Association between SOCS3 hypermethylation and HBV-related hepatocellular carcinoma and effect of sex and age: A meta-analysis

Background:Suppressor 3 of cytokine signaling (SOCS3) hypermethylation has been reported to participate in hepatocellular carcinoma (HCC) development and progression, but conflicting results were published. This study aimed to analyze the clinical effects of SOCS3 hypermethylation in HCC and the effects of sex and age on SOCS3 hypermethylation in HCC.Methods:Databases were searched for relevant case-control and cohort studies on SOCS3 hypermethylation in HBV-related HCC. In vitro and in vivo studies and studies of patients with serious comorbidities were excluded. Review Manager 5.2 was used to estimate the effects of the results among the selected studies. Forest plots, sensitivity analysis, and bias analysis for the included studies were also conducted.Results:Finally, 8 relevant studies met the inclusion criteria. A significant difference in SOCS3 hypermethylation in HCC was found between tumor and nontumor groups (the odds ratio [OR] = 2.01, 95% confidence interval [CI]: 1.48–2.73, P < .00001; P for heterogeneity = .39, I² = 5%). The meta-analysis suggested no significant difference in the effect of sex (OR = 1.00, 95% CI: 0.76–1.31, P = .76; P for heterogeneity = .44, I² = 0%) and age on SOCS3 hypermethylation in HCC (OR = 1.11, 100% CI: 0.78–1.29, P = .03; P for heterogeneity = .14, I² = 36%). Limited publication bias was observed in this study.Conclusion:SOCS3 hypermethylation is associated with HBV-related HCC. Sex and age do not affect the association between SOCS3 hypermethylation and HCC. SOCS3 might be a treatment target for HCC.     

Efficacy and safety of tacrolimus monotherapy versus cyclophosphamide–corticosteroid combination therapy for idiopathic membranous nephropathy: A meta-analysis

ObjectiveThe objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus cyclophosphamide (CTX)-corticosteroid combination therapy in idiopathic membranous nephropathy (IMN) patients.MethodsDatabases including the PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched from inception to October 20, 2020. Eligible studies comparing TAC monotherapy and CTX-corticosteroid combination therapy in IMN patients were included. Data were analyzed using Review Manager Version 5.3.ResultsNine studies were included in the meta-analysis. One randomized controlled trial and eight cohort studies involving 442 patients were identified. Compared with CTX-corticosteroid combination therapy for IMN, TAC monotherapy had higher complete remission (CR) at month 6 (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.35–3.50, P < .01). The 2 therapeutic regimens had similar partial remission (OR 0.69, 95% CI 0.45–1.04, P = .08), total remission (OR 1.38, 95% CI 0.85–2.23, P = 0.19) at month 6, and similar CR (OR 1.64, 95% CI 0.84–3.19, P = .15), partial remission (OR 0.71, 95% CI 0.37–1.38, P = 0.31), and total remission (OR 1.29, 95% CI 0.55–3.01, P = .56) after 1 year. The relapse rate of the TAC group was higher than that of the CTX group, but the difference was not statistically significant (OR 1.85, 95% CI 0.75–4.53, P = .18). There was no difference between the 2 therapeutic regimens concerning glucose intolerance (OR 1.15, 95% CI 0.61–2.14, P = .67), acute renal failure (OR 1.14, 95% CI 0.39–3.33, P = .81), or tremors (OR 4.39, 95% CI 0.75–25.67, P = .10). Incidences of gastrointestinal symptoms (OR 0.29, 95% CI 0.10–0.79, P = .02), infection (OR 0.18, 95% CI 0.08–0.39, P < 0.01), leukopenia (OR 0.14, 95% CI 0.04–0.51, P < .01), and abnormal aminotransferase (OR 0.31, 95% CI 0.13–0.77, P = .01) in the TAC group were all lower than those in the CTX group. Subgroup analysis showed that there was no significant difference between the TAC group and the CTX combined with corticosteroid 0.8 to 1 mg/kg/day group concerning CR at month 6 (P > .05). There was no significant difference between the TAC group and the CTX combined with corticosteroid 0.5 mg/kg/day group concerning abnormal aminotransferase (P > .05).ConclusionTAC monotherapy is comparable to CTX-corticosteroid combination therapy for renal remission in IMN patients. TAC monotherapy had a higher CR in the early stage and had fewer drug-related adverse effects. The relapse rate of TAC monotherapy was higher than that of CTX-corticosteroid combination therapy, but the difference was not significant.     

Efficacy and safety of ticagrelor monotherapy in patients following percutaneous coronary intervention: A systematic review and meta-analysis

Background:We aimed to systematically evaluate the efficacy and safety ticagrelor monotherapy following percutaneous coronary intervention.Methods:Online databases were searched for relevant studies (published between the years 2015 and 2020) comparing 1-month Dual antiplatelet therapy (DAPT) followed by 23-month ticagrelor monotherapy with 12-month DAPT followed by 12-month aspirin monotherapy following percutaneous coronary intervention. Primary outcomes assessed efficacy whereas secondary outcomes assessed safety. Odds ratios (OR) with 95% confidence intervals (CIs) based on a random effect model were calculated and the analysis was carried out by the RevMan 5.3 software.Results:Only 6 studies were selected for this meta-analytical research. The meta-analysis results: MI(OR:0.96, 95% CI:0.86–1.06, P = .40), stroke (OR:1.04, 95% CI: 0.87–1.25, P = .68), stent thrombosis (OR: 0.91,95% CI:0.76–1.10,P = .32),New-Q Wave (OR:0.85,95% CI: 0.72–1.00, P = .05), all cause death (OR:0.91, 95% CI: 0.87–0.96, P < .0001), death from cardiovascular (OR: 0.76, 95% CI: 0.58–0.99, P = .04), revascularization (OR: 0.93, 95% CI: 0.87–0.99, P = .03). Ticagrelor monotherapy was associated with a significantly lower rate of myocardial Infarction (MI), stroke, stent thrombosis, all cause death, death from cardiovascular and revascularization (OR:0.91,95% CI:0.87–0.96, P < .0001) when compared to DAPT. Besides, DAPT was associated with a significantly higher rate of BARC3 or 5 bleeding (OR:0.85, 95% CI: 0.68–1.06; P = .16) when compared to ticagrelor. When bleeding was further subdivided, minor or major bleeding was also significantly higher with DAPT (OR: 0.72, 95% CI: 0.41–1.27; P = .26). GUSTO moderate or severe bleeding was also significantly higher with DAPT (OR: 0.77, 95% CI: 0.39–1.52; P = .45).Conclusion:Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) can optimize ischemic and bleeding risks. And, it can reduce the occurrence of events outcome (MI, revascularization, stroke, stent thrombosis).     

Efficacy and safety of nitrate supplementation on exercise tolerance in chronic obstructive pulmonary disease: A systematic review and meta-analysis

Background:Exercise intolerance was prevalent in people with chronic obstructive pulmonary disease (COPD) and had a detrimental effect on the quality of life. We aimed to evaluate the efficacy and safety of nitrate supplementation in exercise tolerance of people with COPD.Methods:We searched medical databases including Cochrane Library, EMBASE, and PubMed from inception to October 2020 for randomized control trials in treating COPD with nitrate supplementation.Results:Nine trials were identified. Compared with placebo, nitrate supplementation has no significant effect on the following variables: exercise endurance time (standard mean difference [SMD]: 0.06; 95% confidence interval [CI]: –0.39 to 0.52; P = .79), exercise capacity (SMD: 0.30; 95% CI: –0.21 to 0.80; P = .25), oxygen consumption (SMD: –0.04; 95% CI: –0.33 to 0.25; P = .80), resting systolic blood pressure (MD: –2.84; 95% CI: –8.46 to 2.78; P = .32), systolic blood pressure after exercise (MD: –4.66; 95% CI –15.66 to 6.34; P = .41), resting diastolic blood pressure (MD: 0.89; 95% CI: –4.41 to 6.19; P = .74), diastolic blood pressure after exercise (MD: –0.21; 95% CI: –5.51 to 5.10; P = .94), heart rate (MD: –2.52; 95% CI: –7.76 to 2.73; P = .35), and arterial oxygen saturation (MD: –0.44; 95% CI: –2.38 to 1.49; P = .65). No severe adverse effects from nitrate supplementation were reported in the included trails.Conclusion:Current evidence suggests that nitrate supplementation may be safe but ineffective for improving exercise tolerance in people with COPD.     

Comparison of clinical efficacy of robotic right colectomy and laparoscopic right colectomy for right colon tumor: A systematic review and meta-analysis

Background:The purpose of this study was to compare the clinical efficacy of robotic right colectomy (RRC) and laparoscopic right colectomy (LRC) in the treatment of right colon tumor.Methods:We systematically searched PubMed, Web of science, EMBASE ClinicalTrials.gov and Cochrane Central Register for studies (studies published between January 2011 and June 2020). The included studies compared the clinical efficacy of RRC and LRC in the treatment of right colon tumor, and analyzed the perioperative data.Results:Our meta-analysis included 10 studies involving 1180 patients who underwent 2 surgical procedures, RRC and LRC. This study showed that compared with LRC, there was no significant difference in first flatus passage (weighted mean difference [WMD]: −0.37, 95% CI: −1.09–0.36, P = .32), hospital length of stay (WMD: −0.23, 95% CI: −0.73–0.28, P = .32), reoperation (OR: 1.66, 95% CI: 0.67–4.10, P = .27), complication (OR: 0.83, 95% CI: 0.60–1.14, P = .25), mortality (OR: 0.45, 95% CI: 0.02–11.22, P = .63), wound infection (OR: 0.65, 95% CI: 0.34–1.25, P = .20), and anastomotic leak (OR: 0.73, 95% CI: 0.33–1.63, P = .44). This study showed that compared with LRC, the lymph nodes retrieved (WMD: 1.47, 95% CI: −0.00–2.94, P = .05) of RRC were similar, with slight advantages, and resulted in longer operative time (WMD: 65.20, 95% CI: 53.40–77.01, P < .00001), less estimated blood loss (WMD: −13.43, 95% CI: −20.65–6.21, P = .0003), and less conversion to open surgery (OR: 0.30, 95% CI: 0.17–0.54, P < .0001).Conclusions:RRC is equivalent to LRC with respect to first flatus passage, hospital length of stay, reoperation, complication, and results in less conversion to LRC.     

The necessity or not of the addition of fusion to decompression for lumbar degenerative spondylolisthesis patients: A PRISMA compliant meta-analysis

Background:The new emerging application of decompression combined with fusion comes with a concern of cost performance, however, it is a lack of big data support. We aimed to evaluate the necessity or not of the addition of fusion for decompression in patients with lumbar degenerative spondylolisthesis.Methods:Potential studies were selected from PubMed, Web of Science, and Cochrane Library, and gray relevant studies were manually searched. We set the searching time spanning from the creating date of electronic engines to August 2020. STATA version 11.0 was exerted to process the pooled data.Results:Six RCTs were included in this study. A total of 650 patients were divided into 275 in the decompression group and 375 in the fusion group. No statistic differences were found in the visual analog scales (VAS) score for low back pain (weighted mean difference [WMD], –0.045; 95% confidence interval [CI], –1.259–1.169; P = .942) and leg pain (WMD, 0.075; 95% CI, –1.201–1.35; P = .908), Oswestry Disability Index (ODI) score (WMD, 1.489; 95% CI, –7.232–10.211; P = .738), European Quality of Life-5 Dimensions (EQ-5D) score (WMD, 0.03; 95% CI, –0.05–0.12; P = .43), Odom classification (OR, 0.353; 95% CI 0.113–1.099; P = .072), postoperative complications (OR, 0.437; 95% CI, 0.065–2.949; P = .395), secondary operation (OR, 2.541; 95% CI 0.897–7.198; P = .079), and postoperative degenerative spondylolisthesis (OR = 8.59, P = .27). Subgroup analysis of VAS score on low back pain (OR = 0.77, 95% CI, 0.36–1.65; P = .50) was demonstrated as no significant difference as well.Conclusion:The overall efficacy of the decompression combined with fusion is not revealed to be superior to decompression alone. At the same time, more evidence-based performance is needed to supplement this opinion.     

Transarterial chemoembolization plus sorafenib versus sorafenib for intermediate–advanced hepatocellular carcinoma: A meta-analysis comparing clinical outcomes

Background:Hepatocellular carcinoma (HCC) ranks as the sixth most common cancer and the second leading cause of cancer-related death worldwide, local and systemic therapies are beneficial for those who have more advanced disease or are not suitable for radical treatment. We aim to investigate the clinical outcomes of transarterial chemoembolization (TACE) plus sorafenib compared with sorafenib monotherapy for intermediate–advanced HCC.Methods:A systematic search according to preferred reporting items for systematic reviews and meta-analyses guidelines in the PubMed database was conducted from inception to December 31, 2020 for published studies comparing survival outcomes and tumor response between TACE + sorafenib and sorafenib alone for intermediate–advanced HCC.Results:Five eligible cohort studies and a randomized controlled trial with a total of 3015 patients were identified. We found that the TACE + sorafenib group had a significantly better overall survival (OS) (hazard ratio, 0.77; 95% confidence interval [CI] 0.66–0.88, P < .001) than those treated with sorafenib. Median OS ranged from 7.0 to 22.0 months with TACE + sorafenib and from 5.9 to 18.0 months with sorafenib. The combination of TACE + sorafenib had a significantly better time to progression (hazard ratio, 0.74; 95% CI 0.65–0.82, P < .001) than those treated with sorafenib. Median time to progression ranged from 2.5 to 5.3 months with TACE + sorafenib and from 2.1 to 2.8 months with sorafenib. The results showed the TACE + sorafenib group had a higher disease control rate (log odds ratio, 0.52; 95% CI 0.25–0.80, P = .0002), objective response rate (log odds ratio, 0.85; 95% CI 0.37–1.33, P = .0006) than sorafenib group. Hand–foot skin reaction, diarrhea, fatigue, vomiting, and alanine aminotransferase (ALT) elevation were common adverse events. The adverse events were similar between the 2 groups excluding elevated ALT.Conclusion:Although the TACE + sorafenib group had a higher elevated ALT, the combination of TACE + sorafenib had an OS benefit compared with sorafenib in the treatment of intermediate–advanced HCC. Further research is necessary to affirm this finding and clarify whether certain subgroups benefit from different combinations between TACE and sorafenib.     

Postoperative complications observed with robotic versus laparoscopic surgery for the treatment of rectal cancer: An updated meta-analysis of recently published studies

Background:This is an updated meta-analysis comparing the postoperative complications observed with robotic versus laparoscopic surgery (LS) for the treatment of rectal cancer.Methods:Cochrane central, MEDLNE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), Google Scholar, Web of Science and http://www.ClinicalTrials.gov were searched for studies (published after the year 2015), comparing robotic versus LS for the treatment of rectal cancer. The postoperative outcomes were considered as the endpoints in this analysis. RevMan 5.4 was used to carry out the statistical analysis. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the results following data analysis.ResultsA total number of 22,744 participants were included in this study whereby 9178 participants were assigned to the robotic surgery and 13,566 participants were assigned to the LS group. The time period of patients’ enrollment varied from years 2007 to 2017. Our results showed that overall complications (RR: 0.91, 95% CI: 0.71–1.17; P = .45), wound complications (RR: 0.81, 95% CI: 0.64–1.04; P = .09), anastomotic leak (RR: 1.12, 95% CI: 0.88–1.42; P = .37), anastomotic bleeding (RR: 0.88, 95% CI: 0.29–2.64; P = .82), stoma-related complications (RR: 0.88, 95% CI: 0.24–3.21; P = .85), intra-abdominal abscess (RR: 0.53. 95% CI: 0.22–1.31; P = .17), urinary tract infection (RR: 0.94, 95% CI: 0.53–1.66; P = .83), enterocolitis (RR: 1.35, 95% CI: 0.38–4.71; P = .64), reoperation (RR: 0.85, 95% CI: 0.46–1.54; P = .58), and mortality (RR: 0.75, 95% CI: 0.34–1.62; P = .46) were not significantly different between robotic-assisted versus LS for rectal cancer. Postoperative ileus (RR: 1.21, 95% CI: 0.81–1.81; P = .34), readmission (RR: 1.17, 95% CI: 0.75–1.83; P = .48), and urinary retention (RR: 0.51, 95% CI: 0.21–1.23; P = .14) were also similarly manifested.Conclusions:In this updated meta-analysis, both robotic and laparoscopic surgeries were equally effective for the treatment of rectal cancer. Similar postoperative complications were observed. However, our analysis was restricted only to postoperative outcomes, parameters such as duration of surgery were not taken into consideration.     

Fertility-preserving treatment in patients with early-stage endometrial cancer: A protocol for systematic review and meta-analysis

Background:Endometrial cancer (EC) is the second most common malignancy of the female reproductive system worldwide, and the standard treatment for early-stage EC potentially leads to permanent infertility. The objective of this study was to investigate the efficacies of different methods on fertility preservation in patients with early-stage EC.Methods:We searched the major online databases (PubMed, Embase, The Cochrane Library, and Web of Science) to collect the research literature on fertility preservation therapy in patients with early-stage well-differentiated EC aged ≤ 40 years from January 1999 to October 2019. The inclusion was performed using the R software (version R3.5.3) meta-analysis of a single rate. The efficacy of the following three fertility preservation treatments was evaluated from four aspects, the complete remission rate (CRR), recurrence rate (ReR), pregnancy rate (PregR), and live birth rate (LBR): a) taking oral progestin only therapy, b) hysteroscopic resection combined with progestin/levonorgestrel-releasing intrauterine system (LNG-IUS)/GnRH-a, c) LNG-IUS or combined with progestin/GnRH-a.Results:A total of 23 articles were included in this study, including 446 patients with early-stage EC. In the group that took oral progestin only (n = 279), CRR, ReR, PregR, and LBR were 82% (95% confidence interval [CI], 74%–92%, P = .01), 38% (95% CI, 31%-45%, P = .35), 70% (95% CI, 62%–79%, P = .68), and 63% (95% CI, 55%–73%, P = .55), respectively. Hysteroscopic resection combined with progestin/LNG-IUS/GnRH-a therapy group (n = 96) achieved a CRR, ReR, PregR, and LBR of 95% (95% CI, 90%–100%, P = .42), 16% (95% CI, 6%–39%, P = .03), 84% (95% CI, 73%–96%, P = .39), and 72% (95% CI, 59%–87%, P = .28), respectively. LNG-IUS or combined with progestin/GnRH-a therapy group (n = 91) achieved a CRR, ReR, PregR, and LBR of 69% (95% CI, 54%–89%, P < .01), 30% (95% CI, 19%–49%, P = .36), 48% (95% CI, 18%–100%, P < .01), and 36% (95% CI, 10%–100%, P < .01), respectively.Conclusion:It is safe and effective for young patients with early-stage EC to receive oral progestin, hysteroscopic resection combined with progestin/LNG-IUS/GnRH-a, LNG-IUS, or progestin/GnRH-a.INPLASY Registration number:DOI 10.37766/inplasy2020.12.0137     

Modified Robert Jones Bandage in reducing blood loss in total knee arthroplasty: A meta-analysis of randomized controlled trials

Background:The purpose of this meta-analysis was to assess the effects of Modified Robert Jones Bandage (MRJB) in primary total knee arthroplasty (TKA).Methods:PubMed, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were systematically searched for randomized controlled trials (RCTs). All RCTs were compared to receive either MRJB (study group) or conventional wound dressing (control group) in TKA. Statistical analysis was assessed using RevMan 5.3 software.Results:A total of 5 RCTs involving 362 patients were included in the meta-analysis. No significant difference between the 2 groups was found in terms of total blood loss (Mean difference [MD], –25.41; 95% confidence interval [CI], –90.52 to 39.70; P = .44), intra-operative blood loss (MD, –13.77; 95% CI, –31.84 to 4.29; P = .14), drain blood loss (MD, 0.83; 95% CI, –30.07 to 31.72; P = .96), and transfusion rate (risk ratio, 0.95; 95% CI, 0.55–1.64; P = .86); There was also no significant difference in terms of range of motion (MD, –0.93; 95% CI, –3.64 to 1.79; P = .50), visual analog scale pain sores (MD, –0.02; 95% CI, –0.34 to 0.30; P = .90), and operative time (MD, –3.12; 95% CI, –13.42 to 7.18; P = .55), without increasing the risk of wound-related complications (risk ratio, 0.75; 95% CI, 0.27–2.08; P = .58) in both groups. No deep venous thrombosis occurred in all studies.Conclusions:The current meta-analysis of the available evidence indicates patients with MRJB had not required the additional advantage compared to the conventional wound dressing for TKA. However, more high-quality studies are needed to confirm the above conclusions.Level of Evidence:Level I, therapeutic study.     

Association between Alpha B-crystallin expression and prognosis in patients with solid tumors: A protocol for systematic review and meta-analysis

Background:Alpha B-crystallin (CRYAB), as a small heat shock protein, may play critical roles in the tumorigenesis and progression of several kinds of human cancers. However, the prognostic value of CRYAB in solid malignancies remains controversial. The aim of the present study was to investigate the association between CRYAB expression and clinicopathology and prognosis of solid tumor patients.Methods:PubMed, Web of Science, EMBASE, Chinese National Knowledge Infrastructure, and WanFang databases were systematically searched to retrieve studies that investigated the prognostic value of CRYAB expression in various solid tumors. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to determine the strength of association between CRYAB expression and survival in patients with solid tumors. Odds ratios (ORs) with 95% CIs were pooled to assess the correlation between CRYAB expression and clinicopathological characteristics of patients with solid tumors.Results:A total of 17 studies, including 18 cohorts with 6000 patients, were included in this meta-analysis. Our results showed that increased CRYAB expression could predict poor overall survival (HR = 1.81, 95% CI: 1.50–2.19, P < .001), disease-free survival (HR = 1.47, 95% CI: 1.16–1.86, P = .001), and disease-specific survival (HR = 1.40, 95% CI: 1.19–1.63, P < .001) in patients with cancer. Furthermore, the high expression level of CRYAB was associated with certain phenotypes of tumor aggressiveness, such as lymph node metastasis (OR = 2.46, 95% CI: 1.48–4.11, P = .001), distant metastasis (OR = 3.34, 95% CI: 1.96–5.70, P < .001), advanced clinical stage (OR = 2.24, 95% CI: 1.24–4.08, P = .008), low OS rate (OR = 4.81, 95% CI: 2.82–8.19, P < .001), and high recurrence rate (OR = 1.38, 95% CI: 1.11–1.72, P = .004).Conclusions:CRYAB may serve as a valuable prognostic biomarker and therapeutic target in human solid tumors.     

Prognostic and clinicopathological significance of miR-638 in cancer patients: A meta-analysis

Introduction:MiR-638 is believed to be involved in human cancers. However, the prognostic value of miR-638 in human carcinomas is controversial and inconclusive. Therefore, we conducted this meta-analysis to investigate the association between miR-638 expression and clinical outcomes in the patients with various cancers.Methods:We searched Pubmed, Embase, Wanfang, and the China National Knowledge Infrastructure (CNKI) up to September 1, 2020 to identify relevant studies. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were used to correlate expression of miR-638 with prognosis and clinicopathological features.Results:A total of 18 studies involving 1886 patients were included in the meta-analysis. The results revealed that low miR-638 expression was significantly correlated with poor overall survival (OS) (HR = 2.09, 95% CI: 1.46–2.98, P < .001), but not with disease-free survival (DFS) (HR = 1.71, 95% CI: 0.31–9.56, P = .540). Subgroup analysis found that low miR-638 expression was associated with worse OS in patients with digestive system cancer (HR = 2.47, 95% CI: 1.85–3.30, P < .001), the reported directly from articles group (HR = 2.12, 95% CI: 1.34–3.33, P < .001), survival curves group (HR = 2.02, 95% CI: 1.07–3.80, P = .029), in studies with sample size ≥100 (HR = 2.12, 95% CI: 1.34–3.35, P = .001), and in studies with sample size <100 (HR = 2.02, 95%CI: 1.09–3.75, P = .025). Moreover, cancer patients with low miR-638 expression were prone to tumor size (OR = 1.47, 95% CI: 1.03–2.09, P = .035), earlier lymph node metastasis (present vs absent, OR = 2.26, 95% CI: 1.63–3.14, P < .001), earlier distant metastasis (present vs absent, OR = 2.60, 95% CI: 1.45–4.67, P < .001), TNM stage (III-IV vs I-II, OR = 2.01, 95% CI: 1.35–2.99, P = .001), and portal vein invasion (present vs absent, OR = 4.39, 95% CI:2.23–8.64, P < .001), but not associated with age, gender, tumor differentiation, and vascular invasion.Conclusions:MiR-638 may serve as a promising indicator in the prediction of prognosis and clinicopathological features in patients with different kinds of cancers.     

Pooled-analysis of efficacy and safety of minimally invasive versus standard percutaneous nephrolithotomy

Background:This study aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) versus standard percutaneous nephrolithotomy in patients with renal and upper ureteric stones.Methods:We conducted a pooled analysis on randomized controlled trials (RCTs). The eligible RCTs were selected from the following databases: MEDLINE, Embase, Web of Science, and the Cochrane Library. The reference lists of retrieved studies were also investigated.Results:Our analysis included 10 RCTs with 1612 patients. Pooled data from 10 RCTs revealed the following: stone-free rate (odds ratio = 1.46, 95% confidence interval (CI) [1.12,1.88], P = .004), operative time (mean difference [MD]  = 4.10, 95% CI [–1.37,9.56], P = .14), length of hospital stay (MD = –15.31, 95% CI [–29.43,–1.19], P = .03), hemoglobin decrease (MD = –0.86, 95% CI [–1.19,–0.53], P < .00001), postoperative fever (MD = 0.83, 95% CI [0.49,1.40], P = .49), and urine leakage (MD = 0.59, 95% CI [0.25,1.37], P = .22). Besides, we performed sub-group analysis based on vacuum suction effect and multiple kidney stones. For vacuum suction effect, it revealed the following: stone-free rate in vacuum suction group (P = .007) and in non-vacuum suction group (P = .19). Operative time in vacuum suction group (P = .89), non-vacuum suction group (P = .16). Postoperative fever in vacuum suction group (P = .49), non-vacuum suction group (P = .85).Conclusion:This pooled analysis indicated that MPCNL was a safe and effective method for treating renal stones compared with standard percutaneous nephrolithotomy. Besides, the vacuum suction effect in MPCNL played a more important role. When it comes to multiple or staghorn stones, the longer operative time in MPCNL could not be ignored.     

Low-site versus traditional peritoneal dialysis catheterization: A meta-analysis

Background:The objective of this study was to compare the complications of low-site peritoneal dialysis (PD) catheter placement and traditional open surgery in peritoneal dialysis catheter insertion.Methods:The following databases were searched from inception to September 6, 2019: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang. Eligible studies comparing low-site PD catheter placement and traditional open surgery in peritoneal dialysis catheter insertion were included. The data were analyzed using Review Manager Version 5.3.Results:Seven studies were included in the meta-analysis. A total of 504 patients were included in the low-site PD catheter placement group, and 325 patients were included in the traditional open surgery group. Compared with traditional open surgery, low-site PD catheter placement had a lower incidence rate of catheter displacement (odds ratios [OR] 0.11, 95% CI 0.05–0.22, P < .01) and noncatheter displacement dysfunction (OR 0.11, 95% CI 0.04–0.31, P < .01). However, there was no difference between the 2 catheter insertion methods concerning bleeding (OR 0.53, 95% CI 0.23–1.22, P = .13), PD fluid leakage (OR 0.40, 95% CI 0.15–1.10, P = .07), hypogastralgia (OR 0.95, 95% CI 0.32–2.80, P = .93), peritonitis (OR 0.70, 95% CI 0.32–1.54, P = .38), or exit-site and tunnel infections (OR 0.39, 95% CI 0.14–1.03, P = .06).Conclusion:Low-site PD catheter placement reduced the risk of catheter displacement and noncatheter displacement dysfunction and did not increase the risk of bleeding, PD fluid leakage, hypogastralgia, peritonitis, or exit site and tunnel infections. Additional large multicenter randomized controlled trials are needed to confirm these conclusions.     

Efficacy and safety of tacrolimus monotherapy versus tacrolimus-corticosteroid combination therapy for idiopathic membranous nephropathy: A meta-analysis

Objective:The objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus TAC-corticosteroid combination therapy in idiopathic membranous nephropathy (IMN) patients.Methods:Databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched from inception to January 10, 2021. Eligible studies comparing TAC monotherapy and TAC-corticosteroid combination therapy in IMN patients were included. Data were analysed using Review Manager Version 5.3.Results:Seven studies were included in the meta-analysis. One randomized controlled trial and six cohort studies involving 372 patients were identified. Compared with TAC monotherapy, TAC-corticosteroid had a higher total remission at the sixth month (odd ratio (OR) 0.49, 95% confidence interval (CI) 0.31–0.78, P < .01). The two therapy regimens had similar complete remission rates (OR 0.79, 95% CI 0.43–1.48, P = .47) at the sixth month and similar relapse rates (OR 1.44, 95% CI 0.70–2.92, P = .32). TAC-corticosteroid combination therapy had a higher incidence of infection (OR 0.38, 95% CI 0.18–0.81, P = .01). The two therapy regimens had similar incidences of gastrointestinal symptoms (OR 0.96, 95% CI 0.34–2.70, P = .93), abnormal aminotransferase (OR 0.90, 95% CI 0.34–2.38, P = .84), and glucose intolerance (OR 0.58, 95% CI 0.32–1.07, P = .08).Conclusion:TAC-corticosteroid combination therapy had a higher total remission rate at the sixth month but had a higher incidence of infection than TAC monotherapy in the treatment of IMN. The two therapeutic regimens had similar relapse rates.     

The safety and efficacy of low-dose mineralocorticoid receptor antagonists in dialysis patients: A meta-analysis

Introduction:Our aim was to evaluate the safety and efficacy of low-dose mineralocorticoid receptor antagonists (MRAs) in dialysis patients.Methods:We systematically searched PubMed, EMBASE, and Cochrane libraries for clinical trials on the use of MRAs in dialysis patients. Review Manager 5.3 software was used to analyze relevant data and evaluate the quality of evidence.Results:We identified nine randomized controlled trials including 1128 chronic dialysis patients. In terms of safety, when hyperkalemia was defined as serum potassium level ≥5.5 mmol/L, low-dose MRAs were significantly associated with hyperkalemia (relative risk [RR] 1.76, 95% confidence intervals [CI] 1.07–2.89, P = .02); however, when hyperkalemia was defined as serum potassium level ≥6.0 mmol/L or serum potassium level ≥6.5 mmol/L, no significant association was observed between low-dose MRAs and hyperkalemia (RR 1.40, 95% CI 0.83–2.37, P = .20; RR 1.98, 95% CI 0.91–4.30, P = .09, respectively). Use of low-dose MRAs can reduce cardiovascular mortality by 54% compared with the control group (0.46, 95% CI 0.28–0.76, P = .003). Similarly, the RR of all-cause mortality for the low-dose MRAs group was 0.48 (95% CI 0.33–0.72, P = .0003).Conclusion:Low-dose MRAs may benefit dialysis patients without significantly increasing moderate to severe hyperkalemia.     

Association of interleukin-6 gene polymorphisms with the risk of hepatocellular carcinoma: An up-to-date meta-analysis

Background:This study was aimed to evaluate the association between interleukin-6 (IL-6) gene polymorphisms and the risk of hepatocellular carcinoma (HCC) in a meta-analysis.Methods:A literature search was performed for case-control studies published during May, 1993 to May, 2020 focusing on IL-6 gene polymorphisms (–174G > C, –572G > C, and –597G > A) and HCC susceptibility by using PubMed, Cochrane Database, EMBASE, Web of science, and China National Knowledge Infrastructure. From 128 full-text articles, 11 were included in this meta-analysis. I² index was used to assess heterogeneity and Newcastle-Ottawa Scale was utilized for quality assessment.Results:For IL-6 –174G > C polymorphism, in codominant (GG vs CC: odds ratios [OR] = 2.78, 95% confidence intervals [CI] = 1.25–6.19, P = .01, I² = 16%) and recessive (GG+GC vs CC: OR = 2.76, 95% CI = 1.29–5.90, P = .009, I² = 3%) models, IL-6 –174G>C polymorphism was significantly associated with the risk of HCC. In dominant (GG vs CC+GC: OR = 1.80, 95% CI = 0.92–3.54, P = .09, I² = 86%) and allele (G vs C: OR = 1.49, 95% CI = 0.95–2.32, P = .08, I² = 68%) models, IL-6 –174G>C polymorphism had no impact on the risk of HCC. However, in non-Italian Caucasian population, IL-6 –174G>C polymorphism was significantly related to the occurrence of HCC in both dominant (GG vs CC+GC: OR = 3.26, 95% CI = 2.29–4.65, P < .00001, I² = 0%) and allele (G vs C: OR = 2.48, 95% CI = 1.48–4.15, P = .0006) models. Such correlations also could be observed when healthy individuals were selected as controls. For IL-6 –572G>C and –597G>A polymorphisms, no significant association was observed in all models, regardless of the source of control and population subgroups. No publication bias could be calculated when Begg and Egger tests were employed.Conclusion:This meta-analysis indicated that IL-6 –174G>C polymorphism was significantly related with the risk for HCC, especially in non-Italian Caucasian population. No significant association was observed for the correlation between IL-6 –572G>C and –597G>A polymorphisms and HCC susceptibility.     

Sustained low efficiency dialysis is non-inferior to continuous renal replacement therapy in critically ill patients with acute kidney injury: A comparative meta-analysis

Background:Critically ill adults with acute kidney injury (AKI) experience considerable morbidity and mortality. This systematic review aimed to compare the effectiveness of continuous renal replacement therapy (CCRT) versus sustained low efficiency dialysis (SLED) for individuals with AKI.Methods:We carried out a systematic search of existing databases according to standard methods and random effects models were used to generate the overall estimate. Heterogeneity coefficient was also calculated for each outcome measure.Results:Eleven studies having 1160 patients with AKI were included in the analyses. Meta-analysis results indicated that there was no statistically significant difference between SLED versus continuous renal replacement therapy (CRRT) in our primary outcomes, like mortality rate (rate ratio [RR] 0.67, 95% confidence interval [CI] 0.44–1.00; P = .05), renal recovery (RR 1.08, 95% CI 0.83–1.42; P = .56), and dialysis dependence (RR = 1.03, 95% CI 0.69–1.53; P = .89). Also, no statistically significant difference was observed for between SLED versus CRRT in the secondary outcomes: that is, length of intensive care unit stay (mean difference –0.16, 95% CI –0.56–0.22; P = .41) and fluid removal rate (mean difference –0.24, 95% CI –0.72–0.24; P = .32). The summary mean difference indicated that there was a significant difference in the serum phosphate clearance among patients treated with SLED and CRRT (mean difference –1.17, 95% CI –1.90 to –0.44, P = .002).Conclusions:The analysis indicate that there was no major advantage of using continuous renal replacement compared with sustained low efficiency dialysis in hemodynamically unstable AKI patients. Both modalities are equally safe and effective in treating AKI among critically ill patients.     

Clinicopathological and prognostic value of preoperative lymphocyte to monocyte ratio for hepatocellular carcinoma following curative resection: A meta-analysis including 4,092 patients

Background:Previous studies have reported that lymphocyte-to-monocyte ratio (LMR) had novel prognostic value in hepatocellular carcinoma (HCC). The purpose of this meta-analysis was to synthetically evaluate the prognostic role of preoperative LMR in HCC patients following curative resection.Methods:Eligible studies were acquired through searching Pubmed, Web of Science, Cochrane Library and EMbase update to September 2019. Merged hazard ratios (HRs) and 95% confidence intervals (CIs) were applied as effect sizes.Results:A total of ten studies containing 4,092 patients following liver resection were enrolled in this meta-analysis. The pooled results demonstrated that preoperative elevated LMR indicated superior survival outcome (HR: 0.58, 95% CI: 0.34–0.96, P = .035) and recurrence-free survival (RFS)/disease-free survival/time to recurrence (HR = 0.76, 95% CI: 0.58–0.98, P = .034). The significant prognostic role of preoperative LMR was detected in the subgroup of all publication year, country of origin, sample sizes <300, TNM stage of I–IV and LMR cut-off value ≤4. Furthermore, high LMR was significantly associated with male, high AFP, large tumor size, incomplete tumor capsule, advanced TNM stage and BCLC stage, and presence of PVTT.Conclusion:Elevated preoperative LMR indicated superior survival outcome in HCC patients following curative resection, and might serve as a novel prognostic biomarker.     

Prognostic value of the systemic inflammation response index in human malignancy: A meta-analysis

Background:This meta-analysis aimed to evaluate the prognostic value of the systemic inflammation response index (SIRI) in malignancy based on existing evidence.Methods:We searched for relevant literature published in the electronic databases PubMed, Web of Science, Cochrane Library, and Embase before April 10, 2020. Hazard ratios (HR) and corresponding 95% confidence intervals (CI) were calculated and pooled to evaluate the relationship between SIRI and malignancy outcomes.Results:We included 14 articles, describing 6,035 patients. Our findings revealed that patients with high SIRI had worse overall survival (OS) (HR = 2.20, 95% CI: 1.85–2.62, P < .001), disease-free survival (DFS) (HR: 1.92, 95% CI: 1.49–2.48, P < .001), time-to-progression (TTP) (HR: 2.00, 95% CI: 1.55–2.58, P < .001), progression-free survival (PFS) (HR: 1.73, 95% CI: 1.38–2.16, P < .001), cancer-specific survival (CSS) (HR: 3.57, 95% CI: 2.25–5.68, P < 0.001), disease-specific survival (DSS) (HR: 1.99, 95% CI: 1.46 - 2.72, P < .001), and metastasis-free survival (MFS) (HR: 2.26, 95% CI: 1.28–3.99, P = .005) than patients with low SIRI. The correlation between SIRI and OS did not change in a subgroup analysis. Meta-regression indicated that heterogeneity may be related to differences in primary therapy strategies. Sensitivity analysis suggested that our results were reliable.Conclusions:SIRI could be used as a useful predictor of poor prognosis during malignancy treatment.