Effects of effective acute anti-hypertensive therapy on ischemic stroke prognosis: a meta-analysis of randomized controlled trials

Abstract Background: Although multiple randomized controlled trials (RCTs) and meta-analyses have been conducted on the issue of acute phase anti-hypertensive therapies for ischemic stroke (IS) patients, many studies have failed to enhance blood pressure (BP) decrease after these treatments. The effects of effective acute anti-hypertensive therapies on IS prognosis are still unclear.Methods: Published literature was systematically searched in PubMed, Embase and Cochrane Library. Multiple RCTs that included IS patients, in which there was a significant BP decrease in the anti-hypertensive intervention group compared with the control group within 72 h after the onset of stroke, were identified. A meta-analysis was conducted to assess the effects of such therapy on the functional outcome, mortality, and multiple severe adverse events (SAEs) of IS patients.Results: Eight RCTs were included in this study, with a total of 9427 IS patients. According to this meta-analysis, with significant BP differences between the treatment and control groups within 72 h from stroke onset, effective acute anti-hypertensive therapy has a neutral effect on multiple IS prognostic factors, including functional outcome (RR 1.03, 95% CI 0.93-1.13), mortality (RR 1.10, 95% CI 0.89-1.35), and multiple SAEs.Conclusions: Based on current studies, effective acute anti-hypertensive therapy did not improve the prognosis of IS patients, including functional outcome, mortality, and SAEs. There is no evidence that such therapy is beneficial in clinical practice.

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Impact of Ketamine on Pain Management in Cesarean Section: A Systematic Review and Meta-Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/135 ◽

2020 ◽

Vol 2;23 (4;2) ◽

pp. 135-148

Author(s):

Zifeng Xu

Keyword(s):

Cesarean Section ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Control Effect ◽

Randomized Controlled ◽

Time Required ◽

The Cochrane Library

Background: The pain control effect of ketamine versus control in women during cesarean operation is not well determined. Objectives: The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia. Study Design: We used meta-analysis to address this concern. Setting: Meta-analysis-based study. Methods: The databases PubMed, Embase, and the Cochrane Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software. Results: A total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD], –1.10; 95% confidence interval [CI], –1.61, –0.59; P < 0.0001). Application of ketamine during cesarean section also resulted in decreased consumption of morphine when compared with the control group (MD, –6.11 mg; 95% CI, –9.93, –2.29; P = 0.002). In addition, the first time required for analgesia was significantly longer in the ketamine group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001). Limitations: Limited patients were included with moderate strength. Conclusions: Ketamine supplementation during cesarean section reduces pain and morphine consumption and prolongs the postoperative analgesia. Key words: Ketamine, cesarean section, randomized controlled trials, meta-analysis

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The Efficacy and Tolerability of Ubrogepant for Acute Migraine: A Systematic Review and Meta-Analysis

10.21203/rs.2.20666/v1 ◽

2020 ◽

Author(s):

Yun Diao ◽

Hang Yang ◽

Yang Chun Zhou ◽

Biao Du

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Acute Attack ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Acute Migraine ◽

High Quality ◽

Randomized Controlled

Abstract Objective: The aim of this review was to evaluate the efficacy and tolerability of ubrogepant in patients with acute migraine. Methods: We systematically searched PubMed, Embase, MEDLINE, Cochrane Library, and clinicaltrials.gov from inception to JULY, 2019. Randomized controlled trials of the efficacy and/or tolerability of ubrogepant for migraine were included. Meta-analysis was conducted by RevMan 5.3 software. Results: A total of 4 RCTs involving 4 163 patients were included. The meta-analysis showed that:compared to the control group, the percentage of participants with PF, the percentage of participants with PR, the percentage of participants with SPF, the percentage of participants with SPR,the absence of phonophobia in sound，the absence of phonophobia in light and the absence of nausea (RR=1.31,95%CI:1.18~1.45，P<0.00001, RR=1.63,95%CI:1.46~1.82，P<0.00001, RR=1.22,95%CI:1.15~1.29，P<0.00001, RR=1.32,95%CI:1.22~1.42，P<0.00001, RR=1.16,95%CI:1.05~1.27，P=0.002), all the differences were statistically significant. Conclusions: For adult patients with acute migraine, ubrogepant could effectively abort the acute attack. High-quality, adequately powered RCTs are needed to fully evaluate the efficacy and tolerability of ubrogepant for acute migraine.

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The clinical efficacy of continuous renal replacement in the treatment of acute pancreatitis: a meta-analysis of randomized controlled trials

10.22541/au.161306018.81141533/v1 ◽

2021 ◽

Author(s):

sijia Ma ◽

mingming Zhao ◽

zhiyu Pan ◽

jiao Fan ◽

xuexue Zhang ◽

...

Keyword(s):

Acute Pancreatitis ◽

Randomized Controlled Trials ◽

Clinical Efficacy ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Review Author ◽

Inclusion Criteria ◽

Randomized Controlled

Abstract：Objective: The purpose of this study was to investigate the effect of continuous renal replacement therapy(CRRT) on patients with acute pancreatitis(AP). Methods: A comprehensive search of seven databases without language restrictions includes PubMed, Cochrane Library, Scopus, Embase, Web of Science, China National Knowledge Infrastructure(CNKI) and Wan fang database. Randomized controlled trials (RCTs) for the treatment of acute pancreatitis with CRRT were searched. All the included literatures were published before December 2020. Two review authors independently selected the study and extracted the data according to the inclusion criteria. A third review author will and discuss with the first two review authors and resolve the differences. Weighted mean difference(WMD), risk ratio (RR), and 95% confidence interval (CI) were used for estimating the clinical efficacy of AP in CRRT and control treatment. Results: Fifty-three RCTs met the inclusion criteria and were used in the meta-analysis, with a total of 3,382 effective samples. A comprehensive review of the system shows that the mortality rate of the CRRT group was significantly lower than that of the control group, and the difference was statistically significant(RR=0.44,95%CI0.34 to 0.57,P< 0.000001), the patients using CRRT had lower APACHE Ⅱ scores level(WMD=-3.78, 95%CI-4.66 to -2.90,P<0.00001),higher CRP, PCT,TNF-αand IL-6 clearance effect. According to liver function, the patients using CRRT had lower ALT and AST levels. In the same way, according to renal function, the patients using CRRT had lower SCr (WMD=-94.28, 95%CI-125.47 to -63.10, P<0.00001). The patients using CRRT also had higher ALB levels(WMD=2.32, 95%CI-1.05 to 3.59 ,P=0.0003). Moreover, Results shown no statistical difference in Serum potassium level (WMD=-0.00, 95%CI-0.31 to 0.31,P=1.00)between the two groups. Conclusions: Our findings suggest that treatment with CRRT for acute pancreatitis may be more beneficial than conventional treatment. However, high-quality studies with a larger sample size are still needed to confirm our results.

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Effects of Neuromuscular Electrical Stimulation on Hemiplegic Upper Limb of Stroke Survivors: A Meta-Analysis of Randomized Controlled Trials

10.21203/rs.2.19509/v1 ◽

2019 ◽

Author(s):

Wenyue Zhang ◽

Shuye Pei ◽

Juan Huang ◽

Yao Tang ◽

Huaidong Hu

Keyword(s):

Electrical Stimulation ◽

Randomized Controlled Trials ◽

Upper Extremity ◽

Upper Limb ◽

Meta Analysis ◽

Neuromuscular Electrical Stimulation ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled

Abstract Background: Whether NMES helps the recovery of upper limb function in patients with hemiparesis has not been confirmed. We conducted this meta-analysis to examine the effectiveness of neuromuscular electrical stimulation (NMES) for upper limb hemiparesis after stroke.Methods: Data sources such as Pubmed, Embase and Cochrane library databases were searched for all relevant studies that were carried out before December 1, 2018.We selected the randomized controlled trials (RCTs) which included chronic and acute stroke patients with upper extremity dysfunction. Then the intervention group which applied NMES was compared with a control group without NMES. Results: A total of 16 RCTs involving 691 patients were discerned from 248 searched articles. According to the forest plot ,NMES had a significant benefit on FMA-ue scale(SMD=0.44,95%CI 0.13 to 0.74,P=0.006).Also, NMES was positive for ARAT(SMD=0.31,95%CI 0.05 to 0.58,P=0.019)and MAL-AOU(SMD=0.59,95%CI 0.15 to1.04,P=0.009),but not for wrist MAS(SMD=-0.12,95%CI -0.43 to 0.19,P=0.434) or BI(SMD=0.51,95%CI -0.65 to 1.66,P=0.392).Conclusion: NMES application has beneficial impacts on upper extremity motor function in patients with stroke. This study suggests that NMES ought to be applied as a beneficial rehabilitation means in improving the upper function.

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Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Frontiers in Neurology ◽

10.3389/fneur.2021.745106 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sihua Liu ◽

Xiao Zhang ◽

Xuesong Bai ◽

Yutong Yang ◽

Tao Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Artery Dissection ◽

Controlled Trials ◽

Cervical Artery Dissection ◽

Initial Symptom ◽

Randomized Controlled ◽

Cervical Artery

Objective: The optimal management for cervical artery dissection (CAD) is uncertain. This study aimed to summarize the current randomized controlled trials (RCTs) to compare the efficacy and safety of antiplatelet and anticoagulation therapies for CAD.Methods: A literature search was conducted in the major databases, such as MEDLINE, Embase, and the Cochrane Library. Only the RCTs comparing the antiplatelet and anticoagulation therapies for the patients with CAD were included. Combined estimates of the relative risk (RR) of antiplatelet vs. anticoagulation were analyzed. Heterogeneity was measured using the I2 statistical analysis. The analyses were performed in the intention-to-treat (ITT) and per-protocol (PP) population, respectively.Results: Two RCTs involving 444 patients in the ITT population and 370 patients in the PP population were included. The quality of studies was high overall. In the ITT population, compared with the patients in the anticoagulation group, the patients in the antiplatelet group showed a higher rate of ischemic stroke within 3 months (RR = 6.73 [95% CI, 1.22–37.15], I2 = 0%, P = 0.029). No difference between these two treatment groups was found for the outcomes of transient ischemic attack (RR = 0.37 [95% CI, 0.09–1.58], I2 = 0%, P = 0.181), intracranial hemorrhage (RR = 0.33 [95% CI, 0.01–7.98], I2 = 0%, P = 0.494), major extracranial bleeding (RR = 0.31 [95% CI, 0.01–7.60], I2 = 0%, P = 0.476), or the composite of these outcomes within 3 months. For the PP population, the results of the meta-analysis of outcomes between the antiplatelet and anticoagulation groups were consistent with the ITT population.Conclusions: Compared with the antiplatelet group, the anticoagulation group has a lower risk of ischemic stroke without increasing bleeding risk when treating CAD. Anticoagulation seems to be superior over the antiplatelet in treating CAD but needs to be further tested by specifying several issues, such as location, initial symptom types, and treatment protocols.

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Butorphanol effectively prevents etomidate-induced myoclonus: a pooled analysis of 788 patients

Journal of International Medical Research ◽

10.1177/0300060518801457 ◽

2018 ◽

Vol 47 (1) ◽

pp. 353-360

Author(s):

Yu Zhu ◽

Chengmao Zhou ◽

Qixiong He

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Pooled Analysis ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Anesthesia Induction ◽

Randomized Controlled

Objective To evaluate the efficacy of pre-injection of butorphanol on etomidate-induced myoclonus during anesthesia induction. Methods Randomized controlled trials (RCTs) of the ability of butorphanol to prevent etomidate-induced myoclonus were collected by searching PubMed, Cochrane Library, CNKI, and WanFang databases, from the day of database establishment until May 2017. The literature was screened independently by two evaluators, and the data were then extracted and independently evaluated. Finally, meta-analysis was performed by using RevMan 5.2 software. Results Eight RCTs were analyzed. The results of meta-analysis showed that: 1. compared with the control group, butorphanol was effective in preventing etomidate-induced myoclonus [RR = 0.15, 95% CI: 0.11, 0.21]; 2. butorphanol was effective in preventing mild, moderate, and severe etomidate-induced myoclonus [RR = 0.40, 95% CI: 0.25, 0.63; RR = 0.15, 95% CI: 0.08, 0.27; and RR = 0.04, 95% CI: 0.01, 0.09]; 3. butorphanol did not increase the incidence of dizziness and nausea associated with etomidate. Conclusions Butorphanol could reduce the incidence and degree of etomidate-induced myoclonus. Notably, it did not increase the incidence of dizziness and nausea associated with etomidate.

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Ketamine Supplementation To Bupivacaine For Knee Arthroscopy: A Meta-Analysis of Randomized Controlled Trials

10.21203/rs.3.rs-814576/v1 ◽

2021 ◽

Author(s):

Chunhong Li ◽

Zhibo Xiao ◽

Liuli Chen ◽

Songli Pan

Keyword(s):

Randomized Controlled Trials ◽

Pain Control ◽

Knee Arthroscopy ◽

Meta Analysis ◽

Random Effect Model ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Pain Scores

Abstract Introduction: The efficacy of ketamine supplementation to bupivacaine for pain management of knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ketamine supplementation to bupivacaine on the postoperative pain intensity of knee arthroscopy.Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through July 2021 for randomized controlled trials (RCTs) assessing the effect of ketamine supplementation to bupivacaine on pain control of knee arthroscopy. This meta-analysis is performed using the random-effect model.Results: Four RCTs are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, ketamine supplementation remarkably decreases pain scores at 30 min (SMD=-0.98; 95% CI=-1.42 to -0.55; P<0.00001) and number of additional analgesics (OR=0.27; 95% CI=0.10 to 0.71; P=0.008), but reveals no significant impact on pain scores at 1 h (SMD=-1.34; 95% CI=-3.42 to 0.73; P=0.20), pain scores at 6 h (SMD=-0.33; 95% CI=-1.39 to 0.72; P=0.53), time of first analgesic requirement (SMD=1.27; 95% CI=-0.95 to 3.49; P=0.26) or additional analgesic consumption (SMD=-2.25; 95% CI=-5.89 to 1.40; P=0.23). Conclusions: Ketamine supplementation may improve the pain control when in combination with bupivacaine for knee arthroscopy.

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Efficacy and Safety of Immunosuppressive Treatment in IgA Nephropathy: A Meta-analysis of Randomized Controlled Trials

10.1101/515023 ◽

2019 ◽

Author(s):

Zheng Zhang ◽

Yue Yang ◽

Shi-min Jiang ◽

Wen-ge Li

Keyword(s):

Randomized Controlled Trials ◽

Immunosuppressive Therapy ◽

Iga Nephropathy ◽

Meta Analysis ◽

Immunosuppressive Agents ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled

AbstractBackgroundThere is some controversy regarding the efficacy and safety of immunosuppressive agents for the treatment of kidney diseases. The recent STOP-IgAN and TESTING studies have focused attention on the application of immunosuppressive agents in IgA nephropathy (IgAN). This study investigated the benefits and risks of immunosuppressive agents in IgAN.MethodsMEDLINE, EMBASE, the Cochrane Library, and article reference lists were searched for randomized controlled trials (RCTs) comparing immunosuppressive agents with any other non-immunosuppressive agents for treating IgAN. A meta-analysis was performed on the outcomes of proteinuria, creatinine (Cr), estimated glomerular filtration rate (eGFR), and adverse events in patients with IgAN, and trial sequential analyses were also performed for outcomes.ResultsTwenty-nine RCTs (1957 patients) that met our inclusion criteria were identified. Steroids (weighted mean difference [WMD] −0.70, 95% confidence interval [CI] −1.2 to −0.20), non-steroidal immunosuppressive agents (NSI) (WMD −0. 43, 95% CI −0.55 to −0.31), and combined steroidal and non-steroidal immunosuppressive agents (S&NSI) (WMD −1.46, 95% CI −2.13 to −0.79) therapy significantly reduced proteinuria levels in patients with IgAN. Steroid treatment significantly reduced the risk for end-stage renal disease (ESRD) (relative risk [RR] 0.39, CI 0.19 to 0.79). The immunosuppressive therapy group showed significant increases in gastrointestinal, hematological, dermatological, and genitourinary side effects, as well as impaired glucose tolerance or diabetes. Hyperkalemia was more common in the control group.ConclusionImmunosuppressive therapy can significantly reduce proteinuria and ESRD risk in patients with IgAN, but with a concomitant increase in adverse reactions. Therefore, care is required in the application of immunosuppressive agents in IgAN.

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A Meta-analysis of Acupuncture Treatment for Irritable Bowel Syndrome

Journal of Integrative Medicine ◽

10.30564/jim.v10i2.3373 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Biwei Chen ◽

Lili Zhang ◽

Shaozong Chen ◽

Changzhen Gong

Keyword(s):

Irritable Bowel Syndrome ◽

Clinical Research ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Irritable Bowel ◽

Experimental Group

To assess the efficacy of acupuncture for treatment of irritable bowel syndrome through meta-analysis of randomized controlled trials in recent 20 years. Online databases, including CNKI, VIP, WANFANG,PubMed, Cochrane Library, Web of Science and Embase were searched for randomized controlled trials (RCTs) of acupuncture for IBS. Retrieval time was from January 1, 2000 to January 31, 2021. According to Jadad scoring criteria,the bias risk and quality assessment of each RCT included were evaluated by two researchers. RevMan 5.3 software was used for the meta analysis. Eight RCTs were selected which include a total of 1181 patients.The control group has 425 patients and the experimental group has 756 patients. The result of meta-analysis indicates that the total effective rate for the experimental group was superior to that of the control group [OR=3.29,95%CI [2.16~5.03](P<0.01)], and the funnel plot was basically symmetric. Acupuncture therapy is shown to have a good safety and compliance record. However, the number of high-quality trials is small, and there are some deficiencies in the methodology of clinical research. Acupuncture, as a supplementary therapy for irritable bowel syndrome, has positive clinical significance and prospects for application. The methodology of clinical research needs to be further improved.

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Effect of Aidi Injection plus TACE on Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/9196409 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10

Author(s):

Yaoyao Dai ◽

Sicheng Gao ◽

Xing Liu ◽

Qin Gao ◽

Lan Zhang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Randomized Controlled Trials ◽

Clinical Effect ◽

Meta Analysis ◽

Biomedical Literature ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Aidi Injection

We aim to conduct a meta-analysis of studies on the effect of Aidi injection combined with TACE in the treatment of hepatocellular carcinoma (HCC). China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), Chinese Science and Technology Periodical Database (VIP), Allied and Complementary Medicine Database (AMED), EMBASE, Web of Science, PubMed, and Cochrane Library databases to October 1, 2017, were searched to collect the studies. The data analysis was performed using RevMan 5.3 software. Totally 20 clinical trials with 774 (the experimental group: 447 cases; the control group: 327 cases) HCC patients were finally included in this meta-analysis. Meta-analysis results showed that Aidi injection combined with TACE can, to some extent, enhance the clinical effect and improve the overall survival. Meanwhile, it can increase HCC patients’ quality of life. Additionally, Aidi injection plus TACE can reduce adverse events including leukopenia, gastrointestinal reaction, and liver damage in HCC patients (all P < 0.05). Therefore, Aidi injection plus TACE may significantly enhance the clinical effect, suggesting that the combination of TCM and western medicine is promising. The exact outcome needs rigorously designed performances, multicenter, and large randomized controlled trials.

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