scholarly journals 3,4-diaminopyridine Treatment for Lambert-Eaton Myasthenic Syndrome in Adults: A Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Na Zhang ◽  
Daojun Hong ◽  
Taohui Ouyang ◽  
Wei Meng ◽  
Jingwei Huang ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Autoimmune Disorder ◽  
Placebo Treatment ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Compound Muscle Action Potentials ◽  
Myasthenic Syndrome

Abstract Background: Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder of neuromuscular transmission. The objective was to examine the efficacy and safetyof 3,4-diaminopyridine (3,4-DAP) in LEMS. Methods: We searched several databases to identify relevant studies, including PubMed, EMBASE, Cochrane Neuromuscular Disease Group Specialized Register and the Cochrane Controlled Trials Register.The primary outcome Quantitative Myasthenia Gravis (QMG) muscle score and secondary outcome compound muscle action potentials (CMAP) amplitude were pooled by meta-analysis. Results: Six randomised controlled trials (RCT) involving 115 patients with LEMS were included. A meta-analysis of the primary outcome showed a significant improvement of 2.33 (95% CI, -2.81 to -1.85, p<0.001) in QMG muscle score after treatment with 3,4-DAP. Moreover, a meta-analysis of the secondary outcome showed that the overall mean CMAP amplitude improved significantly in LEMS patients with 3, 4-DAP treatment, compared with placebo treatment(mean difference 1.63 mV, 95% CI, 0.85 to 2.41, p<0.001). The overall assessment of all included trials showed low risk of bias and low heterogeneity. Conclusioins: The pooled results demonsrated that 3,4-DAP had a significant effect on LEMS treatment, with improvements in muscle strength score and CMAP amplitude, which are moderate to high evidence from randomized controlled trials.

scholarly journals 3,4-diaminopyridine Treatment for Lambert-Eaton Myasthenic Syndrome in Adults: A Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Na Zhang ◽  
Daojun Hong ◽  
Taohui Ouyang ◽  
Wei Meng ◽  
Jingwei Huang ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Autoimmune Disorder ◽  
Placebo Treatment ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Compound Muscle Action Potentials ◽  
Myasthenic Syndrome ◽  
Randomised Controlled

Abstract Background: Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder of neuromuscular transmission. The objective was to examine the efficacy and safety of 3,4-diaminopyridine (3,4-DAP) in patients with LEMS. Methods: We searched several databases to identify relevant studies, including PubMed, EMBASE, Cochrane Neuromuscular Disease Group Specialized Register and the Cochrane Controlled Trials Register.The primary outcome, quantitative myasthenia gravis (QMG) score and the secondary outcome, compound muscle action potentials (CMAP) amplitude were pooled by meta-analysis. Results: Six randomised controlled trials (RCT) involving 115 patients with LEMS were included. QMG score showed a significant decrease (improvement) of 2.33 points (95% CI, -2.81 to -1.85, p<0.001) after treatment with 3,4-DAP. Moreover, the overall mean CMAP amplitude improved significantly in LEMS patients with 3, 4-DAP treatment, compared with placebo treatment (mean difference 1.63 mV, 95% CI, 0.85 to 2.41, p<0.001). The overall assessment of all included trials showed a low risk of bias and low heterogeneity. Conclusions: The pooled results of randomized controlled trials demonsrated with moderate to high evidence that 3,4-DAP has a significant effect on LEMS treatment, with improvements in muscle strength score and CMAP amplitude.

scholarly journals 3,4-diaminopyridine treatment for Lambert-Eaton myasthenic syndrome in adults: a meta-analysis of randomized controlled trials

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Zhang ◽  
Daojun Hong ◽  
Taohui Ouyang ◽  
Wei Meng ◽  
Jingwei Huang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Autoimmune Disorder ◽  
Placebo Treatment ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register ◽  
Compound Muscle Action Potentials ◽  
Myasthenic Syndrome ◽  
Randomised Controlled

Abstract Background Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder of neuromuscular transmission. The objective was to examine the efficacy and safety of 3,4-diaminopyridine (3,4-DAP) in patients with LEMS. Methods We searched several databases to identify relevant studies, including PubMed, EMBASE, Web of Science, MEDLINE, Cochrane Neuromuscular Disease Group Specialized Register and the Cochrane Central Register of Controlled Trials(CENTRAL). The primary outcome, quantitative myasthenia gravis (QMG) score and the secondary outcome, compound muscle action potentials (CMAP) amplitude were pooled by meta-analysis. Results Six randomised controlled trials (RCTs) involving 115 patients with LEMS were included. QMG score showed a significant decrease (improvement) of 2.76 points (95 % CI, -4.08 to -1.45, p < 0.001) after treatment with 3, 4-DAP. Moreover, the overall mean CMAP amplitude improved significantly in LEMS patients with 3, 4-DAP treatment, compared with placebo treatment (mean difference 1.34 mV, 95 % CI, 0.98 to 1.70, p < 0.001). The overall assessment of all included trials showed a low risk of bias and low heterogeneity. Conclusions The pooled results of RCTs demonsrated with moderate to high evidence that 3,4-DAP has a significant effect on LEMS treatment, with improvements in muscle strength score and CMAP amplitude.

scholarly journals Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiao-Li Chen ◽  
Bei-Lei Zhang ◽  
Chang Meng ◽  
Hui-Bin Huang ◽  
Bin Du
Keyword(s):  
Sensitivity Analysis ◽  
Randomized Controlled Trials ◽  
Critically Ill Patients ◽  
Oxygen Therapy ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Icu Patients ◽  
Randomized Controlled

Abstract Objective Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies’ effect and safety in ICU patients. Methods We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Results We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97–1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05–1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. Conclusions Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.

scholarly journals Liberal or conservative oxygen therapy for ventilated patients in the ICU: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lu Liu ◽  
Yali Tian
Keyword(s):  
Length Of Stay ◽  
Randomized Controlled Trials ◽  
Clinical Outcomes ◽  
Oxygen Therapy ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Icu Mortality ◽  
Randomized Controlled ◽  
Icu Length Of Stay

Abstract Background The acknowledgment that conservative oxygen therapy (COT) was related to better prognosis in the intensive care unit (ICU) was challenged recently. We conducted an updated meta-analysis aimed to determine whether liberal oxygen therapy (LOT) or COT is associated with better improve clinical outcomes. Methods We systematically searched the electronic databases (PubMed, Web of Science and Embase) up to May 2021 for randomized controlled trials (RCTs). The primary outcome was the mortality of the final follow-up time and secondary outcomes were ICU mortality, the ICU length of stay and the number of ventilator-free days. Results A total of 7 RCTs were included, with 2166 patients admitted to the ICU. There was no significant difference in the primary outcome between the LOT and COT. Additionally, LOT could not significantly increase ICU mortality and the ICU length of stay compared with COT. Conclusions The present study showed that COT was not significantly superior to LOT in clinical outcomes. Therefore, additional high-quality studies with novel designs are required to further elucidate this controversy.

scholarly journals The Analgesic Effect of Electroencephalographic Neurofeedback for People With Chronic Pain: Protocol for a Systematic Review and Meta-analysis

10.2196/22821 ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. e22821
Author(s):  
Negin Hesam-Shariati ◽  
Wei-Ju Chang ◽  
James H McAuley ◽  
Andrew Booth ◽  
Zina Trost ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Randomized Controlled Trials ◽  
Analgesic Effect ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Placebo Control ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled

Background Chronic pain is a global health problem, affecting around 1 in 5 individuals in the general population. The understanding of the key role of functional brain alterations in the generation of chronic pain has led researchers to focus on pain treatments that target brain activity. Electroencephalographic neurofeedback attempts to modulate the power of maladaptive electroencephalography frequency powers to decrease chronic pain. Although several studies have provided promising evidence, the effect of electroencephalographic neurofeedback on chronic pain is uncertain. Objective This systematic review aims to synthesize the evidence from randomized controlled trials to evaluate the analgesic effect of electroencephalographic neurofeedback. In addition, we will synthesize the findings of nonrandomized studies in a narrative review. Methods We will apply the search strategy in 5 electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycInfo, and CINAHL) for published studies and in clinical trial registries for completed unpublished studies. We will include studies that used electroencephalographic neurofeedback as an intervention for people with chronic pain. Risk-of-bias tools will be used to assess methodological quality of the included studies. We will include randomized controlled trials if they have compared electroencephalographic neurofeedback with any other intervention or placebo control. The data from randomized controlled trials will be aggregated to perform a meta-analysis for quantitative synthesis. The primary outcome measure is pain intensity assessed by self-report scales. Secondary outcome measures include depressive symptoms, anxiety symptoms, and sleep quality measured by self-reported questionnaires. We will investigate the studies for additional outcomes addressing adverse effects and resting-state electroencephalography analysis. Additionally, all types of nonrandomized studies will be included for a narrative synthesis. The intended and unintended effects of nonrandomized studies will be extracted and summarized in a descriptive table. Results Ethics approval is not required for a systematic review, as there will be no patient involvement. The search for this systematic review commenced in July 2020, and we expect to publish the findings in early 2021. Conclusions This systematic review will provide recommendations for researchers and health professionals, as well as people with chronic pain, about the evidence for the analgesic effect of electroencephalographic neurofeedback. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42020177608; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=177608 International Registered Report Identifier (IRRID) PRR1-10.2196/22821

Acupuncture for tinnitus: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
pp. 096452842093838 ◽  
Author(s):  
Kaiyu Huang ◽  
Shuang Liang ◽  
Lei Chen ◽  
Antoine Grellet
Keyword(s):  
Randomized Controlled Trials ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Small Sample ◽  
Controlled Trials ◽  
Control Groups ◽  
Positive Effects ◽  
Randomized Controlled ◽  
Vas Score ◽  
Secondary Outcomes

Objective: To evaluate the efficacy/effectiveness of acupuncture for the treatment of tinnitus. Methods: Four English and four Chinese databases were searched for randomized controlled trials (RCTs) of acupuncture for tinnitus published before 30 September 2018. RCTs applying acupuncture alone compared with conventional treatments, sham acupuncture, or no treatment, as well as acupuncture plus conventional treatments compared with conventional treatments alone, were included. The primary outcome was the visual analogue scale (VAS). Secondary outcomes included tinnitus handicap inventory (THI) and tinnitus severity index (TSI) scores. Meta-analysis was conducted using RevMan V5.3 software. The protocol was registered in the PROSPERO database (ref. CRD42018108692). Results: Eight studies involving 504 participants were included. Meta-analysis showed no significant differences in the VAS score (mean difference (MD) = −1.81, 95% confidence interval (CI) = −3.69 to 0.07; p = 0.06) between the acupuncture and control groups. However, favorable effects of acupuncture on changes in THI score (MD = −10.11, 95% CI = −12.74 to −7.48; p < 0.001) and TSI score (MD = −8.36, 95% CI = −8.87 to −7.86; p < 0.001) were found. Conclusion: Acupuncture had no significant effect on the primary outcome of VAS score compared with control treatment; however, positive effects on secondary outcomes (THI and TSI score) were observed in acupuncture versus control groups. Due to the low quality and small sample size of the included trials, the level of evidence was insufficient to draw any definitive conclusions. Further rigorous and high-quality studies with larger sample sizes should be conducted to confirm the efficacy/effectiveness of acupuncture for tinnitus.

scholarly journals Efficacy of Acupuncture in Children with Nocturnal Enuresis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Zheng-tao Lv ◽  
Wen Song ◽  
Jing Wu ◽  
Jun Yang ◽  
Tao Wang ◽  
...  
Keyword(s):  
Acupuncture Therapy ◽  
Randomized Controlled Trials ◽  
Clinical Efficacy ◽  
Nocturnal Enuresis ◽  
Meta Analysis ◽  
Placebo Treatment ◽  
Pharmacological Therapy ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Comprehensive Literature Search

Background. Nocturnal enuresis (NE) is recognized as a widespread health problem in young children and adolescents. Clinical researches about acupuncture therapy for nocturnal enuresis are increasing, while systematic reviews assessing the efficacy of acupuncture therapy are still lacking.Objective. This study aims to assess the effectiveness of acupuncture therapy for nocturnal enuresis.Materials and Methods. A comprehensive literature search of 8 databases was performed up to June 2014; randomized controlled trials which compared acupuncture therapy and placebo treatment or pharmacological therapy were identified. A meta-analysis was conducted.Results. This review included 21 RCTs and a total of 1590 subjects. The overall methodological qualities were low. The results of meta-analysis showed that acupuncture therapy was more effective for clinical efficacy when compared with placebo or pharmacological treatment. Adverse events associated with acupuncture therapy were not documented.Conclusion. Based on the findings of this study, we cautiously suggest that acupuncture therapy could improve the clinical efficacy. However, the beneficial effect of acupuncture might be overstated due to low methodological qualities. Rigorous high quality RCTs are urgently needed.

scholarly journals Comparison of postoperative analgesic effects in response to either dexamethasone or dexmedetomidine as local anesthetic adjuvants: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Zhen-Guo Song ◽  
Shen-Yue Pang ◽  
Gui-Yue Wang ◽  
Zhao Zhang
Keyword(s):  
Randomized Controlled Trials ◽  
Nerve Block ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Type I ◽  
Analgesic Effects ◽  
Randomized Controlled ◽  
Upper Limb Surgery ◽  
Significant Difference

AbstractThis review compares the effects of peripheral dexamethasone and dexmedetomidine on postoperative analgesia. We included six randomized controlled trials (354 patients) through a systematic literature search. We found that analgesia duration was comparable between dexamethasone and dexmedetomidine (58.59 min, 95% CI (confidence interval), −  66.13, 183.31 min) with extreme heterogeneity. Secondary outcome was also compared and no significant difference was observed in sensory block onset and duration and motor block duration and also for postoperative nausea and vomiting. It is noteworthy that dexamethasone reduced analgesic consumption (fentanyl) by 29.12 mcg compared with dexmedetomidine. We performed subgroup analyses and found no significant difference between the following: (1) lidocaine vs ropivacaine (P = 0.28), (2) nerve block vs nerve block + general anesthesia (P = 0.47), and (3) upper limb surgery vs thoracoscopic pneumonectomy (P = 0.27). We applied trial sequential analysis to assess the risks of type I and II errors and concluded that the meta-analysis was insufficiently powered to answer the clinical question, and further analysis is needed to establish which adjuvant is better. In conclusion, we believe that existing research indicates that dexamethasone and dexmedetomidine have equivalent analgesic effects in peripheral nerve blocks.

scholarly journals Three-Hourly versus Two-Hourly Feeding Interval in Stable Preterm Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Jogender Kumar ◽  
Jitendra Meena ◽  
Pradeep Debata ◽  
Jeeva Mary Sankar ◽  
Praveen Kumar ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Preterm Infants ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Stage Ii ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Registration Number ◽  
Group 1

Abstract Evidence from randomized controlled trials (RCTs) suggests that three-hourly feeding is safe and might help achieve full feeds earlier in preterm infants. We systematically compared the benefits and harms of three-hourly and two-hourly feeding schedules in preterm infants. We searched electronic databases (MEDLINE, CINAHL, Embase, Web of Science, and Scopus) and trial registries until 30 July 2021 for RCTs comparing the two feeding schedules. We did random-effects meta-analysis using RevMan 5.4 software. The primary outcome was the incidence of stage II or III necrotizing enterocolitis (NEC). Other outcomes were the incidence of any stage NEC, sepsis, mortality, time to full enteral feeds, and hospital stay. Six trials (872 participants) are included. There was no significant difference in the incidence of stage II/III NEC (3 trials; 530 participants; RR 1.39; 95% CI: 0.53,3.65; I2 -0%, low certainty), and any stage NEC (5 studies; 767 participants; RR 0.98; 95% CI: 0.53,1.82; I2 0%, very-low certainty) between three and two-hourly feeding groups. There was no difference in the time to achieve full feeds (5 trials; 755 participants; MD: -0.0 days; 95% CI: -0.32, 0.31, low certainty) or other outcomes. On subgroup analysis, neonates with birthweight <1000 grams and in the three-hourly feeding regime achieved full enteral feeds slower than those in the two-hourly feeding group (1 trial; 84 participants; MD: 2.9 days, 95% CI: 1.16, 4.64, low certainty).ConclusionIn stable preterm infants (1000-1500 grams), three-hourly feeding can be followed safely. In infants <1000 grams, two-hourly feeding should be continued till further evidence.Prospero Registration Number: CRD42021246568

Comparing active immunotherapy efficacy of PD-L1 ≥ 50% NSCLC patients: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21139-e21139
Author(s):  
Yi Hu ◽  
Xiaochen Zhao ◽  
Yuezong Bai ◽  
Longgang Cui ◽  
Fan Zhang
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Randomized Controlled Trials ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Difference ◽  
Nsclc Patients

e21139 Background: Several therapies based on immune checkpoint inhibitors (ICIs) have been approved as the 1L standard of care for PD-L1≥ 50% advanced non-small cell lung cancer (NSCLC). However, little is known about the difference in efficacy between different strategies. We conducted a systematic review and meta-analysis to help clinicians choose more reasonable treatment options. Methods: We searched PubMed, Cochrane library, Embase and major conference proceedings from January 2010 to December 2020 for randomized controlled trials that had available subgroup hazard ratios (HRs) for overall survival according to PD-L1≥ 50%. Only drugs met primary outcome or approved by FDA were included for analysis. The primary outcome was the difference in overall survival (OS). HRs and 95% CI were calculated for the pooled OS using a random-effects model. p<0.05 was considered as statistical difference. Results: A total of 10 randomized controlled trials were included for this meta-analysis. The pooled HR and 95% CI for monotherapy, ICI plus chemotherapy and ICI plus ICI were 0.64 (0.55, 0.74), 0.64 (0.51, 0.79) and 0.70 (0.55, 0.90), respectively. There was no statistical differences between ICI monotherapy and ICI plus chemotherapy (HR 1.00, 95% CI 0.77- 1.30), between ICI monotherapy and ICI plus ICI (HR 0.91, 95% CI 0.69- 1.22) or between ICI plus chemotherapy and ICI plus ICI (HR 0.91, 95% CI 0.66- 1.27). Conclusions: For PD-L1≥ 50% NSCLC patients, active ICI monotherapies showed no different efficacy when compared with ICI combination therapies.

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