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Association of active immunotherapy with outcomes in cancer patients with COVID-19: a systematic review and meta-analysis
Cao C, Gan X, Hu X, Su Y, Zhang Y, Peng X
Aging. 2022;14(undefined)
Abstract
BACKGROUND During the COVID-19 pandemic, there are growing concerns about the safety of administering immunotherapy in cancer patients with COVID-19. However, current clinical guidelines provided no clear recommendation. METHODS Studies were searched and retrieved from electronic databases. The meta-analysis was performed by employing the generic inverse-variance method. A random-effects model was used to calculate the unadjusted odds ratios (ORs) and adjusted ORs with the corresponding 95% CIs. RESULTS This meta-analysis included 20 articles with 6,042 cancer patients diagnosed with COVID-19. According to the univariate analysis, the acceptance of immunotherapy within 30 days before COVID-19 diagnosis did not increase the mortality of cancer patients (OR: 0.92; 95% CI: 0.68-1.25; P=0.61). Moreover, after adjusting for confounders, the adjusted OR for mortality was 0.51, with borderline significance (95% CI: 0.25-1.01; P=0.053). Similarly, the univariate analysis showed that the acceptance of immunotherapy within 30 days before COVID-19 diagnosis did not increase the risk of severe/critical disease in cancer patients (OR: 1.07; 95% CI: 0.78-1.47; P=0.66). No significant between-study heterogeneity was found in these analyses. CONCLUSIONS Accepting immunotherapy within 30 days before the diagnosis of COVID-19 was not significantly associated with a higher risk of mortality or severe/critical disease of infected cancer patients. Further prospectively designed studies with large sample sizes are required to evaluate the present results.
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Efficacy of Platelet-Rich Plasma Versus Placebo in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Trials
Dai W, Yan W, Leng X, Wang J, Hu X, Cheng J, Ao Y
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine. 2021
Abstract
OBJECTIVE To evaluate the efficacy of platelet-rich plasma (PRP) injections versus placebo in the treatment of tendinopathy. DATA SOURCES We performed a systematic literature search in MEDLINE, Embase, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov through November 2020 to identify randomized controlled trials (RCTs) that evaluated the clinical efficacy of PRP versus placebo for the treatment of tendinopathy. Outcomes were analyzed on an intention-to-treat basis with random-effects models. MAIN RESULTS A total of 13 RCTs were included in this meta-analysis. The pooled analysis showed no significant difference in pain relief at 4 to 6 weeks (standard mean difference [SMD]: -0.18, 95% confidence intervals [CI]: -0.62 to 0.26), 12 weeks (SMD: -0.14, 95% CI: -0.55 to 0.26), and ≥24 weeks (SMD: -0.56, 95% CI: -1.16 to 0.05) or function improvement at 4 to 6 weeks (SMD: 0.11, 95% CI: -0.13 to 0.35), 12 weeks (SMD: 0.18, 95% CI: -0.13 to 0.49), and ≥24 weeks (SMD: 0.26, 95% CI: -0.14 to 0.66) for PRP compared with placebo in the treatment of tendinopathy. The sensitivity analysis indicated no significant difference in pain relief or function improvement at 12 weeks between PRP and placebo for different types of tendinopathies, treatment regimens, leukocyte concentrations, or cointerventions. CONCLUSIONS Platelet-rich plasma injection was not found to be superior to placebo in the treatment of tendinopathy, as measured by pain relief and functional improvement at 4 to 6, 12, and ≥24 weeks.
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Surgical vs. Conservative Management for Lobar Intracerebral Hemorrhage, a Meta-Analysis of Randomized Controlled Trials
Akram MJ, Zhao R, Shen X, Yang WS, Deng L, Li ZQ, Hu X, Zhao LB, Xie P, Li Q
Frontiers in neurology. 2021;12:742959
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Editor's Choice
Abstract
BACKGROUND Outcomes regarding the conventional surgical and conservative treatment for the lobar intracerebral hemorrhage (ICH) have not been previously compared. The current meta-analysis was designed to review and compile the evidence regarding the management of patients with lobar intracerebral hemorrhage. METHODS Online electronic databases, including PubMed, Embase, Medline, Cochrane Library, and Google Scholar, were searched for randomized controlled trials (RCTs). Studies were selected on the basis of the inclusion and exclusion criteria. Trials with CT-confirmed lobar intracerebral hemorrhage patients of which treatment regimen was started within 72 h following the stroke were included. Low quality trials were excluded. Death or dependence was defined as primary outcome and death at the end of the follow up was the secondary outcome. RESULTS One hundred five RCTs were screened and 96 articles were excluded on the basis of abstract. Nine articles were assessed for the eligibility and 7 trials were included that involved 1,102 patients. The Odds ratio (OR) for the primary outcome was 0.80 (95% CI, 0.62-1.04, p = 0.09) and for the secondary outcome was 0.79 (95%CI, 0.60-1.03, p = 0.09). CONCLUSION Our findings suggested that surgical treatments did not significantly improve the functional outcome as compared with the conservative medical management for patients with lobar ICH.
PICO Summary
Population
Patients with lobar intracerebral haemorrhage (7 studies, n= 1,102).
Intervention
Surgical treatment, including: endoscopic surgery, open craniotomy, stereotactic aspiration, and endoscopic surgery plus stereotactic aspiration, (n= 552).
Comparison
Conservative management, including non-surgical or pharmacological (n= 550).
Outcome
The overall results showed a non-significant trend toward better prognosis in the surgical group (OR 0.80). No significant difference was observed for death at the end of the follow up between surgical and conservative medical management groups.
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Meta-Analysis of the Impact of Pre-Procedural Serum Albumin on Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement
Liu G, Hu X, Long M, Du ZM, Li Y, Hu CH
International heart journal. 2020
Abstract
Pre-procedural serum albumin's impact on prognosis after transcatheter aortic valve replacement (TAVR) has been studied. Literature on the prognostic role of serum albumin in the survival of patients undergoing TAVR shows conflicting results. This meta-analysis was conducted to evaluate the impact of pre-procedural serum albumin on outcomes after TAVR. A comprehensive literature search of EMBASE, MEDLINE, and the Cochrane Library was undertaken through July 2019. The primary end points were 30-day and one-year all-cause mortality after TAVR. Risk ratios (HRs) and 95% confidence intervals (CIs) were calculated using the random-effect model. Ten eligible studies with 8,236 patients were analyzed. Of the 8,236 patients undergoing TAVR, with a mean age of 83 years, 48.8% were men and were categorized into two groups according to low and normal serum albumin (cut-off value: 3.5 or 4 g/dL). Overall, low albumin was significantly associated with an approximately two-fold increase in 30-day all-cause mortality (HR, 2.09; 95% CI, 1.53-2.86) and a 61% increase risk for one-year mortality (HR, 1.61; 95% CI, 1.31-1.98) in patients after TAVR. Sensitivity analyses showed the results to be robust. The association of low albumin level with an increase in one-year mortality risk was not modified by study design, albumin cut-off value, Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), and study quality. In conclusion, low albumin levels were associated with poor prognosis in patients after TAVR. Pre-procedural albumin can be used as a simple tool related to prognosis after TAVR.
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Timing of surgery for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
Yao Z, Hu X, Ma L, You C, He M
International Journal of Surgery (London, England). 2017;48:266-274.
Abstract
INTRODUCTION The timing of surgery for aneurysmal subarachnoid hemorrhage influences the outcome, but the optimal timing remains controversial. We conducted a systematic review to clarify whether early surgery was better than late surgery for improving outcome. MATERIALS AND METHODS We systematically searched several databases to screen eligible studies. After synthesizing data, an overall effect was shown using a risk ratio (RR) and 95% confidence interval (CI). Subgroup analyses were stratified by multiple variables to control the confounding factors. Sensitivity analyses were applied to check the robustness of the results. Publication bias was measured with Egger's and Begg's tests. RESULTS A total of 14 studies were included in the analysis. Compared with late surgery, early surgery significantly decreased the incidence of poor outcome, regardless of whether patients were in good condition (RR, 0.65 [95%CI, 0.50 0.84]; p = 0.001) or in poor condition on admission (RR, 0.71 [95%CI, 0.61 0.83]; p < 0.0001). Moreover, when patients were in good condition on admission, early surgery also effectively reduced the death rate (RR, 0.61 [95%CI, 0.46 0.82]; p = 0.001). Additionally, early surgery reduced the death rate compared with late surgery in patients older than 50 years (RR, 0.49 [95%CI, 0.27 0.89]; p < 0.002). CONCLUSIONS Early surgery was superior to late surgery in reducing a poor outcome and death rate when patients were in good condition on admission, and decreased the incidence of poor outcome when patients were in poor condition on admission. Age was a potential confounding factor, influencing the effect of early surgery. Further study is required on this issue.