0300060517716502 ◽

2017 ◽

Vol 46 (2) ◽

pp. 654-662 ◽

Cited By ~ 4

Author(s):

Chengmao Zhou ◽

Yu Zhu ◽

Zeqing Bao ◽

Xianxue Wang ◽

Qili Liu

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Randomized Trials ◽

Web Of Science ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled ◽

The Cochrane Library

Objective To investigate the efficacy and safety of ondansetron during cesarean section under spinal anesthesia. Methods We sought randomized controlled trials (RCTs) on ondansetron during spinal anesthesia for cesarean section in The Cochrane Library, PubMed, MEDLINE, and Web of Science from their inception to September 2016. Results Altogether, 21 RCTs were included in this study. Meta-analysis showed that the ondansetron group had a lower incidence of nausea/vomiting and bradycardia than the placebo group during cesarean section under spinal anesthesia [relative risk (RR) = 0.43, 95% confidence interval (CI) (0.36, 0.51) and RR = 0.45, 95% CI (0.26, 0.80), respectively]. There were no significant differences in the incidences of pruritus, hypotension, or shivering during cesarean section under spinal anesthesia [RR = 0.92, 95% CI (0.83, 1.02); RR = 0.72 (0.50, 1.06), 95% CI (0.50, 1.06); and RR = 0.89, 95% CI (0.71, 1.11), respectively]. Conclusion Ondansetron effectively reduces the incidences of nausea/vomiting and bradycardia under spinal anesthesia during cesarean section.

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Bracketless Invisible Orthosis in the Treatment of Children With Malocclusion : A Protocol of Systematic Review

10.21203/rs.3.rs-190842/v1 ◽

2021 ◽

Author(s):

Shi-chen Liu ◽

Xiao-guang Li ◽

Yu-li Xi ◽

Wei Zhao

Keyword(s):

Clinical Efficacy ◽

Web Of Science ◽

Data Extraction ◽

Meta Analysis ◽

Cochrane Library ◽

Efficacy And Safety ◽

Assessment Development ◽

Randomized Controlled ◽

Study Quality Assessment ◽

Grade Approach

Abstract BackgroundMalocclusion is a common oral disorder. Childhood is a critical period for the development of malocclusion. This protocol will explore the clinical efficacy and safety of bracketless invisible orthosis (BIO) in the treatment of children with malocclusion.MethodsThis study will search MEDLINE, PUBMED, Cochrane Library, Web of Science, WANGFANG, VIP, CNKI, and CBM from inception to the present. We will not apply any limitations to the language and publication status. All potential randomized controlled trials (RCTs) on the efficacy of BIO for the treatment of children with malocclusion will be considered for inclusion. Two authors will independently carry out study identification, data extraction, and study quality assessment in each study. Any disagreement will be resolved through discussion with a third author. When a number of included studies are sufficient, we will conduct meta-analysis, as well as subgroup analysis and sensitivity analysis. The certainty of evidence will be appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Outcome of interest will be presented in summary of findings tables, and statistical analysis will be performed utilizing RevMan 5.4 software. DiscussionThis systematic study will summarize all available studies to investigate the clinical efficacy of BIO in treating children with malocclusion. Findings of this study will highlight efficacy and safety of BIO for the treatment of children with malocclusion for both clinical practice and future strategies. Study registrationOSF (https://osf.io/avpmx).

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Efficacy and Safety of rt-PA Intravenous Thrombolysis in Patients with Wake-up Stroke: A Meta-Analysis

10.21203/rs.3.rs-371117/v1 ◽

2021 ◽

Author(s):

Hongfa Liu ◽

Jianghong Luo ◽

Fang Zhang ◽

Ziliang Zhang ◽

Wei Gu ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Fixed Effects ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Recombinant Tissue Plasminogen Activator ◽

Cochrane Library ◽

Efficacy And Safety ◽

Fixed Effects Model ◽

Safety Outcomes

Abstract Background Recombinant tissue plasminogen activator (rt-PA) is one of the most effective therapies for patients with acute ischemic stroke. However, wake-up stroke (WUS) is typically excluded from intravenous thrombolytic therapy because the time of symptom onset is unclear. Therefore, we aimed to assess the efficacy and safety of rt-PA intravenous thrombolysis in patients with WUS by meta-analysis. Methods We completed a systematic literature search of PubMed, Embase, the Cochrane Library, and SinoMed and included relevant studies of WUS patients covering rt-PA thrombolysis and nonthrombolysis (published from January 1, 2000, to February 28, 2021, with no language restrictions). Primary outcomes included safety outcomes and functional outcomes. Safety outcomes was measured according to the incidence of symptomatic intracranial hemorrhage (SICH) and mortality within 90 days. Efficacy outcomes was measured based on 90-day modified Rankin Scale (mRS) score. We assessed pooled data using either a random-effects model (when P < 0.10, I2 > 50%) or a fixed-effects model (when P > 0.10, I2 < 50%). Results Nine studies with 913 patients were included in the meta-analysis. All patients had ischemic stroke confirmed by computed tomography or magnetic resonance imaging. The incidence of mRS 0–2 was significantly higher in the rt-PA thrombolysis group compared with the nonthrombolysis group. And rt-PA thrombolytic WUS patients did not differ significantly from nonthrombolytic WUS patients in terms of 90-day mortality. However, the rate of SICH was also significantly higher in the rt-PA thrombolysis group than that in the nonthrombolysis group. Conclusions Patients with WUS who received rt-PA thrombolysis had a significant positive effect within 90 days. In addition, although there is no significant increase in mortality, we need to be aware of the risk of intracranial hemorrhage transformation associated with rt-PA thrombolysis despite no obvious increase in mortality. The safety of rt-PA intravenous thrombolysis should be closely monitored in patients with WUS.

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Comparative Efficacy and Safety of Duration of Dual Antiplatelet Therapy in Patients with CAD Undergoing Drug-eluting Stent Implantation: A Systematic Review and Network Meta-analysis

Current Pharmaceutical Design ◽

10.2174/1381612826666200625110349 ◽

2020 ◽

Vol 26 (44) ◽

pp. 5739-5745

Author(s):

Jieqiong Guan ◽

Wenjing Song ◽

Pan He ◽

Siyu Fan ◽

Hong Zhi ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Major Bleeding ◽

Dual Antiplatelet Therapy ◽

Meta Analysis ◽

Cochrane Library ◽

Drug Eluting Stent ◽

Efficacy And Safety ◽

Risk Of Bleeding ◽

Increased Risk ◽

Drug Eluting

Objective: The aim was to evaluate the efficacy and safety of duration of dual antiplatelet therapy (DAPT) for patients who received percutaneous coronary intervention (PCI) with a drug-eluting stent. Background: The optimal duration of DAPT to balance the risk of ischemia and bleeding in CAD patients undergoing drug-eluting stent (DES) implantation remains controversial. Methods: PubMed, Cochrane Library, Web of Science, Clinicaltrials.gov, CNKI and Wanfang Databases were searched for randomized controlled trials of comparing different durations of DAPT after DES implantation. Primary outcomes were major adverse cardiac and cerebrovascular events (MACCE), and major bleeding, and were pooled by Bayes network meta-analysis. Net adverse clinical and cerebral events were used to estimate the surface under the cumulative ranking (SUCRA) curves. The subgroup analysis based on clinical status, follow-up and area was conducted using traditional pairwise meta-analysis. Results: A total of nineteen trials (n=51,035) were included, involving six duration strategies. The network metaanalysis showed that T2 (<6-month DAPT followed by aspirin, HR:1.51, 95%CI:1.02-2.22), T3 (standard 6-month DAPT, HR:1.47, 95%CI:1.14-1.91), T4 (standard 12-month DAPT, HR:1.41, 95%CI:1.15-1.75) and T5 (18-24 months DAPT, HR:1.47, 95%CI:1.09-1.97) was associated with significantly increased risk of MACCE compared to T6 (>24-month DAPT). However, no significant difference was found in MACCE risk between T1 (<6-month DAPT followed by P2Y12 monotherapy) and T6. Moreover, T5 was associated with significantly increased risk of bleeding compared to T1(RR:3.94, 95%CI:1.66-10.60), T2(RR:3.65, 95%CI:1.32-9.97), T3(RR:1.93, 95%CI:1.21-3.50) and T4(RR:1.89, 95%CI:1.15-3.30). The cumulative probabilities showed that T6(85.0%), T1(78.3%) and T4(44.5%) were the most efficacious treatment compared to the other durations. In the ACS (<50%) subgroup, T1 was observed to significantly reduce the risk of major bleeding compared to T4, but not in the ACS (≥50%) subgroup. Conclusions: Compared with other durations, short DAPT followed by P2Y12 inhibitor monotherapy showed non-inferiority, with a lower risk of bleeding and not associated with an increased MACCE. In addition, the risk of major bleeding increased significantly, starting with DAPT for 18-month. Compared with the short-term treatment, patients with ACS with the standard 12-month treatment have a better prognosis, including lower bleeding rate and the decreased risk of MACCE. Due to study's limitations, the results should be verified in different risk populations.

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Comparison of clinical efficacy and safety between dexmedetomidine and propofol among patients undergoing gastrointestinal endoscopy: a meta-analysis

Journal of International Medical Research ◽

10.1177/03000605211032786 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110327

Author(s):

Weihua Liu ◽

Wenli Yu ◽

Hongli Yu ◽

Mingwei Sheng

Keyword(s):

Clinical Efficacy ◽

Lower Risk ◽

Gastrointestinal Endoscopy ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Similar Efficacy ◽

Cochrane Library ◽

Efficacy And Safety ◽

Inclusion Criteria ◽

Weighted Mean

Objective To compare the clinical efficacy and safety of dexmedetomidine and propofol in patients who underwent gastrointestinal endoscopy. Methods Relevant studies comparing dexmedetomidine and propofol among patients who underwent gastrointestinal endoscopy were retrieved from databases such as PubMed, Embase, and Cochrane Library. Results Seven relevant studies (dexmedetomidine group, n = 238; propofol group, n = 239) met the inclusion criteria. There were no significant differences in the induction time (weighted mean difference [WMD] = 3.46, 95% confidence interval [CI] = −0.95–7.88, I2 = 99%) and recovery time (WMD = 2.74, 95% CI = −2.72–8.19, I2 = 98%). Subgroup analysis revealed no significant differences in the risks of hypotension (risk ratio [RR] = 0.56, 95% CI = 0.25–1.22) and nausea and vomiting (RR = 1.00, 95% CI = 0.46–2.22) between the drugs, whereas dexmedetomidine carried a lower risk of hypoxia (RR = 0.26, 95% CI = 0.11–0.63) and higher risk of bradycardia (RR = 3.01, 95% CI = 1.38–6.54). Conclusions Dexmedetomidine had similar efficacy and safety profiles as propofol in patients undergoing gastrointestinal endoscopy.

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