Search

Stroke survivors commonly face challenges such as reduced physical activity and cardiorespiratory fitness (CRF) as well as balance and gait impairments, exacerbating their disability. While high-intensity exercise interventions have demonstrated some potential, their effects on these items remain uncertain. Therefore, our study aimed to investigate the impact of high-intensity training protocols on CRF, gait ability, and balance in stroke survivor populations. Two independent investigators systematically searched five databases for relevant RCTs following the PICO model. Through a systematic review of 25 RCTs published up to 31 May 2023, including adult first-stroke survivors, comparing high-intensity exercise training versus low-to-mild or no exercises, we evaluated outcomes such as the Six-Minute Walking Test (6 MWT), peak oxygen uptake (VO2peak), Ten-Meter Walk Test (10 MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG). The protocol was registered in PROSPERO (registration number CRD42023456773). Meta-analyses indicated significant enhancements in CRF, as measured by 6 MWT and VO2peak, following high-intensity exercise interventions. However, no significant differences were observed in BBS, 10 MWT, and TUG. Our findings underscore the potential of high-intensity exercise interventions in ameliorating CRF among stroke survivors, although further research involving standardized protocols and long-term follow-ups is imperative to optimize rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: The association of venetoclax (VEN) with hypomethylating agents (HMAs) such as azacitidine (AZA) and decitabine (DECI) significantly improved the outcome of patients with newly diagnosed acute myeloid leukemia (AML) who are not eligible for intensive chemotherapy. However, it is not clear how applicable the results of clinical trials are in a real-world setting. For this reason, we conducted a systematic review and meta-analysis of real-world studies on this type of AML patient. Overall, AML patients treated with VEN+HMAs had a lower survival rate than was reported in the pivotal VIALE-A trial. Results slightly increased when the analysis was restricted to the studies using VEN+AZA as treatment. Future studies are warranted to investigate whether this discrepancy is due to the different characteristics of enrolled patients or to a non-optimal adherence to therapy. In recent years, the association of venetoclax (VEN) with hypomethylating agents (HMAs) significantly improved the outcome of patients with newly diagnosed acute myeloid leukemia (AML) who were unfit for intensive chemotherapy and became the standard of care after the publication of the pivotal RCT VIALE-A. However, it is still not clear to what extent the results observed in the VIALE-A apply to a real-world setting. For this reason, we carried out a systematic review and meta-analysis of real-world studies on newly diagnosed patients with AML, ineligible for intensive induction chemotherapy, receiving first-line VEN+HMA. We then compared their results in term of survival with those from the VIALE-A. Kaplan-Meier curves were extracted from all included studies and individual survival data was reconstructed. We then estimated a pooled survival curve and compared it with the results of the VIALE-A using the log-rank test. We also conducted a secondary analysis including only studies considering VEN plus azacytidine (AZA) as treatment, as this was the schedule originally used in the VIALE-A. Nineteen real-world studies met the inclusion criteria and were included in the systematic review. Most of them reported a worse survival than the VIALE-A. The pooled survival curve was similar to that reported in the VIALE-A during the first three months of treatment but diverged thereafter (p-value = 0.0001). The pooled median survival among the real-world studies was 9.37 months (95%CI 8.81–10.5), substantially lower than that reported in the VIALE-A (14.7 months; 95%CI 11.9–18.7). Results slightly increased when the analysis was restricted to the studies using VEN+AZA as treatment (median survival: 11.5 months; 95%CI 10.2–14.8). Survival of newly diagnosed AML patients treated with VEN+HMAs in a real-world setting seems to be lower than previously reported in the VIALE-A, while the effect of VEN+AZA is more in line with expected results. Future studies are needed to evaluate whether this apparent discrepancy is due to the different characteristics of enrolled patients or to a non-optimal adherence to therapy, and whether alternative regimens can provide better results in terms of safety and effectiveness. [ABSTRACT FROM AUTHOR]

to summarize the evidence on the efficacy of minimally invasive interventional procedures such as radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) in patients with osteoarthritis or inflammatory arthritis. a literature search was conducted in PubMed and Web of Science databases. Both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) were included. The results were organized according to the treated anatomical site: knee, hip, foot and ankle, shoulder, hand and wrist, sacroiliac joints. Data about treatment efficacy were extracted. The main outcome was change in pain intensity using the 0–10 visual analog scale (VAS) from baseline to 1 month. Additional timepoints at 3, 6 and 12 months were assessed. Change in functional status was evaluated. Pooled estimates were calculated as the mean difference (MD) and 95 % confidence interval relative to baseline. The meta-analyses of RCTs and NRSI were conducted separately. of the 4599 retrieved articles, 164 were included in the review and, considering all the established timepoints, 111 (38 RCTs and 73 NRSI) were selected for the meta-analysis. Only one article described patients with inflammatory arthritis. In the meta-analysis of RCTs, one month after the procedure, MD in VAS was -3.98 (-4.41 to -3.55; k = 21) for knee RFA, and -3.18 (-3.96 to -2.39; k = 8) for sacroiliac joints RFA. In the meta-analysis of NRSI, MD in VAS was -4.12 (-4.63 to -3.61; k = 23) for knee RFA, -3.84 (-4.77 to -2.92; k = 7) for knee TAE, -4.34 (-4.96 to -3.71; k = 2) for hip RFA, -3.83 (-4.52 to -3.15; k = 3) for shoulder RFA and -4.93 (-5.58 to -4.28; k = 14) for sacroiliac joints RFA. Significant decrease in pain intensity was found also at 3, 6 and 12 months. Additionally, functional status improved at all the assessed timepoints. minimally invasive interventional procedures can improve pain and functional status of patients affected by OA or chronic sacroiliac pain of degenerative origin. Further research is warranted in the field of inflammatory rheumatic diseases. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Psoriatic arthritis (PsA) is a specific form of inflammatory arthritis associated with psoriasis affecting in the same measure men and women but with a consistent geographic variability. Since the burden of PsA frequency has important implications in the definition of the healthcare policies, it is important to measure the frequency of disease in the general population. Objective To quantify the global health burden of PsA summarizing the data provided by the population-based available studies investigating prevalence and incidence of the disease. Methods A MEDLINE search was performed to identify all studies reporting the prevalence or incidence of PsA. Fixed- and random-effect models were fitted to estimate the prevalence and incidence pooled estimates. Between-study heterogeneity was evaluated using the Q statistic and the I 2 index and Publication bias using Egger’s asymmetry test. Results Twenty-eight studies were included in the meta-analysis, 17 retrieved from the literature search and 11 from the meta-analysis of Alamanos et al. The random effect pooled PsA prevalence and incidence rates are respectively 133 every 100,000 subjects (95% CI, 107–164 every 100,000 subjects) and 83 every 100,000 PY (95% CI, 41–167 every 100,000 PY). High between-study heterogeneity was found for both prevalence and incidence estimates. Conclusions This study allowed the estimation of a global average prevalence and incidence rates of PsA and the evaluation of the geographic variability. The high between-study heterogeneity suggests the importance to look not only at the pooled estimates but also at the study-specific estimate. [ABSTRACT FROM AUTHOR]

Objective. Oral antidiabetic drugs (including metformin and sulfonylurea) may play a role in the relationship between type 2 diabetes and cancer. To quantify the association between metformin and sulfonylurea and the risk of cancer, we performed a meta-analysis of available studies on the issue. Materials and Methods. We performed a MEDLINE search for observational studies that investigated the risk of all cancers and specific cancer sites in relation to use of metformin and/or sulfonylurea among patients with type 2 diabetes mellitus. Fixed- and random-effect models were fitted to estimate the summary relative risk (RR). Between-study heterogeneity was tested using χ2 statistics and measured with the I2 statistic. Publication bias was evaluated using funnel plot and Egger's regression asymmetry test. Results. Seventeen studies satisfying inclusion criteria and including 37,632 cancers were evaluated after reviewing 401 citations. Use of metformin was associated with significantly decreased RR of all cancers (summary RR 0.61, 95% confidence interval [CI] 0.54--0.70), colorectal cancer (0.64, 95% CI 0.54--0.76), and pancreatic cancer (0.38, 95% CI 0.14--0.91). With the exception of colorectal cancer, significant between-study heterogeneity was observed. Evidence of publication bias for metformin-cancer association was also observed. There was no evidence that metformin affects the risk of breast and prostate cancers, nor that sulfonylurea affects the risk of cancer at any site. Conclusions. Metformin, but not sulfonylurea, appears to reduce subsequent cancer risk. This has relevant implications in light of the exploding global epidemic of diabetes. [ABSTRACT FROM AUTHOR]

We conducted a metaanalysis of published studies on the relation between coffee drinking and endometrial cancer risk, which included 2 cohort (201 cases) and 7 case-control studies (2409 cases). The summary relative risk (RR) for coffee drinkers vs nondrinkers was 0.80 (95% confidence interval [CI], 0.68-0.94), with significant heterogeneity between studies. Compared with nondrinkers, the summary RR was 0.87 (95% CI, 0.78-0.97) for low-to-moderate coffee drinkers and 0.64 (95% CI, 0.48-0.86) for heavy coffee drinkers. The summary RR for an increase of 1 cup/d was 0.93 (95% CI, 0.89-0.97), which suggests an inverse relation between coffee and endometrial cancer. However, the causality must be confirmed. [Copyright &y& Elsevier]

Dual programmed cell death-1 and vascular endothelial growth factor pathway inhibition is the novel standard of care for patients with unresectable hepatocellular carcinoma. Direct comparisons between first-line treatments are lacking. We conducted a literature search in MEDLINE (https://pubmed.ncbi.nlm.nih.gov), the Cochrane library (https://www.cochranelibrary.com) and Embase (www.embase.com) between January 2007 and February 2022. We included phase III randomised controlled trials that tested immune-checkpoint inhibitors or tyrosine kinase inhibitors, including sorafenib, lenvatinib and donafenib, and evaluated as primary end-point overall survival (OS) or progression-free survival (PFS). Studies testing loco-regional therapies were excluded. The primary end-point was to compare the efficacy of first-line options in terms of OS and PFS. We extracted Hazard ratios (HR) and 95% confidence intervals (95% CI) for OS and PFS and performed a frequentist network meta-analysis with fixed effect multivariable meta-regression models. The research protocol was registered in PROSPERO, an international prospective register of systematic reviews (registration code CRD42022312489). Literature review yielded 13709 results, after duplicates removal and exclusion of not relevant studies, 70 papers were available for screening. After full-text review, 9 studies were eligible for analysis. Atezolizumab plus bevacizumab reduced the risk of death compared to placebo (HR 0·40; 95% CI 0·28-0·57), sorafenib (HR 0·58; 95% CI 0·42-0·80), lenvatinib (HR 0·63; 95% CI 0·44-0·89), atezolizumab plus cabozantinib (HR 0·64; 95% CI 0·43-0·97), nivolumab (HR 0·68; 95% CI 0·48-0·98) and donafenib (HR 0·69; 95% CI 0·48-0·99). Atezolizumab plus bevacizumab was not statistically superior to durvalumab plus tremelimumab (HR 0·74; 95% CI 0·52-1·06) and sintilimab plus IBI305 (HR 1·02; 95% CI 0·67-1·55) in reducing the risk of death. Efficacy was associated with a higher risk of grade 3 adverse events. • Immune-checkpoint inhibitor plus anti-vascular endothelial growth factor agent provide the highest reduction in the risk of death in hepatocellular carcinoma. • The efficacy of immune-checkpoint inhibitor plus anti-vascular endothelial growth factor is similar to that of dual checkpoint inhibition. • The efficacy of combination strategies comes at the expense of higher toxicity. • Nivolumab is associated with the lowest risk of adverse events. [ABSTRACT FROM AUTHOR]

Abstract: Objective: In order to provide an updated quantification of the association between alcohol drinking and epithelial ovarian cancer risk, we conducted a meta-analysis of published observational studies. Methods: Using PubMed, we performed a literature search of all case–control and cohort studies published as original articles in English up to September 2011. We included 27 observational studies, of which 23 were case–control studies, 3 cohort studies and one pooled analysis of prospective cohort studies, including a total of 16,554 epithelial ovarian cancer cases. We derived pooled meta-analytic estimates using random-effects models. Results: The pooled relative risk (RR) for any alcohol drinking compared with non/occasional drinking was 1.00 [95% confidence interval (CI), 0.95–1.05]. The RRs were 0.97 (95% CI, 0.92–1.02), 1.03 (95% CI, 0.96–1.11) and 1.09 (95% CI, 0.80–1.50) for light (≤1drink/day), moderate (>1 to <3 drinks) and heavy drinking (≥3drinks/day), respectively. In particular, the pooled RR for invasive epithelial ovarian cancers was 1.00 (95% CI, 0.95–1.06), while for borderline cancers was 0.96 (95% CI, 0.74–1.26). Stratified analyses across cancer histotypes revealed a modest protective effect of alcohol on endometrioid epithelial ovarian tumors (RR=0.82, 95% CI, 0.70–0.96), while no association was found for serous (RR=1.00, 95% CI, 0.84–1.19), mucinous (RR=0.91, 95% CI, 0.78–1.08) and clear cell (RR=0.93, 95% CI, 0.76–1.14) cancers. There was no evidence of publication bias. Conclusions: This comprehensive meta-analysis provided no evidence of a material association between alcohol drinking and epithelial ovarian cancer risk. [Copyright &y& Elsevier]

Summary: Alcohol drinking is a known risk factor for laryngeal cancer. However, little information is available on the risk associated with light alcohol drinking. To address this issue, we conducted a meta-analysis using two methods: (i) random-effects models with reconstruction of alcohol consumption categories and calculation of risk estimates associated with predefined consumption levels using Hamling method and (ii) random-effects meta-regression models. The PubMed database was searched for all case–control or cohort studies published in the English language on the association between alcohol consumption and risk of laryngeal cancer. Forty studies (38 case–control, 2 cohort) reporting on at least three levels of consumption were included. Overall, alcohol drinking versus non-drinking was associated with an approximately 2-fold increase in risk of laryngeal cancer (RR=1.90; 95% CI: 1.59–2.28). While light alcohol drinking (⩽1 drink/day) did not show any significant association with risk of laryngeal cancer (12 studies. RR=0.88; 95% CI: 0.71–1.08), moderate drinking (>1 to <4drinks/day) was associated with a 1.5-fold increase in risk (35 studies. RR=1.47; 95% CI: 1.25–1.72) and heavy drinking (⩾4drinks/day) was associated with a 2.5-fold increased risk (33 studies. RR=2.62; 95% CI: 2.13–3.23). Subgroup analyses for studies that adjusted for main potential confounding factors (age, sex, and tobacco use) and several further subgroup analyses showed similar results, which suggest the robustness of the results. [ABSTRACT FROM AUTHOR]

Summary: Oral and pharyngeal cancers are strongly related to alcohol drinking. We combined findings from all case-control and cohort studies published up to September 2009 and presented analyses by subsites, using a meta-analytic approach. Summary measures were obtained using random-effects models, and taking into account the correlation between estimates from the same study. We also performed a dose-risk analysis, using a random-effects meta-regression model. Compared to non- or occasional drinkers, the overall relative risks (RR) for light drinkers were 1.17 (95% confidence interval, CI, 1.01–1.35) for oral (nine studies) and 1.23 (95% CI, 0.87–1.73) for pharyngeal (five studies) cancer, with no significant heterogeneity between the two sites (p =0.793). RRs for heavy drinkers were 4.64 (95% CI, 3.78–5.70) for oral (17 studies) and 6.62 (95% CI, 4.72–9.29) for pharyngeal (17 studies) cancer (p of heterogeneity between the two sites=0.075). The summary RRs for heavy drinkers were 4.11 (95% CI, 2.46–6.87) for tongue (five studies), 7.76 (95% CI, 4.77–12.62) for oropharyngeal (four studies), and 9.03 (95% CI, 4.46–18.27) for hypopharyngeal (four studies) cancer. In conclusion, the alcohol-related RRs are higher for pharyngeal than for oral cancer, particularly at higher doses, while the association with cancer of the tongue was similar to that for oral cancer. [ABSTRACT FROM AUTHOR]

Summary: Alcohol consumption, together with tobacco, is the best recognised risk factor for oral and pharyngeal cancers (OPC), but several important aspects of this association need to be further explored. In order to provide up to date and more precise quantification of the association between alcohol drinking and OPC risk, we conducted a meta-analysis of available data. We performed a PubMed search of articles published up to September 2009, and we identified 43 case-control and two cohort studies presenting results for at least three categories of alcohol drinking, including a total of 17,085 OPC cases. We derived meta-analytic summary estimates using random-effects models, and taking into account correlation between estimates. We also performed a dose-risk analysis using non-linear random-effects meta-regression models. The pooled relative risk (RR) was 1.21 (95% confidence interval, CI, 1.10–1.33) for⩽1 drink per day, and rose to 5.24 (95% CI, 4.36–6.30) for heavy alcohol drinking (⩾4 drinks per day). The dose-risk analysis resulted in RR of 1.29 for 10g ethanol/day, 3.24 for 50g ethanol/day, 8.61 for 100g ethanol/day, and 13.02 for 125g ethanol/day. This meta-analysis provides more precise evidence of a gross excess of OPC risk for heavy alcohol drinkers. It also indicates an increased risk for moderate doses, i.e., ⩽1 drink or 10g ethanol/day. [Copyright &y& Elsevier]