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Cerebral hemorrhage after thrombolysis in stroke patients with unruptured intracranial aneurysms: a systemic review and meta-analysis
Wen D, Chen Y, Zhu W, Peng Z, Ma L
Journal of neurology. 2022
Abstract
BACKGROUND For ischemic stroke patients with concomitant unruptured aneurysm, intravenous thrombolysis therapy (IVT) remains a disputable decision. We hence performed a meta-analysis to identify the related brain hemorrhage rate of unruptured aneurysms and the risk ratio for their rupture comparing to stroke patients who do not have aneurysms. METHODS A comprehensive search was conducted to identify the studies from the online database from 2000 to September 1st, 2022. Cohort studies were included and assessed by Newcastle-Ottawa Scale (NOS) for quality. The research procedures were subjected to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fixed-effects model was used based on the heterogeneity tests. RESULTS In 10 eligible studies, 7238 ischemic stroke patients were screened, a total of 302 patients with 348 aneurysms were included. 10 studies were eligible for ICH rate analysis, 8 for SAH rate analysis and 7 for risk ratio of stroke patients with unruptured aneurysms. The pooled any ICH rate was 16% (95% CI 11-21%), symptomatic ICH rate was 4% (95% CI 1-7%, I(2) = 0.00%, p = 0.90), and 0% (95% CI 0-1%) for aneurysm-related ICH. Subarachnoid hemorrhage was as low as 2% (95% CI 0-5%), while 0% (95% CI 0-2%) directly related to the aneurysm rupture. The risk ratio of ICH in stroke patients with aneurysms was 1.18 (95% CI 0.79-1.77). Additionally, the hemorrhage rate difference was not evident between saccular and fusiform aneurysms due to a lack of details. CONCLUSIONS IVT is unlikely to induce hemorrhage of pre-existing unruptured aneurysms in stroke patients. Further randomized control studies are warranted to validate these conclusions.
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2.
Antiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin usage in 1142 patients with coronavirus disease 2019: a systematic review and meta-analysis
Pei L, Zhang S, Huang L, Geng X, Ma L, Jiang W, Li W, Chen D
Pol Arch Intern Med. 2020
Abstract
INTRODUCTION Treatment effects of antiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin are controversial in patients with Coronavirus disease 2019 (COVID-19). OBJECTIVES To evaluate the impact of drug therapy on the risk of death in patients with COVID-19. PATIENTS AND METHODS The PubMed, EMBASE, Web of Science, Cochrane Library, and major preprint platforms were searched to retrieve articles till 7 April 2020. The effects of specific drug interventions on mortality were assessed in COVID-19 patients. Odds ratios (ORs) and Risk Ratios (RRs) with corresponding 95% confidence intervals (CIs) were pooled using random-effects models. RESULTS Of 3421 references, six studies were included. Pooled results from retrospective studies revealed that antiviral agents may contribute to survival benefit (OR, 0.42, 95% CI, 0.17-0.99, p=0.048, I2=82.8%), while the RCT found no effects of antiviral agent on mortality (RR 0.77, 95% CI, 0.45-1.30, p=0.33). Glucocorticoids usage leads to an increased risk of death (OR 2.43, 95% CI, 1.44-4.10, p=0.001, I2=61.9%). Antibiotics intervention did not significantly affect mortality (OR 1.13, 95% CI, 0.67-1.89, p=0.64, I2=0%). Likewise, intravenous immunoglobulin had non-significant effects on mortality (OR 2.66, 95% CI, 0.72-9.89, p=0.14, I2=93.1%). CONCLUSIONS With the varied heterogeneities across interventions, the current evidence indicated a probable survival benefit of antiviral agent usage and a harmful effect of glucocorticoids in patients with COVID-19. None of antibiotics or intravenous immunoglobulin usage was associated with survival benefit in patients with COVID-19.
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3.
Nonsurgical Secondary Prophylaxis of Esophageal Variceal Bleeding in Cirrhotic Patients: A Systematic Review and Network Meta-analysis
Jing L, Zhang Q, Chang Z, Liu H, Shi X, Li X, Wang J, Mo Y, Zhang X, Ma L, et al
Journal of clinical gastroenterology. 2020
Abstract
INTRODUCTION The aim of this study was to evaluate the effectiveness of nonsurgical secondary prophylaxis interventions for esophageal varices (EV) rebleeding in cirrhotic patients using network meta-analysis. MATERIALS AND METHODS Secondary prophylaxis of EV rebleeding in cirrhosis is searched on PubMed, Embase, and the Cochrane Library databases. The quality of literatures was extracted by 2 independent investigators according to the requirements of Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.0. Meta-analysis was performed on Review Manager 5.3 software for the incidence of cirrhosis EV rebleeding, rebleeding-related mortality, and overall mortality; and STATA 15.1 software was used for network meta-analysis. RESULTS In all, 57 randomized controlled trials were reviewed. Endoscopic band ligation (EBL)+argon plasma coagulation has not been recommended by guidelines, and it is rarely used; the number of existing studies and the sample size are small. Considering poor stability of the combined results, these studies were excluded; 55 literatures were included. In terms of reducing the incidence of rebleeding, transjugular intrahepatic portosystemic shunt (TIPS) surface under the cumulative ranking curve (SUCRA) (94.3%) was superior to EBL+endoscopic injection sclerotherapy (EIS) (84.4%), EIS+β-blockers (77.9%), EBL (59.8%), EBL+β-blockers+isosorbide-5-mononitrate (52.7%), EBL+β-blockers (51.4%), EIS (34.2%), β-blockers+isosorbide-5-mononitrate (23.7%), β-blockers (20.8%), and placebo (0.8%). In reducing rebleeding-related mortality, TIPS SUCRA (87.2%) was more efficacious than EBL+EIS (83.5%), EIS (47.9%), EBL+β-blockers (47.4%), β-blockers (41.8%), EBL (34.5%), and placebo (7.6%). In reducing overall mortality, TIPS SUCRA (81.1%) was superior to EBL+EIS (68.9%), EIS+β-blockers (59.2%), EBL+β-blockers (55.4%), EIS (48.8%), EBL (48.7%), β-blockers (34.2%), placebo (3.6%). CONCLUSIONS TIPS was more effective in reducing the incidence of cirrhosis EV rebleeding, rebleeding-related mortality, and overall mortality in cirrhosis. Combined with the above results, TIPS is more likely to be recommended as a secondary prophylaxis intervention for EV in cirrhosis.
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4.
The impact of ABO blood group on COVID-19 infection risk and mortality: A systematic review and meta-analysis
Liu N, Zhang T, Ma L, Zhang H, Wang H, Wei W, Pei H, Li H
Blood Reviews. 2020;:100785
Abstract
The 2019 coronavirus disease (COVID-19) has become a global pandemic. Several studies report that ABO blood group polymorphism may be related to COVID-19 susceptibility and clinical outcomes; however, the results are controversial. We conducted a systematic review and meta-analysis to investigate whether ABO blood groups are associated with increased COVID-19 morbidity and mortality. A total of 715 articles were retrieved from seven databases. Ten articles were selected for meta-analysis after removal of duplicates and two levels of screenings. Overall, individuals with blood group A [odds ratio (OR) = 1.33, 95% confidence interval (CI) 1.14 to 1.56] and B (OR = 1.06, 95% CI 1.00 to 1.13) had a substantially higher risk of COVID-19, whereas this was not the case for blood group AB (OR = 1.07, 95% CI 0.88 to 1.30). Individuals with blood group O was not prone to develop the disease (OR = 0.71, 95% CI 0.60 to 0.84). Moreover, the risk of COVID-19 was significantly associated with the Rh-positive blood group (OR = 1.22, 95% CI 0.99 to 1.50). A meta-analysis of 5 studies suggested that blood group A was associated with a significantly increased risk of COVID-19 mortality (OR = 1.25, 95% CI 1.02 to 1.52). Mild publication bias was found in the included studies. This systematic review and meta-analysis indicated that blood groups A and B may be risk factors for COVID-19, whereas the blood group O appears to be protective. Blood group A may be related to unfavourable outcomes. Further rigorous and high-quality research evidence is needed to confirm this association.
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5.
The accuracy of aneurysm size in predicting rebleeding after subarachnoid hemorrhage: a meta-analysis
Yu Z, Zheng J, Guo R, Li M, Li H, Ma L, You C
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2020
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is a severe cerebrovascular disease. Rebleeding is an independent predictor of unfavorable outcome after aneurysmal SAH. However, the accuracy of aneurysm size for predicting rebleeding after aneurysmal SAH is still unclear. Hence, we conducted this meta-analysis to evaluate the predictive accuracy of large aneurysm for rebleeding after SAH. METHODS We performed a literature search in PubMed and Embase. Original studies about aneurysm size and rebleeding after SAH were included. Two reviewers completed data extraction and quality assessment. Pooled sensitivity, specificity, and their 95% confidence intervals (CIs) of large aneurysm for predicting rebleeding were calculated and shown in a forest plot. The overall accuracy of large aneurysm for predicting rebleeding after SAH was shown using a summary receiver operating characteristic (SROC) curve. Publication bias were assessed using Deeks' funnel plot. RESULTS A total of ten studies with 3889 patients met eligibility criteria and were included in this meta-analysis. The pooled sensitivity and specificity of large aneurysm for predicting rebleeding were 0.39 (95% CI 0.25-0.56) and 0.75 (95% CI 0.67-0.82), respectively. The area under SROC curve was 0.67 (95% CI 0.62-0.71). Deeks' funnel plot did not show obvious publication bias among included studies in this meta-analysis. CONCLUSION The specificity of large aneurysm for predicting rebleeding after SAH is relatively high. However, its overall accuracy for predicting aneurysm rebleeding is not very satisfying. A comprehensive model should be developed to improve the accuracy of rebleeding prediction after SAH.
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6.
Accuracy of HAS-BLED and other bleeding risk assessment tools in predicting major bleeding events in atrial fibrillation: a network meta-analysis
Chang G, Xie Q, Ma L, Hu K, Zhang Z, Mu G, Cui Y
Journal of thrombosis and haemostasis : JTH. 2019
Abstract
BACKGROUND Preventing thrombosis is an important part of atrial fibrillation (AF) treatment. However, it may increase the risk of bleeding, and bleeding risk assessment tools' predictive value remains unclear. This network meta-analysis investigated the sensitivity and specificity of HAS-BLED, and other bleeding risk assessment tools, to predicting major bleeding events in AF patients. METHODS The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched using keywords, including "AF," "bleeding," and "HAS-BLED," for results published through 30 Nov 2018. The predictive sensitivity and specificity of each bleeding risk assessment tool was analyzed by network meta-analysis. RESULTS Our analysis included 18 studies, recruiting a total of 321,888 people. The bleeding risk assessment tools analyzed in this study included the ABC-bleeding score, ATRIA, European score, GARFIELD-AF, HAS-BLED, HEMORR2HAGES, ORBIT, Shireman, and mOBRI. A comprehensive analysis of sensitivity and specificity, based on an inconsistency model, showed that European score, ABC and mOBRI have relatively high sensitivity but low specificity, whereas HAS-BLED and HEMORR2HAGES have balanced sensitivity and specificity. ORBIT, ATRIA, Shireman, and GARFIELD-AF had relatively high specificity but low sensitivity. A consistency model analysis showed similar results. CONCLUSIONS HAS-BLED is a balanced bleeding risk assessment tool in terms of sensitivity and specificity, whereas the European score, ABC, and mOBRI are high sensitivity tools and ORBIT, ATRIA, Shireman, and GARFIELD-AF are high specificity tools.
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7.
Intravenous immunoglobulin therapy in adult patients with polymyositis/dermatomyositis: a systematic literature review
Wang DX, Shu XM, Tian XL, Chen F, Zu N, Ma L, Wang GC
Clinical Rheumatology. 2012;31((5):):801-6.
Abstract
The objectives of this study are to review and summarize published information on the use, effectiveness, and adverse effects of intravenous immunoglobulin (IVIG) in patients with polymyositis (PM) or dermatomyositis (DM) and to search MEDLINE and CNKI (Chinese) databases from 1985 to 2011 to retrieve clinical research articles concerning IVIG in adult patients with PM/DM. Of the 14 articles selected, two were randomized controlled trials, nine prospective open studies, and three retrospective studies with a total of 308 adult patients. IVIG has been used successfully in the treatment of PM/DM. The standard dose is 2 g/kg, given in two to five individual daily doses. The course of IVIG treatment is usually 3~6 months. IVIG therapy seemed rarely employed as first-line therapy in PM/DM. In a double-blind study conducted in patients with refractory DM, IVIG combined with corticosteroid significantly improved muscle strength and decreased serum creatine kinase level, compared with placebo. The beneficial effect of IVIG in refractory, flare-up, rapidly progressive, or severe PM/DM has been documented in many open-label trials. IVIG was shown to be effective in most of PM/DM patients with lung involvement and esophageal involvement. In some patients, IVIG can lower the corticosteroid dose required for maintenance, demonstrating the most effective steroid-sparing effect. Adverse effects were generally tolerable. IVIG is effective in the treatment of adult patients with PM/DM and appears to be relatively well tolerated and safe. IVIG may be a good choice especially in patients with refractory, flare-up, rapidly progressive, or severe PM/DM, and can be tried in patients with a contraindication for corticosteroid.