Meta-analysis Of Randomized Trials Research Articles

Duration and dosing of systemic corticosteroids for acute exacerbation of COPD, protocol for a systematic review with meta-analysis of randomized trials and cohort studies.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of deterioration in patients with otherwise stably controlled COPD. Treatments of AECOPD often require the use of corticosteroid therapy in conjunction with bronchodilators and antibiotics. However, the duration and dosage of corticosteroids still remain unclear. We propose to perform this systematic review and meta-analysis of all available randomized control trials (RCTs) and observational cohort studies to comprehensively assess the efficacy and safety of different corticosteroid duration and dosing regimen in the current body of evidence. We will search MEDLINE, EMBASE, CENTRAL via Ovid as well as CINAHL and Web of Science for available literature comparing different corticosteroid duration and dosage in the treatment of AECOPD. We will perform title and full text screening in duplicate, then extract relevant data using a pre-piloted extraction form. We will define short duration as less than 14-day duration of treatment and long duration as greater than 14-day treatment. We will report mortality difference as our primary outcome, with additional comparisons in incidence of re-exacerbation, hospital length of stay, lung function, incidence of hyperglycemia and infection. We will perform risk of bias assessment using the ROB2.0 and ROBINS-I tool, as well as the GRADE assessment to assess the quality of evidence. We will publish the full results of our systematic review and meta-analysis in a peer-reviewed journal. To our knowledge, this represents an updated and most comprehensive review of the literature comparing different duration and dosing regimen of corticosteroid treatments in AECOPD, as we will include both RCTs and observational studies without date or language restrictions. We aim to validate prior meta-analyses and study findings on the efficacy of short duration corticosteroid therapy over longer treatments and to inform future research directions in dosing regimens.

Del Nido Cardioplegia in Adult Cardiac Surgery: Meta-Analysis of Randomized Clinical Trials

To compare the outcomes of patients receiving del Nido solution versus any other type of cardioplegia. A systematic review and meta-analysis of randomized trials. Cardiac operating rooms. Adult patients (≥18 years old) undergoing cardiac surgery. The EMBASE, MEDLINE, and CENTRAL databases were searched systematically from their inception until August 2022 for randomized controlled trials comparing del Nido versus other cardioplegias. Ten studies were included, including 1,812 patients (871 in the del Nido group and 941 in the control group), and published after 2017. There were significant reductions in postoperative stroke and/or transient ischemic attack rate in the del Nido group: 9/467 (1.9%) v 25/540 (4.6%); odds ratio (OR), 0.43; 95% CI, 0.20-0.92 (p=0.007). Del Nido cardioplegia was also associated with significantly shorter aortic cross-clamp time (mean difference, -8.99 minutes; 95% CI, -17.24 to -0.73 [p < 0.001]), significantly reduced need for defibrillation (89/582 [15%] v 252/655 [38%]; OR, 0.33; 95% CI, 0.15-0.72 [p < 0.001]), significantly lower risk of postoperative acute kidney injury (21/235 [8.9%] v 34/301 [11%]; OR, 0.50; 95% CI, 0.26-0.97 [p=0.04]), with no effect on mortality (14/607 [2.3%] v 12/681 [1.8%]; p=0.5). According to the authors' meta-analysis of recent randomized clinical trials, del Nido is a safe cardioplegic solution, which might provide better organ protection in adult cardiac surgery without differences in mortality when compared to other cardioplegic solutions.

Androgen deprivation therapy use and duration with definitive radiotherapy for localised prostate cancer: an individual patient data meta-analysis

Randomised trials have investigated various androgen deprivation therapy (ADT) intensification strategies in men receiving radiotherapy for the treatment of prostate cancer. This individual patient data meta-analysis of relevant randomised trials aimed to quantify the benefit of these interventions in aggregate and in clinically relevant subgroups. For this meta-analysis, we performed a systematic literature search in MEDLINE, Embase, trial registries, the Web of Science, Scopus, and conference proceedings to identify trials with results published in English between Jan 1, 1962, and Dec 30, 2020. Multicentre randomised trials were eligible if they evaluated the use or prolongation of ADT (or both) in men with localised prostate cancer receiving definitive radiotherapy, reported or collected distant metastasis and survival data, and used ADT for a protocol-defined finite duration. The Meta-Analysis of Randomized trials in Cancer of the Prostate (MARCAP) Consortium was accessed to obtain individual patient data from randomised trials. The primary outcome was metastasis-free survival. Hazard ratios (HRs) were obtained through stratified Cox models for ADT use (radiotherapy alone vs radiotherapy plus ADT), neoadjuvant ADT extension (ie, extension of total ADT duration in the neoadjuvant setting from 3-4 months to 6-9 months), and adjuvant ADT prolongation (ie, prolongation of total ADT duration in the adjuvant setting from 4-6 months to 18-36 months). Formal interaction tests between interventions and metastasis-free survival were done for prespecified subgroups defined by age, National Comprehensive Cancer Network (NCCN) risk group, and radiotherapy dose. This meta-analysis is registered with PROSPERO, CRD42021236855. Our search returned 12 eligible trials that provided individual patient data (10 853 patients) with a median follow-up of 11·4 years (IQR 9·0-15·0). The addition of ADT to radiotherapy significantly improved metastasis-free survival (HR 0·83 [95% CI 0·77-0·89], p<0·0001), as did adjuvant ADT prolongation (0·84 [0·78-0·91], p<0·0001), but neoadjuvant ADT extension did not (0·95 [0·83-1·09], p=0·50). Treatment effects were similar irrespective of radiotherapy dose, patient age, or NCCN risk group. Our findings provide the strongest level of evidence so far to the magnitude of the benefit of ADT treatment intensification with radiotherapy for men with localised prostate cancer. Adding ADT and prolonging the portion of ADT that follows radiotherapy is associated with improved metastasis-free survival in men, regardless of risk group, age, and radiotherapy dose delivered; however, the magnitude of the benefit could vary and shared decision making with patients is recommended. University Hospitals Seidman Cancer Center, Prostate Cancer Foundation, and the American Society for Radiation Oncology.

Corticosteroids for Inpatients with Community-Acquired Pneumonia: More Controversy

Recent meta-analyses of randomized trials, including a Cochrane review (NEJM JW Hosp Med May 2018 and Cochrane Database Syst Rev 2017; 12:CD007720),

The effects of prophylactic infusing ephedrine combined with phenylephrine versus ephedrine alone in maternal and neonate undergoing spinal anesthesia for cesarean section: A Meta-analysis of randomized trials

Objective Used a Meta-analysis to evaluate the effects of prophylactic infusing ephedrine alone or combined with phenylephrine on maternal hemodynamics and neonatal blood gas analysis undergoing spinal anesthesia for cesarean section. Methods Randomized controlled trial(RCT) about the effects of prophylactic infusing ephedrine alone or combined with phenylephrine on maternal and neonate undergoing spinal anesthesia for cesarean section were retrieved from Cochrane Library, PubMed, Embase, Wangfang Database, CNKI and SinoMed from the date of their establishment to September, 2017. The documents were screened and the relevant data were extracted according to the inclusion criteria. The methodological quality of the included RCT was evaluated by Jadad scale. Using RevMan 5.3 software for Meta-analysis. Continuous variables were dealt with mean differences(MD) and 95% confidence intercal(CI), and the dichotomous variables were dealt with odd ratio(OR) and 95%CI. Descriptive analysis of the RCTs which is not available for Meta-analysis. Results We identified 9 RCTs including 590 patients, including 5 RCTs in English and 4 RCTs in Chinese. Among them, 294 patients were in the ephedrine group(E group) while 296 patients were in the ephedrine combined with phenylephrine group(EP group). The results of Meta-analysis showed that the incidence of maternal hypotension [OR=0.49, 95%CI(0.3, 0.8), P<0.01], hypertension [OR=0.52, 95%CI(0.30, 0.92), P=0.02], nausea and vomiting [OR=0.32, 95%CI (0.19, 0.53), P<0.01] and the incidence of neonatal acidosis [OR=0.22, 95%CI(0.10, 0.49), P<0.01] were significantly lower in the ephedrine combined phenylephrine group than these parameters in the ephedrine alone groups. The neonatal umbilical artery pH [MD=0.1, 95%CI(0.07, 0.13), P<0.01], base excess(BE) [MD=2.24, 95%CI(0.78, 3.69), P<0.01], oxygen partial pressure(PO2) [MD=1.53, 95CI (0.08, 2.98), P<0.01] value in the ephedrine combined with phenylephrine group was significantly higher than those parameter in the ephedrine alone group. Moreover, the umbilical artery lactic acid [MD=-1.39, 95%CI (-1.73, -1.05), P<0.01], partial pressure of cardon dioxide(PCO2) [MD=-8, 95%CI(-13.2, -2.8), P<0.01] value were lower than those in the ephedrine alone group. The neonatal 1 min and 5 min Apgar score were not significant difference between the two groups. Conclusions Ephedrine combined with phenylephrine can prevent maternal hypotension undergoing spinal anesthesia for cesarean section and to maintain intraoperative hemodynamic stability. It also can reduce the incidence of maternal nausea and vomiting and neonatal acidosis. Key words: Ephedrine; Phenylephrine; Cesarean section; Hemodynamics; Heonate; Meta-analysis

Intravascular ultrasound and outcomes after drug-eluting stent implantation.

There have been nine published randomized trials and 30 registry studies comparing intravascular ultrasound (IVUS)-guided drug-eluting stent implantation versus conventional angiographic guidance. These trials and registries have been evaluated and summarized in (i) eight meta-analyses that included from nine to 18 registries and from one to seven randomized trials and (ii) four meta-analyses that included from three to eight randomized trials. Although with one exception no two meta-analyses have included the same trials or studies, in each meta-analysis, IVUS guidance was associated with a reduction in major adverse cardiac events as well as secondary hard endpoints of death (primarily cardiovascular mortality), myocardial infarction, and stent thrombosis, especially in randomized trial meta-analyses. This was explained in three meta-analyses comparing the acute results of IVUS versus angiographic guidance showing that (i) postdilation was used more frequently, and stent sizes, final angiographic minimum lumen diameters, and IVUS minimum stent areas were larger with IVUS guidance to minimize stent underexpansion and (ii) more stents were implanted and stents were longer with IVUS guidance to minimize geographic miss and treat edge dissections. IVUS-guided stent implantation can be used to minimize contrast during stent implantation, a strategy that is especially useful in patients with underlying renal insufficiency. Finally, an economic analysis showed that IVUS guidance was a dominant and cost-effective strategy, especially in patients with comorbid conditions who were at a higher risk of cardiac events and especially when the benefits of IVUS continued beyond 1 year.

The effectiveness of negative-pressure wound therapy versus standard wound care in the non-healing wounds: A Meta-analysis of randomized trials

Objective To systematically examine the clinical effectiveness and safety of negative pressure wound therapy (NPWT) for chronic wounds.Methods A systematic search of the major electronic databases PubMed,CINAHL,Cochrane,MEDLINE,British Nursing Index,EBSCO,OCLC,Proquest,Nursing Consult,OVID and Elsevier between 2000 to 2014 was conducted.Measures of wound size and time to heahng were extracted from the randomized controlled trials.The credibility of the outcome of each study was evaluated using a specially constructed instrument.Results We identified 28 RCTs,NPWT showed a significant effect on the wound areas reduction and healing time compared with conventional dressings,though no significant difference on complete wound healing or complication rate.Conclusions There is now sufficient evidence to show that NPWT will accelerate healing,to justify its use in the treatment of diabetes-associated chronic leg wounds. Key words: Negative pressure wound therapy; Chronic wounds; Effectiveness; Meta-analysis; Systematic review

High-Potency Statins Are Associated with Excess Risk for Diabetes

Meta-analyses of randomized trials have shown that statin use is associated with excess risk for developing diabetes. These findings prompted the FDA

Endovenous laser ablation versus conventional surgery for great saphenous varicose veins:meta-analysis of randomized trials

To review the available data of randomized controlled clinical trials (RCT) to compare endovenous laser therapy (EVLT) with conventional surgery of high ligation and stripping (HL/S) for the treatment of great saphenous varicose veins. A systematic review of Pubmed, Cochrane Library, Embase, Web of Science, Ovid database, China National Knowledge Infrastructure (CNKI) database and Wanfang database was performed to retrieve RCT studies on the effectiveness of EVLT versus HL/S up to January 1999. The rates of postoperative recurrence at 1 year, 2 years and major complications were analyzed by Review Manager 5.1 software. Eight retrieved RCT studies and 1743 limps were evaluated. The ratios of recurrence were the same for EVLT and HL/S at 1 and 2 years post-operation. For the ratios of major postoperative complications, there was no statistical difference between EVLT and HL/S in thrombosis, wound infection and phlebitis. But EVLT could reduce the ratio of paresthesia. Compared with HL/S, EVLT shows no significant difference in the 1/2-year recurrence rate or the rates of thrombosis, wound infection and phlebitis. However, it can decrease the rate of paresthesia.

Short-term efficacies of Fufangkushen Injection plus chemotherapy in patients with solid tumors: a meta-analysis of randomized trials

To evaluate the short-term efficacies of Fufangkushen Injection plus chemotherapy in patients with solid tumors. A comprehensive retrieval of the relevant literatures was performed by searching major biomedical databases of Medline, Embase, the Cochrane Library, Chinese Biomedical Literature Database (CBM), China Academic Journals Full-text Database (CNKI), Chinese Medical Current Contents (CMCC) and China Online Journals (Wangfang). And study selection and assessment, data collection and analysis were undertaken by two reviewers according to the Cochrane Handbook for Systematic Reviews of Interventions. Short-term efficacies were analyzed in each corresponding subgroup according to the type of tumor. Statistical analysis was performed by Review Manager Software 4.2 (RevMan 4.2). Overall there were 33 studies of randomized controlled trials with a total of 2897 patients. All were of excellent homogeneity. The four subgroup-analyses (colorectal cancer, NSCLC (non-small cell lung cancer), breast cancer and gastric cancer) were performed with a fixed-effects model. The results of meta-analysis demonstrated that the short-term efficacies in patients with colorectal cancer, NSCLC and breast cancer receiving Fufangkushen Injection plus chemotherapy were significantly better than for those receiving chemotherapy alone (OR = 2.48 (1.59, 3.90), Z = 3.94, P < 0.0001; OR = 1.43 (1.20, 1.71), Z = 3.97, P = 0.0001; OR = 2.06 (1.28, 3.34), Z = 2.96, P = 0.003, respectively). However the patients with gastric cancer on combined chemotherapy were not significantly different from those on chemotherapy alone (OR = 1.25 (0.73, 2.13), Z = 0.81, P = 0.46). Fufangkushen Injection might improve the efficacies of chemotherapy in patients with colorectal cancer, NSCLC and breast cancer. Further large-scale multicenter and better designed studies are warranted to offer more convincing evidences.

Single Screening PSA Measurement at Age 60 Predicts Lifetime Cancer Risk

Prostate-specific antigen (PSA) screening is used widely. In a recent meta-analysis of randomized trials, however, researchers found that PSA screening

Fibrates and Cardiovascular Prevention

Since the publication of the ACCORD Lipid Study, in which adding a fibrate (e.g., gemfibrozil, fenofibrate) to a statin did not improve cardiovascular outcomes in patients with diabetes (JW Cardiol Mar 14 2010), fibrates have come under closer scrutiny. Now, investigators in Australia have conducted a meta-analysis of randomized trials evaluating the effects of fibrates …

Hypoglycemia with intensive insulin therapy: A systematic review and meta-analyses of randomized trials of continuous subcutaneous insulin infusion versus multiple daily injections

胰岛素替代治疗从20世纪初开始应用以来经历了几次飞跃,使得治疗方案能够更好地模拟胰岛素的正常生理性分泌并有效控制血糖.但在1型和2型糖尿病患者中进行的血糖控制研究显示,低血糖的发生可妨碍上述进展。

0068: A Meta-Analysis of Randomised Trials Showing the Effect of Adjuvant Radiotherapy On Survival and Recurrence From Stage 1 Endometrial Cancer

0068: A Meta-Analysis of Randomised Trials Showing the Effect of Adjuvant Radiotherapy On Survival and Recurrence From Stage 1 Endometrial Cancer

Can Psychological Interventions Improve Glycemic Control in Type 1 Diabetes

Although diabetes is associated with various psychological problems, data on the effectiveness of psychological interventions in improving glycemic control are limited. British investigators performed this systematic review and meta-analysis of randomized trials of psychological interventions in children (16 studies) and …

大腸癌に対する化学療法 ３ メタアナリシスを中心とした大腸癌補助療法の評価

目的:大腸癌術後補助療法について施行された臨床比較対照試験(RCT)を精査し,そのメタアナリシスの結果をレビューすることによって欧米およびわが国で行われている標準治療の評価,検討を行う.方法:RCTはMEDLINE,学会報告,Trialistとのコンタクト等によって検索を行い,図表・データの解析,また可能な症例では症例個別データを集積したメタアナリシスを行い,すでに発表されているメタアナリシスの結果との整合性を検討する.結果:欧米における研究ではNSABPによるC-01～06,R-01,02,またIMPACTグループによるRCTとそれらのメタアナリシスによって5-FU/Leucovorinが標準治療として認められた.わが国の大腸癌補助療法臨床試験の検討では経ロフッ化ピリミジン製剤の有用性が示唆された.結論:RCTとそれらの試験のメタアナリシスはEBMによる大腸癌補助療法の正確な評価を可能とし,標準治療の確立に有用と考えられる.