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Tang X, Xu X, Chen R, Zhang M, Mei Z, Zhang S. Immune checkpoint inhibitors for patients with microsatellite instability-high colorectal cancer: protocol of a pooled analysis of clinical trials. Front Oncol 2024; 13:1331937. [PMID: 38234398 PMCID: PMC10792030 DOI: 10.3389/fonc.2023.1331937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Colorectal cancer (CRC) is the third most common cause of cancer and the second leading cause of cancer-related deaths worldwide. Microsatellite instability-high (MSI-H) is a distinct molecular subtype of CRC that occurs in approximately 15% of all cases. Recently, immune checkpoint inhibitors (ICIs) have emerged as a promising therapeutic approach for patients with MSI-H colorectal cancer, exhibiting higher response rates than standard chemotherapies. To assess the effectiveness and safety of ICIs for the treatment of patients with MSI-H CRC, we propose a comprehensive pooled analysis of clinical trial data. Methods and analysis A systematic search of multiple electronic databases, including PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov, will be conducted from their inception until September, 2023 to identify eligible randomized controlled trials (RCTs) and non-randomized studies. Inclusion criteria comprise studies of adult patients with histologically confirmed MSI-H CRC treated with immune checkpoint inhibitors, with a comparison to a control group receiving conventional therapies. Outcomes of interest will be overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and incidence of treatment-related adverse events (AEs). The Cochrane Risk of Bias tool and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool will be employed to evaluate the methodological quality of included studies. A random-effects model using the DerSimonian and Laird method will be applied for pooling the effect estimates, calculating hazard ratios (HRs) or risk ratios (RRs) with their corresponding 95% confidence intervals (CIs). Heterogeneity will be assessed using I² statistics, and subgroup analysis and meta-regression will be performed to explore potential effect modifiers in case of substantial heterogeneity. Publication bias will be evaluated with funnel plots and Egger's test. Sensitivity analysis will be conducted to assess the robustness of the results. Discussion This meta-analysis will synthesize available evidence from clinical trials on immune checkpoint inhibitors in treating MSI-H colorectal cancer. The findings will offer valuable information about the effectiveness and safety of ICIs in this patient population, contributing to the refinement of clinical guidelines and enhancing the decision-making process for healthcare providers, policy-makers, and patients. The comprehensive analysis of subgroups and sensitivity allows for an in-depth understanding of potential effect modification, providing essential directions for future research. Ethics and dissemination This study will involve the use of published data; hence, ethical approval is not required. The results of the study will be disseminated through publications in peer-reviewed journals and presentations at relevant conferences. The findings will potentially impact clinical decision-making and contribute to the development of evidence-based treatment recommendations for patients with MSI-H colorectal cancer. Clinical trial registration Open Science Framework identifier, 10.17605/OSF.IO/ZHJ85.
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Affiliation(s)
- Xiaojun Tang
- Department of Spinal Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xinshu Xu
- Department of Anorectal Surgery, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Ruobing Chen
- Department of Anorectal Surgery, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Mengmeng Zhang
- Department of Anorectal Surgery, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Shuangxi Zhang
- Department of Anorectal Surgery, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
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Mei Z, Zhang Z, Han Y, Du P, Yang W, Wang Q, Zheng D. Surgical laser therapy for cryptoglandular anal fistula: Protocol of a systematic review and meta-analysis. PLoS One 2023; 18:e0279388. [PMID: 36598892 PMCID: PMC9812299 DOI: 10.1371/journal.pone.0279388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Anal fistula is the natural evolution of perianal abscess and one of the most common perianal diseases for adults. For complex fistula, it is still very challenging for anorectal surgeons to manage. With the introduction of laser technique in surgery, it is becoming more and more widely used for the treatment of cryptoglandular anal fistula. During the past decade, numerous studies have reported the clinical effectiveness and postoperative outcomes of different forms of laser treatment for anal fistula. However, as these studies were varied in terms of baseline characteristics, the evidence for the true clinical effectiveness of laser treatment for anal fistula need further critical appraisal. Therefore, the purpose of this study is to evaluate the outcomes of surgical laser therapy for cryptoglandular anal fistula stratified by laser type and Parks' classification through a synthesis of quantitative and qualitative evidence. METHODS AND ANALYSIS This study will be carried out with adherence to the Cochrane Handbook. We will search PubMed, Cochrane Library, and Embase until June, 2022 to identify all relevant interventional and observational studies examining the effects of laser therapy on the clinical outcomes for cryptoglandular anal fistula. Data extraction from eligible studies will be performed independently by two unblinded authors using standardized extraction forms. Risk of bias assessment for each study will be conducted using Cochrane tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa scale (NOS) tool for observational studies. The DerSimonian-Laird random-effects model will be used to calculate the pooled estimates. Heterogeneity will be examined by subgroup analysis stratified by laser type and Parks' classification and other study characteristics. Potential publication bias will be assessed by funnel plot symmetrical and Egger's regression tests. CONCLUSIONS The synthesis of quantitative and qualitative evidence of this systemic review will yield updated and comprehensive evidence of laser treatment on specific outcomes, which can provide anorectal surgeons with high level evidence-based recommendations to improve patient care and clinical outcomes. OSF registration number: DOI 10.17605/OSF.IO/36ADW.
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Affiliation(s)
- Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
- * E-mail: (ZM); (DZ)
| | - Zhijun Zhang
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye Han
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peixin Du
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Yang
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingming Wang
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - De Zheng
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- * E-mail: (ZM); (DZ)
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Farkhondeh T, Mansouri B, Binkowski LJ, Błaszczyk M, Pirsaheb M, Azadi NA, Słoboda M, Amirabadizadeh A, Javadmoosavi SY. Blood lead concentrations in children with iron deficiency anemia: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:3199-3212. [PMID: 34731423 DOI: 10.1007/s11356-021-17301-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
Iron deficiency is the most common nutritional disorder detrimental to the behavior, cognitive performance, immune system, and physical growth of infants and preschool- and school-age children. Iron deficiency anemia (IDA) increases children's susceptibility to some metals, including the highly toxic lead (Pb), but the character of this relationship is still disputed. Thus, this study aimed to review and meta-analyze the association between the IDA and blood lead levels (BLL) among children, based on papers indexed by international scientific databases and published up to September 2021. A search was performed of the literature in several databases including the ISI Web of Science, PubMed, and Scopus. The final papers were assessed concerning their quality based on the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Moreover, analyses were performed using R statistical software with the "meta" package. Of the 1528 articles found, only 12 studies met the inclusion criteria and were considered in the meta-analysis. Significantly higher BLL in IDA children (SMD = 2.40; CI 95%, 0.93-3.87 µg/L; p = 0.0014) was seen when compared to non-IDA children. Moreover, the pooled OR is equal to 2.75 (CI 95%, 1.10-6.85 µg/L; p = 0.0303) suggesting a higher risk of IDA development among children with BLL > 10 µg/dL. Thus, we recommend systematic monitoring of Fe and Pb levels among children, especially in countries with limited sources of nutritious food. Since only a few studies were available for this meta-analysis, further studies are necessary to examine the association between IDA and BLL in detail.
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Affiliation(s)
- Tahere Farkhondeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Borhan Mansouri
- The Substance Abuse Prevention Research Center, the Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Lukasz J Binkowski
- The Institute of Biology, the Pedagogical University of Krakow, Krakow, Poland
| | - Martyna Błaszczyk
- The Institute of Biology, the Pedagogical University of Krakow, Krakow, Poland
| | - Meghdad Pirsaheb
- The Research Center for Environmental Determinants of Health, the Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nammam Ali Azadi
- The Biostatistics Department, the School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Maciej Słoboda
- The Department of Environmental Management and Protection, AGH University of Science and Technology, Krakow, Poland
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Seyed Yoosef Javadmoosavi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
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Jiang Z, Wei Y, Cao L, Chen Q, Yang H, Lin Z, Jiang L, Mei Z, Liu Z, Chen Z. The use of acupuncture for advanced cancer care: Protocol for a systematic review and meta-analysis. J Adv Nurs 2021; 77:2085-2091. [PMID: 33426711 DOI: 10.1111/jan.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
AIM To assess the up-to-date evidence of acupuncture for the management of cancer-related and cancer treatment-related outcomes among people with advanced cancer. DESIGN Systematic review with meta-analyses involving multidimensional outcomes. METHODS The protocol of this systematic review has been registered in PROSPERO with the registration number CRD42020212982. Six databases (including Pubmed, EMBASE, Cochrane Library, SinoMed, ClinicalTrials.gov and Chinese Clinical Trial Registry) will be searched from inception through November 2020 to identify relevant interventional trials examining acupuncture management on multidimensional outcomes in patients with advanced cancer. Main outcomes will include cancer and treatment-related symptoms, quality of life, sleep quality and adverse events. DerSimonian & Laird random-effects meta-analysis will be applied to calculate pooled relative risks for binary data and pooled weighted mean differences (WMDs) or standardized mean differences (SMDs) for continuous data. Trial quality ratings and risk of bias will be evaluated using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development and Evaluation approach. DISCUSSION The efficacy of acupuncture on advanced cancer care and outcomes has not yet been determined. Palliative care for patients with advanced cancer may involve multiple challenges that include physical and mental health care. This systematic review will offer updated and comprehensive evidence of acupuncture on specific outcomes induced by advanced cancer and cancer-related treatment, which can give high level clinical recommendations to improve patient care and clinical outcomes.
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Affiliation(s)
- Zhi Jiang
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueliao Wei
- Department of Gastroenterology, The People's Hospital of Hechi, Hechi, China
| | - Lixing Cao
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qicheng Chen
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huimin Yang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhanhong Lin
- Department of Minimally Invasive Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixia Jiang
- Preventive Treatment of Disease Centre, ShunDe Hospital GuangZhou University of Chinese Medicine, Shunde, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Zhongqiu Liu
- International Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiqiang Chen
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Gao Z, Giovanardi CM, Li H, Hao C, Li Q, Zhang X, Mansmann U. Acupuncture for migraine: a protocol for a meta-analysis and meta-regression of randomised controlled trials. BMJ Open 2019; 8:e022998. [PMID: 30798288 PMCID: PMC6278783 DOI: 10.1136/bmjopen-2018-022998] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/15/2018] [Accepted: 10/05/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Although the effectiveness of acupuncture for episodic migraine has been confirmed by multiple clinical trials and Cochrane systematic reviews, the mechanisms underlying the specific effect of acupuncture for migraine remain controversial. We aim to evaluate the effectiveness and safety of acupuncture for both episodic migraine and chronic migraine by meta-analysis and explore the possible factors influencing the specific effect of acupuncture for migraine by meta-regression. METHODS AND ANALYSIS We will search for randomised control trials of acupuncture for migraine in the following eight databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED (via OVID) and four Chinese databases (Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database and Wanfang Database) from inception to 31 December 2017. We will also search OpenSIGLE (opensigle.inist.fr) for conference abstracts. No language restriction will be applied. The selection of studies, data extraction and coding and assessment of risk of bias of the included studies will be conducted independently by two reviewers. Standard meta-analysis and, if appropriate, meta-regression will be performed using the R packages Meta and Metafor. ETHICS AND DISSEMINATION The results of this meta-analysis and meta-regression will be disseminated through publication in a peer-reviewed journal and presented at a relevant conference. The data used in this meta-analysis will not contain individual patient data; therefore, ethical approval is not required. PROSPERO REGISTRATION NUMBER CRD42018087270.
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Affiliation(s)
- Zishan Gao
- Department of Clinical Acupuncture and Moxibustion, Nanjing University of Chinese Medicine, Nanjing, China
| | - Carlo Maria Giovanardi
- Italian Federation of Acupuncture Societies (FISA), Association of Medical Acupuncturists of Bologna (A.M.A.B.), Bologna, Italy
| | - Hongxiao Li
- School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Hao
- Department of Clinical Acupuncture and Moxibustion, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qian Li
- School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xu Zhang
- School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ulrich Mansmann
- Department of Medical Data Processing, Biometrics, and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
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Treatments for subacute cough in primary care: systematic review and meta-analyses of randomised clinical trials. Br J Gen Pract 2018; 68:e694-e702. [PMID: 30201828 DOI: 10.3399/bjgp18x698885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/11/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Subacute cough following a non-specific viral infection lasting 3-8 weeks is common. However, despite many treatment options there are no systematic reviews evaluating these. AIM To provide a systematic overview of treatment options and outcomes evaluated in randomised clinical trials (RCTs). DESIGN AND SETTING Systematic review and meta-analyses assessing the overall effects of any treatment for subacute cough. METHOD The authors systematically searched PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials (last search March 2017) for RCTs in adult patients with subacute cough. The authors considered trials evaluating any outcome of any drug or non-drug treatments, apart from traditional Chinese and Asian medicines. They combined treatment effects on cough-related outcomes in random effects meta-analyses. RESULTS Six eligible RCTs including 724 patients were identified. These assessed montelukast, salbutamol plus ipratropium bromide, gelatine, fluticasone propionate, budesonide, and nociception opioid 1 receptor agonist and codeine. Five studies reported effects on various cough severity scores at various timepoints. No treatment option was associated with a clear benefit on cough recovery or other patient-relevant outcomes in any of the studies or in meta-analyses for cough outcomes at 14 days and 28 days. Reported adverse events were rather mild and reported for 14% of patients across all treatments. CONCLUSION Evidence on treatment options for subacute cough is weak. There is no treatment showing clear patient-relevant benefits in clinical trials.
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