scholarly journals Antithrombotic Agents for tPA‐Induced Cerebral Hemorrhage: A Systematic Review and Meta‐Analysis of Preclinical Studies

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Yang Ye ◽  
Fu‐Tao Zhang ◽  
Xiao‐Yi Wang ◽  
Hong‐Xuan Tong ◽  
Yu‐Tian Zhu
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Infarct Size ◽  
Cerebral Hemorrhage ◽  
Meta Analysis ◽  
Hemorrhagic Transformation ◽  
Mean Difference ◽  
Preclinical Studies ◽  
Antithrombotic Agents ◽  
Standardized Mean Difference

Background tPA (tissue‐type plasminogen activator) remains the only approved drug for acute ischemic stroke, with a potentially serious adverse effect: hemorrhagic transformation. The effects of antithrombotic agents on tPA‐induced hemorrhagic transformation after ischemic stroke are not clearly defined. We performed a systematic review and meta‐analysis in preclinical studies aiming to evaluate the efficacy of antithrombotic agents on tPA‐induced hemorrhagic transformation after ischemic stroke. Methods and Results We conducted a systematic review and meta‐analysis of studies testing antithrombotic agents in animal models of tPA‐induced hemorrhagic transformation. The pooled effects were calculated using random‐effects models, and heterogeneity was explored through meta‐regression and subgroup analyses. Publication bias was assessed using trim and fill method and the Egger test. The efficacy of 18 distinct interventions was described in 22 publications. The pooled data showed a significant improvement in cerebral hemorrhage, infarct size, and neurobehavioral outcome in treated compared with control animals (standardized mean difference, 0.45 [95% CI, 0.11–0.78]; standardized mean difference, 1.18 [95% CI, 0.73–1.64]; and standardized mean difference, 0.91 [95% CI, 0.49–1.32], respectively). Subgroup analysis indicated that quality score, random allocation, control of temperature, anesthetic used, stroke model used, route of drug delivery, time of drug administration, and time of assessment were significant factors that influenced the effects of interventions. Conclusions Administration with antiplatelet agents revealed statistically significant improvement in all the outcomes. Anticoagulant agents showed significant effects in infarct size and neurobehavioral score, but fibrinolytic agents did not show any significant improvement in all the outcomes. The conclusions should be interpreted cautiously given the heterogeneity and publication bias identified in this analysis.

Intralymphatic immunotherapy for allergic rhinitis: A systematic review and meta-analysis

2021 ◽  
Vol 42 (4) ◽  
pp. 283-292 ◽  
Author(s):  
Michael T. Werner ◽  
John V. Bosso
Keyword(s):  
Systematic Review ◽  
Allergic Rhinitis ◽  
Adverse Event ◽  
Skin Prick Testing ◽  
Meta Analysis ◽  
Mean Difference ◽  
Random Effects Model ◽  
Nasal Provocation ◽  
Intralymphatic Immunotherapy ◽  
Standardized Mean Difference

Background: Only a fraction of patients with allergic rhinitis receive allergen-specific immunotherapy (AIT). AIT is most commonly delivered subcutaneously in a series of injections over 3‐5 years. Common obstacles to completing this therapy include cost and inconvenience. Intralymphatic immunotherapy (ILIT) has been proposed as a faster alternative, which requires as few as three injections spaced 4 weeks apart. Objective: This systematic review and meta-analysis evaluated the current evidence that supports the use of ILIT for allergic rhinitis. Methods: Clinical trials were identified in the published literature by using an electronic search strategy and were evaluated by using a risk of bias tool. Treatment outcome (symptom scores, medication scores, and combined symptom and medication scores) and provocation testing results (nasal provocation and skin-prick testing) were included in a meta-analysis of standardized mean difference with subgrouping by using a random-effects model. Overall adverse event rates were tabulated, and overall risk ratios were calculated by using a random-effects model. Results: We identified 17 clinical trials that met eligibility criteria. The standardized mean difference of ILIT on the symptom and medication score was ‐0.72 (95% confidence interval [CI], ‐0.98 to ‐0.46; p < 0.0001) (n = 10). The standardized mean difference of ILIT on nasal provocation and skin-prick testing was ‐1.00 (95% CI, ‐1.38 to ‐0.61; p < 0.0001) (n = 7) and ‐0.73 (95% CI, ‐0.99 to ‐0.47; p < 0.0001) (n = 7), respectively. No statistically significant heterogeneity was detected. The overall adverse event rate was 39.5% for ILIT and 23.5% for placebo. Also, 98.4% of adverse events were mild. Conclusion: Our meta-analysis demonstrated that ILIT was safe, conferred desensitization to seasonal and nonseasonal allergens, alleviated allergic rhinitis symptoms, and reduced medication use. A larger randomized, double-blind, placebo controlled trial will be necessary for wider adaptation of this form of AIT.

scholarly journals The effect of unilateral and bilateral laparoscopic surgery for endometriosis on Anti-Mullerian Hormone (AMH) level after 3 and 6 months: a systematic review and meta-analysis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Anisodowleh Nankali ◽  
Mohsen Kazeminia ◽  
Parnian Kord Jamshidi ◽  
Shamarina Shohaimi ◽  
Nader Salari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Laparoscopic Surgery ◽  
Growth Factors ◽  
Web Of Science ◽  
Meta Analysis ◽  
Research Work ◽  
Mean Difference ◽  
Transient Growth ◽  
Common Causes ◽  
Standardized Mean Difference

Abstract Background Endometriosis is one of the most common causes of infertility. The causes of the disease and its definitive treatments are still unclear. Moreover, Anti-Mullerian Hormone (AMH) is a glycoprotein dimer that is a member of the transient growth factors family. This research work aimed to identify the effect of unilateral and bilateral laparoscopic surgery for endometriosis on AMH levels after 3 months, and 6 months, using meta-analysis. Methods In this study, the articles published in national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were searched to find electronically published studies between 2010 and 2019. The heterogeneous index between studies was determined using the I2 index. Results In this meta-analysis and systematic review, 19 articles were eligible for inclusion in the study. The standardized mean difference was obtained in examining of unilateral laparoscopic surgery for endometriosis (before intervention 2.8 ± 0.11, and after 3 months 2.05 ± 0.13; and before intervention 3.1 ± 0.46 and after 6 months 2.08 ± 0.31), and in examining bilateral laparoscopic surgery for endometriosis examination (before intervention 2.0 ± 08.08, and after 3 months 1.1 ± 0.1; and before intervention 2.9 ± 0.23 and after 6 months 1.4 ± 0.19). Conclusion The results of this study demonstrate that unilateral and bilateral laparoscopic surgery for endometriosis is effective on AMH levels, and the level decreases in both comparisons.

Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

2019 ◽  
Vol 29 (8) ◽  
pp. 4077-4087 ◽  
Author(s):  
Chong Hyun Suh ◽  
Seung Chai Jung ◽  
Se Jin Cho ◽  
Donghyun Kim ◽  
Jung Bin Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Hemorrhagic Transformation ◽  
Perfusion Ct

scholarly journals Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis

2019 ◽  
Vol 57 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Tom A Rayner ◽  
Sean Harrison ◽  
Paul Rival ◽  
Dominic E Mahoney ◽  
Massimo Caputo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Impairment ◽  
Minimally Invasive ◽  
Risk Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Ascending Aorta ◽  
Mean Difference ◽  
Standardized Mean Difference

Summary Limited uptake of minimally invasive surgery (MIS) of the aorta hinders assessment of its efficacy compared to median sternotomy (MS). The objective of this systematic review is to compare operative and perioperative outcomes for MIS versus MS. Online databases Medline, EMBASE, Cochrane Library and Web of Science were searched from inception until July 2018. Both randomized and observational studies of patients undergoing aortic root, ascending aorta or aortic arch surgery by MIS versus MS were eligible for inclusion. Primary outcomes were 30-day mortality, reoperation for bleeding, perioperative renal impairment and neurological events. Intraoperative and postoperative timing measures were also evaluated. Thirteen observational studies were included comparing 1101 MIS and 1405 MS patients. The overall quality of evidence was very low for all outcomes. Mortality and the incidence of stroke were similar between the 2 cohorts. Meta-analysis demonstrated increased length of cardiopulmonary bypass (CPB) time for patients undergoing MS [standardized mean difference 0.36, 95% confidence interval (CI) 0.15–0.58; P = 0.001]. Patients receiving MS spent more time in hospital (standardized mean difference 0.30, 95% CI 0.17–0.43; P &lt; 0.001) and intensive care (standardized mean difference 0.17, 95% CI 0.06–0.27; P &lt; 0.001). Reoperation for bleeding (risk ratio 1.51, 95% CI 1.06–2.17; P = 0.024) and renal impairment (risk ratio 1.97, 95% CI 1.12–3.46; P = 0.019) were also greater for MS patients. There was substantial heterogeneity in meta-analyses for CPB and aortic cross-clamp timing outcomes. MIS may be associated with improved early clinical outcomes compared to MS, but the quality of the evidence is very low. Randomized evidence is needed to confirm these findings.

scholarly journals A Systematic Review and Meta-Analysis of Seasonal Influenza Vaccination of Health Workers

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1104
Author(s):  
Tingting Li ◽  
Xiaoling Qi ◽  
Qin Li ◽  
Wenge Tang ◽  
Kun Su ◽  
...  
Keyword(s):  
Systematic Review ◽  
Influenza Vaccination ◽  
Randomized Clinical Trials ◽  
Health Workers ◽  
Meta Analysis ◽  
Random Effect ◽  
Mean Difference ◽  
Sensitivity Analyses ◽  
Standardized Mean Difference ◽  
Influenza Vaccinations

A systematic review and meta-analysis was conducted to estimate the pooled effect of influenza vaccinations for health workers (HWs). Nine databases were screened to identify randomized clinical trials and comparative observational studies that reported the effect of influenza vaccination among HWs. The risk ratio (RR), standardized mean difference, and 95% confidence interval (CI) were employed to study the effect size using fixed/random-effect models. Subgroup analyses and sensitivity analyses were conducted accordingly. Publication bias was examined. Sixteen studies (involving 7971 HWs from nine countries) were included after a comprehensive literature search. The combined RR regarding the incidence of laboratory-confirmed influenza was 0.36 (95% CI: 0.25 to 0.54), the incidence of influenza-like illness (ILI) was 0.69 (95% CI: 0.45 to 1.06), the absenteeism rate was 0.63 (95% CI: 0.46 to 0.86), and the integrated standardized mean difference of workdays lost was −0.18 (95% CI: −0.28 to −0.07) days/person. The subgroup analysis indicated that vaccination significantly decreases the incidence of laboratory-confirmed influenza in different countries, study populations, and average-age vaccinated groups. Influenza vaccinations could effectively reduce the incidence of laboratory-confirmed influenza, absenteeism rates, and workdays lost among HWs. It is advisable, therefore, to improve the coverage and increase the influenza vaccination count among HWs, which may benefit both workers and medical institutions.

scholarly journals Oxygen Cost of Walking in People with Multiple Sclerosis and Its Association with Fatigue: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Scott Rooney ◽  
Gavin McWilliam ◽  
Leslie Wood ◽  
Fiona Moffat ◽  
Lorna Paul
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Energy Expenditure ◽  
Meta Analysis ◽  
Positive Association ◽  
Mean Difference ◽  
Oxygen Cost ◽  
Future Studies ◽  
Standardized Mean Difference ◽  
The Relationship

Abstract Background: This systematic review and meta-analysis aimed to compare the oxygen cost of walking in people with multiple sclerosis (MS) and controls and to assess the relationship between oxygen cost of walking and fatigue in people with MS. Methods: Four databases (CINAHL, MEDLINE, ProQuest, Web of Science) were searched up to September 2020. Studies were included if they recruited adults with MS and either compared oxygen cost of walking in those with MS and a control population or determined the relationship between oxygen cost of walking and fatigue. Meta-analysis of the standardized mean difference in oxygen cost of walking between people with MS and controls was performed. Results: Nine studies were included in this review, of which seven compared oxygen cost of walking in people with MS (n = 176) and controls (n = 142) and four investigated the relationship between oxygen cost of walking and fatigue. Meta-analysis revealed that people with MS (with predominantly mild-to-moderate disability) had a significantly higher oxygen cost of walking compared with controls (standardized mean difference = 2.21, 95% CI = 0.88 to 3.54, P = .001). In addition, three studies found a significant yet weak positive association between oxygen cost of walking and fatigue. Conclusions: People with MS expend more energy when walking compared with controls. This increase in energy expenditure may contribute to the development of fatigue, as some studies found that higher oxygen costs of walking were associated with greater fatigue. Future studies should investigate whether reducing energy expenditure during movement improves fatigue.

Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies

2021 ◽  
pp. 1357633X2110477
Author(s):  
Ita Daryanti Saragih ◽  
Santo Imanuel Tonapa ◽  
Carolyn M. Porta ◽  
Bih-O Lee
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Sexual Health ◽  
Condom Use ◽  
Self Efficacy ◽  
Meta Analysis ◽  
Mean Difference ◽  
Adolescent Sexual Health ◽  
Randomized Controlled ◽  
Standardized Mean Difference

Introduction Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents. Methods A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis. Results A total of 15 studies ( N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08–0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23–0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31–0.92). Discussion Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward.

scholarly journals Neuroimaging Markers of Cerebral Small Vessel Disease on Hemorrhagic Transformation and Functional Outcome After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 13 ◽  
Author(s):  
Yiqiao Wang ◽  
Xiaoting Yan ◽  
Jie Zhan ◽  
Peiming Zhang ◽  
Guangming Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Cerebral Small Vessel Disease ◽  
Vessel Disease ◽  
Increased Risk

Objective: The aim of this study was to perform a systematic review and meta-analysis to assess whether cerebral small vessel disease (CSVD) on neuroimaging of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) is associated with an increased risk of hemorrhagic transformation (HT), symptomatic intracranial hemorrhage (sICH), and poor functional outcome (PFO).Methods: A thorough search of several databases was carried out to identify relevant studies up to December 2020. We included studies of patients with AIS and neuroimaging markers of CSVD treated with IVT. The primary outcome was HT, and the secondary outcomes were sICH and 3-month PFO. The quality of the studies involved was evaluated using the Newcastle–Ottawa Scale (NOS). The meta-analysis with the fixed effects model was performed.Results: Twenty-four eligible studies (n = 9,419) were pooled in the meta-analysis. All included studies were regarded as high quality with the NOS scores of at least 6 points. The meta-analysis revealed associations between the presence of CSVD and HT, sICH, and the 3-month PFO after IVT. Compared with no CSVD, the presence of CSVD was associated with an increased risk of HT (OR: 1.81, 95% CI: 1.52–2.16), sICH (OR: 2.42, 95% CI: 1.76–3.33), and 3-month PFO (OR: 2.15, 95% CI: 1.89–2.44). For patients with AIS complicated with CSVD, compared with a CSVD score of 0–1, a CSVD score of 2–4 was associated with an increased risk of HT (OR: 3.10, 95% CI: 1.67–5.77), sICH (OR: 2.86, 95% CI: 1.26–6.49), and 3-month PFO (OR: 4.58, 95% CI: 2.97–7.06).Conclusion: Patients with AIS complicated with neuroimaging markers of CSVD are at increased risk of HT and 3-month PFO after IVT. However, it is still necessary to clarify the exact role of CSVD in the occurrence, development, and prognosis of AIS.Systematic Review Registration:www.ClinicalTrials.gov, identifier CRD4202123 3900.

scholarly journals Blood–Brain Barrier Disruption and Hemorrhagic Transformation in Acute Ischemic Stroke: Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Francesco Arba ◽  
Chiara Rinaldi ◽  
Danilo Caimano ◽  
Federica Vit ◽  
Giorgio Busto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Brain Barrier ◽  
Meta Analysis ◽  
Hemorrhagic Transformation ◽  
Mr Studies ◽  
Brain Barrier ◽  
Blood Brain ◽  
Ct Studies

Introduction: Hemorrhagic transformation (HT) is a complication of reperfusion therapy for acute ischemic stroke. Blood–brain barrier (BBB) disruption is a crucial step toward HT; however, in clinical studies, there is still uncertainty about this relation. Hence, we conducted a systematic review and meta-analysis to summarize the current evidence.Methods: We performed systematic review and meta-analysis of observational studies from January 1990 to March 2020 about the relation between BBB disruption and HT in patients with acute ischemic stroke with both computed tomography (CT) and magnetic resonance (MR) assessment of BBB. The outcome of interest was HT at follow-up imaging evaluation (within 48 h from symptom onset). We pooled data from available univariate odds ratios (ORs) in random-effects models with DerSimonian–Laird weights and extracted cumulative ORs.Results: We included 30 eligible studies (14 with CT and 16 with MR), N = 2,609 patients, with 88% and 70% of patients included in CT and MR studies treated with acute stroke therapy, respectively. The majority of studies were retrospective and had high or unclear risk of bias. BBB disruption was measured with consistent methodology in CT studies, whereas in MR studies, there was more variability. All CT studies provided a BBB disruption cutoff predictive of HT. Four CT and 10 MR studies were included in the quantitative analysis. We found that BBB disruption was associated with HT with both CT (OR = 3.42; 95%CI = 1.62–7.23) and MR (OR = 9.34; 95%CI = 3.16–27.59). There was a likely publication bias particularly for MR studies.Conclusion: Our results confirm that BBB disruption is associated with HT in both CT and MR studies. Compared with MR, CT has been more uniformly applied in the literature and has resulted in more consistent results. However, more efforts are needed for harmonization of protocols and methodology for implementation of BBB disruption as a neuroradiological marker in clinical practice.

Muscle hypertrophy and strength gains after resistance training with different volume matched loads: a systematic review and meta-analysis.

2022 ◽  
Author(s):  
Leonardo Henrique Fernandes Carvalho ◽  
Roberto Moriggi Junior ◽  
Júlia Barreira ◽  
Brad Jon Schoenfeld ◽  
John Orazem ◽  
...  
Keyword(s):  
Systematic Review ◽  
Resistance Training ◽  
Muscle Hypertrophy ◽  
Meta Analysis ◽  
Dynamic Strength ◽  
Pooled Analysis ◽  
High Load ◽  
Mean Difference ◽  
Volume Load ◽  
Standardized Mean Difference

The purpose of this paper was to conduct a systematic review and meta-analysis of studies that compared muscle hypertrophy and strength gains between resistance training protocols employing very low (VLL<30% of 1RM or >35 RM), low (LL30%-59% of 1RM, or 16–35 RM), moderate (ML60%-79% of 1RM, or 8 -15RM) and high load (HL≥80% of 1RM, or ≤7 RM) with matched volume loads (sets x reps x weight). A pooled analysis of the standardized mean difference for 1RM strength outcomes across the studies showed a benefit favoring HL vs. LL and vs. ML; and favoring ML vs. LL. Results from LL and VLL indicated little difference. A pooled analysis of the standardized mean difference for hypertrophy outcomes across all studies showed no differences between the training loads. Our findings indicate that, when volume load is equated between conditions, the highest loads induce superior dynamic strength gains. Alternatively, hypertrophic adaptations are similar irrespective of the magnitude of load. NOVELTY BULLETS: • Training with higher loads elicits greater gains in 1RM muscle strength when compared to lower loads, even when volume load is equated between conditions. • Muscle hypertrophy is similar irrespective of the magnitude of load, even when volume load is equated between conditions.

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