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Efficacy and safety of tranexamic acid in intracranial haemorrhage: A meta-analysis
Xiong Y, Guo X, Huang X, Kang X, Zhou J, Chen C, Pan Z, Wang L, Goldbrunner R, Stavrinou L, et al
PloS one. 2023;18(3):e0282726
Abstract
BACKGROUND Although some studies have shown that tranexamic acid is beneficial to patients with intracranial haemorrhage, the efficacy and safety of tranexamic acid for intracranial haemorrhage remain controversial. METHOD The PubMed, EMBASE, and Cochrane Library databases were systematically searched. The review followed PRISMA guidelines. Data were analyzed using the random-effects model. RESULTS Twenty-five randomized controlled trials were included. Tranexamic acid significantly inhibited hematoma growth in intracranial hemorrhage (ICH) and traumatic brain injury (TBI) patients. (ICH: mean difference -1.76, 95%CI -2.78 to -0.79, I2 = 0%, P < .001; TBI: MD -4.82, 95%CI -8.06 to -1.58, I2 = 0%, P = .004). For subarachnoid hemorrhage (SAH) patients, it significantly decreased the risk of hydrocephalus (OR 1.23, 95%CI 1.01 to 1.50, I2 = 0%, P = .04) and rebleeding (OR, 0.52, 95%CI 0.35 to 0.79, I2 = 56% P = .002). There was no significance in modified Rankin Scale, Glasgow Outcome Scale 3-5, mortality, deep vein thrombosis, pulmonary embolism, or ischemic stroke/transient ischemic. CONCLUSION Tranexamic acid can significantly reduce the risk of intracranial haemorrhage growth in patients with ICH and TBI. Tranexamic acid can reduce the incidence of complications (hydrocephalus, rebleeding) in patients with SAH, which can indirectly improve the quality of life of patients with intracranial haemorrhage.
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Web-Based Short Video Intervention and Short Message Comparison of Repeat Blood Donation Behavior Based on an Extended Theory of Planned Behavior: Prospective Randomized Controlled Trial Study
Hu Q, Hu W, Han W, Pan L
Journal of medical Internet research. 2022
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Abstract
Background: Although blood is an indispensable and important resource for clinical treatment, an imbalance between supply and demand may occur as the population ages and diversifies. Studies indicate that repeat blood donors are safe blood sources because of their voluntary blood donation education and frequent blood screening. However, the high rate of reduction in the number of first-time voluntary blood donors and low rate of repeated blood donation are common problems worldwide. Objective: This study aimed to evaluate the effect of an intervention in nonregular blood donors using web-based videos and SMS text messages, in which the former was guided by the extended theory of planned behavior, to discover effective intervention methods to improve repeat blood donation rates among nonregular blood donors. Methods: A total of 692 nonregular blood donors in Zhejiang province were randomly divided into intervention and control groups. The control group received regular, short reminder messages for a 6-month period, whereas the intervention group received web-based videos on the WeChat platform. The intervention group was guided by an extended theory of planned behavior, which included 9 factors: the respondents' attitude, subjective behavioral norms, perceived behavioral control, the willingness to donate blood, outcome expectations, self-identity, blood donation-related anxiety, cognition of the blood donation environment, and previous blood donation experience. The intervention group was divided into 2 stages: those with an intervention at 3 months and those with a follow-up 3 months later. After 6 months, the redonation rate was evaluated for the 2 groups, and the scale in the intervention group was determined both before and after the intervention. A t test, chi-square test, logistic stepwise regression, and ANOVA were performed. Results: The intervention group's redonation rate was 16.14%, which was significantly higher than the control group's redonation rate of 5.16%; P<.001. Men who were aged 31 to 45 years and had donated blood twice had a higher redonation rate after the web-based video intervention than after the SMS text messages; P<.05. The repeat donors' improved blood donation anxiety (P=.01), outcome expectations (P=.008), and cognition of the blood donation environment (P=.005) after the intervention were significantly higher than those of the nonrepeat donors. Conclusions: The web-based short video intervention based on the extended theory of planned behavior can effectively improve redonation rates. Outcome expectations, blood donation anxiety, and cognition of the blood donation environment can directly influence irregular blood donors to redonate blood.
PICO Summary
Population
Non-regular blood donors (n= 692).
Intervention
Web-based videos sent via WeChat, and guided by an extended theory of planned behavior (Intervention group), (n= 285).
Comparison
Regular, short text reminder SMS messages (Control group), (n= 407).
Outcome
The Intervention group re-donation rate was significantly higher (16.14%), than the Control group rate (5.16%). Men aged 31 to 45, who had donated blood twice had a higher re-donation rate after the web-based video intervention than after the text messages. After the web-based intervention, repeat donors' improved blood anxiety, outcome expectations, and cognition of the blood donation environment were significantly higher than those of the non-repeat donors.
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Efficacy of therapies in the treatment of Guillain-Barre syndrome: A network meta-analysis
Lin J, Gao Q, Xiao K, Tian D, Hu W, Han Z
Medicine. 2021;100(41):e27351
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Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is a disease with the features of acuteness, paralysis, inflammation, and in peripheral nerves. There are many current treatment options with varying efficacy, and to assess their effectiveness, we performed a network meta-analysis (NMA). The study protocol was registered at PROSPERO (CRD: 42019119178). Posted history: this manuscript was previously posted to medRxiv: doi: https://doi.org/10.1101/2020.06.03.20121780. METHODS The literature search database includes Web of Science, PubMed, Embase, and the Cochrane library that meets the requirements. We performed the NMA using controlled trials with 2 kinds of outcomes. We used the gemtc R package to perform the NMA to evaluate different GBS treatments' relative results. The consistency of direct and indirect evidence was also assessed by R software with gemtc package. RESULTS This NMA study included a total of 2474 subjects from 28 trials with 15 kinds of therapies. No improvement was observed in methylprednisolone and prednisolone compared with placebo. Conversely, plasma exchange (PE) and intravenous immunoglobulin (IVIg) were more effective than placebo. There was no significant difference between different doses and courses of PE and IVIg. For combination treatment, such as IVIg+eculizumab, immunoadsorption followed by IVIg and PE followed by IVIg, they didn't show significant advantages than IVIg and PE in NMA. On the consistency examination between direct and indirect evidence, there was no apparent heterogeneity between them. Funnel plots indicated there was little possibility of publication bias in this study. CONCLUSION PE or IVIg has significant efficacy for GBS patients. The effects of several kinds of therapies should be further explored. Corticosteroids have no considerable impact on GBS.
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Different dose regimes and administration methods of tranexamic acid in cardiac surgery: a meta-analysis of randomized trials
Guo J, Gao X, Ma Y, Lv H, Hu W, Zhang S, Ji H, Wang G, Shi J
BMC anesthesiology. 2019;19(1):129
Abstract
BACKGROUND The efficacy of tranexamic acid (TXA) to reduce perioperative blood loss and allogeneic blood transfusion in cardiac surgeries has been proved in previous studies, but its adverse effects especially seizure has always been a problem of concern. This meta-analysis aims to provide information on the optimal dosage and delivery method which is effective with the least adverse outcomes. METHODS We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE for all relevant articles published before 2018/12/31. Inclusion criteria were adult patients undergoing elective heart surgeries, and only randomized control trials comparing TXA with placebo were considered. Two authors independently assessed trial quality and extracted relevant data. RESULTS We included 49 studies with 10,591 patients into analysis. TXA significantly reduced transfusion rate (RR 0.71, 95% CI 0.65 to 0.78, P<0.00001). The overall transfusion rate was 35%(1573/4477) for patients using TXA and 49%(2190/4408) for patients in the control group. Peri-operative blood loss (MD - 246.98 ml, 95% CI - 287.89 to - 206.06 ml, P<0.00001) and re-operation rate (RR 0.62, 95% CI 0.49 to 0.79, P<0.0001) were also reduced significantly. TXA usage did not increase risk of mortality, myocardial infarction, stroke, pulmonary embolism and renal dysfunction, but was associated with a significantly increase in seizure attack (RR 3.21, 95% CI 1.04 to 9.90, P = 0.04).The overall rate of seizure attack was 0.62%(21/3378) for patients using TXA and 0.15%(5/3406) for patients in the control group. In subgroup analysis, TXA was effective for both on-pump and off-pump surgeries. Topical application didn't reduce the need for transfusion requirement, while intravenous delivery no matter as bolus injection alone or bolus plus continuous infusion were effective. Intravenous high-dose TXA didn't further decrease transfusion rate compared with low-dose regimen, and increased the risk of seizure by 4.83 times. No patients in the low-dose group had seizure attack. CONCLUSIONS TXA was effective in reducing transfusion requirement in all kinds of cardiac surgeries. Low-dose intravenous infusion was the most preferable delivery method which was as effective as high-dose regimen in reducing transfusion rate without increasing the risk of seizure.
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Hemoglobin targets for the anemia in patients with dialysis-dependent chronic kidney disease: a meta-analysis of randomized, controlled trials
Ye Y, Liu H, Chen Y, Zhang Y, Li S, Hu W, Yang R, Zhang Z, Lv L, Liu X
Renal failure. 2018;40(1):671-679
Abstract
BACKGROUND Anemia is extremely common among dialysis patients and underlies some of the symptoms associated with reduced kidney function, including fatigue, depression, reduced exercise tolerance, and dyspnea. OBJECTIVES A clearer cognition of the prognosistic impact of hemoglobin (Hb) or hematocrit (Hct) target for the outcomes of dialysis patients is urgent. This article aims to establish the suitable hemoglobin in order to provide clinical guidance. METHODS MEDLINE, EmBase, the Cochrane Library and other databases were searched with both MeSH terms and keywords to gather randomized controlled trials that assessed all-cause mortality, cardiovascular events, fistula thrombosis, infectious diseases and transfusion among dialysis-dependent patients using erythropoiesis-stimulating agents. The meta-analysis was accomplished via Revman 5.3 version. FINDINGS Totally, nine eligible studies were included, with study subjects involving 3228 patients. There was a significantly higher risk of fistula thrombosis without heterogeneity (RR 1.34, 95% CI 1.15-1.55; p < 0.05) in the higher Hb target group than in the lower Hb target group in the fixed effects model. However, no significant difference was found in all-cause mortality in the fixed effects model (RR 1.09, 95% CI 0.93-1.27; p = 0.30), cardiovascular events (RR 0.77, 95% CI 0.31-1.92; p = 0.58), infectious diseases (RR 0.69, 95% CI 0.24-1.96; p = 0.49) and transfusion (RR 0.92, 95% CI 0.42-1.99; p = 0.82) in the random effects model between the higher Hb target group and the lower Hb target group. DISCUSSION The results favor lower Hb target. To target lower Hb target when treating dialysis patients with anemia may decrease the risk of fistula thrombosis without increasing the risk of death, cardiovascular events, infectious diseases and transfusion.
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Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly: a prospective randomised controlled trial exploring hidden perioperative blood loss
Cai L, Wang T, Di L, Hu W, Wang J
Bmc Musculoskeletal Disorders. 2016;17((1)):475.
Abstract
BACKGROUND Hip fracture is a severe and common injury that occurs predominantly in the elderly. Blood loss in the perioperative period is associated with a greater risk of dying in anaemic patients. The aim of the study was to explore the best way to treat stable intertrochanteric fractures, taking hidden blood loss into account. METHODS This prospective, randomised blinded study included patients aged over 65 years with stable intertrochanteric fractures (Evans grades I and II). The patients were allocated to one of two groups treated via extramedullary or intramedullary fixation. Patient data were retrieved from electronic charts. Functional recovery was evaluated using the Functional Recovery Score of Zuckerman. Postoperative complications were also recorded. The formula of Nadler and Gross was used to calculate blood loss. RESULTS There were 92 patients in the extramedullary and 106 in the intramedullary group. Age, sex, the cause of injury, the type of fracture, the observed blood loss, functional recovery, time to union, complications, and American Society of Anesthesiologists classification did not differ significantly between the two groups (all p-values > 0.05). The frequencies of lung infection, electrolyte imbalance, and hypoproteinemia differed between groups (all p-values < 0.05). Total and hidden blood loss were higher in the intramedullary group (p = 0.001). CONCLUSION Extramedullary (compared with intramedullary) fixation of stable intertrochanteric fractures significantly reduces perioperative blood loss but affords similar functional outcomes and times to union. In view of the morbidity and complications associated with acute anaemia and transfusions, extramedullary fixation may be the optimal choice for treatment of stable fractures, being associated with reduced blood loss. TRIAL REGISTRATION The study was retrospectively registered at the Chinese Clinical Trial Registry, number: ChiCTR-INQ-16009754 , trial registration date: 6th Nov. 2016.