Scientific reports
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Meta Analysis
Intra-articular dexmedetomidine in knee arthroscopy: A systematic review and meta-analysis.
The aim of this meta-analysis is to evaluate the analgesic effects of intra-articular dexmedetomidine (DEX) in arthroscopic knee surgery. A comprehensive literature search was conducted to identify randomized controlled trials (RCTs) comparing intra-articular DEX versus control for postoperative analgesia in knee arthroscopy. Trial sequential analysis (TSA) was applied to determine the reliability of the evidence. ⋯ Intra-articular DEX did not affect the incidence of postoperative nausea and vomiting, hypotension, bradycardia, or somnolence. This meta-analysis demonstrated that intra-articular administration of DEX improved pain outcomes in the early postoperative period after knee arthroscopy. Due to the limited number of trials and patients included in this meta-analysis, more evidence is required to confirm these findings.
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Review Meta Analysis
Hypomagnesemia and clinical benefits of anti-EGFR monoclonal antibodies in wild-type KRAS metastatic colorectal cancer: a systematic review and meta-analysis.
Hypomagnesemia is a recognized side-effect of cetuximab- or panitumumab-based chemotherapy for metastatic colorectal cancer (mCRC). The clinical relevance of hypomagnesemia is under debate. Thus, a systematic review and meta-analysis of retrospective studies and randomized clinical trials (RCTs) comparing hypomagnesemia with normal magnesium levels in wild-type KRAS mCRC was performed. ⋯ By subgroup analysis, frontline, later lines or combination therapy with hypomagnesemia were associated with PFS benefits (HR: 0.78; 95% CI: 0.62-0.98; HR: 0.60; 95% CI: 0.40-0.90; HR: 0.62; 95% CI: 0.41-0.94, respectively). In patients with wild-type KRAS mCRC, hypomagnesemia is associated with better clinical benefits of PFS, OS and ORR when treated with cetuximab- or panitumumab-based chemotherapy. Future clinical trials should corroborate its predictive role.
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Meta Analysis
Chemotherapy plus Panitumumab Versus Chemotherapy plus Bevacizumab in Metastatic Colorectal Cancer: A Meta-analysis.
Panitumumab and bevacizumab have been widely used in combination with chemotherapy for patients with wild type RAS metastatic colorectal cancer (mCRC). Whether panitumumab or bevacizumab was the optimal option remained controversial. Thus, we conducted a meta-anaylsis to evaluate chemotherapy plus panitumumab (C + P) versus chemotherapy plus bevacizumab (C + B) in wild type RAS mCRC. ⋯ In wild type RAS population, PFS [hazard ratio (HR) = 0.96; 95% confidence interval (CI), 0.76 to 1.15] and OS (HR = 0.90; 95% CI, 0.54 to 1.27) and ORR [relative ratio (RR) = 2.06; 95% CI, 0.86 to 4.90] appeared similar between the two treatments, the incidence of AEs slightly increased (RR = 1.16; 95% CI 1.08 to 1.26). In conclusion, there was insufficient evidence to precisely conclude that combination treatment of C + P had an improved efficacy compared with C + B. Further large-scale and better-designed clinical trials are still needed to evaluate the combination treatment of C + P in patients with wild type RAS mCRC.
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Studies on the association of dysnatraemia with all-cause mortality risk in chronic kidney disease (CKD) patients have yielded inconsistent results. This meta-analysis aimed to evaluate the association of hyponatremia or hypernatremia with all-cause mortality risk in CKD patients. An electronic literature search was performed in Web of Science, Pubmed and Embase databases from inception to March 2017 for available observational studies evaluating the association of dysnatraemia with all-cause mortality risk in CKD patients. ⋯ In time-dependent analyses, both time-averaged hyponatremia (HR 1.65; 95% CI: 1.27-2.15) and hypernatremia (HR 1.41; 95% CI: 1.20-1.65) had a higher independent risk of all-cause mortality. Furthermore, subgroup analyses by type of patients, study design, sample size and follow-up duration revealed similar results across most of these analyses. Baseline hyponatremia and time-dependent hyponatremia or hypernatremia were independently associated with increased all-cause mortality risk in CKD patients.
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The aim of this systematic review and meta-analysis is to evaluate the pros and cons of adjuvant low dose intrathecal meperidine for spinal anaesthesia. We searched electronic databases for randomized controlled trials using trial sequential analysis (TSA) to evaluate the incidence of reduced rescue analgesics, shivering, pruritus, nausea and vomiting when applying adjuvant intrathecal meperidine. Twenty-eight trials with 2216 patients were included. ⋯ However, nausea and vomiting increased (RR, 1.84, 95% CI, 1.29 to 2.64; TSA-adjusted RR, 1.72, 95% CI, 1.33 to 2.23; RR, 2.23, 95% CI, 1.23 to 4.02; TSA-adjusted RR,1.96, 95% CI, 1.20 to 3.21). Under TSA, these results provided a sufficient level of evidence. In conclusion, adjuvant low dose intrathecal meperidine effectively attenuates spinal anaesthesia-associated shivering and reduces rescue analgesics with residual concerns for the nausea and vomiting.