Impact of Patients’ Gender on Efficacy of Immunotherapy in Patients With Metastatic Kidney Cancer: A Systematic Review and Meta-analysis

Recent meta-analyses on checkpoint inhibitors in cancer report conflicting data regarding the association of patient gender with inhibitor efficacy. In advanced kidney cancer, checkpoint inhibitors have shown improved outcomes in first- and second-line settings compared with standard of care, but the role of patient gender on treatment outcome is unclear. We aimed to assess the efficacy of immunotherapy according to patient gender in advanced kidney cancer.We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed using PubMed, Scopus, Web of Science, and The Cochrane Library to identify eligible studies published through February 16, 2019. Studies were included if they reported on the differential outcomes of male and female patients with metastatic kidney cancer receiving immunotherapy. Our outcomes of interest were overall survival (OS) or progression-free survival (PFS).Four randomized controlled trials comprising a total of 3664 patients (2715 males and 949 females) met our inclusion criteria. Both men and women with metastatic kidney cancer had an OS and PFS advantage with immunotherapy compared with standard-of-care, but no statistically significant difference between the genders was observed (OS hazard ratio [HR] for men, 0.69; 95% confidence interval [CI], 0.59-0.8; P = .40; HR for women, 0.62; 95% CI, 0.48-0.81; P = .13; PFS HR for men, 0.7; 95% CI, 0.59-0.82; P = .24; HR for women, 0.68; 95% CI, 0.52-0.90; P = .105).In patients with advanced kidney cancer receiving checkpoint inhibitors, there seems to be no association of patient gender with treatment outcome.     

The Prevalence of Incidental Simple Ovarian Cysts ≥ 3 cm Detected by Transvaginal Sonography in Early Pregnancy

ObjectiveTo determine the prevalence of simple ovarian cysts of ≥ 3 cm diameter detected by transvaginal sonography (TVS) in a population of asymptomatic women in early pregnancy.MethodsWe conducted a retrospective review of 10 830 consecutive women presenting prior to 14 weeks’ gestational age (GA) for early dating TVS. The records of all women with simple cysts ≥ 3 cm in diameter were included. The study population was divided into five groups by GA: ≤ 6 weeks; 6.1–8 weeks; 8.1–10 weeks; 10.1–12 weeks; and 12.1–14 weeks.ResultsA simple cyst ≥ 3 cm in diameter was present in 4.9% of women at ≤ 6 weeks’ gestation, in 5.1% between 6.1 and 8 weeks, in 5.3% between 8.1 and 10 weeks, in 3.2% between 10.1. and 12 weeks, and in 1.5% between 12 and 14 weeks. Overall, a simple cyst ≥ 3 cm was present in 516 women (4.8%). Prior to 10 weeks, 5.1% had simple cysts ≥ 3 cm, dropping to 2.7% after 10 weeks, a statistically significant decrease (P < 0.0001). Between 10.1 weeks and 12 weeks, the prevalence dropped to 3.2%, and then to 1.5% in the 12.1–14 week group.ConclusionThis investigation provides reference data on the prevalence of detecting simple ovarian cysts ≥ 3 cm by TVS in an asymptomatic early pregnancy population. A progressive decline in the frequency of detecting simple ovarian cysts ≥ 3 cm begins after 10 weeks’ gestational age.     

急性脑梗死患者血浆NPY、CGRP及血清IGF-Ⅰ水平测定

目的:探讨脑梗死患者血浆NPY、CGRP及血清IGF-Ⅰ水平的变化及其临床意义.方法:随机选择了32例脑梗死患者,采用放射免疫分析分别测定了患者治疗前后的血浆NPY、CGRP及血清IGF-Ⅰ水平,并将组间的差异进行了统计学处理及分析.结果:32例脑梗死患者治疗前NPY水平较对照组升高极显著(P＜0.01),CGRP及IGF-Ⅰ水平则较对照组下降均非常显著(P均＜0.01);经治疗患者血浆NPY水平较治疗前已显著降低(P＜0.05),血浆CGRp及血清IGF-Ⅰ水平较治疗前则均明显上升(P均＜0.05).结论:脑梗死患者血浆NPY、CGRP及血清IGF-Ⅰ水平的变化与其发病关系密切,其测定对于了解患者的病情程度及制订治疗方案有重要临床价值.     

Association between bariatric surgery and anemia

ObjectivesSeveral studies have recently conducted to investigate the link between anemia and bariatric surgery (BS). The results from these studies, however, were inconsistent. Therefore, a meta-analysis was conducted to determine whether BS for weight loss is a risk factor for anemia.MethodsStudies were identified relevant papers published a cutoff date of May 2022 for meta-analysis by searching four electronic databases (PubMed, EMBASE, Web of Science and Cochrane Library). Pairs of authors conducted title and abstract, full-text assessment, data extraction and risk of bias assessment, and quality of articles. Random-effects models were used to estimate the pooled effect size and evaluated the overall quality of evidence. The sources of heterogeneity were assessed with I². The Newcastle-Ottawa scale (NOS) was used to assess the methodologic quality of selected studies. The publication bias was assessed using funnel plots and Egger's test statistics.ResultsIn all, eight studies comprising 3150 patients were finally included in the final study analysis. Of these, pooled analysis of eight studies detecting association between anemia and BS for weight loss yield a statistically significant correlation (SMD ?1.12 (?1.46—?0.78, I² = 93%). Subgroup analyses were performed according to postoperative follow-up time and operation method. Before 24 months postoperatively, no patient had a significant decrease in hemoglobin. More than 24 months after BS, patients show a significant reduction in hemoglobin. In addition, the hemoglobin level was not changed after sleeve gastrectomy (SG) and adjustable gastric banding (AGB) (SMD ?0.19 (?1.04—0.67, I² = 0% for SG; SMD ?0.30 (?0.82—0.22 for AGB), but the hemoglobin level was significantly reduced after Roux-en-Y gastric bypass (RYGB) (SMD ?1.19 (?1.52—?0.87, I² = 94.2%).ConclusionThis current meta-analysis found that at 24 months after RYGB, the patient's hemoglobin level was significantly reduced, increasing the risk of anemia. Therefore, attention should be paid to the occurrence of anemia after BS. A large, placebo-controlled, multi-center study is needed to clarify the role of BS for weight loss in this patient anemia.