Pooled Estimate Of Relative Risk Research Articles

Assessment of COVID-19 severity using computed tomography imaging: A systematic review and meta-analysis

Computed tomography (CT) imaging has been reported to be a reliable tool for the evaluation of suspected cases and follow-up of confirmed cases of coronavirus disease 2019 (COVID-19). Despite the generation of a considerable amount of imaging data related to COVID-19, there is a need for an updated systematic review and meta-analysis pertaining to the questions of clinical significance. We aimed to analyze the correlation between abnormal chest CT findings and disease severity in patients with COVID-19. We searched for case series/studies published in the English language until March 24, 2020 that reported the clinical and chest CT imaging features of confirmed cases of COVID-19 in the PubMed database. A total of 208 studies were screened, and 71 were finally included in the meta-analysis. Study characteristics and relative risk (RR) estimates were extracted from each article and pooled using the random-effects meta-analysis model. There were a total of 6406 patients studied in a total of 71 studies; the male to female ratio was 1.08:1, and the mean age was 45.76 years; of these, 2057 patients from 14 studies were categorized into severe (24.3%) and mild (75.7%) disease groups. Imaging features that were more frequently noted in patients with severe disease than in those with mild disease included bilateral lung involvement (88.7% vs. 49.8%), scattered distribution (80.4% vs. 46.5%), multiple lobe involvement (95.7% vs. 59.6%), consolidation (88.3% vs. 60.3%), crazy-paving pattern (45.4% vs. 27.6%), air-bronchogram sign (29.7% vs. 15.1%), interlobular septal thickening (84.2% vs. 55.8%), and subpleural line (36.8% vs. 26.4%) differences between the two disease groups were statistically significant (P < 0.001). For 3778 patients in 29 studies, a significant pooled RR estimate was associated with abnormal chest CT findings in patients with COVID-19 (RR, 5.46%; 95% confidence interval [CI], 3.72%–8.04%; I2 = 86%). Individual assessment of the CT features revealed that a significant pooled RR estimate was associated with pure ground-glass opacity (GGO) (RR, 1.63%; 95% CI, 1.12%–2.38%; I2 = 79%), while lower pooled RR estimates were associated with CT features like crazy-paving pattern (RR, 1.37%; 95% CI, 1.10%–1.71%; I2 = 60%), consolidation (RR, 0.47%; 95% CI, 0.32%–0.7%; I2 = 83.5%), GGO with consolidation (RR, 0.73%; 95% CI, 0.52%–1.02%; I2 = 75%), and air-bronchogram sign (RR, 0.58%; 95% CI, 0.36%–0.96%; I2 = 94%). In conclusion, the number, location, extent, and type of radiological lesions are associated with COVID-19 progression and severity, suggesting the feasibility of using CT imaging in the assessment of disease severity in all age groups and efficient allocation of resources for patient management at the institutional level.

Coffee Consumption and Stroke Risk: Evidence from a Systematic Review and Meta-Analysis of more than 2.4 Million Men and Women

BackgroundResults of stroke risk and coffee consumption are inconclusive. This study aimed to provide an updated systematic review and meta-analysis of the association between coffee consumption and stroke risk. MethodRandom-effects models were used to pool relative risk estimates (RRs) with 95% confidence intervals (CIs). The highest versus the lowest categories of coffee consumption as well as dose-response analysis with a one-stage robust error meta-regression model (REMR) were assessed for stroke risk. ResultsIn total, 21 studies including 30 independent cohorts that comprised more than 2.4 million participants were included. The pooled RR with 95% CI for the highest versus the lowest categories of coffee consumption was 0.87 (0.80–0.94) with moderate heterogeneity (I2 = 32.0%). Sensitivity analysis suggested that the influence of each individual data set to an overall result was not significant. As suggested by Begg's funnel plots and Egger tests (p=0.006), some evidence for publication bias was observed. Further analysis with the trim-and-fill method indicated no noticeable harm to our results was generated by any potential bias. Dose-response analysis suggested a nonlinear relationship (U-shape) between stroke risk and coffee (p = 0.0002). The strongest association for stroke (21% lower risk) was found for coffee consumption of 3–4 cups/day and no further reduction in stroke risk was observed with increasing levels of coffee consumption beyond this amount. ConclusionOur study provided evidence of a significant inverse association between coffee consumption and risk of stroke. Future large prospective studies with excellent design are warranted to confirm our findings and provide a more definitive conclusion.

Association of Psoriasis With the Risk of Developing or Dying of Cancer

The risk of cancer developing in people with psoriasis has raised some concern, with little clarity regarding differentiation in risk according to psoriasis severity. To conduct a systematic review and meta-analysis of observational studies on the risk of cancer incidence and mortality in people with psoriasis. Six electronic databases (MEDLINE, Embase, MEDLINE in Process, Cochrane Central Register, Web of Science, and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) were searched from inception to November 15, 2017, for eligible studies. Cohort and case-control studies that provided estimates of the risk of cancer incidence or cancer mortality associated with psoriasis were included. Data were extracted relating to study design, study population, and risk estimates. Study-specific estimates of the relative risk (RR) were combined using a random-effects model. Heterogeneity was quantified using the I2 statistic. Data were analyzed from April 9, 2018, through February 22, 2019. Pooled RR estimates for cancer incidence and cancer mortality for psoriasis cohorts compared with people without psoriasis. A total of 58 unique studies were included, with quality varying for the incidence and the mortality studies. Severe psoriasis (RR, 1.22; 95% CI, 1.08-1.39 [9 studies]) and all severities of psoriasis (RR, 1.18; 95% CI, 1.06-1.31 [7 studies]) were associated with an increased risk of cancer (overall), and associations were found for a range of site-specific cancers, including colon (RR, 1.18 [95% CI, 1.03-1.35]), colorectal (RR, 1.34 [95% CI, 1.06-1.70]), kidney (RR, 1.58 [95% CI, 1.11-2.24]), laryngeal (RR, 1.79 [95% CI, 1.06-3.01]), liver (RR, 1.83 [95% CI, 1.28-2.61]), lymphoma (RR, 1.40 [95% CI, 1.24-1.57]), non-Hodgkin lymphoma (RR, 1.28 [95% CI, 1.15-1.43]), keratinocyte cancers (RR, 1.71 [95% CI, 1.08-2.71]), esophageal (RR, 2.05 [95% CI, 1.04-4.07]), oral cavity (RR, 2.80 [95% CI, 1.99-3.93]), and pancreatic (RR, 1.41 [95% CI, 1.16-1.73]). Overall cancer mortality risk was higher in patients with severe psoriasis (RR, 1.22; 95% CI, 1.08-1.38 [4 studies]). Specifically, liver (RR, 1.43 [95% CI, 1.09-1.88]), esophageal (RR, 2.53 [95% CI, 1.87-3.41]), and pancreatic (RR, 1.31 [95% CI, 1.02-1.69]) cancer mortality were found to be elevated in those with severe psoriasis. The heterogeneity of estimates was often very high despite stratification. Marked attenuation of risk was found in those studies that adjusted estimates for smoking, alcohol consumption, and obesity. In this study, people with psoriasis appeared to have an increased risk of cancer incidence and cancer-related mortality involving a range of site-specific cancers. Future research examining specific lifestyle factors, treatments, and the inflammatory processes that contribute to psoriasis may help provide additional information on the underlying mechanisms for the apparent increased cancer risk.

Comparing clinical outcomes of NOACs with warfarin on atrial fibrillation with Valvular heart diseases: a meta-analysis

BackgroundWarfarin is the standard of care and NOAC (Novel oral anticoagulants) are a group of newer drugs for such purposes. NOAC has a generally better profile (Clear interaction, less side effect, require less monitoring). However, its efficacy on valvular atrial fibrillation remains unclear.MethodWe researched literature articles from Embase, Cochrane and PubMed. Then we meta-analysed these six articles to assess pooled estimate of relative risk (RR) and 95% confidence intervals (Cl) using random-effects model for stroke, systemic embolic event, major bleeding and all-cause mortality. Heterogeneity across study was tested with Cochran’s Q Test and I2 Test. The bias of studies was first tested by examining the symmetry of Funnel Plot. Cochrane’s Collaboration Tool was also used to report any presented bias.ResultsWe collected 496 articles in total and finally we included six articles in our meta-analysis. For SSEE (Stroke, Systemic Embolic Event), the pooled relative risk showed a significantly better clinical outcome of NOAC (RR: 0.66; 95% CI: 0.46 to 0.95). However, there is no significant difference in major bleeding (RR: 0.714, 95% CI:0.46 to 1.11) and all-cause mortality (RR: 0.84, 95% CI: 0.58 to 1.21).ConclusionCompared to Warfarin, NOAC is significantly more protective against the embolic event, but no significant difference in lowering risk of major bleeding, all-cause mortality or all aspects of post-TAVI (Trans-catheter aortic valve implantation).

Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis

IntroductionHuman papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO self-care guidelines, we conducted a systematic...

Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis

BackgroundSelf-collection of samples for diagnostic testing offers the advantages of patient autonomy, confidentiality and convenience. Despite data showing their feasibility and accuracy, there is a need to better understand how...

Should home-based ovulation predictor kits be offered as an additional approach for fertility management for women and couples desiring pregnancy? A systematic review and meta-analysis

IntroductionTo inform the WHO Guideline on self-care interventions, we conducted a systematic review of the impact of ovulation predictor kits (OPKs) on time-to-pregnancy, pregnancy, live birth, stress/anxiety, social harms/adverse events...

Self-administration of injectable contraception: a systematic review and meta-analysis

IntroductionDepot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) may facilitate self-administration and expand contraceptive access. To inform WHO guidelines on self-care interventions, we conducted a systematic review and meta-analysis comparing self-administration...

Coffee consumption and liver cancer risk in Japan: a meta-analysis of six prospective cohort studies.

ABSTRACTPrevious epidemiological studies have shown that coffee consumption may reduce liver cancer risk. The present study aimed to summarize the evidence for this association in the Japanese population by performing a meta-analysis of the results of relevant cohort studies conducted in Japan. We searched studies published prior to September 1, 2018 in PubMed. Extracted data were analyzed using a random effects model. A total of six cohort studies from five publications were included in the final analysis. The pooled estimate of relative risk with 95% confidence interval (CI) for the group with highest coffee consumption was 0.50 (95% CI: 0.38–0.66, p < 0.001) compared with non-coffee drinkers or those who almost never drink coffee. No evidence of publication bias was observed (p for Begg’s test = 0.85). This meta-analysis suggested that coffee consumption among Japanese people has a significant role in preventing liver cancer.

Meta-analysis of prophylactic hydration versus no hydration on contrast-induced acute kidney injury.

Guidelines recommend prophylactic hydration for all patients with compromised renal function undergoing contrast exposure. However, the AMACING study published recently showed a noninferior result of hydration compared with no prophylaxis in high-risk patients and led to a heat discussion. This study aimed to validate the effectiveness of prophylactic hydration in different subsets of patients undergoing a contrast procedure. We carried out a meta-analysis of randomized-controlled trials to assess pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for incidences of contrast-induced acute kidney injury (CI-AKI), in-hospital all-cause mortality, and need for dialysis. Compared with no prophylaxis, patients receiving prophylactic hydration had a lower risk of CI-AKI [RR: 0.66 (95% CI: 0.55-0.79); P≤0.001; Pheterogeneity=0.42] and a lower risk of deaths of all-cause [RR: 0.57 (95% CI: 0.33-0.98); P=0.04; Pheterogeneity=0.47], but did not have a decreased risk of need for dialysis [RR: 0.39 (95% CI: 0.12-1.23); P=0.11; Pheterogeneity=0.31]. In subgroup analyses on the incidence of CI-AKI by baseline estimated glomerular filtration rate (eGFR), no benefit from prophylactic hydration was indicated in patients with a baseline eGFR ranging from 30 to 60 ml/min/1.73 m [RR: 1.02 (95% CI: 0.66-1.60); Pheterogeneity=0.66; Pinteraction=0.03]. Our analysis indicated that prophylactic hydration was associated with a lower risk of CI-AKI and all-cause deaths, but not with the need for dialysis in the overall population. However, no prophylactic hydration is noninferior to intravenous hydration on the incidence of CI-AKI in patients with a baseline eGFR ranging from 30 to 60 ml/min/1.73 m.

The effect of pathological fractures on the prognosis of patients with osteosarcoma: a meta-analysis of 14 studies.

Osteosarcoma is a leading cause of malignant tumor related death. We conducted a meta-analysis to evaluate the association between pathological fractures and prognosis in patients with osteosarcoma. We searched PubMed, Web of Science, and Embase for studies published until May 15, 2017. Crude and adjusted relative risk (RR) with 95% confidence intervals were used to compare data between the case and control groups. Fourteen studies and 3910 patients were included in the final meta-analysis. No statistically significant difference was detected between the pathological fracture and non-pathological fracture groups in local recurrences analysis (RR = 1.102, 95% CI: 0.813–1.495, P = 0.531); however, a statistically significant difference was found between group in distant metastasis (RR = 1.424, 95% CI: 1.089–1.862, P = 0.01). For survival rates, the following RRs were calculated: 3-year overall survival (OS) (RR = 0.736, 95% CI: 0.593–0.912, P = 0.005); 5-year OS (RR = 0.889, 95% CI: 0.791–0.999, P = 0.049); 3-year event-free survival (EFS) (RR = 0.812, 95% CI: 0.682–0.966, P = 0.018); and 5-year EFS (RR = 0.876, 95% CI: 0.785–0.978, P = 0.019). The pooled estimate of RR was 0.673 (95% CI: 0.364–1.244, P = 0.206) for local recurrence in the amputation and limb salvage groups. In conclusion, our analysis indicated that there were no differences in local recurrence and local recurrence after limb salvage between patients with or without a fracture. Additionally, the patients with pathological fracture had a higher risk of distant metastasis and lower 3-year OS, 5-year OS, 3-year EFS, and 5-year EFS. Considering the limitations of this study, we believe that future large-scale studies should be performed to confirm our conclusions.

Decentralized care for multidrug-resistant tuberculosis: a systematic review and meta-analysis.

ObjectiveTo assess the effectiveness of decentralized treatment and care for patients with multidrug-resistant (MDR) tuberculosis, in comparison with centralized approaches.MethodsWe searched ClinicalTrials.gov, the Cochrane library, Embase®, Google Scholar, LILACS, PubMed®, Web of Science and the World Health Organization’s portal of clinical trials for studies reporting treatment outcomes for decentralized and centralized care of MDR tuberculosis. The primary outcome was treatment success. When possible, we also evaluated, death, loss to follow-up, treatment adherence and health-system costs. To obtain pooled relative risk (RR) estimates, we performed random-effects meta-analyses.FindingsEight studies met the eligibility criteria for review inclusion. Six cohort studies, with 4026 participants in total, reported on treatment outcomes. The pooled RR estimate for decentralized versus centralized care for treatment success was 1.13 (95% CI: 1.01–1.27). The corresponding estimate for loss to follow-up was RR: 0.66 (95% CI: 0.38–1.13), for death RR: 1.01 (95% CI: 0.67–1.52) and for treatment failure was RR: 1.07 (95% CI: 0.48–2.40). Two of three studies evaluating health-care costs reported lower costs for the decentralized models of care than for the centralized models.ConclusionTreatment success was more likely among patients with MDR tuberculosis treated using a decentralized approach. Further studies are required to explore the effectiveness of decentralized MDR tuberculosis care in a range of different settings.

Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Disease

BackgroundValvular heart disease (VHD) and atrial fibrillation (AF) often coexist. Phase III trials comparing non–vitamin K antagonist oral anticoagulants (NOACs) with warfarin excluded patients with moderate/severe mitral stenosis or mechanical heart valves, but variably included patients with other VHD and valve surgeries. ObjectivesThis study aimed to determine relative safety and efficacy of NOACs in patients with VHD. MethodsWe performed a meta-analysis of the 4 phase III AF trials of the currently available NOACs versus warfarin in patients with coexisting VHD to assess pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for stroke/systemic embolic events (SSEE), major bleeding, intracranial hemorrhage (ICH), and all-cause death. ResultsCompared with warfarin, the rate of SSEE in patients treated with higher-dose NOACs was lower and consistent among 13,585 patients with (RR: 0.70; 95% CI: 0.58 to 0.86) or 58,098 without VHD (RR: 0.84; 95% CI: 0.75 to 0.95; interaction p = 0.13). Major bleeding in patients on higher-dose NOACs versus warfarin was similar and consistent among patients with (RR: 0.93; 95% CI: 0.68 to 1.27) or without VHD (RR: 0.85; 95% CI: 0.70 to 1.02; interaction p = 0.63 for VHD/no-VHD difference). Intracranial hemorrhage was lower with higher-dose NOACs than with warfarin irrespective of VHD (RR: 0.47; 95% CI: 0.24 to 0.93, and 0.49; 95% CI: 0.41 to 059, respectively; interaction p = 0.91). No protective effect of higher-dose NOACs in preventing all-cause death seemed to be present in patients with VHD versus without VHD (RR:1.01; 95% CI: 0.90 to 1.14 vs. RR: 0.88; 95% CI: 0.82 to 0.94, respectively; interaction p = 0.03). ConclusionsHigh-dose NOACs provide overall efficacy and safety similar in AF patients with or without VHD.

An updated dose-response meta-analysis of coffee consumption and liver cancer risk.

Prospective cohort studies of the relationship between coffee consumption and liver cancer risk have drawn different conclusions. Therefore, a dose-response meta-analysis of prospective cohort studies was performed to disentangle this causal relationship. Prospective cohort studies of the association between coffee consumption and liver cancer risk published prior to Jan 9, 2016 were identified by searching in the PubMed and EMBASE databases. Extracted data were analyzed using a random-effects model. Of the 2892 records identified using the search strategy, a total of twenty cohort studies from ten publications were included in the final meta-analysis. The pooled estimate of relative risk (RR) with 95% confidence interval (CI) for highest vs. non/occasional coffee drinkers was 0.55(0.44–0.67). No evidence of publication bias was observed (p for Egger’s test = 0.229). Sensitivity analysis indicated the results were robust. Dose-response analysis revealed a significant linear dose-response relationship between coffee consumption and liver cancer risk (p = 0.36). Subgroup analyses stratified by pre-specified variables (gender, geographic region, and adjusted factors) indicated similar results within individual subgroups. Our meta-analysis suggested that coffee consumption is inversely associated with liver cancer risk.

Do Prolonged Prophylactic Antibiotics Reduce the Incidence of Surgical-Site Infections in Immediate Prosthetic Breast Reconstruction?

Approximately 50,000 women in the United States undergo mastectomy and immediate prosthetic breast reconstruction annually, and most receive postoperative prophylactic antibiotics. The effect of these antibiotics on the risk of surgical-site infections remains unclear. The authors searched the Medline, Embase, and Cochrane Library databases for studies that compared less than 24 hours and greater than 24 hours of antibiotics following immediate prosthetic breast reconstruction. Primary outcomes were surgical-site infections and implant loss. Conservative random effects models were used to obtain pooled relative risk estimates. The authors identified 927 studies, but only four cohort studies and one randomized controlled trial met their inclusion criteria. Unadjusted incidences of surgical-site infections were 14 percent with more than 24 hours of antibiotics, 19 percent with less than 24 hours of antibiotics, and 16 percent overall. Unadjusted incidences of implant loss were 8 percent with more than 24 hours of antibiotics, 10 percent with less than 24 hours of antibiotics, and 9 percent overall. The pooled relative risk of implant loss was 1.17 (95 percent CI, 0.39 to 3.6) with less than 24 hours of antibiotics, which was not statistically significant. Prolonged antibiotic use did not have a statistically significant effect on reducing surgical-site infections or implant loss. There was significant heterogeneity between studies, and prolonged antibiotics may have increased the risk of implant loss in the randomized controlled trial. Definitive evidence may only be obtained with data from more prospective randomized controlled trials.

Effects of Ambient Air Pollution on Respiratory and Cardiovascular Mortality: Meta-Analysis and Meta-Regression

Introduction: Prior research has asserted that strokes, heart attacks and certain respiratory conditions account for the majority of premature, pollution-related deaths. We have completed various studies on the effects of air pollution on mortality due to cardiovascular and respiratory causes in individual cities across the southern United States. Some studies have shown positive associations between pollutants and mortality, while others have returned negative or inconclusive outcomes. The objective of this analysis was to develop an overall estimate of the impact of air pollution on mortality. We also investigated the diversity and/or similarity of results among studies. Methods: Meta-analysis and sub-group analysis were performed on previous results to estimate the relative risk (RR) of mortality from cardiovascular or respiratory causes due to short-term exposure to fine particles with diameter less than 2.5 µm (PM2.5), ozone (O3), elemental carbon (EC), organic carbon (OC), sulfur dioxide (SO2) and nitrogen dioxide (NO2). In studies where heterogeneity was detected, we performed meta-regression to determine factors that contributed to study variance. We also performed sensitivity analysis to determine the robustness of these estimates. Results: Fixed effects meta-analysis showed an increased risk of cardiovascular death from exposure to EC, OC, and SO2. Pooled RR estimates between cardiovascular death and PM2.5 or O3 were not statistically significant. Pooled RR for an increase in respiratory death from OC exposure was statistically significant. Meta-analysis did not show an increased risk of respiratory death from any other pollutant. Conclusion: Some individual studies showed an increase risk of cardiovascular or respiratory death from exposure to pollution in certain cities. Pooled RR estimated via meta-analysis were not always consistent. It is important to understand the impact of covariates between studies and model selection on risk outcomes.

Association between pesticide exposure and risk of kidney cancer: a meta-analysis.

This meta-analysis aimed to evaluate the correlation between pesticide exposure and kidney cancer. We conducted a systematic search of the Cochrane Library, Embase, Web of Knowledge, and Medline (updated to March 1, 2015) to identify all relevant studies. References of the retrieved articles were also identified. Fixed- or random-effect models were used to summarize the estimates of relative risk (RR) with 95% confidence interval for the association between exposure of pesticide and risk of kidney cancer. The pooled RR estimate indicated that pesticide exposure might have an elevated risk for kidney cancer (RR =1.10, 95% confidence interval 1.01–1.19). In a subgroup analysis of high quality articles, we detected that pesticide exposure is a significant risk factor for kidney cancer in a subgroup analysis of case-control studies, (Newcastle–Ottawa Quality Assessment Scale score >6) (RR =1.31, 95% confidence interval 1.12–1.51). North America studies, odds ratio studies, and studies with effect estimate adjusted for more than two confounder studies. In conclusion, pesticide exposure may be a risk factor for kidney cancer.

Efficacy of Same-Day Vs. Next-Day Pegfilgrastim for the Prevention of Chemotherapy-Induced (Febrile) Neutropenia (CIN/FN): A Meta-Analysis

Introduction: CIN/FN is a major dose-limiting toxicity of many cancer chemotherapy (CTX) regimens. CIN/FN may require hospitalization, increase monitoring requirements and diagnostic and treatment costs, and reduce patient quality of life. Myeloid growth factors such as filgrastim or pegfilgrastim have been shown to reduce the incidence and severity of neutropenic complications. International guidelines recommend that pegfilgrastim be administered once per cycle 24-72 hours after chemotherapy, though recent NCCN guidelines mention the option of same-day administration. From the patients' perspective, the time lag is potentially cumbersome because of the need for additional visits. Several studies varying in design and outcomes have evaluated same-day administration of pegfilgrastim compared to standard (next-day) administration 24-72 hours after completion of the CTX cycle.Purpose: To conduct a meta-analysis of studies of same-day vs. next-day pegfilgrastim administration in terms of the incidence of (1) Grade 4 CIN during cycle 1 of CTX and (2) CTX dose reduction in subsequent CTX cycles.Methods: We performed a search for same-day administration of pegfilgrastim using PubMed search engines to complement investigators' familiarity with the literature. Considering heterogeneity (I2) across studies, random-effects meta-analyses were used to quantify pooled estimates of relative risk (RR), taking into account both within- (standard error) and between-study variance (τ2) using the DerSimonian and Laird method. Z-scores (weighted mean divided by the standard error of the weighted mean) and associated p-values (testing against the null hypothesis of RR = 1.0) quantified the precision of pooled RRs across studies. All analyses were performed using StataMP 14 (College Station, Texas, USA).Results: There were8 comparative studies with data on Grade 4 neutropenia that included a total of 446 patients treated the same day and 697 patients treated next day (Figure 1). Patients treated with pegfilgrastim on the same day after the first cycle of chemotherapy were equally likely to develop Grade 4 neutropenia as those treated the next day (RR = 1.13, 95% CI 0.87-1.47, p =0.371; I2 =54.1%, p=0.033). There were 8 comparative studies with data on chemotherapy dose reduction that included a total of 414 patients treated the same day and 428 patients treated next day (Figure 2). Patients treated with pegfilgrastim on the same day were equally likely to require a reduction in chemotherapy dose compared with those treated the next day (RR = 0.97, 95% CI 0.68-1.39, p =0.863; I2 =62.7%, p=0.009).Conclusion: The incidence of Grade 4 neutropenia and CTX dose reduction in patients receiving same-day pegfilgrastim were equal to those undergoing standard administration. To be confirmed through controlled studies, same-day administration of pegfilgrastim can be considered in the prophylaxis of CIN/FN in patients receiving myelotoxic CTX. [Display omitted] [Display omitted] DisclosuresMcBride:Janssen Scientific Affairs, LLC: Consultancy. Persky:Gilead Sciences, Inc: Speakers Bureau.

Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies.

Whether orthostatic hypotension (OH) is a risk factor for cardiovascular morbidity and death is uncertain. Currently available evidence derives from non-homogeneous and partly ambiguous studies. We aimed at assessing the relationship between OH and death or major adverse cardiac and cerebrovascular events (MACCEs) by integrating results of previous studies. We performed a meta-analysis of prospective observational studies reporting on the association between prevalent OH, mortality, and incident MACCE, published from 1966 through 2013. Mantel-Haenszel pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for all-cause death were assessed as the primary endpoint at the longest follow-up; incident coronary heart disease (CHD), heart failure (HF), and stroke were assessed as secondary endpoints. We also performed post hoc subgroup analyses stratified by age and a meta-regression analysis. We identified a total of 13 studies, including an overall population of 121 913 patients, with a median follow-up of 6 years. Compared with the absence of OH, the occurrence of OH was associated with a significantly increased risk of all-cause death (RR 1.50; 95% CI 1.24-1.81), incident CHD (RR 1.41; 95% CI 1.22-1.63), HF (RR 2.25; 95% CI 1.52-3.33), and stroke (RR 1.64; 95% CI 1.13-2.37). When analysed according to age, pooled estimates of RR (95% CI) for all-cause death were 1.78 (1.25-2.52) for patients <65 years old, and 1.26 (0.99-1.62) in the older subgroup. Orthostatic hypotension is associated with a significantly increased risk of all-cause death, incident CHD, HF, and stroke.

Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities? : a systematic review and meta-analysis.

Opinion remains divided as to whether the development of pathological fracture affects the prognosis of patients with an osteosarcoma of the extremities. We conducted a comprehensive systematic review and meta-analysis of papers which reported the outcomes of osteosarcoma patients with and without a pathological fracture. There were eight eligible papers for final analysis which reported on 1713 patients, of whom 303 (17.7%) had a pathological fracture. The mean age for 1464 patients in six studies was 23.2 years old (2 to 82). The mean follow-up for 1481 patients in seven studies was 90.1 months (6 to 240). The pooled estimates of local recurrence rates in osteosarcoma patients with and without pathological fractures were 14.4% (8.7 to 20.0) versus 11.4% (8.0 to 14.8). The pooled estimate of relative risk was 1.39 (0.89 to 2.20). The pooled estimates of five-year event-free survival rates in osteosarcoma patients with and without a pathological fracture were 49.3% (95% CI 43.6 to 54.9) versus 66.8% (95% CI 60.7 to 72.8). The pooled estimate of relative risk was 1.33 (1.12 to 1.59). There was no significant difference in the rate of local recurrence between patients who were treated by amputation or limb salvage. The development of a pathological fracture is a negative prognostic indicator in osteosarcoma and is associated with a reduced five-year event-free survival and a possibly higher rate of local recurrence. Our findings suggest that there is no absolute indication for amputation, as similar rates of local recurrence can be achieved in patients who are carefully selected for limb salvage.