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Strahlentherapie Und Onkologie : Organ... Jun 2023Although single-fraction high-dose-rate brachytherapy (SFHDR) for localized prostate cancer has been tried in clinical trials, relevant medical evidence is currently... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Although single-fraction high-dose-rate brachytherapy (SFHDR) for localized prostate cancer has been tried in clinical trials, relevant medical evidence is currently lacking. It is necessary to systematically analyze the safety and efficacy of SFHDR.
METHODS
Comprehensive and systematic searches for eligible studies were performed in PubMed, Embase, and the Cochrane Library databases. The primary endpoints included safety and efficacy, represented by toxic effects and biochemical recurrence-free survival (bRFS), respectively. The proportion rates were used as the effect measure for each study and were presented with corresponding 95% confidence intervals (CI) and related 95% prediction interval (PI). Restricted maximum-likelihood estimator (REML) and the Hartung-Knapp method were used in the meta-analysis.
RESULTS
Twenty-five studies met the inclusion criteria for quantitative analysis, including 1440 patients. The median age of patients was 66.9 years old (62-73 years old) and the median follow-up was 47.5 months (12-75 months). The estimates of cumulative occurrence for severe gastrointestinal (GI) and genitourinary (GU) toxic effects were 0.1% (95% CI 0-0.2%) and 0.4% (95% CI 0-1.2%), and for grade 2 toxic effects were 1.6% (95% CI 0.1-4.7%) and 17.1% (95% CI 5.4-33.5%), respectively. The estimate of 3‑year bRFS was 87.5% (95% CI 84.4-90.3%) and 71.0% (95% CI 63.0-78.3%) for 5‑year bRFS. The pooled bRFS rates for low-risk patients were 99.0% (95% CI 85.2-100.0%) at 3 years and 80.9% (95% CI 75.4-85.9%) at 5 years, and the risk group was found to be statistically correlated with bRFS (3-year bRFS, P < 0.01; 5‑year bRFS, P = 0.04).
CONCLUSION
SFHDR is associated with favorable tolerability and suboptimal clinical benefit in patients with localized prostate cancer. Ongoing and planned high-quality prospective studies are necessary to verify its safety and efficacy.
Topics: Male; Humans; Aged; Middle Aged; Brachytherapy; Prospective Studies; Prostatic Neoplasms; Urogenital System; Risk Factors
PubMed: 37093230
DOI: 10.1007/s00066-023-02063-z -
Nutrition, Metabolism, and... Jun 2015High resting heart rate has been associated with increased risk of type 2 diabetes in several studies, but the available data are not consistent and it is unclear if... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
High resting heart rate has been associated with increased risk of type 2 diabetes in several studies, but the available data are not consistent and it is unclear if there is a dose-response relationship between resting heart rate and type 2 diabetes risk. We aimed to clarify this association by conducting a systematic review and meta-analysis of published studies.
METHODS AND RESULTS
PubMed, Embase and Ovid Medline databases were searched for prospective studies published up until October 11th, 2013. Summary relative risks were estimated using a random effects model. Ten cohort studies with >5628 cases and 119,915 participants were included. The summary RR for high vs. low resting heart rate was 1.83 (95% CI: 1.28-2.60, I(2) = 88%, n = 7), and in the dose-response analysis the summary RR was 1.20 (95% CI: 1.07-1.34, I(2) = 93%, n = 9) for an increase of 10 beats per minute. The heterogeneity was to a large degree explained by two studies. There was evidence of nonlinear associations between resting heart rate (pnonlinearity < 0.0001) and risk of type 2 diabetes.
CONCLUSION
The current meta-analysis indicates a strong positive association between high resting heart rate and the risk of type 2 diabetes. As a non-invasive marker of type 2 diabetes risk, resting heart rate may have potential in the clinical setting, especially for interventions aimed at lowering the risk of type 2 diabetes. Additional studies are needed to clarify the mechanisms that may be responsible for the assoiation between resting heart rate and type 2 diabetes.
Topics: Diabetes Mellitus, Type 2; Heart Rate; Humans; Nonlinear Dynamics; Predictive Value of Tests; Prognosis; Rest; Risk Assessment; Risk Factors
PubMed: 25891962
DOI: 10.1016/j.numecd.2015.02.008 -
Cancers Aug 2022Variations in dose prescription methods in stereotactic body radiotherapy (SBRT) for early stage non-small-cell lung cancer (ES-NSCLC) make it difficult to properly... (Review)
Review
Relationship between Dose Prescription Methods and Local Control Rate in Stereotactic Body Radiotherapy for Early Stage Non-Small-Cell Lung Cancer: Systematic Review and Meta-Analysis.
Variations in dose prescription methods in stereotactic body radiotherapy (SBRT) for early stage non-small-cell lung cancer (ES-NSCLC) make it difficult to properly compare the outcomes of published studies. We conducted a comprehensive search of the published literature to summarize the outcomes by discerning the relationship between local control (LC) and dose prescription sites. We systematically searched PubMed to identify observational studies reporting LC after SBRT for peripheral ES-NSCLC. The correlations between LC and four types of biologically effective doses (BED) were evaluated, which were calculated from nominal, central, and peripheral prescription points and, from those, the average BED. To evaluate information on SBRT for peripheral ES-NSCLC, 188 studies were analyzed. The number of relevant articles increased over time. The use of an inhomogeneity correction was mentioned in less than half of the articles, even among the most recent. To evaluate the relationship between the four BEDs and LC, 33 studies were analyzed. Univariate meta-regression revealed that only the central BED significantly correlated with the 3-year LC of SBRT for ES-NSCLC ( = 0.03). As a limitation, tumor volume, which might affect the results of this study, could not be considered due to a lack of data. In conclusion, the central dose prescription is appropriate for evaluating the correlation between the dose and LC of SBRT for ES-NSCLC. The standardization of SBRT dose prescriptions is desirable.
PubMed: 35954478
DOI: 10.3390/cancers14153815 -
Nutrients Mar 2023Previous cohort studies have reported conflicting associations between alcohol consumption and chronic kidney disease, characterized by proteinuria and low glomerular... (Meta-Analysis)
Meta-Analysis Review
A Dose-Dependent Association between Alcohol Consumption and Incidence of Proteinuria and Low Glomerular Filtration Rate: A Systematic Review and Meta-Analysis of Cohort Studies.
Previous cohort studies have reported conflicting associations between alcohol consumption and chronic kidney disease, characterized by proteinuria and low glomerular filtration rate (GFR). This systematic review, which included 14,634,940 participants from 11 cohort studies, assessed a dose-dependent association of alcohol consumption and incidence of proteinuria and low estimated GFR (eGFR) of <60 mL/min/1.73 m. Compared with non-drinkers, the incidence of proteinuria was lower in drinkers with alcohol consumption of ≤12.0 g/day (relative risk 0.87 [95% confidence interval 0.83, 0.92]), but higher in drinkers with alcohol consumption of 36.1-60.0 g/day (1.09 [1.03, 1.15]), suggesting a J-shaped association between alcohol consumption and the incidence of proteinuria. Incidence of low eGFR was lower in drinkers with alcohol consumption of ≤12.0 and 12.1-36.0 than in non-drinkers (≤12.0, 12.1-36.0, and 36.1-60.0 g/day: 0.93 [0.90, 0.95], 0.82 [0.78, 0.86], and 0.89 [0.77, 1.03], respectively), suggesting that drinkers were at lower risk of low eGFR. In conclusion, compared with non-drinkers, mild drinkers were at lower risk of proteinuria and low eGFR, whereas heavy drinkers had a higher risk of proteinuria but a lower risk of low eGFR. The clinical impact of high alcohol consumption should be assessed in well-designed studies.
Topics: Humans; Glomerular Filtration Rate; Incidence; Risk Factors; Alcohol Drinking; Cohort Studies; Proteinuria
PubMed: 37049433
DOI: 10.3390/nu15071592 -
British Journal of Clinical Pharmacology Apr 2023Standard doses of daptomycin at 4 and 6 mg/kg were used for the treatment of skin and soft tissue for infections and bacteraemia, respectively. However, increased doses... (Meta-Analysis)
Meta-Analysis Review
AIMS
Standard doses of daptomycin at 4 and 6 mg/kg were used for the treatment of skin and soft tissue for infections and bacteraemia, respectively. However, increased doses of daptomycin are recommended for complicated infections by Gram-positive organisms.
METHODS
A systematic review was conducted using 4 databases. We compared treatment success between standard-dose (SD, 4-6 mg/kg) and high-dose (HD, >6 mg/kg) daptomycin in patients with all-cause bacteraemia, complicated bacteraemia, infective endocarditis, osteomyelitis and foreign body/prosthetic infection as the primary outcome. We also compared the success between SD and HD2 (≥8 mg/kg) daptomycin treatments in patients with these diseases as the secondary outcome. The incidence of creatine phosphokinase (CPK) elevation was evaluated as safety.
RESULTS
In patients with complicated bacteraemia and infective endocarditis, the treatment success was significantly lower in the SD group than in the HD group (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.30-0.76 and OR 0.50, 95% CI 0.30-0.82) and HD2 group (OR 0.38, 95% CI 0.21-0.69 and OR 0.30, 95% CI 0.15-0.60), respectively. A significant difference was demonstrated only in the HD2 group in patients with bacteraemia, including simple infection. SD did not decrease the success rate for the treatment of osteomyelitis and foreign body/prosthetic infection. The incidence of elevated CPK was significantly lower in SD group than in HD group.
CONCLUSION
SD daptomycin was associated with significantly lower treatment success than HD in patients with complicated bacteraemia/infective endocarditis. The CPK elevation should be considered in patients treated with high daptomycin doses.
Topics: Humans; Daptomycin; Anti-Bacterial Agents; Bacteremia; Osteomyelitis; Endocarditis; Treatment Outcome; Retrospective Studies
PubMed: 36693240
DOI: 10.1111/bcp.15671 -
BMJ Open Jun 2023To summarise the available evidence on the risk of myocarditis and/or pericarditis following mRNA COVID-19 vaccination, compared with the risk among unvaccinated... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarise the available evidence on the risk of myocarditis and/or pericarditis following mRNA COVID-19 vaccination, compared with the risk among unvaccinated individuals in the absence of COVID-19 infection.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Electronic databases (Medline, Embase, Web of Science and WHO Global Literature on Coronavirus Disease), preprint repositories (medRxiv and bioRxiv), reference lists and grey literature were searched from 1 December 2020 until 31 October 2022.
STUDY SELECTION
Epidemiological studies of individuals of any age who received at least one dose of an mRNA COVID-19 vaccine, reported a risk of myo/pericarditis and compared the risk of myo/pericarditis to individuals who did not receive any dose of an mRNA COVID-19 vaccine.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently conducted screening and data extraction. The rate of myo/pericarditis among vaccinated and unvaccinated groups was recorded, and the rate ratios were calculated. Additionally, the total number of individuals, case ascertainment criteria, percentage of males and history of SARS-CoV-2 infection were extracted for each study. Meta-analysis was done using a random-effects model.
RESULTS
Seven studies met the inclusion criteria, of which six were included in the quantitative synthesis. Our meta-analysis indicates that within 30-day follow-up period, vaccinated individuals were twice as likely to develop myo/pericarditis in the absence of SARS-CoV-2 infection compared to unvaccinated individuals, with a rate ratio of 2.05 (95% CI 1.49-2.82).
CONCLUSION
Although the absolute number of observed myo/pericarditis cases remains quite low, a higher risk was detected in those who received mRNA COVID-19 vaccinations compared with unvaccinated individuals in the absence of SARS-CoV-2 infection. Given the effectiveness of mRNA COVID-19 vaccines in preventing severe illnesses, hospitalisations and deaths, future research should focus on accurately determining the rates of myo/pericarditis linked to mRNA COVID-19 vaccines, understanding the biological mechanisms behind these rare cardiac events and identifying those most at risk.
Topics: Humans; Male; COVID-19; COVID-19 Vaccines; Myocarditis; Pericarditis; RNA, Messenger; SARS-CoV-2; Vaccination
PubMed: 37339840
DOI: 10.1136/bmjopen-2022-065687 -
Nutrition, Metabolism, and... Jun 2017Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is... (Meta-Analysis)
Meta-Analysis Review
Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality - A systematic review and dose-response meta-analysis of prospective studies.
BACKGROUND AND AIM
Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is not consistent. Differences by gender, adjustment for confounding factors, as well as the potential impact of subclinical disease are not clear. A previous meta-analysis missed a large number of studies, and data for atrial fibrillation have not been summarized before. We therefore aimed to clarify these associations in a systematic review and meta-analysis of prospective studies.
METHODS AND RESULTS
PubMed and Embase were searched up to 29 March 2017. Summary RRs and 95% confidence intervals (CIs) were calculated using random effects models. Eighty seven studies were included. The summary RR per 10 beats per minute increase in resting heart rate was 1.07 (95% CI: 1.05-1.10, I = 61.9%, n = 31) for coronary heart disease, 1.09 (95% CI: 1.00-1.18, I = 62.3%, n = 5) for sudden cardiac death, 1.18 (95% CI: 1.10-1.27, I = 74.5%, n = 8) for heart failure, 0.97 (95% CI: 0.92-1.02, I = 91.4%, n = 9) for atrial fibrillation, 1.06 (95% CI: 1.02-1.10, I = 59.5%, n = 16) for total stroke, 1.15 (95% CI: 1.11-1.18, I = 84.3%, n = 35) for cardiovascular disease, 1.14 (95% CI: 1.06-1.23, I = 90.2%, n = 12) for total cancer, and 1.17 (95% CI: 1.14-1.19, I = 94.0%, n = 48) for all-cause mortality. There was a positive dose-response relationship for all outcomes except for atrial fibrillation for which there was a J-shaped association.
CONCLUSION
This meta-analysis found an increased risk of coronary heart disease, sudden cardiac death, heart failure, atrial fibrillation, stroke, cardiovascular disease, total cancer and all-cause mortality with greater resting heart rate.
Topics: Cardiovascular Diseases; Cause of Death; Heart Rate; Humans; Neoplasms; Nonlinear Dynamics; Odds Ratio; Prognosis; Prospective Studies; Risk Assessment; Risk Factors
PubMed: 28552551
DOI: 10.1016/j.numecd.2017.04.004 -
Tidsskrift For Den Norske Laegeforening... Mar 2015Prostate cancer is a radiosensitive type of cancer for which radiotherapy is used for both curative and palliative purposes. Low-dose-rate brachytherapy is an internal... (Review)
Review
BACKGROUND
Prostate cancer is a radiosensitive type of cancer for which radiotherapy is used for both curative and palliative purposes. Low-dose-rate brachytherapy is an internal radiotherapy technique which allows high doses of radiation to be delivered to a tumour at short range and with a high degree of precision. We have conducted a systematic review of the evidence base for this treatment. The method is not established in Norway.
METHOD
This review is based on systematic review articles and publications on treatment, outcomes, adverse effects and health economics considerations found by searching the databases Cochrane Library, Current Controlled Trials, Medline, Embase and NICE (National Institute of Clinical Excellence).
RESULTS
Subsequent to long-term observations of the efficacy, adverse effects and costs presented in 43 selected studies, including one randomised, controlled trial, there is still uncertainty as to which of the three methods low-dose brachytherapy, external radiotherapy and radical prostatectomy is optimal. The reason for this is the methodological differences in patient selection and in endpoints such as biochemical disease-free interval and cause-specific survival. The evidence base appears to suggest that low-dose-rate brachytherapy causes more frequent grade 2 and 3 doctor-reported urogenital adverse effects than prostatectomy, but better patient-reported sexual functions and fewer patients with urinary incontinence than after surgery. Low-dose-rate brachytherapy appears to be socioeconomically cost-effective.
INTERPRETATION
The evidence base with respect to therapeutic effect and toxicity in men with low-risk prostate cancer treated with low-dose brachytherapy is regarded as solidly documented. However, there are no good prospective randomised multi-centre trials with overall survival as an endpoint.
Topics: Brachytherapy; Cost-Benefit Analysis; Disease-Free Survival; Erectile Dysfunction; Humans; Male; Prostatic Neoplasms; Treatment Outcome; Urinary Incontinence
PubMed: 25806763
DOI: 10.4045/tidsskr.13.1404 -
British Journal of Haematology Aug 2015'Double-hit lymphomas' (DHL), defined by concurrent MYC and BCL2 (or, alternatively, BCL6) rearrangements, have a very poor outcome compared to standard-risk, diffuse... (Meta-Analysis)
Meta-Analysis Review
Front-line, dose-escalated immunochemotherapy is associated with a significant progression-free survival advantage in patients with double-hit lymphomas: a systematic review and meta-analysis.
'Double-hit lymphomas' (DHL), defined by concurrent MYC and BCL2 (or, alternatively, BCL6) rearrangements, have a very poor outcome compared to standard-risk, diffuse large B-cell lymphomas (DLBCL). Consequently, dose-intensive (DI) therapies and/or consolidation with high-dose therapy and transplant have been explored in DHL, although benefit has been debated. This meta-analysis compared survival outcomes in DHL patients receiving dose-escalated regimens [DI: R-Hyper-CVAD (rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone) or R-CODOX-M/IVAC (rituximab, cyclophosphamide, doxorubicin, vincristine, methotrexate/ifosfamide, etoposide, high dose cytarabine); or intermediate-dose: R-EPOCH (rituximab, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone)] versus standard-dose regimens (R-CHOP; rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) in the first-line setting. Data were synthesized to estimate hazard ratios of dose-escalated treatments versus R-CHOP using a Weibull proportional hazards model within a Bayesian meta-analysis framework. Eleven studies examining 394 patients were included. Patients were treated with either front-line R-CHOP (n = 180), R-EPOCH (n = 91), or R-Hyper-CVAD/rituximab, methotrexate, cytarabine (R-M/C), R-CODOX-M/R-IVAC (DI) (n = 123). Our meta-analysis revealed that median progression-free survival (n = 350) for the R-CHOP, R-EPOCH and DI groups was 12·1, 22·2, and 18·9 months, respectively. First-line treatment with R-EPOCH significantly reduced the risk of a progression compared with R-CHOP (relative risk reduction of 34%; P = 0·032); however, overall survival (n = 374) was not significantly different across treatment approaches. A subset of patients might benefit from intensive induction with/without transplant. Further investigation into the role of transplant and novel therapy combinations is necessary.
Topics: Antineoplastic Combined Chemotherapy Protocols; DNA-Binding Proteins; Disease-Free Survival; Humans; Lymphoma, Large B-Cell, Diffuse; Proto-Oncogene Proteins c-bcl-2; Proto-Oncogene Proteins c-bcl-6; Proto-Oncogene Proteins c-myc; Survival Rate
PubMed: 25907897
DOI: 10.1111/bjh.13463 -
Journal of Cardiothoracic and Vascular... Sep 2022The clinical efficacy of corticosteroids remains unclear. The primary aim of this systematic review and meta-analysis was to evaluate the use of high-dose versus low-... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The clinical efficacy of corticosteroids remains unclear. The primary aim of this systematic review and meta-analysis was to evaluate the use of high-dose versus low- dose corticosteroids on the mortality rate of COVID-19 patients.
DESIGN
Systematic review and meta-analysis.
SETTING
Electronic search for randomized controlled trials and observational studies (MEDLINE, EMBASE, CENTRAL).
PARTICIPANTS
Hospitalized adults ≥ 18 years old who were SARS-CoV-2 PCR positive.
INTERVENTIONS
High-dose and low-dose corticosteroids.
MEASUREMENTS AND MAIN RESULTS
A total of twelve studies (n=2759 patients) were included in this review. The pooled analysis demonstrated no significant difference in mortality rate between the high-dose and low-dose corticosteroids groups (n=2632; OR: 1.07 [95%CI 0.67, 1.72], p=0.77, I=76%, trial sequential analysis=inconclusive). No significant differences were observed in the incidence of intensive care unit (ICU) admission rate (n=1544; OR: 0.77[95%CI 0.43, 1.37], p=0.37, I= 72%), duration of hospital stay (n=1615; MD: 0.53[95%CI -1.36, 2.41], p=0.58, I=87%), respiratory support (n=1694; OR: 1.51[95%CI 0.77, 2.96], p=0.23, I=84%), duration of mechanical ventilation (n=419; MD: -1.44[95%CI -4.27, 1.40], p=0.32, I=93%), incidence of hyperglycemia (n=516, OR: 0.91[95%CI 0.58, 1.43], p=0.68, I=0%) and infection rate (n=1485, OR: 0.86[95%CI 0.64, 1.16], p=0.33, I=29%).
CONCLUSION
The meta-analysis demonstrated high-dose corticosteroids did not reduce mortality rate. However, high-dose corticosteroids did not pose higher risk of hyperglycemia and infection rate for COVID-19 patients. Due to the inconclusive trial sequential analysis, substantial heterogeneity and low level of evidence, future large-scale randomized clinical trials are warranted to improve the certainty of evidence for the use of high-dose compared to low-dose corticosteroids in COVID-19 patients.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; COVID-19; Humans; Hyperglycemia; Respiration, Artificial; SARS-CoV-2
PubMed: 35715291
DOI: 10.1053/j.jvca.2022.05.011