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Urologia Internationalis 2015We conducted a meta-analysis to quantitatively evaluate the correlation between alcohol consumption and the risk of urolithiasis by summarizing the results of published... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We conducted a meta-analysis to quantitatively evaluate the correlation between alcohol consumption and the risk of urolithiasis by summarizing the results of published case-control and cohort studies and the potential dose-response association.
METHODS
A systematic literature search of articles up to February 2014 was conducted via PubMed, Web of Science, Cochrane Library, Scopus, EMBASE, the Chinese National Knowledge Infrastructure databases, and the references of the retrieved articles. Fixed- or random-effect models were used to summarize the estimates of odds ratio (OR) with 95% confidence interval (95% CI) for the highest versus the lowest consumption of alcohol. A dose-response meta-analysis was also conducted.
RESULTS
The pooled OR estimates indicated that alcohol consumption was associated with a decreased risk of urolithiasis (OR=0.683, 95% CI 0.577-0.808). In addition, the dose-response meta-analysis indicated that the rate of urolithiasis decreased by 10% for a 10 g/day increase in alcohol intake (OR=0.898, 95% CI 0.851-0.948). No evidence of publication bias was found by Begg's or Egger's test (p=0.130, p=0.130, respectively).
CONCLUSION
Our meta-analysis indicated that alcohol intake is associated with a decreased risk of urolithiasis.
Topics: Alcohol Drinking; Dose-Response Relationship, Drug; Ethanol; Female; Humans; Male; Odds Ratio; Protective Factors; Risk Assessment; Risk Factors; Urolithiasis
PubMed: 25033956
DOI: 10.1159/000365358 -
Global Spine Journal Sep 2023Literature review and meta-analysis.
STUDY DESIGN
Literature review and meta-analysis.
OBJECTIVES
Single-center series may be underpowered to detect whether high-dose (HD) tranexamic acid (TXA) confers a higher risk of complications. We sought to determine the safety and efficacy of HD TXA as compared to low-dose (LD) or placebo.
METHODS
A systematic literature review was performed to find studies where spine surgery patients were given HD TXA (loading dose ≥30 mg/kg). Complication rates were pooled, and meta-analyses performed on outcomes of interest. Articles were evaluated for risk of bias and a strength of evidence assessment was given for each conclusion.
RESULTS
Twenty three studies (n = 2331) were included. The pooled medical complication rate was 3.2% in pediatric patients, 8.2% in adults. Using lower dose TXA or placebo as the reference, meta-analysis showed no difference in medical complications (n = 1,723, OR 1.22 [95% CI, .78 to 1.22]; = .388; I = 0%) or thrombotic events (n = 1158 patients, OR 1.27 [95% CI, .71 to 2.63]; = .528; I = 0%). Compared to LD, HD TXA was associated with less intraoperative blood loss (823 patients, WMD = -285 [95% CI, -564 to -5.90]; = .0454; I = 86%), fewer perioperative transfusions (n = 505, OR .28 [95% CI, .082 to .96]; = .043; I = 76%) and lower perioperative transfusion volumes (n = 434, WMD -227.7 mL [95% CI, -377.3 to -78.02]; = .0029; I = 0%).
CONCLUSION
Compared to LD TXA or placebo, there is moderate evidence that HD is not associated with an increased risk of medical complications. Compared to LD, there is moderate evidence that HD reduces transfusion requirements. High-Dose TXA can be safely utilized in healthy patients undergoing major spine surgery.
PubMed: 36592635
DOI: 10.1177/21925682221148686 -
Reproductive Biomedicine Online Apr 2017In this systematic review and meta-analysis, the effectiveness and safety among different dosage of methotrexate protocols for the treatment of unruptured tubal ectopic... (Comparative Study)
Comparative Study Meta-Analysis Review
In this systematic review and meta-analysis, the effectiveness and safety among different dosage of methotrexate protocols for the treatment of unruptured tubal ectopic pregnancy was evaluated. Six studies of randomized contorlled trials were identified through searches conducted on PubMed, Embase and Cochrane Library between January 1974 and March 2016. The overall success rate of multiple-dose protocol was similar to the single-dose protocol (RR 1.07, 95% CI 0.99 to 1.17, I = 0%). The difference between double-dose and single-dose groups was not significant (RR 1.09, 95% CI 0.98 and 1.20, I = 0%). The incidence of side-effects of double-dose regimen was similar with single-dose regimen. Side-effects, however, are more common in multiple-dose regimen (RR 1.64, 95% CI 1.15 to 2.34, P = 0.006, I = 0%). This meta-analysis indicated that the incidence of side-effects of multiple-dose protocol was significantly higher than single-dose protocol, and the success rates between them were similar. The double-dose regimen was an efficient and safe alternative to the single-dose protocol. Further high-quality researches are needed to confirm our findings and to develop the optimal protocol.
Topics: Abortifacient Agents, Nonsteroidal; Clinical Protocols; Female; Humans; Methotrexate; Pregnancy; Pregnancy, Ectopic; Time Factors; Treatment Outcome
PubMed: 28131495
DOI: 10.1016/j.rbmo.2017.01.004 -
Therapeutic Advances in Medical Oncology 2023FOLFIRINOX, used in metastatic pancreatic cancer (MPC), is highly efficacious but also toxic. Various dose modifications for FOLFIRINOX have been introduced to reduce... (Review)
Review
BACKGROUND
FOLFIRINOX, used in metastatic pancreatic cancer (MPC), is highly efficacious but also toxic. Various dose modifications for FOLFIRINOX have been introduced to reduce toxicity. However, these studies lack a unified pattern for 'planned' dose modification, and the 'actually administered' dose varied more.
OBJECTIVE
To map a 10-year trend for 'planned' and 'actual' doses of FOLFIRINOX and investigate the clinical outcomes according to dose modification.
DATA SOURCES AND METHODS
A comprehensive systematic literature search was conducted from January 2011 to September 2021. All studies for FOLFIRINOX as first-line treatment in MPC were considered. Selected studies were firstly classified according to prospective retrospective research, secondly standard modified FOLFIRINOX, and thirdly 'planned' 'actual' dose. For evidence-mapping for the trend of dose modification, we developed a web-based interactive bubble-plot program (www.RDI-map.com). Objective response rate (ORR) and hematologic toxicity were set as endpoints for the comparison of clinical outcomes according to dose modification.
RESULTS
A total of 37 studies were identified for evidence-mapping (11 prospective and 26 retrospective studies). There were 12 different types of 'planned' dose modification in FOLFIRINOX ranging 75-100% oxaliplatin, 75-100% irinotecan, 0-100% 5-fluorouracil (5-FU) bolus, and 75-133% 5-FU continuous injection. The 'actual' dose further decreased to 54-96%, 61-88%, 0-92%, and 63-98%, respectively. For the standard modified FOLFIRINOX, the ORR was 28.2% (95% CI: 22.5-33.9%) and 33.8% (95% CI: 30.3-37.3%), respectively ( = 0.100), and the incidence of febrile neutropenia was 11.6% (95% CI: 0-16.0%) and 5.5% (95% CI: 0-8.9%), respectively ( = 0.030).
CONCLUSIONS
RDI-map.com enables multifactorial evidence-mapping for practical FOLFIRINOX dose reduction. The pattern of dose modification was not consistent across studies, and there was a significant gap between the 'planned' and 'actual' doses. Modified FOLFIRINOX showed similar efficacy to the standard regimen with reduced incidence of febrile neutropenia.
PubMed: 37441327
DOI: 10.1177/17588359231175441 -
International Journal of Gynaecology... Jun 2018It remains unclear which methotrexate protocol for the treatment of ectopic pregnancy has a higher success rate or a higher adverse effect rate. (Meta-Analysis)
Meta-Analysis
BACKGROUND
It remains unclear which methotrexate protocol for the treatment of ectopic pregnancy has a higher success rate or a higher adverse effect rate.
OBJECTIVE
To compare the treatment success rates and adverse effect rates of single-dose and non-single-dose (two-dose and multi-dose) methotrexate protocols in the treatment of ectopic pregnancy.
SEARCH STRATEGY
Various databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched on July 1, 2017, using search terms including "methotrexate" and "pregnancy."
SELECTION CRITERIA
Randomized controlled trials comparing different methotrexate protocols for the treatment of ectopic pregnancy were included.
DATA COLLECTION AND ANALYSIS
Relative risks (RRs) and 95% confidence intervals (CIs) were calculated to compare treatment success rates and adverse effect rates.
MAIN RESULTS
The single-dose and non-single-dose protocols had similar success rates (RR 1.00, 95% CI 0.96-1.04; 11 trials, 1121 patients, I =18%). The non-single-dose protocols had a higher adverse effect rate than did the single-dose protocol (RR 0.73, 95% CI 0.59-0.91; nine trials, 934 patients, I =0%).
CONCLUSIONS
The single-dose methotrexate protocol was the optimal protocol for the medical treatment of ectopic pregnancy.
Topics: Female; Humans; Pregnancy; Methotrexate; Pregnancy, Ectopic; Randomized Controlled Trials as Topic; Clinical Protocols
PubMed: 29485731
DOI: 10.1002/ijgo.12473 -
Strahlentherapie Und Onkologie : Organ... Feb 2024High-dose-rate brachytherapy (HDR-BT) plays an important role in the treatment of locally recurrent prostate cancer after definitive treatment. The objective of this... (Review)
Review
BACKGROUND
High-dose-rate brachytherapy (HDR-BT) plays an important role in the treatment of locally recurrent prostate cancer after definitive treatment. The objective of this study is to summarize the efficacy and toxicity of HDR-BT in these patients.
METHODS
We performed a systematic review of PubMed and EMBASE from inception to July 2023. The primary endpoint was relapse-free survival (RFS) in different subgroups, and the secondary endpoint was gastrointestinal (GI) and genitourinary (GU) toxicity. A semi-automated tool (WebPlotDigitizer) and a new Shiny application combined with R software (R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; https://www.R-project.org/ ) helped to reconstruct survival curves.
RESULTS
Twenty-six studies met the inclusion criteria for quantitative analysis, including 1447 patients. A total of 761 patients from 13 studies were included in survival reconstruction, and the median RFS time was 61.2 months (57.6-72.0 months). The estimated 2‑, 3‑, and 5‑year rates were 75.9% (95% confidence interval [CI] 72.8 ~ 79.2%), 66.7% (95% CI 63.0 ~ 70.5%), and 52.3% (95% CI 47.5 ~ 57.4%), respectively. Whole-gland irradiation with multiple fractions (≥ 2 F) resulted in better RFS compared with focal gland irradiation with fewer fractions (1 F mostly; hazard ratio [HR]: 0.60, 95% CI 0.47-0.77, p < 0.0001). According to the different median time from primary treatment to salvage therapy (TRS) and median age at recurrence, short median TRS (56-67.2 months vs. 70-120 months; HR 0.52, 95% CI 0.68-0.40; p < 0.0001) and younger median age (60-70 years vs. 71-75 years; HR 0.58, 95% CI 0.46-0.74; p < 0.0001) were positive factors for RFS. The cumulative incidences estimated for grade ≥ 3 acute and late GU toxicities were 1% (95% CI 0 ~ 1%) and 5% (95% CI 4 ~ 7%), respectively. Three patients (3/992) experienced grade ≥ 3 late GI toxicity, and no cases of grade ≥ 3 acute GI toxicity were reported.
CONCLUSION
HDR-BT has a high safety profile and good RFS benefit for salvage treatment of radiorecurrent prostate cancer. In terms of RFS, whole-gland irradiation with multiple fractions seems to be better than focal gland irradiation with fewer fractions, while short TRS and younger age are good prognostic factors. In view of the low level of evidence in the included studies and the large heterogeneity of each study, these conclusions still need to be confirmed by randomized controlled trials.
PubMed: 38386054
DOI: 10.1007/s00066-024-02205-x -
The Journal of Evidence-based Dental... Jun 2021To comprehensively evaluate implant survival, clinical and biochemical parameters, as well as possible dose-response relationship with hemoglobin A1c (HbA1c) in patients... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To comprehensively evaluate implant survival, clinical and biochemical parameters, as well as possible dose-response relationship with hemoglobin A1c (HbA1c) in patients with differing diabetic control.
METHODOLOGY
Five electronic databases were searched for studies that compared implant outcomes in patients with differing HbA1c values. Research quality was evaluated using Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Narrative synthesis and meta-analysis were performed for survival rate, plaque index (PI), bleeding on probing (BOP), probing pocket depth, and marginal bone loss (MBL). Categorical dose-response meta-analysis (DRMA) was conducted according to length of follow-up.
RESULTS
Twenty-two studies met the inclusion criteria. Prospective studies were mostly of moderate quality, but non-prospective papers had serious to critical risk of bias. Survival rate was high for the first 3 years (92.6%-100%) for patients with HbA1c less than 8%. Meta-analysis revealed worsening clinical parameters with increasing HbA1c. DRMA further established a significant dose-response relationship between glycemic control with BOP (10% more bleeding, 95% CI 0.05-0.16, P = .008) and MBL (0.05 mm more bone loss, 95% CI 0.01-0.09, P = .002) per HbA1c category, but no association with probing pocket depth. Osseointegration progressed at a slower rate, and inflammatory cytokines and bone biomarkers were adversely affected in patients with HbA1c above 8%.
CONCLUSION
Moderate evidence suggests a high short-term survival but possible dose-response trend of worsening BOP and MBL in association with glycemic control. Clinically, HbA1c values must be considered for risk assessment before placement and throughout the lifespan of the implant placed in a patient with diabetes.
Topics: Alveolar Bone Loss; Dental Implants; Diabetes Mellitus, Type 2; Glycemic Control; Humans; Periodontal Index; Prospective Studies
PubMed: 34391557
DOI: 10.1016/j.jebdp.2021.101543 -
Clinical Epidemiology 2017The aim was to investigate whether coffee or caffeine consumption is associated with reproductive endpoints among women with natural fertility (ie, time to pregnancy... (Review)
Review
OBJECTIVE
The aim was to investigate whether coffee or caffeine consumption is associated with reproductive endpoints among women with natural fertility (ie, time to pregnancy [TTP] and spontaneous abortion [SAB]) and among women in fertility treatment (ie, clinical pregnancy rate or live birth rate).
DESIGN
This study was a systematic review and dose-response meta-analysis including data from case-control and cohort studies.
METHODS
An extensive literature search was conducted in MEDLINE and Embase, with no time and language restrictions. Also, reference lists were searched manually. Two independent reviewers assessed the manuscript quality using the Newcastle-Ottawa Scale (NOS). A two-stage dose-response meta-analysis was applied to assess a potential association between coffee/caffeine consumption and the outcomes: TTP, SAB, clinical pregnancy, and live birth. Heterogeneity between studies was assessed using Cochrane -test and statistics. Publication bias was assessed using Egger's regression test.
RESULTS
The pooled results showed that coffee/caffeine consumption is associated with a significantly increased risk of SAB for 300 mg caffeine/day (relative risk [RR]: 1.37, 95% confidence interval [95% CI]: 1.19; 1.57) and for 600 mg caffeine/day (RR: 2.32, 95% CI: 1.62; 3.31). No association was found between coffee/caffeine consumption and outcomes of fertility treatment (based on two studies). No clear association was found between exposure to coffee/caffeine and natural fertility as measured by fecundability odds ratio (based on three studies) or waiting TTP (based on two studies).
CONCLUSION
Results from this meta-analysis support the growing evidence of an association between coffee/caffeine intake and the risk of SAB. However, viewing the reproductive capacity in a broader perspective, there seems to be little, if any, association between coffee/caffeine consumption and fecundity. In general, results from this study are supportive of a precautionary principle advised by health organizations such as European Food Safety Authority (EFSA) and World Health Organization (WHO), although the advised limit of a maximum of two to three cups of coffee/200-300 mg caffeine per day may be too high.
PubMed: 29276412
DOI: 10.2147/CLEP.S146496 -
SAGE Open Medicine 2023There is a high prevalence of inadequate dose adjustment among inpatients with renal insufficiency worldwide. There is, however, a paucity of studies that summarizes the... (Review)
Review
OBJECTIVE
There is a high prevalence of inadequate dose adjustment among inpatients with renal insufficiency worldwide. There is, however, a paucity of studies that summarizes the topic in the African context. Therefore, this study aims to summarize the prevalence of inappropriate drug dose adjustment (IDDA) and associated factors among inpatients with renal impairment in Africa.
METHODS
A literature search for English-language articles was conducted using reputable databases such as PubMed/MEDLINE, Google Scholar, and Science Direct. The search was carried out between 3 February and 3 March of 2022. All published articles that were online at the time of data collection were considered. Observational studies that examined the prevalence of IDDA for any type of drug in renal impairment as a primary or secondary outcome were included in our analysis. Statistical software such as Open Meta Analyst and Review Manager were used to examine outcome measures. I statistics, Logit event rate, and Der Simonian and Laird's random effect models were also used.
RESULTS
Seven articles were qualified for the systematic review and meta-analysis. All included studies comprised a total of 1918 patients. A total of 5072 prescriptions were assessed, and 1879 (37%) of them had at least one drug that required a dose adjustment. The pooled prevalence of IDDA among adult patients with renal impairment was 13.7% (95% confidence interval (CI) = 7.9%-19.5%) in Africa. Based on the number of prescriptions containing medications that required dose adjustment, the pooled prevalence accounts for 39.3% (95% CI = 24.1%-54.4%) (932/1879). Factors associated with inappropriate drug prescribing and usage concerning renal function were the number/types of prescribed medicines (most common), age, stage of renal impairment, comorbidity, and unemployment.
CONCLUSIONS
In this study, IDDA practice appears to be a common challenge among inpatients with renal insufficiency in Africa. The number and type of medications prescribed, age, stage of renal impairment, comorbidity, and unemployment were factors associated with inappropriate drug prescribing and use. In addition to expanding such studies, hospitals across Africa must conduct research on the clinical outcomes of IDDA practices in patients with renal impairment.
PubMed: 36741935
DOI: 10.1177/20503121221150104 -
Heliyon Sep 2023As a nutritious food, Tart cherries ( L) benefit cardiovascular health. This study aims to clarify the effectiveness of Tart cherry in controlling blood pressure, heart... (Review)
Review
Dose-dependent effect of tart cherry on blood pressure and selected inflammation biomarkers: A GRADE-assessed systematic review and meta-analysis of randomized controlled trials.
OBJECTIVES
As a nutritious food, Tart cherries ( L) benefit cardiovascular health. This study aims to clarify the effectiveness of Tart cherry in controlling blood pressure, heart rate, and inflammatory biomarkers, the appropriate dosage for this effect, and suggest directions for future studies.
METHODS
PubMed, Scopus, and Web of Science were searched (up to May 2022), to identify eligible randomized controlled trials. It measured publication bias and was assessed for all outcomes. Evidence quality was evaluated using the Cochrane risk of bias tool and GRADE (Grades of Recommendations, Assessment, Development, and Evaluations)
RESULTS
Regarding the 21 included trials, Tart cherry didn't affect blood pressure, heart rate, high-sensitive C-reactive protein, and interleukin-6 (P > 0.05). In contrast, with moderate certainty, it can reduce serum C-reactive protein (WMD: - 0.39 mg/l; 95% CI: - 0.74, - 0.05; P = 0.024) and with very low certainty can decrease tumor necrosis factor-alpha (WMD: - 0.14 pg/ml; 95% CI: - 0.27, - 0.02; P = 0.026). In addition, dose-response analysis implies that with each 30 ml elevation in dose, CRP reduces by 0.19 mg/l (95% CI: - 0.37, - 0.01).
CONCLUSIONS
Tart cherry can control inflammation by administering the proper dose. Even though tart cherry generally doesn't affect blood pressure and heart rate, further high-quality studies are needed to determine its effect.
PubMed: 37809623
DOI: 10.1016/j.heliyon.2023.e19987