WorldWideScience

Sample records for hutterites meta-analysis combining

  1. Meta analysis a guide to calibrating and combining statistical evidence

    CERN Document Server

    Kulinskaya, Elena; Staudte, Robert G

    2008-01-01

    Meta Analysis: A Guide to Calibrating and Combining Statistical Evidence acts as a source of basic methods for scientists wanting to combine evidence from different experiments. The authors aim to promote a deeper understanding of the notion of statistical evidence.The book is comprised of two parts - The Handbook, and The Theory. The Handbook is a guide for combining and interpreting experimental evidence to solve standard statistical problems. This section allows someone with a rudimentary knowledge in general statistics to apply the methods. The Theory provides the motivation, theory and results of simulation experiments to justify the methodology.This is a coherent introduction to the statistical concepts required to understand the authors' thesis that evidence in a test statistic can often be calibrated when transformed to the right scale.

  2. Combining individual participant and aggregated data in a meta-analysis with correlational studies.

    Science.gov (United States)

    Pigott, Terri; Williams, Ryan; Polanin, Joshua

    2012-12-01

    This paper presents methods for combining individual participant data (IPD) with aggregated study level data (AD) in a meta-analysis of correlational studies. Although medical researchers have employed IPD in a wide range of studies, only a single example exists in the social sciences. New policies at the National Science Foundation requiring grantees to submit data archiving plans may increase social scientists' access to individual level data that could be combined with traditional meta-analysis. The methods presented here extend prior work on IPD to meta-analyses using correlational studies. The examples presented illustrate the synthesis of publicly available national datasets in education with aggregated study data from a meta-analysis examining the correlation of socioeconomic status measures and academic achievement. The major benefit of the inclusion of the individual level is that both within-study and between-study interactions among moderators of effect size can be estimated. Given the potential growth in data archives in the social sciences, we should see a corresponding increase in the ability to synthesize IPD and AD in a single meta-analysis, leading to a more complete understanding of how within-study and between-study moderators relate to effect size. Copyright © 2012 John Wiley & Sons, Ltd.

  3. Combining multiple imputation and meta-analysis with individual participant data.

    Science.gov (United States)

    Burgess, Stephen; White, Ian R; Resche-Rigon, Matthieu; Wood, Angela M

    2013-11-20

    Multiple imputation is a strategy for the analysis of incomplete data such that the impact of the missingness on the power and bias of estimates is mitigated. When data from multiple studies are collated, we can propose both within-study and multilevel imputation models to impute missing data on covariates. It is not clear how to choose between imputation models or how to combine imputation and inverse-variance weighted meta-analysis methods. This is especially important as often different studies measure data on different variables, meaning that we may need to impute data on a variable which is systematically missing in a particular study. In this paper, we consider a simulation analysis of sporadically missing data in a single covariate with a linear analysis model and discuss how the results would be applicable to the case of systematically missing data. We find in this context that ensuring the congeniality of the imputation and analysis models is important to give correct standard errors and confidence intervals. For example, if the analysis model allows between-study heterogeneity of a parameter, then we should incorporate this heterogeneity into the imputation model to maintain the congeniality of the two models. In an inverse-variance weighted meta-analysis, we should impute missing data and apply Rubin's rules at the study level prior to meta-analysis, rather than meta-analyzing each of the multiple imputations and then combining the meta-analysis estimates using Rubin's rules. We illustrate the results using data from the Emerging Risk Factors Collaboration.

  4. Meta-analysis of individual and combined effects of mycotoxins on growing pigs

    Directory of Open Access Journals (Sweden)

    Ines Andretta

    2016-08-01

    Full Text Available ABSTRACT Little is known about the toxicity of concomitantly occurring mycotoxins in pig diets. This study was conducted to evaluate, through meta-analysis, the individual and the combined effects of mycotoxins on pig performance. The meta-analysis followed three sequential analyses (graphical, correlation, and variance-covariance based on a database composed of 85 published papers, 1,012 treatments and 13,196 animals. Contamination of diets with individual mycotoxins reduced (p < 0.05 feed intake by 14 % and weight gain by 17 %, while combined mycotoxins reduced the same responses by 42 % and 45 %, respectively, in comparison with the non-challenged group. The correlation (p < 0.05 between reduction in weight gain (ΔG and reduction in feed intake (ΔFI was 0.67 in individual challenges and 0.93 in combined challenges. The estimated ΔG was –6 % in individual challenges and –7 % in combined challenges when ΔFI was zero, suggesting an increase in the maintenance requirements of challenged animals. Most of ΔG (58 % in individual challenges and 84 % in combined challenges was attributed to the changes in feed efficiency. The association of mycotoxins enhances individual toxic effects and the ΔFI is important in explaining the deleterious effects on the growth of challenged pigs.

  5. Fixed-dose combination vs monotherapy in hypertension: a meta-analysis evaluation.

    Science.gov (United States)

    Hilleman, D E; Ryschon, K L; Mohiuddin, S M; Wurdeman, R L

    1999-07-01

    Fixed-dose combination antihypertensive therapy has received interest since the publication of the JNC-VI report. Relatively few head-to-head comparative studies between fixed-dose combinations and first-line monotherapies for hypertension have been published. The objective of this study was to conduct a meta-analysis of various first-line monotherapies and the fixed-dose combination of amlodipine/benazepril. The results of the meta-analysis were used to compare the efficacy and safety of the first-line monotherapies with amlodipine/benazepril. The meta-analysis included 82 studies that included 110 treatment groups (cohorts). The study compared nine different monotherapies and one combination therapy (amlodipine/benazepril). Of the 82 studies, 22 were placebo-controlled and 60 were active treatment controlled. The mean absolute decrease in supine diastolic blood pressure (BP) ranged from 9.7 to 13.3 mm Hg with verapamil showing the greatest effect and captopril the least (13.3 +/- 3.0 mm Hg; 9.7 +/- 2.9 mm Hg, respectively). When studies were weighted by sample size, atenolol, verapamil, lisinopril and amlodipine/benazepril showed the greatest BP effect. When studies were weighted by variance, amlodipine/benazepril and atenolol showed the greatest BP effect. The percentage of patients controlled on therapy ranged from 54% to 79%. Lisinopril and amlodipine/benazepril showed the greatest percent controlled. The overall incidence of adverse effects ranged from 12.1% to 41.8% with lisinopril having the lowest and nifedipine having the highest incidence. The overall incidence of adverse effects resulting in drug discontinuance ranged from 1.3% to 10.7%, with amlodipine/benazepril having the lowest and nifedipine having the highest incidence. The results of the meta-analysis indicate that amlodipine/benazepril produces above average reductions in BP with a lower than average incidence of overall side effects and the lowest incidence of adverse effects resulting in drug

  6. Mechanical versus clinical data combination in selection and admissions decisions: a meta-analysis.

    Science.gov (United States)

    Kuncel, Nathan R; Klieger, David M; Connelly, Brian S; Ones, Deniz S

    2013-11-01

    In employee selection and academic admission decisions, holistic (clinical) data combination methods continue to be relied upon and preferred by practitioners in our field. This meta-analysis examined and compared the relative predictive power of mechanical methods versus holistic methods in predicting multiple work (advancement, supervisory ratings of performance, and training performance) and academic (grade point average) criteria. There was consistent and substantial loss of validity when data were combined holistically-even by experts who are knowledgeable about the jobs and organizations in question-across multiple criteria in work and academic settings. In predicting job performance, the difference between the validity of mechanical and holistic data combination methods translated into an improvement in prediction of more than 50%. Implications for evidence-based practice are discussed. (c) 2013 APA, all rights reserved.

  7. The benefit of adjuvant chemotherapy combined with postoperative radiotherapy for endometrial cancer: a meta-analysis.

    Science.gov (United States)

    Park, Hyun Jong; Nam, Eun Ji; Kim, Sunghoon; Kim, Yong Bae; Kim, Young Tae

    2013-09-01

    The objective of our study was to determine whether adjuvant chemotherapy combined with postoperative radiotherapy would have benefits for the disease-free survival and overall survival in patients with high-risk endometrial cancer. Electronic searches for studies of adjuvant chemotherapy combined with postoperative radiotherapy in endometrial cancer patients between March 1971 and March 2012 were made on MEDLINE, SCOPUS, and the Cochrane library. Articles with more than 4 stars on the Newcastle-Ottawa scale or a score of more than 4 on the modified Jadad scale were included. A meta-analysis was performed, and pooled hazard ratios (HR) of progression-free survival (PFS) and overall survival (OS) between patients whose adjuvant chemotherapy was combined with radiotherapy (the CTx+RTx group) and patients with adjuvant radiotherapy only (the RTx group) were derived from the fixed effect model or random effect model. Three observational studies and 3 randomized clinical trials (RCTs) were included in the final analysis. Subgroup analysis for FIGO stage showed that the CTx+RTx group had a more significant survival benefit compared to that of the RTx group in advanced stage endometrial cancer (OS HR 0.53, 95% CI 0.36-0.80; PFS HR 0.54, 95% CI 0.37-0.77), but no significant benefit in early stage endometrial cancer (OS HR 0.96, 95% CI 0.70-1.32; PFS HR 1.00, 95% CI 0.39-2.58). This meta-analysis suggests that adjuvant chemotherapy combined with postoperative radiotherapy could probably reduce disease progression and overall death in patients with advanced-stage disease. In order to examine whether the multimodal treatment has benefit in high-risk endometrial cancer, we need further large-scale RCTs. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. A meta-analysis of bevacizumab combined with chemotherapy in the treatment of ovarian cancer

    Directory of Open Access Journals (Sweden)

    T S Wang

    2014-01-01

    Full Text Available Introduction: Angiogenesis plays an important role in the biology of ovarian cancer. The clinical efficacy and side effects of bevacizumab, the vascular endothelial growth factor inhibitor, on survival and toxicity in women with this ovarian cancer, was not conclusive. We performed this systematic review and meta-analysis in order to clarify the efficacy of bevacizumab combined with chemotherapy in the treatment of ovarian cancer. Materials and Methods: We searched the electronic database of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CNKI for clinical controlled trials of comparing bevacizumab combined with chemotherapy and chemotherapy alone in the treatment of ovarian cancer. The primary outcomes of eligible studies included median progression-free survival (PFS, overall survival (OS, and toxicities such as enterobrosis, hypertension, albuminuria, congestive heart failure (CHF, neutrophils, thrombosis, and bleeding. The Hazard ratio (HR and relative risk were used for the meta-analysis and were expressed with 95% confidence intervals (CIs. All the statistical analyses were carried out by  Stata 11.0 software (http://www.stata.com; Stata Corporation, College Station, TX, USA. Results: We included 5 studies with 1798 cases in the bevacizumab combined with the chemotherapy group and 1810 subjects in the chemotherapy alone group. The pooled results showed that bevacizumab + chemotherapy compared with chemotherapy alone can significant prolong the median PFS (HR, 0.64; 95% CI, 0.46-0.82; P 0.05; the toxicity analysis showed that the enterobrosis, hypertension, albuminuria, neutrophils, thrombosis, and bleeding were significantly increased in the bevacizumab + chemotherapy group compared with chemotherapy alone (Pall 0.05. Conclusion: Bevacizumab combined with chemotherapy prolonged the median PFS in patients with ovarian cancer but also increase the risk of developing enterobrosis, hypertension, albuminuria, neutrophils

  9. Combination Therapy of Ursodeoxycholic Acid and Corticosteroids for Primary Biliary Cirrhosis with Features of Autoimmune Hepatitis: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yan Zhang

    2013-01-01

    Full Text Available A meta-analysis was performed of RCTs comparing therapies that combine UDCA and corticosteroids with UDCA monotherapy. In this paper, we found that the combination therapy of UDCA and corticosteroids was more effective for PBC-AIH.

  10. Meta-analysis of pathway enrichment: combining independent and dependent omics data sets.

    Directory of Open Access Journals (Sweden)

    Alexander Kaever

    Full Text Available A major challenge in current systems biology is the combination and integrative analysis of large data sets obtained from different high-throughput omics platforms, such as mass spectrometry based Metabolomics and Proteomics or DNA microarray or RNA-seq-based Transcriptomics. Especially in the case of non-targeted Metabolomics experiments, where it is often impossible to unambiguously map ion features from mass spectrometry analysis to metabolites, the integration of more reliable omics technologies is highly desirable. A popular method for the knowledge-based interpretation of single data sets is the (Gene Set Enrichment Analysis. In order to combine the results from different analyses, we introduce a methodical framework for the meta-analysis of p-values obtained from Pathway Enrichment Analysis (Set Enrichment Analysis based on pathways of multiple dependent or independent data sets from different omics platforms. For dependent data sets, e.g. obtained from the same biological samples, the framework utilizes a covariance estimation procedure based on the nonsignificant pathways in single data set enrichment analysis. The framework is evaluated and applied in the joint analysis of Metabolomics mass spectrometry and Transcriptomics DNA microarray data in the context of plant wounding. In extensive studies of simulated data set dependence, the introduced correlation could be fully reconstructed by means of the covariance estimation based on pathway enrichment. By restricting the range of p-values of pathways considered in the estimation, the overestimation of correlation, which is introduced by the significant pathways, could be reduced. When applying the proposed methods to the real data sets, the meta-analysis was shown not only to be a powerful tool to investigate the correlation between different data sets and summarize the results of multiple analyses but also to distinguish experiment-specific key pathways.

  11. Meta-analysis of pathway enrichment: combining independent and dependent omics data sets.

    Science.gov (United States)

    Kaever, Alexander; Landesfeind, Manuel; Feussner, Kirstin; Morgenstern, Burkhard; Feussner, Ivo; Meinicke, Peter

    2014-01-01

    A major challenge in current systems biology is the combination and integrative analysis of large data sets obtained from different high-throughput omics platforms, such as mass spectrometry based Metabolomics and Proteomics or DNA microarray or RNA-seq-based Transcriptomics. Especially in the case of non-targeted Metabolomics experiments, where it is often impossible to unambiguously map ion features from mass spectrometry analysis to metabolites, the integration of more reliable omics technologies is highly desirable. A popular method for the knowledge-based interpretation of single data sets is the (Gene) Set Enrichment Analysis. In order to combine the results from different analyses, we introduce a methodical framework for the meta-analysis of p-values obtained from Pathway Enrichment Analysis (Set Enrichment Analysis based on pathways) of multiple dependent or independent data sets from different omics platforms. For dependent data sets, e.g. obtained from the same biological samples, the framework utilizes a covariance estimation procedure based on the nonsignificant pathways in single data set enrichment analysis. The framework is evaluated and applied in the joint analysis of Metabolomics mass spectrometry and Transcriptomics DNA microarray data in the context of plant wounding. In extensive studies of simulated data set dependence, the introduced correlation could be fully reconstructed by means of the covariance estimation based on pathway enrichment. By restricting the range of p-values of pathways considered in the estimation, the overestimation of correlation, which is introduced by the significant pathways, could be reduced. When applying the proposed methods to the real data sets, the meta-analysis was shown not only to be a powerful tool to investigate the correlation between different data sets and summarize the results of multiple analyses but also to distinguish experiment-specific key pathways.

  12. Meta-Analysis of a Continuous Outcome Combining Individual Patient Data and Aggregate Data: A Method Based on Simulated Individual Patient Data

    Science.gov (United States)

    Yamaguchi, Yusuke; Sakamoto, Wataru; Goto, Masashi; Staessen, Jan A.; Wang, Jiguang; Gueyffier, Francois; Riley, Richard D.

    2014-01-01

    When some trials provide individual patient data (IPD) and the others provide only aggregate data (AD), meta-analysis methods for combining IPD and AD are required. We propose a method that reconstructs the missing IPD for AD trials by a Bayesian sampling procedure and then applies an IPD meta-analysis model to the mixture of simulated IPD and…

  13. Combination therapy of sorafenib and TACE for unresectable HCC: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Lei Liu

    Full Text Available BACKGROUND AND AIM: A large number of studies have tried to combine sorafenib with TACE for patients with unresectable hepatocellular carcinoma (HCC and the results were controversial. We conducted this systematic review and meta-analysis to evaluate the safety and efficacy of combination therapy of sorafenib and TACE in the management of unresectable HCC. METHODS: MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Library were searched from January 1990 to October 2013 and these databases were searched for appropriate studies combining TACE and sorafenib in treatment of HCC. Two authors independently reviewed the databases and extracted the data and disagreements were resolved by discussion. Effective value and safety were analyzed. Effective value included disease control rate (DCR, time to progression (TTP and overall survival (OS. RESULTS: 17 studies were included in the study. In the 10 noncomparative studies, DCR ranged from 18.4 to 91.2%. Median TTP ranged from 7.1 to 9.0 months, and median OS ranged from 12 to 27 months. In the 7 comparative studies, the hazard ratio (HR for TTP was found to be 0.76 (95% CI 0.66-0.89; P<0.001 with low heterogeneity among studies (P = 0.243; I(2 = 25.5%. However, the HR for OS was found to be 0.81 (95% CI 0.65-1.01; P = 0.061 with low heterogeneity among studies (P = 0.259; I(2 = 25.4%. The common toxicities included fatigue, diarrhea, nausea, hand foot skin reaction (HFSR, hematological events, hepatotoxicity, alopecia, hepatotoxicity, hypertension and rash/desquamation. AEs are generally manageable with dose reductions. CONCLUSIONS: Combination therapy may bring benefits for unresectable HCC patients in terms of TTP but not OS. Further well-designed randomized controlled studies are needed to confirm the efficacy of combination therapy.

  14. Combination of meta-analysis and graph clustering to identify prognostic markers of ESCC

    Directory of Open Access Journals (Sweden)

    Hongyun Gao

    2012-01-01

    Full Text Available Esophageal squamous cell carcinoma (ESCC is one of the most malignant gastrointestinal cancers and occurs at a high frequency rate in China and other Asian countries. Recently, several molecular markers were identified for predicting ESCC. Notwithstanding, additional prognostic markers, with a clear understanding of their underlying roles, are still required. Through bioinformatics, a graph-clustering method by DPClus was used to detect co-expressed modules. The aim was to identify a set of discriminating genes that could be used for predicting ESCC through graph-clustering and GO-term analysis. The results showed that CXCL12, CYP2C9, TGM3, MAL, S100A9, EMP-1 and SPRR3 were highly associated with ESCC development. In our study, all their predicted roles were in line with previous reports, whereby the assumption that a combination of meta-analysis, graph-clustering and GO-term analysis is effective for both identifying differentially expressed genes, and reflecting on their functions in ESCC.

  15. Combination of meta-analysis and graph clustering to identify prognostic markers of ESCC.

    Science.gov (United States)

    Gao, Hongyun; Wang, Lishan; Cui, Shitao; Wang, Mingsong

    2012-04-01

    Esophageal squamous cell carcinoma (ESCC) is one of the most malignant gastrointestinal cancers and occurs at a high frequency rate in China and other Asian countries. Recently, several molecular markers were identified for predicting ESCC. Notwithstanding, additional prognostic markers, with a clear understanding of their underlying roles, are still required. Through bioinformatics, a graph-clustering method by DPClus was used to detect co-expressed modules. The aim was to identify a set of discriminating genes that could be used for predicting ESCC through graph-clustering and GO-term analysis. The results showed that CXCL12, CYP2C9, TGM3, MAL, S100A9, EMP-1 and SPRR3 were highly associated with ESCC development. In our study, all their predicted roles were in line with previous reports, whereby the assumption that a combination of meta-analysis, graph-clustering and GO-term analysis is effective for both identifying differentially expressed genes, and reflecting on their functions in ESCC.

  16. Radiotherapy combined with surgical treatment for retroperitoneal neoplasms: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Chang QIU

    2015-06-01

    Full Text Available Objective To systematic review the prognosis of radiotherapy combined with surgery for the treatment of retroperitoneal neoplasms. Methods Articles concerning randomized clinical trials (RCTs in which radiotherapy (pre-, intraand post-operation in combination with surgery was compared with surgery alone were retrieved by searching Cochrane Library ( Jun 2014, Medline ( Jan 1950–June 2014, Chinese Biomedical Literature Database ( Jan 1994–Jun 2014, Chinese Science and Technology Periodicals Database ( Jan 1994–Jun 2014, China National Knowledge Infrastructure ( Jan 1994–Jun 2014 and Wanfang Database ( Jan 1997–Jun 2014 in English and Chinese languages. The selection/inclusion criteria and exclusion criteria were ascertained by reviewing the relevant literature. The quality of data of RCTs were assessed by two researchers independently. The Stata 12.0 was used to analyze the data to calculate or extract the hazard ratio (HR and 95%CI. Descriptive analysis was used for the articles which are not suitable for meta-analysis. Results The appropriate articles were selected. A analysis of nine articles (including 1 Chinese paper and 8 English papers suggests that the combination of radiotherapy and surgery for RCTs is more effective than surgery alone (Merge HR=0.57, 95%CI: 0.40-0.74, P=0.000, and there was a statistically significant difference between two groups. Conclusion Retroperitoneal neoplasm patients should receive appropriate radiotherapy at the same time of surgery to improve the prognosis and elevate the survival rate. DOI: 10.11855/j.issn.0577-7402.2015.05.10

  17. Meta-analysis of combined therapy for adult hepatitis B virus-associated glomerulonephritis

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yong Zheng; Ri-Bao Wei; Li Tang; Ping Li; Xiao-Dong Zheng

    2012-01-01

    AIM:To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis (HBVGN) patients.METHODS:A computerized literature search was carried out in the PubMed database,Embase,the Cochrane Library,Chinese BioMedical Literature on disc,Chinese Medical Current Contents,Chinese National Knowledge Infrastructure,Wanfang and VIP (Chinese Technological Journal of Database) to collect articles between June 1980 and December 2010 on therapy with immunosuppressants,e.g.,glucorticosteroids,mycophenolate mofetil and leflunomide,combined with antivirals,e.g.,interferon,lamivudine,entecavir and adefovir dipivoxil,in adult HBV-GN patients.The primary outcomes were remission of proteinuria,clearance of HBV e-antigen,and elevation of serum albumin.The secondary outcomes were blood levels of alanine aminotransferase,serum creatinine,and HBV-DNA titer.Meta-analysis was performed using Review Manager 5.1.Fixed or random effect models were employed to combine the results after a heterogeneity test.The effects of the combined therapy were analyzed for different doses of glucorticosteroid and different types of HBV-GN.RESULTS:Twelve clinical trials with 317 patients were included.A significantly higher incidence of HBV-GN was found in male patients (relative risk =2.40,95%CI:1.98-2.93).Combined therapy reduced the proteinuria significantly with a mean difference of 4.19(95% CI:3.86-4.53) and increased the serum albumin concentration significantly with a mean difference of -11.95 (95% CI:-12.97-10.93) without significant alterations of liver function (mean difference:4.62,95%CI:-2.55-11.79) and renal function (mean difference:10.29,95% CI:0.14-20.45).No significant activation of HBV-DNA replication occurred (mean difference:0.12,95% CI:-0.37-0.62).There was no significant difference between the high dose glucorticosteroid group and the low dose glucorticosteroid group in terms of proteinuria

  18. Psychotherapy, Pharmacotherapy, and Their Combination for Adolescents with Major Depressive Disorder: A Meta-Analysis

    Science.gov (United States)

    Singh, Nikita; Reece, John

    2014-01-01

    This meta-analysis aims to inform clinical practice of treatment strategies for adolescents with major depressive disorder (MDD). The efficacy of three empirically validated treatments was compared to determine the most effective treatment. These were: cognitive-behavioural therapy (CBT), selective serotonin reuptake inhibitor (SSRI)…

  19. Meta-analysis on inoperable pancreatic cancer: A comparison between gemcitabine-based combination therapy and gemcitabine alone

    Institute of Scientific and Technical Information of China (English)

    De-Rong Xie; Han-Lin Liang; Yu Wang; Shuan-Shuan Guo; Qiong Yang

    2006-01-01

    AIM: To compare gemcitabine-based combination therapy and gemcitabine (GEM) alone in patients with advanced pancreatic cancer (APCa) through metaanalysis.METHODS: MEDLINE and EMBASE searches were supplemented by information from trial registers of randomized controlled trials (RCTs) for GEM-based combination therapy and GEM alone for APCa. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available RCTs. The meta-analysis involved overall survival (OS), objective remission rate (ORR), clinical benefit rate (CBR), time to progress/progress free survival (TTP/PFS) and toxicity.RESULTS: The meta-analysis included 22 RCTs. There was significant improvement in the GEM combination group with regard to the 6-mo survival rate (RD = 0.04,95% CI 0.01-0.06, P = 0.008), 1-year survival rate (RD = 0.03, 95% CI 0.01-0.05, P = 0.01), ORR (RD =0.04, 95% CT 0.01-0.07, P = 0.02), CBR (RD = 0.10,95% CI 0.02-0.17, P = 0.01) and 6-mo TTP/PFS (RD =0.07, 95% CI 0.04-0.10, P < 0.00001). However, the Grade 3-4 toxicity set by WHO was higher for the GEM combination group for neutropenia (RD = 0.05, 95%CI 0.01-0.10, P = 0.02), thrombocytopenia (RD = 0.05,95% CI 0.02-0.08, P = 0.002) and vomiting/nausea (RD= 0.03, 95% CI 0.00-0.05, P = 0.02).CONCLUSION: GEM-based combination therapy may improve the overall survival and palliation in optimal patients with APCa as compared with GEM alone.

  20. Combined intratympanic and systemic use of steroids for idiopathic sudden sensorineural hearing loss: a meta-analysis.

    Science.gov (United States)

    Gao, Yang; Liu, Dong

    2016-11-01

    The main objective of the meta-analysis was to investigate whether intratympanic steroid injections in combination with systemic steroids would provide an additional advantage over systemic steroid therapy (SST) alone in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). The results will provide a meaningful suggestion in clinical therapy of ISSNHL. The electronic database search was based on the database in OVID Medline, Embase and PubMed up to December 15, 2015 with the goal of identifying all available observational studies examining the effects of combination therapy and SST in ISSNHL patients. Observational studies that compared the pure tone average (PTA) improvement and recovery rate between combination therapy and SST group in ISSNHL patients were selected. Finally we have identified eight eligible studies that focused on comparing the combination therapy and SST in ISSNHL from designated researches. In the PTA improvement group, seven studies have been analyzed to compare the pooled mean differences between two therapy modalities and subgroups based on initial hearing loss and treatment delay. In the recovery rate group, six studies were calculated for pooled risk ratios and subgroup analysis was also conducted. Through our meta-analysis, we have reached the conclusion that combination therapy exhibited better outcomes in PTA improvement than SST alone, especially in severe-profound initial hearing loss cases. Combination therapy also showed advantages in recovery rate. Whether time of treatment delay would influence the PTA improvement and recovery rate requires further researches.

  1. Shenqifuzheng injection combined with chemotherapy in the treatment of advanced gastric cancer: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Kunhou Yao

    2014-01-01

    Full Text Available Objective: The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of Shenqifuzheng (SQFZ injection combined with chemotherapy in the treatment of advanced gastric cancer. Materials and Methods: We conducted an electronic search by using PubMed, EMBASE, ASCO, ESMO and Chinese National Knowledge Infratructure (CNKI, databases. The randomized controlled trials about Shenqifuzheng injection combined with chemotherapy versus chemotherapy alone in the treatment of advanced gastric cancer were reviewed and collected. Pooled odds ratio (OR for the response rate and KPS improvement were calculated using the software MetaAnalyst 3.1. Results: Fifteen trials met our inclusion criteria and finally included in this meta-analysis. The objective response rate (ORR in patients treated with Shenqifuzheng injection combined with chemotherapy was much higher than that of chemotherapy only (OR = 1.66, 95% CI: 1.20-2.29 with statistical significance (P < 0.05. The pooled data showed the combined treatment can significant increase the Karnofsky score (KPS compared with the chemotherapy only (OR = 3.74, 95% CI: 2.66-5.27 (P < 0.05. Conclusion: SQFZ injection combined with chemotherapy treatment regimen can improve the clinical efficacy and performance status in patients with advanced gastric cancer compared with chemotherapy alone.

  2. Comparative efficacy of combination bronchodilator therapies in COPD: a network meta-analysis

    Directory of Open Access Journals (Sweden)

    Huisman EL

    2015-09-01

    Full Text Available Eline L Huisman,1 Sarah M Cockle,2 Afisi S Ismaila,3,4 Andreas Karabis,1 Yogesh Suresh Punekar2 1Mapi Group, Real World Strategy and Analytics and Strategic Market Access, Houten, the Netherlands; 2Value Evidence and Outcomes, GlaxoSmithKline, Uxbridge, UK; 3Value Evidence and Outcomes, GlaxoSmithKline R&D, Research Triangle Park, NC, USA; 4Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Background: Several new fixed-dose combination bronchodilators have been recently launched, and assessing their efficacy relative to each other, and with open dual combinations is desirable. This network meta-analysis (NMA assessed the efficacy of umeclidinium and vilanterol (UMEC/VI with that of available dual bronchodilators in single/separate inhalers. Methods: A systematic literature review identified randomized controlled trials of ≥10 weeks among chronic obstructive pulmonary disease patients (≥40 years, assessing the efficacy of combination bronchodilators in single or separate inhalers. Comparative assessment was conducted on change from baseline in trough forced expiratory volume in 1 second (FEV1, St George’s Respiratory Questionnaire (SGRQ total scores, transitional dyspnea index (TDI focal scores, and rescue medication use at 12 weeks and 24 weeks using an NMA within a Bayesian framework. Results: A systematic literature review identified 77 articles of 26 trials comparing UMEC/VI, indacaterol/glycopyrronium (QVA149, formoterol plus tiotropium (TIO 18 µg, salmeterol plus TIO, or indacaterol plus TIO, with TIO and placebo as common comparators at 12 weeks and approximately 24 weeks. The NMA showed that at 24 weeks, efficacy of UMEC/VI was not significantly different compared with QVA149 on trough FEV1 (14.1 mL [95% credible interval: -14.2, 42.3], SGRQ total score (0.18 [-1.28, 1.63], TDI focal score (-0.30 [-0.73, 0.13], and rescue medication use (0.02 [-0.27, 0.32]; compared with salmeterol plus

  3. Meta-analysis of survival in patients with HNSCC discriminates risk depending on combined HPV and p16 status.

    Science.gov (United States)

    Coordes, Annekatrin; Lenz, Klaus; Qian, Xu; Lenarz, Minoo; Kaufmann, Andreas M; Albers, Andreas E

    2016-08-01

    Data indicate a better prognosis for human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC). HPV and p16 detection are established markers for HPV-related HNSCC. Both are accepted as survival-independent predictors. Previous studies investigating the survival in HNSCC patients depending on HPV(+/-) and p16(+/-) status consistently found discordant results with p16(-)/HPV(+) and p16(+)/HPV(-). However, no meta-analysis regarding the survival according to combined HPV/p16 status has been performed yet. The objective of this study was to discriminate the impact of combined HPV(+/-) and p16(+/-) status on survival. Data sources were identification and review of publications assessing survival of the distinct subgroups with both p16 and HPV investigated in HNSCC until February, 2015. A meta-analysis was performed to classify survival and clinical outcomes. 18 out of 397 articles (4424 patients) were eligible for the meta-analysis. The percent proportion of the subgroups was 25 % for HPV(+)/p16(+), 61.2 % for HPV(-)/p16(-), 7.1 % for HPV(-)/p16(+) and 6.8 % for HPV(+)/P16(-). The meta-analysis showed a significantly improved 5-year overall survival (OS), 5-year disease-free survival and their corresponding hazard ratio for HPV(+)/p16(+) HNSCC in comparison to HPV(-)/p16(-), HPV(+)/p16(-) and HPV(-)/p16(+). The 5-year OS of the HPV(-)/p16(+) subgroup was intermediate while HPV(+)/p16(-) and HPV(-)/p16(-) HNSCC had the shortest survival. With current therapeutic strategies, survival of patients with HNSCC is better if associated with HPV(+)/p16(+) or HPV(-)/p16(+). Clinical trials are needed to confirm the distinct survival pattern and to investigate possible differences in survival for HPV(+)/p16(-) and HPV(-)/p16(+) HNSCC. To further differentiate p16(+) HNSCC, HPV testing may be advisable.

  4. Disturbed by Meta-Analysis?

    Science.gov (United States)

    Wachter, Kenneth W.

    1988-01-01

    Defines meta-analysis as statistical procedures for combining results from previous separate studies. Discusses four charges promoted by some skeptics as it relates to this statistical procedure. States that many of the trends making a place for meta-analysis are disturbing. (RT)

  5. The Efficacy and Safety of Entecavir and Interferon Combination Therapy for Chronic Hepatitis B Virus Infection: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Qiao-Ling Xie

    Full Text Available The objective of this study was to evaluate the effectiveness and safety of entecavir (ETV and interferon (IFN combination therapy in the treatment of chronic hepatitis B (CHB mono-infection via a meta-analysis of randomized controlled trials (RCTs. All eligible RCTs evaluating combination therapy for treating CHB were identified from nine electronic databases. A meta-analysis was performed in accordance with the Cochrane Systemic Review handbook. Eleven trials encompassing 1010 participants were included in this meta-analysis. It showed that at 12 and ≥ 96 weeks of therapy, the combination of ETV and IFN was not better than ETV in improving the undetectable HBV DNA (12 weeks: RR=1.12, 95% CI=0.88-1.42; ≥ 96 weeks: RR = 0.64, 95% CI=0.21-1.98, respectively and HBeAg seroconversion rates (12 weeks: RR=1.35, 95% CI=0.60-3.04; ≥ 96 weeks: RR=1.36, 95% CI=0.75-2.64, respectively. But at 48 weeks of therapy and approximately 2 years of follow up, combination therapy was superior to ETV in improving the undetectable HBV DNA (48 weeks: RR=1.46, 95% CI=1.13-1.90; follow up: RR=2.20, 95% CI=1.26-3.81, respectively and HBeAg seroconversion rates (48 weeks: RR=1.82, 95% CI=1.44-2.30; follow up: RR=1.92, 95% CI=1.19-3.11, respectively. When compared to IFN group, at 24 and 48 weeks of therapy, combination group showed a greater undetectable HBV DNA (24 weeks: RR=2.14, 95% CI=1.59-2.89; 48 weeks: RR=2.28, 95% CI=1.54-3.37, respectively and ALT normalization rate (24 weeks: RR=1.56, 95% CI= 1.24-1.96; 48 weeks: RR=1.55, 95% CI = 1.16-2.07, respectively. At 48 weeks of therapy, combination group achieved a greater HBeAg seroconversion rate than IFN (48 weeks: RR=1.58, 95% CI=1.24-2.00. No significant differences were observed in the side effects of the three therapies. So we can conclude that ETV and IFN combination therapy is more effective than ETV or IFN mono-therapy in CHB treatment. ETV, IFN, and the combination of the two are safe in CHB treatment.

  6. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

    Science.gov (United States)

    SAATCHI, Masoud; SHOKRANEH, Ali; NAVAEI, Hooman; MARACY, Mohammad Reza; SHOJAEI, Hasan

    2014-01-01

    Objective Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. Material and Methods A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Results Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115). Conclusions According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of

  7. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Masoud SAATCHI

    2014-10-01

    Full Text Available Objective: Enterococcus faecalis (E. faecalis is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH. Whether a combination of CH and chlorhexidine (CHX is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. Material and Methods: A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Results: Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles. Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001. Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115. Conclusions: According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate

  8. Efficacy and safety of target combined chemotherapy in advanced gastric cancer: a meta-analysis and system review.

    Science.gov (United States)

    Zou, Kun; Yang, Shuailong; Zheng, Liang; Yang, Chaogang; Xiong, Bin

    2016-09-15

    The aim of our meta-analysis is to assess the efficacy and safety of the target combined chemotherapy for the patients with unresectable advanced or recurrent gastric cancer. In accordance with the standard meta-analysis procedures, the patients included in our study were with unresectable advanced or recurrent gastric cancer and allocated randomly to receive target combined chemotherapy or the traditional chemotherapy. The search was applied to PubMed, EMBASE, Science Citation Index Expanded, Cocran's library (from inception to February 2016). All analyses were performed by STATA 12.0, with the odds ratio, hazard ratio, and 95 % confidence interval as the effect measures. Fourteen studies were included in this meta-analysis. A total of 5067 patients with advanced gastric cancer were divided into two arms: traditional chemotherapy arm and target combined chemotherapy arm. A significant improvement for overall survival (hazard ratio was 0.89, 95 % confidence interval: 0.83-0.95) and overall response rate (odds ratio was 1.44, 95 % confidence interval: 1.15-1.81) was observed, but no significant difference was found for progression-free survival (hazard ratio was 0.89, 95 % confidence interval: 0.77-1.00) in the target combined chemotherapy arm. In subgroup analysis, increasing benefits regarding overall survival and progression-free survival were found in anti epidermal growth factor receptor target drugs for selected patients subgroup and anti vascular endothelial growth factor receptor target drugs for unselected patients subgroup, but not in anti epidermal growth factor receptor target drugs for unselected patients subgroup. Besides, some adverse events were increased in the target combined chemotherapy arm. The target combined chemotherapy represented a better overall survival benefit and treatment efficiency and higher incidence of some grade 3-4 adverse events than the traditional chemotherapy for patients with unresectable advanced or recurrence gastric

  9. The use of meta-analysis or research synthesis to combine driving simulation or naturalistic study results on driver distraction.

    Science.gov (United States)

    Caird, Jeff K; Johnston, Katherine A; Willness, Chelsea R; Asbridge, Mark

    2014-06-01

    Three important and inter-related topics are addressed in this paper. First, the importance of meta-analysis and research synthesis methods to combine studies on traffic safety, in general, and on driver distraction, in particular, is briefly reviewed. Second, naturalistic, epidemiologic, and driving simulation studies on driver distraction are used to illustrate convergent and divergent results that have accumulated thus far in this domain of research. In particular, mobile phone conversation, passenger presence, and text messaging naturalistic studies use meta-analyses and research syntheses to illustrate important patterns of results that are in need of more in-depth study. Third, a number of driver distraction study limitations such as poorly defined dependent variables, lack of methodological detail, and omission of statistical information prevent the integration of many studies into meta-analyses. In addition, the overall quality of road safety studies suffers from these same limitations and suggestions for improvement are made to guide researchers and reviewers. Practical Applications. The use of research synthesis and meta-analysis provide comprehensive estimates of the impact of distractions on driving performance, which can be used to guide public policy and future research.

  10. Effect of narrow band ultraviolet B phototherapy as monotherapy or combination therapy for vitiligo: a meta-analysis.

    Science.gov (United States)

    Li, Ronghua; Qiao, Meng; Wang, Xiaoyan; Zhao, Xintong; Sun, Qing

    2017-01-01

    The treatment of vitiligo is still one of the most difficult dermatological challenges, although there are many therapeutic options. Narrow band ultraviolet B (NB-UVB) phototherapy is considered to be a very important modality for generalized vitiligo. The aim of this study was to explore whether a combination of NB-UVB and topical agents would be superior to NB-UVB alone for treating vitiligo. We searched the electronic databases such as PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary outcome was the proportion of ≥50% repigmentation (a clinical significance), and secondary outcome was the proportion of ≥75% repigmentation (an excellent response). Seven randomized controlled trials (RCTs) involving 240 patients (413 lesions) were included in this meta-analysis. The study showed no significant difference between NB-UVB combination therapy (NB-UVB and topical calcineurin inhibitor or vitamin D analogs) and NB-UVB monotherapy in the outcomes of ≥50% repigmentation and ≥75% repigmentation. However, lesions located on the face and neck had better results in ≥50% repigmentation (RR = 1.40, 95% CI 1.08-1.81) and ≥75% repigmentation (RR = 1.88, 95% CI 1.10-3.20) with NB-UVB and topical calcineurin inhibitor combination therapy vs. NB-UVB monotherapy. The meta-analysis suggested that adding neither topical calcineurin inhibitors nor topical vitamin-D3 analogs on NB-UVB can yield significantly superior outcomes than NB-UVB monotherapy for treatment of vitiligo. However, addition of topical calcineurin inhibitors to NB-UVB may increase treatment outcomes in vitiligo affecting face and neck. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. A meta-analysis of the combined effect of housing and environmental enrichment characteristics on the behaviour and performance of pigs

    NARCIS (Netherlands)

    Averos, X.; Brossard, L.; Dourmad, J.Y.; Greef, de K.H.; Edge, H.L.; Edwards, S.A.; Meunier-Salaün, M.C.

    2010-01-01

    To quantify the combined effect of housing conditions and environmental enrichment on the behaviour and performance of pigs, a meta-analysis was performed using information from 45 experiments in 42 published manuscripts. Multiple regression models were applied to evaluate the effects of space allow

  12. Effect of combination therapy on joint destruction in rheumatoid arthritis: a network meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Niels Graudal

    Full Text Available BACKGROUND: Despite significant cost differences, the comparative effect of combination treatments of disease modifying anti-rheumatic drugs (DMARDs with and without biologic agents has rarely been examined. Thus we performed a network meta-analysis on the effect of combination therapies on progression of radiographic joint erosions in patients with rheumatoid arthritis (RA. METHODS AND FINDINGS: The following combination drug therapies compared versus single DMARD were investigated: Double DMARD: 2 DMARDs (methotrexate, sulfasalazine, leflunomide, injectable gold, cyclosporine, chloroquine, azathioprin, penicillamin or 1 DMARD plus low dose glucocorticoid (LDGC; triple DMARD: 3 DMARDs or 2 DMARDs plus LDGC; biologic combination: 1 DMARD plus biologic agent (tumor necrosis factor α inhibitor (TNFi or abatacept or tocilizumab or CD20 inhibitor (CD20i. Randomized controlled trials were identified in a search of electronic archives of biomedical literature and included in a star-shaped network meta-analysis and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement protocol. Effects are reported as standardized mean differences (SMD. The effects of data from 39 trials published in the period 1989-2012 were as follows: Double DMARD: -0.32 SMD (CI: -0.42, -0.22; triple DMARD: -0.46 SMD (CI: -0.60, -0.31; 1 DMARD plus TNFi: -0.30 SMD (CI: -0.36, -0.25; 1 DMARD plus abatacept: -0.20 SMD (CI: -0.33, -0.07; 1 DMARD plus tocilizumab: -0.34 SMD (CI: -0.48, -0.20; 1 DMARD plus CD20i: -0.32 SMD (CI: -0.40, -0.24. The indirect comparisons showed similar effects between combination treatments apart from triple DMARD being significantly better than abatacept plus methotrexate (-0.26 SMD (CI: -0.45, -0.07 and TNFi plus methotrexate (-0.16 SMD (CI: -0.31, -0.01. CONCLUSION: Combination treatment of a biologic agent with 1 DMARD is not superior to 2-3 DMARDs including or excluding LDGC in preventing

  13. Effect of topical calcineurin inhibitors as monotherapy or combined with phototherapy for vitiligo treatment: a meta-analysis.

    Science.gov (United States)

    Dang, Yu-Ping; Li, Qiang; Shi, Fei; Yuan, Xiao-Ying; Liu, Wei

    2016-01-01

    Vitiligo is a common skin disease for which immunomodulating calcineurin inhibitors have been considered reasonable treatment. We searched the MEDLINE, Embase, and Cochrane central register of controlled trials databases for articles published prior to September 2014. Thirteen studies were included in the meta-analysis. After pooling the trials, we concluded that calcineurin inhibitors showed a better therapeutic effect on vitiligo than placebo, according to lesion report (RR = 2.62, 95%CI, 1.39-4.93, p = 0.003) and patient report (RR = 1.42, 95%, 0.87-2.31, p = 0.157). Subgroup analysis was performed to determine whether the combination with phototherapy was a source of heterogeneity. The trial sequence analysis indicated that the results of combined therapy by lesion report were reliable and conclusive. However, in the patient report trials, the frequency of lesions on the hand and foot was higher, and the effect of combined therapy was still not significant. Calcineurin inhibitors showed a better therapeutic effect than placebo in the treatment of vitiligo with phototherapy. However, the typical UV-resistant sites (i.e., hand and foot) were still difficult to cure even with combined therapy. Because of concerns about photocarcinogenesis, the clinical application of combined therapy should be explored with caution.

  14. A Meta-Analysis of Arsenic Trioxide Combined with Transcatheter Arterial Chemoembolization for Treatment of Primary Hepatic Carcinoma

    Directory of Open Access Journals (Sweden)

    Ling He

    2016-01-01

    Full Text Available Primary hepatic carcinoma (PHC is one of the most common malignant tumours in the world. More and more research has shown that As2O3 combined with TACE has a good curative effect in treating PHC. The objectives of this study were to evaluate the therapeutic efficacy and safety of As2O3 combined with TACE in treating PHC. The CNKI, VIP, Wanfang, PubMed, and Cochrane databases were searched from their inception until December 2015. Randomized controlled trials (RCTs comparing As2O3 combined with TACE versus TACE alone in treating PHC were identified. Stata SE 12.0 was used for data analysis. 17 RCTs with 1055 patients were included. Meta-analysis showed that, compared with TACE alone, As2O3 combined with TACE showed significant effects in improving the clinical efficacy rate (P<0.01, decreasing the value of alpha-fetoprotein (P<0.01, increasing the one-year survival rate (P<0.01, and improving the quality of life of PHC patients (P<0.01. Fifteen studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, As2O3 combined with TACE therapy appears to be potentially effective in treating PHC and is generally safe. However, further studies with rigorous designs trials and multiregional cooperation trials are needed.

  15. Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    von Wolff Alessa

    2012-06-01

    Full Text Available Abstract Background Chronic depression represents a substantial portion of depressive disorders and is associated with severe consequences. This review examined whether the combination of pharmacological treatments and psychotherapy is associated with higher effectiveness than pharmacotherapy alone via meta-analysis; and identified possible treatment effect modifiers via meta-regression-analysis. Methods A systematic search was conducted in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL, MEDLINE, EMBASE, ISI Web of Science, BIOSIS, PsycINFO, and CINAHL. Primary efficacy outcome was a response to treatment; primary acceptance outcome was dropping out of the study. Only randomized controlled trials were considered. Results We identified 8 studies with a total of 9 relevant comparisons. Our analysis revealed small, but statistically not significant effects of combined therapies on outcomes directly related to depression (BR = 1.20 with substantial heterogeneity between studies (I² = 67%. Three treatment effect modifiers were identified: target disorders, the type of psychotherapy and the type of pharmacotherapy. Small but statistically significant effects of combined therapies on quality of life (SMD = 0.18 were revealed. No differences in acceptance rates and the long-term effects between combined treatments and pure pharmacological interventions were observed. Conclusions This systematic review could not provide clear evidence for the combination of pharmacotherapy and psychotherapy. However, due to the small amount of primary studies further research is needed for a conclusive decision.

  16. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis

    Science.gov (United States)

    Stegeman, Bernardine H; de Bastos, Marcos; Rosendaal, Frits R; van Hylckama Vlieg, A; Helmerhorst, Frans M; Stijnen, Theo

    2013-01-01

    Objective To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. Design Systematic review and network meta-analysis. Data sources PubMed, Embase, Web of Science, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, and ScienceDirect up to 22 April 2013. Review methods Observational studies that assessed the effect of combined oral contraceptives on venous thrombosis in healthy women. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported. The requirement for crude numbers did not allow adjustment for potential confounding variables. Results 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 1.9 and 3.7 per 10 000 woman years, in line with previously reported incidences of 1-6 per 10 000 woman years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 µg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene, desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk. Conclusion All combined oral contraceptives investigated in this analysis were

  17. Evaluation of Individual and Combined Applications of Serum Biomarkers for Diagnosis of Hepatocellular Carcinoma: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Bin Hu

    2013-12-01

    Full Text Available The clinical value of Serum alpha-fetoprotein (AFP to detect early hepatocellular carcinoma (HCC has been questioned due to its low sensitivity and specificity found in recent years. Other than AFP, several new serum biomarkers including the circulating AFP isoform AFP-L3, des-gamma-carboxy prothrombin (DCP and Golgi protein-73 (GP73 have been identified as useful HCC markers. In this investigation, we review the current knowledge about these HCC-related biomarkers, and sum up the results of our meta-analysis on studies that have addressed the utility of these biomarkers in early detection and prognostic prediction of HCC. A systematic search in PubMed, Web of Science, and the Cochrane Library was performed for articles published in English from 1999 to 2012, focusing on serum biomarkers for HCC detection. Data on sensitivity and specificity of tests were extracted from 40 articles that met the inclusion criteria, and the summary receiver operating characteristic curve (sROC was obtained. A meta-analysis was carried out in which the area under the curve (AUC for each biomarker or biomarker combinations (AFP, DCP, GP73, AFP-L3, AFP + DCP, AFP + AFP-L3, and AFP + GP73 was used to compare the diagnostic accuracy of different biomarker tests. The AUC of AFP, DCP, GP73, AFP-L3, AFP + DCP, AFP + AFP-L3, and AFP + GP73 are 0.835, 0.797, 0.914, 0.710, 0.874, 0.748, and 0.932 respectively. A combination of AFP + GP73 is superior to AFP in detecting HCC and differentiating HCC patients from non-HCC patients, and may prove to be a useful marker in the diagnosis and screening of HCC. In addition, the AUC of GP73, AFP + DCP and AFP + GP73 are better than that of AFP. The clinical value of GP73, AFP + DCP, or AFP + GP73 as serological markers for HCC diagnosis needs to be addressed further in future studies.

  18. Combination therapy of renin-angiotensin system inhibitors plus calcium channel blockers versus other two-drug combinations for hypertension: a systematic review and meta-analysis.

    Science.gov (United States)

    Lu, Z; Chen, Y; Li, L; Wang, G; Xue, H; Tang, W

    2017-01-01

    Many randomized clinical trials (RCTs) have investigated the efficacy and safety of renin-angiotensin system inhibitors (RASIs) plus calcium channel blockers (CCBs), compared with other two-drug combinations, but systematic assessment in this aspect is still lacking. We carried out the present meta-analysis of randomized controlled trials to evaluate the long-term effect and safety of RASIs plus CCBs. Literatures were searched in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials in September 2014. A fixed-effect model was used to estimate the pooled effect of trials identified. Thirty-four trials with 41 694 patients were included. Compared with RASIs plus diuretics, RASIs plus CCBs decreased total cardiovascular (CV) events (relative risk (RR) 0.82, 95% confidence interval (CI): 0.75, 0.91, adjusted RR (ARR) 1.7%) and withdrawals due to adverse effect (WDAE) (RR 0.87, 95% CI: 0.80, 0.94, ARR 1.3%). Compared with CCBs plus diuretics, RASIs plus CCBs decreased WDAE (RR 0.63, 95% CI: 0.45, 0.90, ARR 1.1%). Our meta-analysis indicates that RASIs plus CCBs provide a superior safety and prevention of CV events to RASIs plus diuretics, whereas this combination is also safer than CCBs plus diuretics. We also raise a new hypothesis. More high-quality RCTs focused on hard end points with CV, cerebrovascular and renal events are needed to confirm the hypothesis we have brought out.

  19. [Combined epidural-spinal analgesia during labor: a quantitative systematic review of the literature (meta-analysis)].

    Science.gov (United States)

    Pascual-Ramírez, J; Haya Palazuelo, J; Valverde Mantecón, J M

    2013-11-01

    To perform a meta-analysis on the use of combined epidural-intrathecal analgesia during labor, including intrathecal fentanyl and/or morphine compared to usual epidural techniques. A literature search was made looking for randomized clinical trials in MEDLINE, EMBASE and Cochrane Library. The size of the effect for quantitative variables was analyzed by weighted mean difference; for qualitative variables, by odds ratio. Variables analyzed were: labor duration, type of delivery (spontaneous, instrumental and caesarean section), motor blockade, pain, and satisfaction. The analysis used in most cases was a random effects model. A total of 21 trials, which included 3.646 patients, were selected out of the 38 initially found. The type of delivery variable with its 3 subgroups was the only one to show uniformity (p>Q 0.1; I(2)<50%). There were no differences in the variables analyzed except pain, which was advantageous for the group with intrathecal fentanyl or morphine by 0.55 points out of 10. Combined analgesia including intrathecal fentanyl-morphine does not offer significant advantages compared to the standard epidural. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  20. Meta-analysis of gemcitabine and cisplatin combination chemotherapy versus gemcitabine alone for pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Diyu Huang

    2016-01-01

    Conclusions: Overall response rate, stable disease, and progressive disease, as well as 1-year survival rate in patients who received GEM + CIS, were superior to those treated with GEM alone. Combination chemotherapy with GEM and CIS may offer greater benefits in the treatment of pancreatic cancer than that of GEM alone although the combination group had higher hematological toxicities.

  1. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis.

    Science.gov (United States)

    Barbosa, Fabiano Timbó; da Cunha, Rafael Martins; da Silva Ramos, Fernando Wagner; de Lima, Fernando José Camello; Rodrigues, Amanda Karine Barros; do Nascimento Galvão, Ailton Mota; de Sousa-Rodrigues, Célio Fernando; Lima, Paula Monique Barbosa

    2016-01-01

    Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32-1.95), MI (RR=0.96, 95% CI=0.52-1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50-0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA has been used in association with general anesthesia (GA for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA, myocardial infarction (MI, length of hospital stay (LHS, length of ICU stay (ICUS, reoperations, blood transfusion (BT, quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD was estimated for continuous variables, and relative risk (RR and risk difference (RD for categorical variables. RESULTS: 17 original articles analyzed. Meta-analysis of mortality (RD = -0.01, 95% CI = -0.03 to 0.01, CVA (RR = 0.79, 95% CI = 0.32-1.95, MI (RR = 0.96, 95% CI = 0.52-1.79 and LHS (MD = -1.94, 95% CI = -3.99 to 0.12 were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50-0.93. ICUS was lower in NA (MD = -2.09, 95% CI = -2.92 to -1.26. CONCLUSION: There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.

  3. Combined EGFR and VEGFR versus single EGFR signaling pathways inhibition therapy for NSCLC: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Xinji Zhang

    Full Text Available BACKGROUND: Lung cancer is a heterogeneous disease with multiple signaling pathways influencing tumor cell survival and proliferation, and it is likely that blocking only one of these pathways allows others to act as salvage or escape mechanisms for cancer cells. Whether combined inhibition therapy has greater anti-tumor activity than single inhibition therapy is a matter of debate. Hence, a meta-analysis comparing therapy inhibiting both VEGFR and EGFR signaling pathways with that inhibiting EGFR signaling pathway alone was performed. METHODOLOGY AND PRINCIPAL FINDINGS: We searched PubMed, EMBASE database and the proceedings of major conferences for relevant clinical trials. Outcomes analyzed were objective tumor response rate (ORR, progression-free survival (PFS, overall survival (OS and toxicity. Besides, subgroup analyses were performed to investigate whether the combined inhibition therapy is best performed using combination of selective agents or a single agent with multiple targets. Six trials recruiting 3,302 patients were included in the analysis. Combined inhibition therapy was associated with a 3% improvement in OS as compared with single-targeted therapy, but this difference was not statistically significant (HR, 0.97; 95% CI, 0.89-1.05; P=0.472. Patients receiving combined inhibition therapy had significant longer PFS than the group with single-targeted therapy (HR, 0.80; 95% CI, 0.67-0.95; P=0.011. There was no difference in the ORR between the groups (OR, 1.44; 95% CI, 0.95-2.18; P=0.085. Subgroup analysis revealed that combined inhibition therapy using combination regimens was associated with statistically significant improvement in both ORR and PFS. Toxicity was greater in combined inhibition therapy. CONCLUSIONS: There is no evidence to support the use of combined inhibition therapy in unselected patients with advanced NSCLC. However, given the significant advantage in ORR and PFS, combined inhibition therapy using combination

  4. Which Combinations of Techniques in Internet Based Interventions Effectively Change Health Behavior? a Meta-analysis

    NARCIS (Netherlands)

    Genugten, L. van; Dusseldorp, E.; Webb, T.L.; Empelen, P. van

    2016-01-01

    Background: Many online interventions designed to promote health behaviors combine multiple behavior change techniques (BCTs) and additional modes of delivery (MoD, e.g. text messages) to maximize effectiveness. Also, usability factors may influence effectiveness. This study aims to identify

  5. Psychological treatment versus combined treatment of depression: A meta-analysis.

    NARCIS (Netherlands)

    Cuijpers, P.; Straten, van A.; Warmerdam, E.H.; Andersson, G.

    2009-01-01

    Background: A large number of studies have shown that psychological treatments have significant effects on depression. Although several studies have examined the relative effects of psychological and combined treatments, this has not been studied satisfactorily in recent statistical meta-analyses. M

  6. Combined Therapy of Diabetic Peripheral Neuropathy with Breviscapine and Mecobalamin: A Systematic Review and a Meta-Analysis of Chinese Studies

    OpenAIRE

    Chanjiao Zheng; Weilin Ou; Huanyu Shen; Zhiheng Zhou; Jiaji Wang

    2015-01-01

    Objective. A meta-analysis on combined therapy of diabetic peripheral neuropathy (DPN) with breviscapine and mecobalamin was performed to evaluate the efficacy of this therapy. Methods. Six English databases (Medline, Cochrane Library, PubMed, EMBASE, Web of Science, and CINAHL) and four Chinese databases (China National Knowledge Infrastructure, VIP Journals Database, CBM, and Wanfang database) were searched for studies on the clinical trials in which DPN was treated with breviscapine and me...

  7. Meta-Analysis of Pathway Enrichment: Combining Independent and Dependent Omics Data Sets

    OpenAIRE

    Kaever, Alexander; Landesfeind, Manuel; Feussner, Kirstin; Morgenstern, Burkhard; Feussner, Ivo; Meinicke, Peter

    2014-01-01

    A major challenge in current systems biology is the combination and integrative analysis of large data sets obtained from different high-throughput omics platforms, such as mass spectrometry based Metabolomics and Proteomics or DNA microarray or RNA-seq-based Transcriptomics. Especially in the case of non-targeted Metabolomics experiments, where it is often impossible to unambiguously map ion features from mass spectrometry analysis to metabolites, the integration of more reliable omics techn...

  8. LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Rodrigo GJ

    2017-03-01

    Full Text Available Gustavo J Rodrigo,1 David Price,2,3 Antonio Anzueto,4,5 Dave Singh,6 Pablo Altman,7 Giovanni Bader,8 Francesco Patalano,8 Robert Fogel,7 Konstantinos Kostikas8 1Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay; 2Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; 3Observational and Pragmatic Research Institute, Singapore; 4University of Texas Health Science Center, 5South Texas Veterans Health Care System, San Antonio, TX, USA; 6Medicines Evaluation Unit, National Institute for Health Research Respiratory and Allergy Clinical Research Facility, University Hospital of South Manchester NHS Foundation Trust, University of Manchester, Manchester, England, UK; 7Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 8Novartis Pharma AG, Basel, Switzerland Background: Randomized controlled trials (RCTs indicate that long-acting bronchodilator combinations, such as β2-agonist (LABA/muscarinic antagonist (LAMA, have favorable efficacy compared with commonly used COPD treatments. The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS in adults with stable moderate-to-very-severe COPD. Methods: This systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases included RCTs comparing ≥12 weeks’ LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only. Eligible studies were independently selected by two authors using predefined data fields; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results: Eighteen studies (23 trials were eligible (N=20,185. LABA/LAMA significantly improved trough forced expiratory volume in 1 second (FEV1 from baseline to week 12 versus both LAMA and LABA/ICS (0.07 L and 0.08 L, P<0.0001, with patients more likely to achieve clinically

  9. Empirical mono- versus combination antibiotic therapy in adult intensive care patients with severe sepsis – A systematic review with meta-analysis and trial sequential analysis

    DEFF Research Database (Denmark)

    Sjövall, Karl Fredrik Lennart; Perner, Anders; Hylander Møller, Morten

    2017-01-01

    Objectives To assess benefits and harms of empirical mono- vs. combination antibiotic therapy in adult patients with severe sepsis in the intensive care unit (ICU). Methods We performed a systematic review according to the Cochrane Collaboration methodology, including meta-analysis, risk of bias...... reviewers independently evaluated studies for inclusion, extracted data, and assessed risk of bias. Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated and the risk of random errors was assessed by TSA. Results Thirteen RCTs (n = 2633) were included; all were judged as having high risk......, indicating that a 20% relative risk difference in mortality may be excluded between the two groups. For the other outcomes, TSA indicated lack of data and high risk of random errors. Conclusions This systematic review of RCTs with meta-analysis and TSA demonstrated no differences in mortality or other...

  10. Cytokine-induced killer cell combination with TACE in the treatment of hepatocellular cancers:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Biao Chen; Ximing Xu; Miao Xiang; Jiao Yang; Tingting Yu; Yi Hu

    2013-01-01

    Objective:The aim of the study was to evaluate the ef icacy and safety of cytokine-induced kil er (CIK) cellcombined with transcatheter arterial chemoembolization (TACE) therapy in the treatment of hepatocellular carcinoma (HCC). Methods:Randomized control ed trials (RCTs) on CIK cells combination with TACE based-therapy were identified by elec-tronic searches in the Cochrane Library, MEDLINE, Pubmed, Wanfang, VIP, CNKI and other electronic databases. We in-cluded any RCTs evaluating CIK cellcombination with TACE for the treatment of hepatocellular cancers. The quality of RCTs meeting inclusion criteria was evaluated and data on short-term and long-term curative ef ects, quality of life, liver function and immunologic function were extracted. For quantitative data, we conducted meta-analysis with ReMan 5.1 software and the GRADE System was used to rate the level of evidence and strength of recommendation. For qualitative data, data mainly adopted descriptive methods. Results:The 9 RCTs involving 870 cases meeting the inclusion criteria were included. The meta-analysis showed significant survival benefit on 0.5-year survival rate (RR=1.51, 95%CI, 1.35-1.69, P<0.00001) in fa-vor of CIK based therapy. This ef ect was consistent at other prospective dates, including 1-year survival rate (RR=2.30, 95%CI, 1.94-2.72, P<0.00001), 2-year survival rate (RR=7.03, 95%CI, 3.83-12.91, P<0.0001). Meanwhile, the CIK-based group also demonstrated a significantly prolonged time-to-progression (TTP) (SD=1.62, 95%CI, 1.30-1.94, P<0.0001) and overal survival (OS) (SD=20.6, 95%CI, 20.2-21.18, P<0.0001). Moreover, a favored response rate (RR=CR+PR) (RR=2, 95%CI, 1.65-2.43, P<0.00001) and the quality of life improvement rate (KPS) (RR=1.76, 95%CI, 1.26-2.45, P=0.0008) were also observed in patients receiving CIK cells and TACE therapy. Furthermore, patients in the CIK group showed lower AFP (SD=-165.23, 95%CI,-178.51--151.94, P<0.00001), ALT (SD=-33.14, 95%CI,-40.30--36.37, P<0

  11. Combined Imaging Markers Dissociate Alzheimer's Disease and Frontotemporal Lobar Degeneration - An ALE Meta-Analysis.

    Science.gov (United States)

    Schroeter, Matthias L; Neumann, Jane

    2011-01-01

    To compare and dissociate the neural correlates of Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD), we combine and synthesize here recent comprehensive meta-analyses. Systematic and quantitative meta-analyses were conducted according to the QUOROM statement by calculating anatomical likelihood estimates (ALE). AD (n = 578) and the three subtypes of FTLD, frontotemporal dementia, semantic dementia (SD), and progressive non-fluent aphasia (n = 229), were compared in conjunction analyses, separately for atrophy and reductions in glucose metabolism. Atrophy coincided in the amygdala and hippocampal head in AD and the FTLD subtype SD. The other brain regions did not show any overlap between AD and FTLD subtypes for both atrophy and changes in glucose metabolism. For AD alone (n = 826), another conjunction analysis revealed a regional dissociation between atrophy and hypoperfusion/hypometabolism, whereby hypoperfusion and hypometabolism coincided in the angular/supramarginal gyrus and inferior precuneus/posterior cingulate gyrus. Our data together with other imaging studies suggest a specific dissociation of AD and FTLD if, beside atrophy, additional imaging markers in AD such as abnormally low parietal glucose utilization and perfusion are taken into account. Results support the incorporation of standardized imaging inclusion criteria into future diagnostic systems, which is crucial for early individual diagnosis and treatment in the future.

  12. [Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis].

    Science.gov (United States)

    Barbosa, Fabiano Timbó; Cunha, Rafael Martins da; Ramos, Fernando Wagner da Silva; Lima, Fernando José Camello de; Rodrigues, Amanda Karine Barros; Galvão, Ailton Mota do Nascimento; de Sousa-Rodrigues, Célio Fernando; Lima, Paula Monique Barbosa

    2016-01-01

    Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. 17 original articles analyzed. Meta-analysis of mortality (RD=-0.01, 95% CI=-0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32 to 1.95), MI (RR=0.96, 95% CI=0.52 to 1.79) and LHS (MD=-1.94, 95% CI=-3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50 to 0.93). ICUS was lower in NA (MD=-2.09, 95% CI=-2.92 to -1.26). There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. Hierarchical Dependence in Meta-Analysis

    Science.gov (United States)

    Stevens, John R.; Taylor, Alan M.

    2009-01-01

    Meta-analysis is a frequent tool among education and behavioral researchers to combine results from multiple experiments to arrive at a clear understanding of some effect of interest. One of the traditional assumptions in a meta-analysis is the independence of the effect sizes from the studies under consideration. This article presents a…

  14. Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis

    OpenAIRE

    Shan Liu; Bo Hu; Yuanyuan Zhang; Wenyang Li; Jinlin Song

    2016-01-01

    Background With the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alon...

  15. Efficacy and safety of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinomas compared with radiofrequency ablation alone: A time to event meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Xin; Hu, Yanan; Ren, Mudan; Lu, Xin Lan; Lu, Gui Fang; He, Shui Xiang [Dept. of Gastroenterology, First Affiliated Hospital of Xi' an Jiaotong University, Xi' an (China)

    2016-02-15

    To compare the efficacy and safety of combined radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA alone for hepatocellular carcinomas (HCC). Randomized controlled trial (RCT) studies that compared the clinical or oncologic outcomes of combination therapy of TACE and RFA versus RFA for the treatment of HCC were identified through literature searches of electronic databases (Pubmed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, and Google Scholar). Hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence interval (CI) were combined as the effective value to assess the summary effects. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. Six RCTs with 534 patients were eligible for inclusion in this meta-analysis. The meta-analysis showed that the combination of TACE and RFA is associated with a significantly longer overall survival (HR = 0.62, 95% CI: 0.49-0.78, p < 0.001) and recurrence-free survival (HR = 0.55, 95% CI: 0.40-0.76, p < 0.001) in contrast with RFA monotherapy. The seemingly higher incidence of major complications in the combination group compared with RFA group did not reach statistical significance (OR = 1.17, 95% CI: 0.39-3.55, p = 0.78). In patients with HCC, the combination of TACE and RFA is associated with significantly higher overall survival and recurrence-free survival, as compared with RFA monotherapy, without significant difference in major complications.

  16. A meta-analysis combining parallel and cross-over randomized controlled trials to assess impact of iodine fortified foods on urinary iodine concentration among children.

    Science.gov (United States)

    Athe, Ramesh; Mendu, Vishnu Vardhana Rao; Krishnapillai, Madhavan Nair

    2015-01-01

    The purpose of this analysis was to combine evidence from parallel and cross-over randomized controlled trials to assess the impact of iodine fortified foods on urinary iodine concentration (UIC) in children. A structured search for studies on iodine intervention studies on MEDLINE, Pro Quest, and the Cochrane Library from Jan, 1990 to Dec, 2012 was carried out. Carry-over effect was estimated by general linear model. We explored two methods to pool continuous outcomes in a meta-analysis by combining parallel and cross-over trial designs. The standard mean difference was calculated for net change in UIC. Fixed or random-effects models were used to summaries fortified food response data. Meta-regression and covariate meta-analysis were performed to explore the influ-ence of confounders on the net pooled effect on UIC. The overall pooled estimate, which combined parallel with cross-over trials in the absence of carry-over effect of UIC from 9 studies, showed a significant increase in the fortified group compared with the control group (n=3448; standard mean difference=2.02 μg/L; 95% CI: 1.30, 2.73; I2=99%, τ2=1.81, p<0.01). Meta-regression analysis indicated that dose of the feeding was positively related to the effect size (regression coefficient=0.014; 95% CI: 0.003, 0.026; p<0.019). The net pooled effect size after removing the confounders was 1.59 (95% CI: 0.953, 2.23) μg/L. There was an association between intakes of io-dine fortified foods and UIC in children. These results suggest that we can combine parallel with cross-over trials for meta-analysis for nutrients such as iodine when absorption is high.

  17. Effects of a nutraceutical combination containing berberine (BRB), policosanol, and red yeast rice (RYR), on lipid profile in hypercholesterolemic patients: A meta-analysis of randomised controlled trials.

    Science.gov (United States)

    Millán, Jesus; Cicero, Arrigo F G; Torres, Francisco; Anguera, Anna

    2016-01-01

    A nutraceutical combination containing berberine, policosanol, and red yeast rice, largely marketed in Europe (Armolipid Plus(®)) (AP), has been reported to induce significant improvements in plasma lipids, insulin resistance and other components of the metabolic syndrome. However, literature study designs and results were heterogeneous and it was thus necessary to systematically review and meta-analyse all relevant randomised clinical trials (RCTs) to explore and quantify the effects of the dietary supplement AP on lipid profile. The aim of our meta-analysis was the evaluation of the effect of AP on lipid profile. We conducted a structures search on PubMed and Google Scholar to identify eligible articles published prior to 2015. Eleven RCTs were subjected to meta-analysis by means of random effects models using the Standardised Mean Differences approach (Hedges' method) and the Mean Differences approach as a sensitivity analysis. Data from 11 randomised clinical trials, corresponding to 1970 nutraceutical combination and 1954 control patients (3924 total patients), were included after the peer evaluation and data extraction of two independent evaluators. Heterogeneity was significant in all models. A significant effect was found for all lipid parameters. The effect size (relative change from baseline (%)) was -1.3 (9.9%) for total cholesterol, -1.17 (-13.7%) for LDL-c, +0.17 (+3.7%) for HDL-c and -0.24 (-7.0%) for Triglycerides. This meta-analysis confirms that the nutraceutical combination containing berberine, policosanol, and red yeast rice has shown to be an effective product for the improvement of the lipid profile. Copyright © 2016 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. A Meta-Analysis for Postoperative Complications in Tibial Plafond Fracture: Open Reduction and Internal Fixation Versus Limited Internal Fixation Combined With External Fixator.

    Science.gov (United States)

    Wang, Dong; Xiang, Jian-Ping; Chen, Xiao-Hu; Zhu, Qing-Tang

    2015-01-01

    The treatment of tibial plafond fractures is challenging to foot and ankle surgeons. Open reduction and internal fixation and limited internal fixation combined with an external fixator are 2 of the most commonly used methods of tibial plafond fracture repair. However, conclusions regarding the superior choice remain controversial. The present meta-analysis aimed to quantitatively compare the postoperative complications between open reduction and internal fixation and limited internal fixation combined with an external fixator for tibial plafond fractures. Nine studies with 498 fractures in 494 patients were included in the present study. The meta-analysis found no significant differences in bone healing complications (risk ratio [RR] 1.17, 95% confidence interval [CI] 0.68 to 2.01, p = .58], nonunion (RR 1.09, 95% CI 0.51 to 2.36, p = .82), malunion or delayed union (RR 1.24, 95% CI 0.57 to 2.69, p = .59), superficial (RR 1.56, 95% CI 0.43 to 5.61, p = .50) and deep (RR 1.89, 95% CI 0.62 to 5.80) infections, arthritis symptoms (RR 1.20, 95% CI 0.92 to 1.58, p = .18), or chronic osteomyelitis (RR 0.31, 95% CI 0.05 to 1.84, p = .20) between the 2 groups. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Meta-analysis in medicine

    Directory of Open Access Journals (Sweden)

    Zodpey S

    2003-11-01

    Full Text Available When it comes to health care, everybody - medical professionals, policymakers and patients - wants to know what works and what does not. Every day clinicians debate, implicitly or explicitly, whether new research findings are convincing enough to change the way they practice. The quality of research varies, and so much information is being produced that it is impossible for anyone to know and evaluate it all. Traditionally, randomized controlled trials are considered gold standard study designs. However, if they report discordant results and generate controversies, then what should we look for? The answer to this imbroglio is meta-analysis. Steps in designing and conducting meta-analysis involve describing the purpose of meta-analysis, designing a research question, searching for studies, specifying study selection (inclusion and exclusion and appraisal criteria, deciding data extraction procedures (including statistical reanalysis, assessing combinability of studies, selecting an analytical strategy (use of models and sensitivity analysis, anticipating systematic errors (biases and limitations, and presenting and disseminating results of the meta-analysis. The Cochrane Collaboration is significantly contributing to the development of this area of research and making a noticeable dent on the practice of evidence based medicine across the globe. Meta-analytic approaches have been used to resolve long standing controversies in the field of medicine, including dermatology.

  20. The Efficacy and Clinical Safety of Various Analgesic Combinations for Post-Operative Pain after Third Molar Surgery: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Alvin Ho Yeung Au

    Full Text Available To run a systematic review and meta-analysis of randomized clinical trials aiming to answer the clinical question "which analgesic combination and dosage is potentially the most effective and safe for acute post-operative pain control after third molar surgery?".A systematic search of computer databases and journals was performed. The search and the evaluations of articles were performed by 2 independent reviewers in 3 rounds. Randomized clinical trials related to analgesic combinations for acute post-operative pain control after lower third molar surgery that matched the selection criteria were evaluated to enter in the final review.Fourteen studies with 3521 subjects, with 10 groups (17 dosages of analgesic combinations were included in the final review. The analgesic efficacy were presented by the objective pain measurements including sum of pain intensity at 6 hours (SPID6 and total pain relief at 6 hours (TOTPAR6. The SPID6 scores and TOTPAR6 scores of the reported analgesic combinations were ranged from 1.46 to 6.44 and 3.24 - 10.3, respectively. Ibuprofen 400mg with oxycodone HCL 5mg had superior efficacy (SPID6: 6.44, TOTPAR6: 9.31. Nausea was the most common adverse effect, with prevalence ranging from 0-55%. Ibuprofen 200mg with caffeine 100mg or 200mg had a reasonable analgesic effect with fewer side effects.This systematic review and meta-analysis may help clinicians in their choices of prescribing an analgesic combination for acute post-operative pain control after lower third molar surgery. It was found in this systematic review Ibuprofen 400mg combined with oxycodone HCL 5mg has superior analgesic efficacy when compared to the other analgesic combinations included in this study.

  1. The Efficacy and Clinical Safety of Various Analgesic Combinations for Post-Operative Pain after Third Molar Surgery: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Au, Alvin Ho Yeung; Choi, Siu Wai; Cheung, Chi Wai; Leung, Yiu Yan

    2015-01-01

    Objectives To run a systematic review and meta-analysis of randomized clinical trials aiming to answer the clinical question “which analgesic combination and dosage is potentially the most effective and safe for acute post-operative pain control after third molar surgery?”. Materials and Methods A systematic search of computer databases and journals was performed. The search and the evaluations of articles were performed by 2 independent reviewers in 3 rounds. Randomized clinical trials related to analgesic combinations for acute post-operative pain control after lower third molar surgery that matched the selection criteria were evaluated to enter in the final review. Results Fourteen studies with 3521 subjects, with 10 groups (17 dosages) of analgesic combinations were included in the final review. The analgesic efficacy were presented by the objective pain measurements including sum of pain intensity at 6 hours (SPID6) and total pain relief at 6 hours (TOTPAR6). The SPID6 scores and TOTPAR6 scores of the reported analgesic combinations were ranged from 1.46 to 6.44 and 3.24 – 10.3, respectively. Ibuprofen 400mg with oxycodone HCL 5mg had superior efficacy (SPID6: 6.44, TOTPAR6: 9.31). Nausea was the most common adverse effect, with prevalence ranging from 0-55%. Ibuprofen 200mg with caffeine 100mg or 200mg had a reasonable analgesic effect with fewer side effects. Conclusion This systematic review and meta-analysis may help clinicians in their choices of prescribing an analgesic combination for acute post-operative pain control after lower third molar surgery. It was found in this systematic review Ibuprofen 400mg combined with oxycodone HCL 5mg has superior analgesic efficacy when compared to the other analgesic combinations included in this study. PMID:26053953

  2. S-1 monotherapy versus S-1 combination therapy in gemcitabine-refractory advanced pancreatic cancer: A meta-analysis (PRISMA) of randomized control trials.

    Science.gov (United States)

    Zhong, Sheng; Qie, Shuai; Yang, Liu; Yan, Qi; Ge, Linna; Wang, Zhongfeng

    2017-07-01

    Pancreatic cancer (PC) is one of the most lethal digestive system tumors. Most new cases are diagnosed based on metastasis or local aggression and are known as "advanced PC." Recently, studies investigating S-1 have indicated that it has a better clinical curative effect on PC. We conducted a meta-analysis to evaluate the efficacy and safety of S-1 monotherapy compared with S-1 combination regimens in patients with gemcitabine (GEM)-refractory PC. Trials published between 1978 and 2016 were identified by an electronic search of public databases (Medline, Embase, and the Cochrane Library). All prospective studies were independently identified by 2 authors for inclusion. The response rate (RR), progression-free and overall survival (PFS and OS, respectively), and the primary toxicities were extracted for the meta-analysis. Four randomized controlled trials consisting of 623 patients were included in the analysis, among which 315 patients underwent S-1 monotherapy and 308 patients underwent S-1 combination therapy. The pooled data showed a significantly higher response rate and longer PFS in the S-1 combination group than in the S-1 monotherapy group (RR, 1.75; 95% confidence interval [CI], 1.19-2.57; P = .005 and hazard ration [HR], 0.75; 95% CI, 0.62-0.91; P = .005). There were no significant differences in OS or adverse events. Compared with the S-1 monotherapy group, the S-1 combination group had a higher response rate and longer PFS. Both groups had few adverse events, which were balanced between the groups. The subgroup analysis suggested that S-1 combination regimens with leucovorin or irinotecan (CPT-11) provided promising efficacy. These promising combination regimens should be considered for patients with advanced PC who choose S-1 as their second-line therapy.

  3. Individual patient data meta-analysis of combined treatments versus psychotherapy (with or without pill placebo), pharmacotherapy or pill placebo for adult depression: a protocol

    Science.gov (United States)

    Weitz, Erica; Kleiboer, Annet; van Straten, Annemieke; Hollon, Steven D; Cuijpers, Pim

    2017-01-01

    Introduction There are many proven treatments (psychotherapy, pharmacotherapy or their combination) for the treatment of depression. Although there is growing evidence for the effectiveness of combination treatment (psychotherapy + pharmacotherapy) over pharmacotherapy alone, psychotherapy alone or psychotherapy plus pill placebo, for depression, little is known about which specific groups of patients may respond best to combined treatment versus monotherapy. Conventional meta-analyses techniques have limitations when tasked with examining whether specific individual characteristics moderate the effect of treatment on depression. Therefore, this protocol outlines an individual patient data (IPD) meta-analysis to explore which patients, with which clinical characteristics, have better outcomes in combined treatment compared with psychotherapy (alone or with pill placebo), pharmacotherapy and pill placebo. Methods and Analysis Study searches are completed using an established database of randomised controlled trials (RCTs) on the psychological treatment of adult depression that has previously been reported. Searches were conducted in PubMed, PsycInfo, Embase and the Cochrane Central Register of Controlled Trials. RCTs comparing combination treatment (psychotherapy + pharmacotherapy) with psychotherapy (with or without pill placebo), pharmacotherapy or pill placebo for the treatment of adult depression will be included. Study authors of eligible trials will be contacted and asked to contribute IPD. Conventional meta-analysis techniques will be used to examine differences between studies that have contributed data and those that did not. Then, IPD will be harmonised and analysis using multilevel regression will be conducted to examine effect moderators of treatment outcomes. Dissemination Study results outlined above will be published in peer-reviewed journals. Study results will contribute to better understanding whether certain patients respond best to combined

  4. Efficacy and safety of olanzapine/fluoxetine combination in the treatment of treatment-resistant depression: a meta-analysis of randomized controlled trials

    Science.gov (United States)

    Luan, Shuxin; Wan, Hongquan; Wang, Shijun; Li, He; Zhang, Baogang

    2017-01-01

    Background Whether olanzapine/fluoxetine combination (OFC) is superior to olanzapine or fluoxetine monotherapy in patients with treatment-resistant depression (TRD) remains controversial. Thus, we conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of OFC with olanzapine or fluoxetine monotherapy for patients with TRD. Materials and methods RCTs published in PubMed, Embase, Web of Science, and the ClinicalTrials.gov registry were systematically reviewed to assess the efficacy and safety of OFC. Outcomes included mean changes from baseline in Montgomery–Asberg Depression Rating Scale (MADRS), Clinical Global Impression-Severity (CGI-S), Hamilton Rating Scale for Anxiety (HAM-A), Brief Psychiatric Rating Scale (BPRS) scores, response rate, remission rate, and adverse events. Results were expressed with weighted mean difference (WMD) with 95% confidence intervals (CIs) and risk ratio (RR) with 95% CIs. Results A total of five RCTs with 3,020 patients met the inclusion criteria and were included in this meta-analysis. Compared with olanzapine or fluoxetine monotherapy, OFC was associated with greater changes from baseline in MADRS (WMD =−3.37, 95% CI: −4.76, −1.99; Pfluoxetine monotherapy in the treatment of patients with TRD. Our results provided supporting evidence for the use of OFC in TRD. However, considering the limitations in this study, more large-scale, well-designed RCTs are needed to confirm these findings. PMID:28280343

  5. Is Huachansu Beneficial in Treating Advanced Non-Small-Cell Lung Cancer? Evidence from a Meta-Analysis of Its Efficacy Combined with Chemotherapy

    Directory of Open Access Journals (Sweden)

    Bingduo Zhou

    2015-01-01

    Full Text Available Background. Huachansu, the sterilized water extract of Bufo bufo gargarizans toad skin, is used in China to alleviate the side-effects and enhance the therapeutic effect of chemotherapy in advanced non-small-cell lung cancer (NSCLC. We conducted a meta-analysis to assess Huachansu’s efficacy. Methods. We extensively searched electronic databases (CENTRAL, EMBASE, MEDLINE, CBM, Cochrane Library, CNKI, CEBM, WFDP, CSCD, CSTD, and IPA for randomized controlled trials containing Huachansu plus chemotherapy as the test group and chemotherapy as the control group. Seventeen trials were selected based on the selection criteria. The pooled relative ratio (RR of indicators with 95% confidence interval (95% CI was calculated for efficacy evaluation. Results. The meta-analysis demonstrated a statistically significant improvement in objective tumor response, one-year survival, Karnofsky performance status, pain relief, and alleviation of severe side-effects (nausea and vomiting, leukocytopenia in the test group as compared to the control group, but no significant difference in thrombocytopenia. Conclusions. This study demonstrated the efficacy of Huachansu combined with chemotherapy in the treatment of advanced NSCLC. However, limitations exist and high-quality trials are needed for further verification.

  6. A hybrid Bayesian hierarchical model combining cohort and case-control studies for meta-analysis of diagnostic tests: Accounting for partial verification bias.

    Science.gov (United States)

    Ma, Xiaoye; Chen, Yong; Cole, Stephen R; Chu, Haitao

    2014-05-26

    To account for between-study heterogeneity in meta-analysis of diagnostic accuracy studies, bivariate random effects models have been recommended to jointly model the sensitivities and specificities. As study design and population vary, the definition of disease status or severity could differ across studies. Consequently, sensitivity and specificity may be correlated with disease prevalence. To account for this dependence, a trivariate random effects model had been proposed. However, the proposed approach can only include cohort studies with information estimating study-specific disease prevalence. In addition, some diagnostic accuracy studies only select a subset of samples to be verified by the reference test. It is known that ignoring unverified subjects may lead to partial verification bias in the estimation of prevalence, sensitivities, and specificities in a single study. However, the impact of this bias on a meta-analysis has not been investigated. In this paper, we propose a novel hybrid Bayesian hierarchical model combining cohort and case-control studies and correcting partial verification bias at the same time. We investigate the performance of the proposed methods through a set of simulation studies. Two case studies on assessing the diagnostic accuracy of gadolinium-enhanced magnetic resonance imaging in detecting lymph node metastases and of adrenal fluorine-18 fluorodeoxyglucose positron emission tomography in characterizing adrenal masses are presented.

  7. Intraocular pressure-lowering effects of commonly used fixed-combination drugs with timolol: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Jin-Wei Cheng

    Full Text Available BACKGROUND: The first goal of medical therapy in glaucoma is to reduce intraocular pressure (IOP, and the fixed-combination medications are needed to achieve sufficiently low target IOP. The aim of this systematic review and meta-analysis is to evaluate IOP-lowering effect of the commonly used fixed-combination drugs containing 0.5% timolol. METHODS: Pertinent publications were identified through systematic searches. Over 85% of the patients had to be diagnosed with primary open-angle glaucoma (POAG or ocular hypertension (OHT. Forty-one randomized clinical trials were included in the meta-analysis. The main efficacy measures were the absolute and relative values of mean diurnal IOP reduction, and the highest and lowest IOP reductions on the diurnal IOP curve. The pooled 1- to 3-month IOP-lowering effects after a medicine-free washout period was calculated by performing meta-analysis using the random effects model, and relative treatment effects among different fixed combinations were assessed using a mixed-effects meta-regression model. RESULTS: The relative reductions for mean diurnal IOP were 34.9% for travoprost/timolol, 34.3% for bimatoprost/timolol, 33.9% for latanoprost/timolol, 32.7% for brinzolamide/timolol, 29.9% for dorzolamide/timolol, and 28.1% for brimonidine/timolol. For the highest IOP decrease, relative reductions ranged from 31.3% for dorzolamide/timolol to 35.5% for travoprost/timolol; for the lowest IOP decrease, those varied from 25.9% for dorzolamide/timolol to 33.1% for bimatoprost/timolol. Both latanoprost/timolol and travoprost/timolol were more effective in lowering mean diurnal IOP than brimonidine/timolol (WMD: 5.9 and 7.0 and dorzolamide/timolol (WMD: 3.8 and 3.3. CONCLUSIONS: All six commonly used fixed-combination drugs containing timolol can effectively lower IOP in patients with POAG and OHT, and both latanoprost/timolol and travoprost/timolol might achieve better IOP-lowering effects among the six fixed-combination

  8. Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Shan Liu

    Full Text Available With the popularity of minimally invasive surgery (MIS in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone.The authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and ClinicalTrials.gov (up to June 30, 2015. The main clinical outcomes were the reduction of probing pocket depths (PPDs, gain of clinical attachment level (CAL, recession of gingival margin (REC and radiographic bone fill. Review Manager 5.2 (Cochrane Collaboration, Oxford, England was used to calculate the heterogeneity and mean differences of the main clinical outcomes.In total, 464 studies in the literature were identified but only four were ultimately feasible. The results showed no significant difference regarding CAL gain (P = 0.32 and PPD reduction (P = 0.40 as well as REC increase (P = 0.81 and radiographic bone fill (P = 0.64 between the MIS plus biomaterials group and the MIS alone group.The meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group, indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach. There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes.

  9. The hutterite variant of Treacher Collins syndrome: a 28-year-old story solved.

    Science.gov (United States)

    Caluseriu, Oana; Lowry, Brian R; McLeod, Ross; Lamont, Ryan; Parboosingh, Jillian S; Bernier, Francois P; Innes, A Micheil

    2013-11-01

    Treacher Collins syndrome (TCS), the best known form of mandibulofacial dysostosis (MFD) comprises a recognizable pattern of anomalies. In 1985, Lowry et al. reported on two Hutterite sisters born to apparently unaffected parents with TCS, raising the possibility of an autosomal recessive (AR) variant of TCS, subsequently given a unique Mendelian Inheritance of Man (MIM) number (248390). Recently, biallelic mutations in POLR1C were found in TCS patients, confirming AR TCS as a distinct entity. The Hutterites, an endogamous Anabaptist group, like other genetically isolated populations, provide a powerful resource for mapping AR disorders. We elected to study the molecular basis of TCS in the Hutterite population including the original kindred described in 1985, and another unrelated Hutterite patient. Prior to starting this study, a TCOF1 mutation had apparently been excluded in the original family at two outside institutions. We hypothesized that an AR variant of TCS was present in the three Hutterite patients, but homozygosity mapping did not show convincing evidence of shared regions between the affected individuals. TCOF1 analysis was undertaken and mutations were found in the three affected patients and an unaffected parent. These data show that the initial Hutterite family reported with AR TCS in fact has classic TCS due to a TCOF1 mutation, despite recent data confirming the existence of AR TCS in other populations. These results have significant counseling implications for the affected families in the Hutterite population and in the population at large. © 2013 Wiley Periodicals, Inc.

  10. Effects of combined oral sucrose and nonnutritive sucking (NNS) on procedural pain of NICU newborns, 2001 to 2016: A PRISMA-compliant systematic review and meta-analysis.

    Science.gov (United States)

    Liu, Yi; Huang, Xinchun; Luo, Biru; Peng, Wentao

    2017-02-01

    Both oral sucrose (OS) and nonnutritive sucking (NNS) are effective nonpharmacological methods to alleviate procedures pain in neonatal intensive care unit (NICU) newborns when they were used alone, but the combined effect of OS+NNS remains controversial. So, we conducted this study to evaluate the efficiency of NNS combined with oral sucrose on pain relief in NICU newborns undergoing painful procedures. We searched PubMed, Ovid (Medline), Embase (Medline), Cochrane Central Library, and other resources such as Google Scholar, bibliographies of included literatures for all available articles. Two reviewers screened literatures and extracted data independently. The fixed effects model was used to pool the results using Reviewer Manager (RevMan) 5.3. As each study included in our meta-analysis had been approved by Ethics Committee or institutional review board, thus our study did not need ethical approval. Seven randomized controlled trials, including 599 participants, were contained in our meta-analysis. The combination of oral sucrose and NNS is associated with reduced pain scores (mean difference [MD], -0.52; 95% confidence interval [CI], -0.68 to -0.36); shortened crying time (MD,-0.92; 95% CI, -1.39 to -0.44); but the 2 groups did not differ significantly in reducing bradycardia (MD, 0.73; 95% CI, 0.32-1.68), tachycardia (MD, 0.65; 95% CI, 0.38-1.10), or desaturations (MD, 0.73; 95% CI, 0.32-1.68). The pooled evidence indicates that the combination measures may serve as an evidence-based guideline for pain relief among patients having minor pain. Besides, it also indicates that OS combined with NNS can be an alternative for better prevention and management of procedure pain in NICU newborns. Nevertheless, the results may be limited due to incomplete data, and thus, more randomized controlled trials or well-designed studies are required to determine the effects of OS+NNS in the future.

  11. Efficacy of lamivudine and thymosin alpha-1 combination therapy in treatment of HBeAg-positive chronic hepatitis B: a meta-analysis

    Directory of Open Access Journals (Sweden)

    QI Youtao

    2014-07-01

    Full Text Available ObjectiveTo evaluate the efficacy of lamivudine and thymosin alpha-1 combination therapy in the treatment of HBeAg-positive chronic hepatitis B (CHB by meta-analysis. MethodsRandomized controlled trials (RCTs of lamivudine and thymosin alpha-1 combination therapy in treatment of HBeAg-positive CHB (follow-up for at least 24 weeks, from January 1998 to date, were identified by searching Cochrane Library, PubMed, EMBASE, EBSCO, CNKI, Wanfang Data, and CQVIP. Lamivudine monotherapy RCTs were searched for in the same way as control tests. Efficacy was measured by odds ratio. Meta-analysis was carried out with RevMan 5.2 software. ResultsNine RCTs involving 600 patients were included, with 320 cases in the combination therapy group and 280 in the control group. At the end of follow-up, the combination therapy group had significantly higher serum ALT recovery rate, HBV-DNA negative conversion rate, HBeAg negative conversion rate, and HBeAg seroconversion rate than the control group (P<0.01 for all, with pooled odds ratios (95% confidence intervals of 4.84 (3.28, 7.16, 2.09 (1.45, 3.01, 5.32 (3.35, 8.46, and 6.22 (3.78, 10.25, respectively. ConclusionLamivudine and thymosin alpha-1 combination therapy is more likely to achieve sustained response rate than lamivudine monotherapy for HBeAg-positive CHB. More RCTs of high quality and large scale are required to verify this conclusion.

  12. Systematic Review and Meta-Analysis of the Efficacy and Safety of Combined Epinephrine and Corticosteroid Therapy for Acute Bronchiolitis in Infants

    Directory of Open Access Journals (Sweden)

    Kok P. Kua

    2017-06-01

    Full Text Available Objective: To evaluate the effectiveness of combined epinephrine and corticosteroid therapy for acute bronchiolitis in infants.Methods: Four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from their inception to February 28, 2017 for studies involving infants aged less than 24 months with bronchiolitis which assessed the use of epinephrine and corticosteroid combination therapy. The methodological quality of the included studies was assessed using the Cochrane Collaboration's Risk of Bias Tool. A random-effects meta-analysis was used to pool the effect estimates. The primary outcomes were hospital admission rate and length of hospital stay.Results: Of 1,489 citations identified, 5 randomized controlled trials involving 1,157 patients were included. All studies were of high quality and low risk of bias. Results of the meta-analysis showed no significant differences in the primary outcomes. Hospitalization rate was reduced by combinatorial therapy of epinephrine and corticosteroid in only one out of five studies, whereas pooled data indicated no benefit over epinephrine plus placebo. Clinical severity scores were significantly improved in all five RCTs when assessed individually, but no benefit was observed compared to epinephrine monotherapy when the data were pooled together. Pooled data showed that combination therapy was more effective at improving oxygen saturation level (mean difference: −0.70; 95% confidence interval: −1.17 to −0.22, p = 0.004. There was no difference in the risk of serious adverse events in infants treated with the combined epinephrine and corticosteroid therapy.Conclusions: Combination treatment of epinephrine and dexamethasone was ineffective in reducing hospital admission and length of stay among infants with bronchiolitis.

  13. Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: systematic review and meta-analysis.

    Science.gov (United States)

    Martínez-Vázquez, M A; Vázquez-Elizondo, G; González-González, J A; Gutiérrez-Udave, R; Maldonado-Garza, H J; Bosques-Padilla, F J

    2012-01-01

    Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain, bloating, and changes in bowel habit. To determine the clinical effectiveness of the antispasmodic agents available in Mexico for the treatment of IBS. We carried out a systematic review and meta-analysis of randomized controlled clinical trials on antispasmodic agents for IBS treatment. Clinical trials identified from January 1960 to May 2011 were searched for in MEDLINE, the Cochrane Library, and in the ClinicalTrials.gov registry. Treatment response was evaluated by global improvement of symptoms or abdominal pain, abdominal distention/bloating, and frequency of adverse events. The effect of antispasmodics vs placebo was expressed in OR and 95% CI. Twenty-seven studies were identified, 23 of which fulfilled inclusion criteria. The studied agents were pinaverium bromide, mebeverine, otilonium, trimebutine, alverine, hyoscine, alverine/simethicone, pinaverium/simethicone, fenoverine, and dicyclomine. A total of 2585 patients were included in the meta-analysis. Global improvement was 1.55 (CI 95%: 1.33 to 1.83). Otilonium and the alverine/simethicone combination produced significant values in global improvement while the pinaverium/simethicone combination showed improvement in bloating. As for pain, 2394 patients were included with an OR of 1.52 (IC 95%: 1.28 a 1.80), favoring antispasmodics. Antispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations. Copyright © 2011 Asociación Mexicana de Gastroenterología. Published by Elsevier España. All rights reserved.

  14. Efficacy of indacaterol 75 μg versus fixed-dose combinations of formoterol-budesonide or salmeterol-fluticasone for COPD: a network meta-analysis.

    Science.gov (United States)

    Cope, Shannon; Kraemer, Matthias; Zhang, Jie; Capkun-Niggli, Gorana; Jansen, Jeroen P

    2012-01-01

    The purpose of this study was to update our network meta-analysis in order to compare the efficacy of indacaterol 75 μg with that of a fixed-dose combination of formoterol and budesonide (FOR/BUD) and a fixed-dose combination salmeterol and fluticasone (SAL/FP) for the treatment of chronic obstructive pulmonary disease (COPD) based on evidence identified previously in addition to two new randomized clinical trials. Fifteen randomized, placebo-controlled clinical trials including COPD patients were evaluated: indacaterol 75 μg once daily (n = 2 studies), indacaterol 150 μg once daily (n = 5), indacaterol 300 μg once daily (n = 4), FOR/BUD 9/160 μg twice daily (n = 2), FOR/BUD 9/320 μg twice daily (n = 2), SAL/FP 50/500 μg twice daily (n = 4), and SAL/FP 50/250 μg twice daily (n = 1). All trials were analyzed simultaneously using a Bayesian network meta-analysis and relative treatment effects between all regimens were obtained. Treatment-by-covariate interactions were included where possible to improve the similarity of the trials. Outcomes of interest were trough forced expiratory volume in 1 second (FEV(1)) and transitional dyspnea index at 12 weeks. Based on the results without adjustment for covariates, indacaterol 75 μg resulted in a greater improvement in FEV(1) at 12 weeks compared with FOR/BUD 9/160 μg (difference in change from baseline 0.09 L [95% credible interval 0.04-0.13]) and FOR/BUD 9/320 μg (0.07 L [0.03-0.11]) and was comparable with SAL/FP 50/250 μg (0.00 L [-0.07-0.07]) and SAL/FP 50/500 μg (0.01 L [-0.04-0.05]). For transitional dyspnea index, data was available only for indacaterol 75 μg versus SAL/FP 50/500 μg (-0.49 points [-1.87-0.89]). Based on results of a network meta-analysis with and without covariates, indacaterol 75 μg is expected to be at least as efficacious as FOR/BUD (9/320 μg and 9/160 μg) and comparable with SAL/FP (50/250 μg and 50/500 μg) in terms of lung function. In terms of breathlessness (transitional

  15. Immunoregulation of Shenqi Fuzheng Injection Combined with Chemotherapy in Cancer Patients: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Ting, Wang; Xiumei, Gao

    2017-01-01

    Background. Immunosuppression is a well-recognised complication of chemotherapy in cancer patients. We assemble the clinical evidence that SQI, an adjuvant drug for lung cancer and gastric cancer which was widely prescribed in China, interventions could increase objective tumour response and regulate immunity in cancer patients undergoing chemotherapy. Methods. We undertook a systemic review of the clinical data from randomised controlled trials up to September 2015 in which a SQI intervention was compared with a control arm in patients undergoing conventional chemotherapy. Revman 5.0 Software was used for the data analysis. Results. 49 randomised controlled trials were included in the systematic review. The meta-analysis results demonstrated that the SQI intervention with conventional chemotherapy exhibited better therapeutic efficacy than the conventional chemotherapy group with a statistically significant higher objective tumour response. Cotreatment with SQI could enhance NK, CD3+, CD4+ level, and CD4+/CD8+ ratio comparing with the conventional chemotherapy group. Conclusions. The conclusions of this review might suggest a high risk of bias due to the low quality and the limitation of cancer types in the included trials. A more reliable conclusion regarding the immunoregulation of SQI could be reached based on more trials of higher quality.

  16. A non-parametric meta-analysis approach for combining independent microarray datasets: application using two microarray datasets pertaining to chronic allograft nephropathy

    Directory of Open Access Journals (Sweden)

    Archer Kellie J

    2008-02-01

    Full Text Available Abstract Background With the popularity of DNA microarray technology, multiple groups of researchers have studied the gene expression of similar biological conditions. Different methods have been developed to integrate the results from various microarray studies, though most of them rely on distributional assumptions, such as the t-statistic based, mixed-effects model, or Bayesian model methods. However, often the sample size for each individual microarray experiment is small. Therefore, in this paper we present a non-parametric meta-analysis approach for combining data from independent microarray studies, and illustrate its application on two independent Affymetrix GeneChip studies that compared the gene expression of biopsies from kidney transplant recipients with chronic allograft nephropathy (CAN to those with normal functioning allograft. Results The simulation study comparing the non-parametric meta-analysis approach to a commonly used t-statistic based approach shows that the non-parametric approach has better sensitivity and specificity. For the application on the two CAN studies, we identified 309 distinct genes that expressed differently in CAN. By applying Fisher's exact test to identify enriched KEGG pathways among those genes called differentially expressed, we found 6 KEGG pathways to be over-represented among the identified genes. We used the expression measurements of the identified genes as predictors to predict the class labels for 6 additional biopsy samples, and the predicted results all conformed to their pathologist diagnosed class labels. Conclusion We present a new approach for combining data from multiple independent microarray studies. This approach is non-parametric and does not rely on any distributional assumptions. The rationale behind the approach is logically intuitive and can be easily understood by researchers not having advanced training in statistics. Some of the identified genes and pathways have been

  17. A non-parametric meta-analysis approach for combining independent microarray datasets: application using two microarray datasets pertaining to chronic allograft nephropathy.

    Science.gov (United States)

    Kong, Xiangrong; Mas, Valeria; Archer, Kellie J

    2008-02-26

    With the popularity of DNA microarray technology, multiple groups of researchers have studied the gene expression of similar biological conditions. Different methods have been developed to integrate the results from various microarray studies, though most of them rely on distributional assumptions, such as the t-statistic based, mixed-effects model, or Bayesian model methods. However, often the sample size for each individual microarray experiment is small. Therefore, in this paper we present a non-parametric meta-analysis approach for combining data from independent microarray studies, and illustrate its application on two independent Affymetrix GeneChip studies that compared the gene expression of biopsies from kidney transplant recipients with chronic allograft nephropathy (CAN) to those with normal functioning allograft. The simulation study comparing the non-parametric meta-analysis approach to a commonly used t-statistic based approach shows that the non-parametric approach has better sensitivity and specificity. For the application on the two CAN studies, we identified 309 distinct genes that expressed differently in CAN. By applying Fisher's exact test to identify enriched KEGG pathways among those genes called differentially expressed, we found 6 KEGG pathways to be over-represented among the identified genes. We used the expression measurements of the identified genes as predictors to predict the class labels for 6 additional biopsy samples, and the predicted results all conformed to their pathologist diagnosed class labels. We present a new approach for combining data from multiple independent microarray studies. This approach is non-parametric and does not rely on any distributional assumptions. The rationale behind the approach is logically intuitive and can be easily understood by researchers not having advanced training in statistics. Some of the identified genes and pathways have been reported to be relevant to renal diseases. Further study on the

  18. Efficacy of indacaterol 75 µg versus fixed-dose combinations of formoterol-budesonide or salmeterol-fluticasone for COPD: a network meta-analysis

    Directory of Open Access Journals (Sweden)

    Cope S

    2012-07-01

    Full Text Available Shannon Cope,1 Matthias Kraemer,2 Jie Zhang,3 Gorana Capkun-Niggli,2 Jeroen P Jansen11MAPI Consultancy, Boston, MA, USA; 2Novartis Pharmaceuticals, Basel, Switzerland; 3Novartis Pharmaceuticals, East Hanover, NJ, USABackground: The purpose of this study was to update our network meta-analysis in order to compare the efficacy of indacaterol 75 µg with that of a fixed-dose combination of formoterol and budesonide (FOR/BUD and a fixed-dose combination salmeterol and fluticasone (SAL/FP for the treatment of chronic obstructive pulmonary disease (COPD based on evidence identified previously in addition to two new randomized clinical trials.Methods: Fifteen randomized, placebo-controlled clinical trials including COPD patients were evaluated: indacaterol 75 µg once daily (n = 2 studies, indacaterol 150 µg once daily (n = 5, indacaterol 300 µg once daily (n = 4, FOR/BUD 9/160 µg twice daily (n = 2, FOR/BUD 9/320 µg twice daily (n = 2, SAL/FP 50/500 µg twice daily (n = 4, and SAL/FP 50/250 µg twice daily (n = 1. All trials were analyzed simultaneously using a Bayesian network meta-analysis and relative treatment effects between all regimens were obtained. Treatment-by-covariate interactions were included where possible to improve the similarity of the trials. Outcomes of interest were trough forced expiratory volume in 1 second (FEV1 and transitional dyspnea index at 12 weeks.Results: Based on the results without adjustment for covariates, indacaterol 75 µg resulted in a greater improvement in FEV1 at 12 weeks compared with FOR/BUD 9/160 µg (difference in change from baseline 0.09 L [95% credible interval 0.04–0.13] and FOR/BUD 9/320 µg (0.07 L [0.03–0.11] and was comparable with SAL/FP 50/250 µg (0.00 L [-0.07–0.07] and SAL/FP 50/500 µg (0.01 L [-0.04–0.05]. For transitional dyspnea index, data was available only for indacaterol 75 µg versus SAL/FP 50/500 µg (-0.49 points [-1.87–0.89].Conclusion: Based on results of a network

  19. PRISMA-combined Myeloperoxidase -463G/A gene polymorphism and coronary artery disease: A meta-analysis of 4744 subjects.

    Science.gov (United States)

    Li, Yan-Yan; Wang, Hui; Qian, Jin; Kim, Hyun Jun; Wu, Jing-Jing; Wang, Lian-Sheng; Zhou, Chuan-Wei; Yang, Zhi-Jian; Lu, Xin-Zheng

    2017-03-01

    Myeloperoxidase (MPO) -463G/A gene polymorphism may be associated with an increased risk of developing coronary artery disease (CAD). Studies on the subject, however, do not provide a clear consensus. This meta-analysis was performed to explore the relationship between MPO gene -463G/A polymorphism and CAD risk. This meta-analysis combines data from 4744 subjects from 9 independent studies. By using fixed or random effect models, the pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were assessed. Our analysis found a significant association between MPO gene -463G/A polymorphism and CAD in the whole population under all genetic models: allelic (OR: 0.68, 95% CI: 0.54-0.85, P = 0.0009), recessive (OR: 0.41, 95% CI: 0.22-0.76, P = 0.005), dominant (OR: 0.682, 95% CI: 0.534-0.871, P = 0.002), homozygous (OR: 0.36, 95% CI: 0.16-0.79, P = 0.01), heterozygous genetic model (OR: 0.832, 95% CI: 0.733-0.945, P = 0.004), and additive (OR: 0.64, 95% CI: 0.46-0.90, P = 0.01), especially in the Chinese subgroup (P  0.05). The MPO gene -463G/A polymorphism is associated with CAD risk, especially within the Chinese population. The A allele of MPO gene -463G/A polymorphism might protect the people from suffering the CAD risk.

  20. TACE combined with liver resection versus liver resection alone in the treatment of resectable HCC:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Tingting Yu; Ximing Xu; Biao Chen

    2013-01-01

    Objective:The ef icacy of preoperative transarterial chemoembolization (TACE) for hepatectomy on hepatocel-luar carcinoma (HCC) is stil controversial. This study aims to evaluate the ef icacy of preoperative TACE on resectable HCC. Methods:Pubmed, SCI, Medline, EMBASE, Cochrane Datebase, CNKI were searched. The articles that focused on pre-operative TACE for resectable HCC, published from 1990 to 2012, were col ected by computerized search of literatures and manual search of bibliographies. The relevant clinical trials’ data were reviewed by meta-analysis using the random ef ects model or fixed ef ect model by heterogeneity. The outcomes were expressed as odds ratio (OR) with 95%confidence intervals (CIs). Results:A total of 1347 patients were included in these 7 studies, the cases were divided into the preoperative TACE group and the non-preoperative TACE group, and there was no dif erence between the two groups in the 3-year disease-free survival rate, with an odds ratio of 1.14 (95%CI=0.90-1.45, P=0.27);the 5-year disease-free survival rate in the preopera-tive TACE group was better than that in the non-TACE group with an odds ratio of 1.35 (95%CI=1.07-1.74, P=0.02);the 5-year overal survival rate in the preoperative TACE group was higher than that in the non-TACE group with an odds ratio of 0.59 (95%CI=0.46-0.77, P<0.0001). Conclusion:The present data suggests that preoperative TACE has no dif erent in improving the 3-year disease-free survival rate with non-TACE group for resectable HCC, while it can improve the 5-year disease-free survival rate and the 5-year overal survival rate. More randomized control ed trials using large sample size are needed to provide suf icient evidence to confirm current conclusion.

  1. The Efficacy and Safety of the Combination of Total Glucosides of Peony and Leflunomide for the Treatment of Rheumatoid Arthritis: A Systemic Review and Meta-Analysis.

    Science.gov (United States)

    Feng, Zhitao; Xu, Juan; He, Guochao; Cao, Meiqun; Duan, Lihong; Chen, Liguo; Wu, Zhengzhi

    2016-01-01

    Objective. To evaluate the efficacy and safety of the total glucosides of peony (TGP) and leflunomide (LEF) for the treatment of rheumatoid arthritis (RA). Methods. Randomized controlled trials (RCTs) on the efficacy and safety of the combination of TGP and LEF versus LEF alone for the treatment of RA were retrieved by searching PubMed, EMBASE, Cochrane Library, the China National Knowledge Infrastructure database, and Wanfang database. Results. Eight RCTs including 643 RA patients were included in the present meta-analysis. The quality of included studies was poor. The levels of ESR (P < 0.0001), CRP (P < 0.0001), and RF (P < 0.0001) in RA patients who received the combination of TGP and LEF were significantly lower than RA patients who received LEF therapy alone. The pooled results suggest that the combination of TGP and LEF caused less abnormal liver function than LEF alone (P = 0.02). No significant difference in the gastrointestinal discomfort was identified between the combination of TGP and LEF and LEF alone groups (P = 0.18). Conclusion. The combination of TGP and LEF in treatment of RA presented the characteristics of notably decreasing the levels of laboratory indexes and higher safety in terms of liver function. However, this conclusion should be further investigated based on a larger sample size.

  2. Safety and efficacy of fibrate-statin combination therapy compared to fibrate monotherapy in patients with dyslipidemia: a meta-analysis.

    Science.gov (United States)

    Choi, Hye Duck; Shin, Wan Gyoon; Lee, Ju-Yeun; Kang, Byoung Cheol

    2015-01-01

    Dyslipidemia is a major risk factor for the development of cardiovascular disease. Treatment with fibrate, statins, or other lipid-lowering drugs prevents primary or recurrent cardiovascular events. However, all lipid-lowering drugs have side effects, which may become more severe if combination therapy is prescribed. We performed a meta-analysis of published data to compare the safety and efficacy of fibrates alone, compared to fibrate-statin combinations, in patients with dyslipidemia. Six articles were assessed in terms of the efficacy of therapy and nine from the viewpoint of therapeutic safety. In terms of efficacy, fibrate-statin combinations afforded significantly greater reductions in the levels of total cholesterol (SE=-2.248; 95% CI 1.986-2.510), LDL cholesterol (SE=-2.274; 95% CI 2.015-2.533), and triglycerides (SE=-0.465; 95% CI 0.272-0.658) compared to fibrate alone. In terms of safety, treatment with fibrate alone was associated with a significant decrease in the number of kidney-related adverse events (RR=-0.547; 95% CI 0.368-0.812), compared to treatment with fibrate-statin combinations. We suggest that treatment with a fibrate-statin combination affords clinical benefits that are superior to treatment with fibrate alone, but increases the risk of side effects (particularly renal). Therapy should thus be carefully monitored. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Clinical Therapeutic Effects of Aspirin in Combination with Fufang Danshen Diwan, a Traditional Chinese Medicine Formula, on Coronary Heart Disease: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Jianchun Huang

    2016-10-01

    Full Text Available Background/Aims: Coronary heart disease is characterized by vascular stenosis or occlusion resulting in myocardial ischemia, hypoxia and necrosis. In China, the combination of aspirin and Fufang Danshen Diwan (FDD, a traditional Chinese medicine formula, has been suggested in the treatment of coronary heart disease. There have been several studies comparing the effectiveness of aspirin alone and in combination with FDD to treat coronary artery disease; however, it remains unclear whether combined aspirin therapy is superior. This study was thus designed to clarify this issue through a systematic review and meta-analysis. Methods: Databases including PubMed, EMBASE, China National Knowledge Infrastructure (CNKI database, Wanfang Data and VIP Information were searched. Papers were reviewed systematically by two researchers and analyzed using Cochrane software Revman 5.1. Results: Fourteen randomized controlled trials enrolling 1367 subjects were included. Meta-analyses revealed that aspirin in combination with FDD was significantly more effective at alleviating angina pectoris and improving electrocardiogram (ECG results relative to aspirin therapy alone, reflected by the summary effects for the clinical markedly effective (OR = 2.45; 95% CI 1.95-3.08 and the total effective (OR = 3.92; 95% CI 2.87-5.36 rates. In addition, combined aspirin and FDD was significantly more efficacious than aspirin monotherapy at improving blood lipid levels, as indicated by the following outcomes: 1 reduction of TC level (SMD −1.12; 95% CI −1.49 to −0.76; 2 reduction of TG level (SMD −0.94; 95% CI −1.15 to -0.74; 3 reduction of LDL level (SMD -0.68; 95% CI -0.88 to -0.48; and 4 improvement of HDL level (SMD 0.52; 95% CI 0.04 to 0.99 . No serious adverse events were reported in any of the included trials. Conclusion: The present meta-analysis demonstrated that aspirin in combination with FDD was more effective than aspirin alone for treating coronary heart

  4. Comparative efficacy of inhaled corticosteroid and long-acting beta agonist combinations in preventing COPD exacerbations: a Bayesian network meta-analysis

    Directory of Open Access Journals (Sweden)

    Oba Y

    2014-05-01

    Full Text Available Yuji Oba, Nazir A Lone University of Missouri, School of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, Columbia, MO, USA Background: A combination therapy with inhaled corticosteroid (ICS and a long-acting beta agonist (LABA is recommended in severe chronic obstructive pulmonary disease (COPD patients experiencing frequent exacerbations. Currently, there are five ICS/LABA combination products available on the market. The purpose of this study was to systematically review the efficacy of various ICS/LABA combinations with a network meta-analysis. Methods: Several databases and manufacturer's websites were searched for relevant clinical trials. Randomized control trials, at least 12 weeks duration, comparing an ICS/LABA combination with active control or placebo were included. Moderate and severe exacerbations were chosen as the outcome assessment criteria. The primary analyses were conducted with a Bayesian Markov chain Monte Carlo method. Results: Most of the ICS/LABA combinations reduced moderate-to-severe exacerbations as compared with placebo and LABA, but none of them reduced severe exacerbations. However, many studies excluded patients receiving long-term oxygen therapy. Moderate-dose ICS was as effective as high-dose ICS in reducing exacerbations when combined with LABA. Conclusion: ICS/LABA combinations had a class effect with regard to the prevention of COPD exacerbations. Moderate-dose ICS/LABA combination therapy would be sufficient for COPD patients when indicated. The efficacy of ICS/LABA combination therapy appeared modest and had no impact in reducing severe exacerbations. Further studies are needed to evaluate the efficacy of ICS/LABA combination therapy in severely affected COPD patients requiring long-term oxygen therapy. Keywords: combination therapy

  5. Combination therapy of fenofibrate and ursodeoxycholic acid in patients with primary biliary cirrhosis who respond incompletely to UDCA monotherapy: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2015-05-01

    Full Text Available Yan Zhang,1,2,* Sainan Li,1,* Lei He,1 Fan Wang,1 Kan Chen,1 Jingjing Li,1 Tong Liu,1 Yuanyuan Zheng,1 Jianrong Wang,1,3 Wenxia Lu,1,3 Yuqing Zhou,1,4 Qin Yin,1,4 Yujing Xia,1 Yingqun Zhou,1 Jie Lu,1 Chuanyong Guo1 1Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 2Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 3The First Clinical Medical College of Nanjing Medical University, Nanjing, 4The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China *These authors contributed equally to this work Background: Although the effectiveness of treatment with ursodeoxycholic acid (UDCA and fenofibrate for primary biliary cirrhosis (PBC has been suggested by small trials, a systematic review to summarize the evidence has not yet been carried out.Methods: A meta-analysis of all long-term randomized controlled trials comparing the combination of UDCA and fenofibrate with UDCA monotherapy was performed via electronic searches.Results: Six trials, which included 84 patients, were assessed. Combination therapy with UDCA and fenofibrate was more effective than UDCA monotherapy in improving alkaline phosphatase (mean difference [MD]: -90.44 IU/L; 95% confidence interval [CI]: -119.95 to -60.92; P<0.00001, gamma-glutamyl transferase (MD: -61.58 IU/L; 95% CI: -122.80 to -0.35; P=0.05, immunoglobulin M (MD: -38.45 mg/dL; 95% CI: -64.38 to -12.51; P=0.004, and triglycerides (MD: -0.41 mg/dL; 95% CI: -0.82 to -0.01; P=0.05. However, their effects on pruritus (odds ratio [OR]: 0.39; 95% CI: 0.09–1.78; P=0.23, total bilirubin (MD: -0.05 mg/dL; 95% CI: -0.21 to 0.12; P=0.58, and alanine aminotransferase (MD: -3.31 IU/L; 95% CI: -14.60 to 7.97; P=0.56 did not differ significantly. This meta-analysis revealed no significant differences in the incidence of adverse events (OR: 0.21; 95% CI: 0.03–1.25; P=0.09 between patients treated with

  6. [Systematic review and Meta-analysis of Shenqi Fuzheng injection combined with first-line chemotherapy for non-small cell lung cancer].

    Science.gov (United States)

    Hao, Teng-teng; Xie, Yan-ming; Liao, Xing; Wang, Jing

    2015-10-01

    The paper is to systematically evaluate the effect and safety of Shenqi Fuzheng injection (SFI) combined with first-line chemotherapy for non-small cell lung cancer (NSCLC). Randomized controlled trials (RCTs) on Shenqi Fuzheng injection (SFI) combined with first-line chemotherapy (experiment group) and chemotherapy alone group ( control group) were electronically retrieved from Medline, EMbase, Clinical Trials, Cochrane Library, CBM, CNKI, VIP, and Wanfang Data base. All trials were assessed for quality according to the Cochrane Reviewer's Handbook for Systematic Reviews of Intervention and then Meta-analysis was performed withRevMan5. 2 Software. A total of 43 RCTs (3433 patients) were included after screening and selecting. Results of Meta-analysis showed that: Objective remission rate (ORR): ORR of experimental group was about 20% higher than that of control group [RR = 1.23, 95% CI (1.11,1.35), P < 0.0001]. Disease control rate (DCR):DCR of SFI combined with first-line chemotherapy was 11% higher than that of first-line chemotherapy alone [RR = 1.11, 95% CI (1.07, 1.16), P < 0.000 01]. Life quality evaluated by Kosovan performance status (KPS) showed that: life quality improvement rate of experimental group was about twice of that in control group [RR = 2.02, 95% CI (1.81, 2.26), P < 0.000 01]. Toxic and side reaction analysis showed that: the incidence of side reactions in experimental group was about 50% lower than that in control group [RR = 0.59, 95% CI (0.53, 0.66), P < 0.000 01]. Immune function test showed that: the function of experimental group was 3.2 (standard deviations) times greater than that of control group [MD = 3.23, 95% CI (2.86, 3.60), P < 0.000 01]. We can see that SFI combined with first-line chemotherapy for NSCLC can increase objective efficacy, improve life quality, decrease toxic and side reactionsinduced by chemotherapy, and improve the immune functions. As most of the included studies in this systematic evaluation had poor quality

  7. Meta-analysis with R

    CERN Document Server

    Schwarzer, Guido; Rücker, Gerta

    2015-01-01

    This book provides a comprehensive introduction to performing meta-analysis using the statistical software R. It is intended for quantitative researchers and students in the medical and social sciences who wish to learn how to perform meta-analysis with R. As such, the book introduces the key concepts and models used in meta-analysis. It also includes chapters on the following advanced topics: publication bias and small study effects; missing data; multivariate meta-analysis, network meta-analysis; and meta-analysis of diagnostic studies.  .

  8. Combined Therapy of Diabetic Peripheral Neuropathy with Breviscapine and Mecobalamin: A Systematic Review and a Meta-Analysis of Chinese Studies

    Directory of Open Access Journals (Sweden)

    Chanjiao Zheng

    2015-01-01

    Full Text Available Objective. A meta-analysis on combined therapy of diabetic peripheral neuropathy (DPN with breviscapine and mecobalamin was performed to evaluate the efficacy of this therapy. Methods. Six English databases (Medline, Cochrane Library, PubMed, EMBASE, Web of Science, and CINAHL and four Chinese databases (China National Knowledge Infrastructure, VIP Journals Database, CBM, and Wanfang database were searched for studies on the clinical trials in which DPN was treated with breviscapine and mecobalamin, and RevMan 5.1 package was employed for analyzing pooled trials and publication bias. Results. A total of 17 articles including 1398 DPN patients were identified. Homogeneity was observed among different studies (P=0.74. The efficacy of combined therapy with breviscapine and mecobalamin was significantly better than that in control group [P<0.0001 (OR=5.01, 95% CI: 3.70–6.78]. Conclusion. Available findings suggest that the therapeutic efficacy of breviscapine combining mecobalamin is superior to mecobalamin alone, and this strategy is required to be popularized in clinical practice.

  9. Efficacy of Tenofovir-Based Combination Therapy versus Tenofovir Monotherapy in Chronic Hepatitis B Patients Presenting with Suboptimal Responses to Pretreatment: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Ling Chen

    2016-01-01

    Full Text Available Background/Aims. It remains unclear whether tenofovir disoproxil fumarate- (TDF- based combination therapy produces better outcomes than TDF monotherapy in chronic hepatitis B (CHB patients. The aim of this study was to compare the efficacy of the two regimens by performing a meta-analysis. Methods. A comprehensive literature search was performed on the comparison of TDF-based combination therapy and monotherapy for CHB patients in the PubMed, Embase, Web of Science, and the Cochrane Libraries. Both dichotomous and continuous variables were extracted and pooled outcomes were expressed as risk ratio (RR or standard mean difference (SMD. Results. Nine eligible studies (1089 subjects in total were included in our analysis. The proportion of patients with undetectable HBV DNA at 24, 48, and 96 weeks were similar between the two comparable groups (62.5% versus 70.9%, P=0.086; 78.1% versus 83.7%, P=0.118; 86.4% versus 87.9%, P=0.626, resp.. HBV DNA reduction, rates of ALT normalization, hepatitis B e antigen (HBeAg loss, and HBeAg seroconversion were also similar between the two groups. Conclusions. On the current data, TDF-based combination therapy seemed to be no better than those achieved by monotherapy. Further studies are needed to verify this comparison.

  10. Overall survival benefits for combining targeted therapy as second-line treatment for advanced non-small-cell-lung cancer: a meta-analysis of published data.

    Directory of Open Access Journals (Sweden)

    Wei-Xiang Qi

    Full Text Available BACKGROUND: Combining targeted therapy has been extensively investigated in previously treated advanced non-small-cell lung cancer (NSCLC, but it is still unclear whether combining targeted therapy might offer any benefits against standard monotherapy with erlotinib. We thus performed a meta-analysis of randomized controlled trials to compare the efficacy and safety of combining targeted therapy versus erlotinib alone as second-line treatment for advanced NSCLC. METHODS: Several databases were searched, including Pubmed, Embase and Cochrane databases. The endpoints were overall survival (OS, progression-free survival (PFS, overall response rate (ORR and grade 3 or 4 adverse event (AEs. The pooled hazard ratio (HR or odds ratio (OR, and 95% confidence intervals (CI were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials. RESULTS: Eight eligible trials involved 2417 patients were ultimately identified. The intention to treatment (ITT analysis demonstrated that combining targeted therapy significantly improved OS (HR 0.90, 95% CI: 0.82-0.99, p = 0.024, PFS (HR 0.83, 95% CI: 0.72-0.97, p = 0.018, and ORR (OR 1.35, 95% CI 1.01-1.80, P = 0.04. Sub-group analysis based on phases of trials, EGFR-status and KRAS status also showed that there was a tendency to improve PFS and OS in combining targeted therapy, except that PFS for patients with EGFR-mutation or wild type KRAS favored erlotinib monotherapy. Additionally, more incidence of grade 3 or 4 rash, fatigue and hypertension were observed in combining targeted therapy. CONCLUSIONS: With the available evidence, combining targeted therapy seems superior over erlotinib monotherapy as second-line treatment for advanced NSCLC. More studies are still needed to identify patients who will most likely benefit from the appropriate combining targeted therapy.

  11. Efficacy and safety of subthalamic nucleus deep brain stimulation combined with drug therapy for treating Parkinson's disease: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Hai-jiao WANG

    2017-02-01

    Full Text Available Objective To evaluate the efficacy and safety of subthalamic nucleus deep brain stimulation (STN-DBS combined with drug therapy for treating Parkinson's disease (PD. Methods Retrieve relevant randomized controlled trials (RCTs from online databases (January 1, 1980-October 1, 2016 as PubMed, EBMASE/SCOPUS and Cochrane Library with key words: subthalamic nucleus, deep brain stimulation, DBS, STN, Parkinson disease, random. Selection of studies was performed according to pre-designed inclusion and exclusion criteria. Quality of studies was evaluated by using Jadad Scale and Cochrane Handbook for Systematic Reviews of Interventions. All data were pooled by RevMan 5.2 software for Meta-analysis. Results The research enrolled 3245 articles, from which 6 studies with Jadad score ≥ 4 were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 958 PD patients were included. Meta-analysis showed that comparing with best medical treatment (BMT, STN-DBS combined with drug therapy significantly reduced the scores of Unified Parkinson's Disease Rating Scale (UPDRSⅢ in the "on" phase (SMD =-0.570, 95%CI: -0.710—0.430; P = 0.000 and in the "off" phase (SMD =-1.170, 95%CI: -1.500—0.850; P = 0.000, UPDRSⅠscore (SMD =-0.150, 95%CI: -0.290—0.010; P = 0.030, and 39-Item Parkinson's Disease Questionnaire (PDQ-39 score (SMD =-0.510, 95%CI: -0.660—0.370; P = 0.000. But it can increase the occurrence of severe adverse events (RD = 0.140, 95% CI:0.090-0.190; P = 0.000 and dysarthria (RD = 0.070, 95%CI: 0.010-0.120; P = 0.020, while decrease the occurrence of dyskinesia (RR = 0.450, 95% CI: 0.330-0.620; P = 0.000. Conclusions Subthalamic nucleus deep brain stimulation combined with drug therapy could greatly improve motor function, mental status and quality of life of PD patients, however, clinicians should pay more attention to the increased risk of severe adverse events and dysarthria after operation. DOI: 10.3969/j

  12. Network meta-analysis: an introduction for clinicians.

    Science.gov (United States)

    Rouse, Benjamin; Chaimani, Anna; Li, Tianjing

    2017-02-01

    Network meta-analysis is a technique for comparing multiple treatments simultaneously in a single analysis by combining direct and indirect evidence within a network of randomized controlled trials. Network meta-analysis may assist assessing the comparative effectiveness of different treatments regularly used in clinical practice and, therefore, has become attractive among clinicians. However, if proper caution is not taken in conducting and interpreting network meta-analysis, inferences might be biased. The aim of this paper is to illustrate the process of network meta-analysis with the aid of a working example on first-line medical treatment for primary open-angle glaucoma. We discuss the key assumption of network meta-analysis, as well as the unique considerations for developing appropriate research questions, conducting the literature search, abstracting data, performing qualitative and quantitative synthesis, presenting results, drawing conclusions, and reporting the findings in a network meta-analysis.

  13. Meta-analysis: low-dose intake of vitamin E combined with other vitamins or minerals may decrease all-cause mortality.

    Science.gov (United States)

    Jiang, Shan; Pan, Zhenyu; Li, Hui; Li, Fenglan; Song, Yanyan; Qiu, Yu

    2014-01-01

    It has been suggested that vitamin E alone or combined with other vitamins or minerals can prevent oxidative stress and slow oxidative injury-related diseases, such as cardiovascular disease and cancer. A comprehensive search of PubMed/MEDLINE, EMBASE and the Cochrane Library was performed. Relative risk was used as an effect measure to compare the intervention and control groups. A total of 33 trials were included in the meta-analysis. Neither vitamin E intake alone (RR=1.01; 95% CI, 0.97 to 1.04; p=0.77) nor vitamin E intake combined with other agents (RR=0.97; 95% CI, 0.89 to 1.06; p=0.55) was correlated with all-cause mortality. Subgroup analyses revealed that low-dose vitamin E supplementation combined with other agents is associated with a statistically significant reduction in all-cause mortality (RR=0.92; 95% CI, 0.86 to 0.98; p=0.01), and vitamin E intake combined with other agents is associated with a statistically significant reduction in mortality rates among individuals without probable or confirmed diseases (RR=0.92; 95% CI, 0.86 to 0.99; p=0.02). Neither vitamin E intake alone nor combined with other agents is associated with a reduction in all-cause mortality. But a low dose (vitamin E combined with other agents is correlated with a reduction in all-cause mortality, and vitamin E intake combined with other agents is correlated with a reduction in the mortality rate among individuals without probable or confirmed diseases.

  14. Interpreting and using meta-analysis in clinical practice.

    Science.gov (United States)

    Holly, Cheryl; Slyer, Jason T

    2013-01-01

    Systematic reviews, which can include a meta-analysis, are considered the gold standard for determination of best practice. Meta-analysis combines the results from many primary studies to identify patterns among the individual study results and then assesses the overall effectiveness of a specific healthcare intervention. The purpose of this article was to describe the process of performing a meta-analysis, discuss advantages and disadvantages of meta-analyses, and interpret the results of a meta-analysis from current research relevant to orthopaedic nursing practice.

  15. Efficacy of canagliflozin combined with antidiabetic drugs in treating type 2 diabetes mellitus: Meta-analysis of randomized control trials.

    Science.gov (United States)

    Meng, Qi; Shen, Yun; Liu, Dajin; Jiang, Fei

    2016-05-01

    Canagliflozin has been proposed as an effective treatment for type 2 diabetes. This meta-analysis of randomized control trials aimed to evaluate the effect of canagliflozin combined with other hypoglycemic drugs. We searched Medline, Embase, Cochrane Library, Google Scholar and ClinicalTrials.gov for randomized control trials comparing canagliflozin combined with conventional antidiabetic drugs vs placebo. Our main end-points were glycemic control and change in weight. We assessed pooled data by use of a random-effects model. Of 161 identified studies, six were eligible and were included in our analysis (n = 4670 participants). Compared with the placebo, mean changes in glycosylated hemoglobin were -0.60% (95% confidence interval -0.67 to -0.54%; I (2) = 0%) for canagliflozin 100 mg, and -0.76% (95% confidence interval -0.84 to -0.68%; I (2) = 20%) for canagliflozin 300 mg with bodyweight loss. Canagliflozin as an add-on drug to other antidiabetic drugs effectively lowers blood glucose without significant weight gain.

  16. MRI combined with PET-CT of different tracers to improve the accuracy of glioma diagnosis: a systematic review and meta-analysis.

    Science.gov (United States)

    Yang, Yihan; He, Mike Z; Li, Tao; Yang, Xuejun

    2017-09-16

    Based on studies focusing on positron emission tomography (PET)-computed tomography (CT) combined with magnetic resonance imaging (MRI) in the diagnosis of glioma, we conducted a systematic review and meta-analysis evaluating the pros and cons and the accuracy of different examinations. PubMed and Cochrane Library were searched. The search was conducted until April 2017. Two reviewers independently conducted the literature search according to the criteria set initially. Based on the exclusion criteria, 15 articles are included in this study. Of all studies that used MRI examination, there are five involving 18F-fluorodeoxyglucose-PET, five involving 11C-methionine-PET, five involving 18F-fluoro-ethyl-tyrosine-PET, and three involving 18F-fluorothymidine-PET. Due to the limitations such as lack of data, small sample size, and unrepresentative studies, we use a non-quantitative methodology. MRI examination can provide the anatomy information of glioma more clearly. PET-CT examinations based on tumor metabolism using different tracers have more advantages in determining the degree of glioma malignancy and boundaries. However, information provided by PET-CT of different tracers is not the same. With respect to the novel hybrid MRI/PET examination equipment proposed in recent years, the combination of MRI and PET-CT can definitively improve the diagnostic accuracy of glioma.

  17. Meta-analysis with R

    OpenAIRE

    Schwarzer, G; Carpenter, JR; Rucker, G

    2015-01-01

    This book provides a comprehensive introduction to performing meta-analysis using the statistical software R. It is intended for quantitative researchers and students in the medical and social sciences who wish to learn how to perform meta-analysis with R. As such, the book introduces the key concepts and models used in meta-analysis. It also includes chapters on the following advanced topics: publication bias and small study effects; missing data; multivariate meta-analysis, network meta-ana...

  18. The contribution of active medication to combined treatments of psychotherapy and pharmacotherapy for adult depression: A meta-analysis.

    NARCIS (Netherlands)

    Cuijpers, P.; Straten, van A.; Hollon, S.D.; Andersson, G.

    2010-01-01

    Objective:  Although there is sufficient evidence that combined treatments of psychotherapy and pharmacotherapy are more effective for depression in adults than each of the treatments alone, it remains unclear what the exact contribution of active medication is to the overall effects of combined tre

  19. Combination Measles-Mumps-Rubella-Varicella Vaccine in Healthy Children: A Systematic Review and Meta-analysis of Immunogenicity and Safety.

    Science.gov (United States)

    Ma, Shu-Juan; Li, Xing; Xiong, Yi-Quan; Yao, A-Ling; Chen, Qing

    2015-11-01

    A combined measles-mumps-rubella-varicella (MMRV) vaccine is expected to facilitate universal immunization against these 4 diseases. This study was undertaken to synthesize current research findings of the immunogenicity and safety of MMRV in healthy children.We searched PubMed, Embase, BIOSIS Previews, Web of Science, Cochrane Library, and other databases through September 9, 2014. Eligible randomized controlled trials (RCTs) were selected and collected independently by 2 reviewers. Meta-analysis was conducted using Stata 12.0 and RevMan 5.3.Twenty-four RCTs were included in qualitative synthesis. Nineteen RCTs compared single MMRV dose with measles-mumps-rubella vaccine with or without varicella vaccine (MMR + V/MMR). Similar seroconversion rates of these 4 viruses were found between comparison groups. There were comparable geometric mean titers (GMTs) against mumps and varicella viruses between MMRV group and MMR + V/MMR group. MMRV group achieved enhanced immune response to measles component, with GMT ratio of 1.66 (95% confidence interval [CI] 1.48, 1.86; P measles/rubella-like rash (relative risks 1.44-1.45) in MMRV groups.MMRV had comparable immunogenicity and overall safety profiles to MMR + V/MMR in healthy children based on current evidence.

  20. A combination of omega-3 fatty acids, folic acid and B-group vitamins is superior at lowering homocysteine than omega-3 alone: A meta-analysis.

    Science.gov (United States)

    Dawson, Samantha Loren; Bowe, Steven John; Crowe, Timothy Charles

    2016-06-01

    The aim of the study was to assess whether omega-3 polyunsaturated fatty acid supplementation alone or in combination with folic acid and B-group vitamins is effective in lowering homocysteine. The Medline Ovid, Embase and Cochrane databases were searched for randomized-controlled trial studies that intervened with omega-3 supplementation (with or without folic acid) and measured changes in homocysteine concentration. Studies were pooled using a random effects model for meta-analysis. Three different models were analyzed: all trials combined, omega-3 polyunsaturated fatty acid trials, and omega-3 polyunsaturated fatty acids with folic acid and B-group vitamin trials. Nineteen studies were included, consisting of 3267 participants completing 21 trials. Studies were heterogeneous; varying by dose, duration and participant health conditions. Across all trials, omega-3 supplementation was effective in lowering homocysteine by an average of 1.18μmol/L (95%CI: (-1.89, -0.48), P=.001). The average homocysteine-lowering effect was greater when omega-3 supplementation was combined with folic acid and B-group vitamins (-1.37μmol/L, 95%CI: (-2.38, -0.36), Pomega-3 supplementation alone (-1.09μmol/L 95%CI: (-2.04, -0.13), P=.03). Omega-3 polyunsaturated fatty acid supplementation was associated with a modest reduction in homocysteine. For the purposes of reducing homocysteine, a combination of omega-3s (0.2-6g/day), folic acid (150 - 2500μg/day) and vitamins B6 and B12 may be more effective than omega-3 supplementation alone.

  1. Combination antibiotic therapy versus monotherapy for Pseudomonas aeruginosa bacteraemia: a meta-analysis of retrospective and prospective studies.

    Science.gov (United States)

    Hu, Yangmin; Li, Leiqing; Li, Wenlu; Xu, Huimin; He, Ping; Yan, Xiaofeng; Dai, Haibin

    2013-12-01

    The choice of antibiotic monotherapy or combination therapy to treat Pseudomonas aeruginosa bacteraemia is controversial. The aim of this review was to compare both types of therapy to determine which delivers the best outcome for P. aeruginosa bacteraemia. We systematically searched electronic bibliographic databases, including PubMed, Ovid EMBASE and The Cochrane Library, for clinical studies that compared combination therapy with monotherapy in the treatment of P. aeruginosa bacteraemia. Eligible articles were analysed using Stata(®)/SE software v.12.0. Stratification analysis was conducted by study design and treatment type. Publication bias was assessed using Begg's funnel plot and Egger's test. Ten studies (eight retrospective and two prospective) involving 1239 patients were analysed. We found no difference between combination therapy and monotherapy when the data were combined (odds ratio = 0.89, 95% confidence interval 0.57-1.40; P = 0.614) or when data were analysed in subgroups. Neither combination therapy nor monotherapy treatment appears to have a significant effect on mortality rates in patients with P. aeruginosa bacteraemia. Further studies evaluating the effects of combination therapy or monotherapy in more specialised cases, such as when encountering a multidrug-resistant organism, are necessary.

  2. Effects of Combined Aerobic and Resistance Exercise on Exercise Capacity, Muscle Strength and Quality of Life in HIV-Infected Patients: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Mansueto Gomes Neto

    Full Text Available Many HIV-infected patients demonstrate disability and lower aerobic capacity. The inclusion of resistance training combined with aerobic exercise in a single program is known as combined aerobic and resistance exercise (CARE and seems to be an effective strategy to improve muscle weakness, as well as aerobic capacity in HIV-infected patients. We performed a meta-analysis to investigate the effects of CARE in HIV-infected patients.We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, CINAHL (from the earliest date available to august 2014 for controlled trials that evaluated the effects of CARE in HIV-infected patients. Weighted mean differences (WMD and 95% confidence intervals (CIs were calculated, and heterogeneity was assessed using the I2 test.Seven studies met the study criteria. CARE resulted in improvement in Peak VO2 WMD (4.48 mL·kg-1·min-1 95% CI: 2.95 to 6.0, muscle strength of the knee extensors WMD (25.06 Kg 95% CI: 10.46 to 39.66 and elbow flexors WMD (4.44 Kg 95% CI: 1.22 to 7.67 compared with no exercise group. The meta-analyses also showed significant improvement in Health status, Energy/Vitality and physical function domains of quality of life for participants in the CARE group compared with no exercise group. A nonsignificant improvement in social function domain of quality of life was found for participants in the CARE group compared with no exercise group.Combined aerobic and resistance exercise may improve peak VO2, muscle strength and health status, energy and physical function domains of quality of life and should be considered as a component of care of HIV-infected individuals.

  3. Combined effects of aerobic exercise and diet on lipids and lipoproteins in overweight and obese adults: a meta-analysis

    Science.gov (United States)

    This study used the aggregate data meta-analytic approach to determine the combined effects of aerobic exercise and diet on lipids and lipoproteins in overweight and obese adults. Twelve studies representing 859 men and women (443 intervention, 416 control) were included. Using random-effects models...

  4. Optimal duration of combined psychotherapy and pharmacotherapy for patients with moderate and severe depression: A meta-analysis

    DEFF Research Database (Denmark)

    Møldrup, Claus; Østergaard, Svetlana

    2011-01-01

    Background: To investigate the most effective duration of combined psychotherapy and pharmacotherapy for achieving remission and preventing relapse in depressive patients compared to pharmacotherapy alone. Methods: A systematic review of English articles using PubMed, EMBASE, Web of Science...... of the studies, clinical binary outcomes such as response, remission or relapse were extracted. Result: All pooled analyses were based on random-effects models. Twenty-one articles describing the influence of additional psychotherapy on remission and 15 articles reporting the influence on relapse in depression......, the Cochrane Library, and PsychINFO was performed in September 2009. Clinical studies comparing pharmacotherapy alone with pharmacotherapy in combination with a psychological intervention for depression treatment that reported response, remission or relapse as outcomes were included in the analysis. For each...

  5. Treatment adherence in schizophrenia: a patient-level meta-analysis of combined CATIE and EUFEST studies.

    Science.gov (United States)

    Czobor, Pál; Van Dorn, Richard A; Citrome, Leslie; Kahn, Rene S; Fleischhacker, W Wolfgang; Volavka, Jan

    2015-08-01

    The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) obtained a sample of 1493 chronic schizophrenia patients. The European First Episode Schizophrenia Trial (EUFEST) studied a sample of 498 patients. We have combined these two samples to study the predictors and correlates of adherence to treatment. Here we report on adherence to pharmacological treatment at the six and twelve month assessments of these trials with a combined subsample of 1154 schizophrenia patients. Individual patients׳ data were used for analyses. We used logistic regression to examine the effects of substance use, akathisia, parkinsonism, dyskinesia, hostility, and insight on pharmacological adherence. The results showed that reduced adherence to pharmacological treatment was associated with substance use (p=0.0003), higher levels of hostility (p=0.0002), and impaired insight (p<0.0001). Furthermore, poor adherence to study medication was associated with earlier discontinuation in the combined data. The clinical implications of the results point to the importance of routine assessments and interventions to address patients׳ insight and comorbid substance use and the establishment of therapeutic alliance.

  6. Usefulness of {sup 18}F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: A meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Tang Shuang [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Huang Gang, E-mail: huang2802@163.com [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Liu Jianjun [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Liu Tao [Department of Orthopedics, Soochow University, Suzhou (China); Treven, Lyndal [Faculty of Public Health, University of Sydney, Sydney (Australia); Song Saoli; Zhang Chenpeng; Pan Lingling [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127 (China); Zhang Ting [Department of Anesthesiology, Renji Hospital, Shanghai (China)

    2011-04-15

    The aim was to evaluate the diagnostic value of {sup 18}F-fluorodeoxyglucose-positron emission tomography ({sup 18}F-FDG PET), combined {sup 18}F-fluorodeoxyglucose-positron emission tomography/computed tomography ({sup 18}F-FDG PET/CT) and endoscopic ultrasonography (EUS) in diagnosing patients with pancreatic carcinoma. MEDLINE, EMBASE, Cochrane library and some other databases, from January 1966 to April 2009, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of {sup 18}F-FDG PET, PET/CT and EUS for patients with pancreatic cancer were collected. Methodological quality was assessed. The statistic software called 'Meta-Disc 1.4' was used for data analysis. Results: 51 studies were included in this meta-analysis. The pooled sensitivity estimate for combined PET/CT (90.1%) was significantly higher than PET (88.4%) and EUS (81.2%). The pooled specificity estimate for EUS (93.2%) was significantly higher than PET (83.1%) and PET/CT (80.1%). The pooled DOR estimate for EUS (49.774) was significantly higher than PET (32.778) and PET/CT (27.105). SROC curves for PET/CT and EUS showed a little better diagnostic accuracy than PET alone. For PET alone, when interpreted the results with knowledge of other imaging tests, its sensitivity (89.4%) and specificity (80.1%) were closer to PET/CT. For EUS, its diagnostic value decreased in differentiating pancreatic cancer for patients with chronic pancreatitis. In conclusion, PET/CT was a high sensitive and EUS was a high specific modality in diagnosing patients with pancreatic cancer. PET/CT and EUS could play different roles during different conditions in diagnosing pancreatic carcinoma.

  7. The efficacy and safety of bevacizumab combined with chemotherapy in treatment of HER2-negative metastatic breast cancer: a meta-analysis based on published phase III trials.

    Science.gov (United States)

    Fang, Yuan; Qu, Xinlan; Cheng, Boran; Chen, Yuanyuan; Wang, Zhenmeng; Chen, Fangfang; Xiong, Bin

    2015-03-01

    Bevacizumab (Bev) combined with chemotherapy significantly improves progression-free survival (PFS) but not overall survival (OS) in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC). The efficacy and safety depend on the type of chemotherapy combined with Bev. We performed a meta-analysis of phase III trials to evaluate the efficacy and safety of Bev + standard chemotherapy for HER2-negative MBC. The Cochrane Central Register of Controlled Trials, the Cochrane databases, EMBASE, MEDLINE, and ClinicalTrials.gov were analyzed. The primary outcomes included PFS, OS, and toxicity. Event-based hazard ratios (HRs) and relative risks (RRs) were expressed with the 95% confidence intervals (CIs). Four randomized controlled trials consisting of 3082 patients were included. Bev + standard chemotherapy improved PFS (HR 0.70, CI 0.64-0.77, P = 0.000) but had no effect on OS (HR 0.92, CI 0.82-1.02, P = 0.119). Bev + chemotherapy increased the incidence of febrile neutropenia (RR 1.45, CI 1.00 to 2.09, P = 0.048), proteinuria (RR 11.68, CI 3.72-36.70, P = 0.000), sensory neuropathy (RR 1.33, CI 1.05-1.70, P = 0.020), and grade ≥3 hypertension (RR 13.94, CI 7.06-27.55, P = 0.000). No differences in efficacy were observed between Bev + paclitaxel and Bev + capecitabine (Cape), but Bev + Cape increased the incidence of neutropenia. Bev + standard chemotherapy improved PFS in HER2-negative MBC patients. No benefit in OS was observed. Bev + Cape and Bev + paclitaxel had similar treatment efficacy, but Bev + Cape had a higher incidence of neutropenia.

  8. PRISMA-combined α-blockers and antimuscarinics for ureteral stent-related symptoms: A meta-analysis.

    Science.gov (United States)

    Zhang, Yu-Ming; Chu, Pei; Wang, Wen-Jin

    2017-02-01

    As a monotherpay, a-blockers and anti-muscarinics are both efficacy for ureteral stent-related symptoms (SRS). The aim of the study was to systematically evaluate their efficacy of a combination therapy for SRS. Relevant studies investigating α-blockers and/or anti-muscarinics for SRS were identified though searching online databases including PubMed, EMBASE, Cochrane Library, and other sources up to March 2016. The RevMan software was used for data analysis, and senesitivity analysis and inverted funnel plot were also adopted. Seven randomized controlled trials (RCTs) and 1 prospective controlled trial including 545 patients were selected. Compared with α-blockers, the combination group achieved significant improvements in total International Prostate Symptom Score (IPSS) [-3.93 (2.89, 4.96), P < 0.00001], obstructive subscore [-1.29 (0.68, 1.89), P < 0.0001], irritative subscore [-2.93 (2.18, 3.68), P < 0.00001], and quality of life score [-0.99 (0.42, 1.55), P < 0.001]. Compared with antimuscarinics, there were also significant differences in total IPSS [-3.49 (2.43, 4.55), P < 0.00001], obstructive subscore [-1.40 (0.78, 2.01), P < 0.00001], irritative subscore [-2.10 (1.30, 2.90), P < 0.00001], and quality of life score [-1.18 (0.58, 1.80), P < 0.001] in favor of combination group. No significant difference was found in the visual analog pain score and the urinary symptoms score in Ureteral Stent Symptom Questionnaire (USSQ). No significant difference in complications was found. Current analysis shows significant advantages of combination therapy compared with monotherapy of α-blockers or antimuscarinics alone mainly based on IPSS. More RCTs adopting validated USSQ as outcome measures are warranted to support the finding.

  9. A meta-analysis of combination therapy versus single-agent therapy in anthracycline- and taxane-pretreated metastatic breast cancer: results from nine randomized Phase III trials

    Directory of Open Access Journals (Sweden)

    Xu L

    2016-07-01

    Full Text Available Liang Xu,1,2,* Xiaobo Wu,3,* Chun Hu,1,2 Zhiying Zhang,4 Le Zhang,1,2 Shujing Liang,1,2 Yingchun Xu,5 Fengchun Zhang1,2 1Department of Oncology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 2Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 3Prevention and Cure Center of Breast Disease, Third Hospital of Nanchang, Nanchang, 4Graduate School, Xuzhou Medical College, Xuzhou, 5Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Nowadays, the philosophy of treating metastatic breast cancer (MBC is slowly evolving. Especially for the anthracycline- and taxane-pretreated MBC patients, no standard therapy exists in this setting. Whether to choose doublet agents or single agent as salvage treatment remains fiercely debated. Thus, we conducted a meta-analysis to resolve this problem. Databases including PubMed, EMBASE, and Cochrane library were searched for Phase III randomized clinical trials (published before August 2015 comparing the efficacy and adverse effects between the combination therapy and single-agent therapy in anthracycline- and taxane-pretreated MBC patients. The primary end point was the overall survival (OS, and the secondary end points were the progression-free survival (PFS, overall response rate (ORR, and grade 3 or 4 toxicities. The pooled hazard ratio (HR and pooled risk ratio (RR were used to evaluate the efficacy. Analyses were also performed to estimate the side effects and safety of both groups. In all, nine eligible randomized clinical trials were included in this meta-analysis. Improvements were proven in the doublet agents group on OS (HR 0.90, 95% confidence interval [CI] 0.84–0.96, P=0.002, PFS (HR 0.81, 95% CI 0.76–0.88, P<0.001, and ORR (RR 1.72, 95% CI 1.34–2.21, P<0.001. Notably, subgroup analysis

  10. Effect of combining tramadol and morphine in adult surgical patients: a systematic review and meta-analysis of randomized trials.

    Science.gov (United States)

    Martinez, V; Guichard, L; Fletcher, D

    2015-03-01

    The role for tramadol in multimodal postsurgical analgesic strategies remains unclear. We undertook a systematic review to evaluate the utility of combining tramadol with morphine after surgery. We searched the MEDLINE, EMBASE, LILAC, Cochrane, and Clinical Trial Register databases for randomized, controlled studies comparing tramadol with placebo or active control in patients undergoing surgery. Fourteen studies (713 patients) were included. There was a limited but significant postoperative morphine-sparing effect, with a weighted mean difference (WMD) of -6.9 (95% confidence interval -11.3 to -2.5) mg. This effect was not associated with a decrease in morphine-related adverse effects. No difference in the incidence of nausea, vomiting, sedation, or shivering was observed. There was no decrease in pain intensity at 24 h; the WMD was -0.9 (-7.2; 5.2) on a 100 mm visual analogue scale at 24 h. We found no significant clinical benefit from the combination of i.v. tramadol and morphine after surgery.

  11. Efficacy and Safety of Metronidazole Monotherapy versus Vancomycin Monotherapy or Combination Therapy in Patients with Clostridium difficile Infection: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Rui Li

    Full Text Available Clostridium difficile infection (CDI has become a global epidemiological problem for both hospitalized patients and outpatients. The most commonly used drugs to treat CDI are metronidazole and vancomycin. The aim of this study was to compare the efficacy and safety of metronidazole monotherapy with vancomycin monotherapy and combination therapy in CDI patients.A comprehensive search without publication status or other restrictions was conducted. Studies comparing metronidazole monotherapy with vancomycin monotherapy or combination therapy in patients with CDI were considered eligible. Meta-analysis was performed using the Mantel-Haenszel fixed-effects model, and odds ratios (ORs with 95% confidence intervals (95% CIs were calculated and reported.Of the 1910 records identified, seventeen studies from thirteen articles (n = 2501 patients were included. No statistically significant difference in the rate of clinical cure was found between metronidazole and vancomycin for mild CDI (OR = 0.67, 95% CI (0.45, 1.00, p = 0.05 or between either monotherapy and combination therapy for CDI (OR = 1.07, 95% CI (0.58, 1.96, p = 0.83; however, the rate of clinical cure was lower for metronidazole than for vancomycin for severe CDI (OR = 0.46, 95% CI (0.26, 0.80, p = 0.006. No statistically significant difference in the rate of CDI recurrence was found between metronidazole and vancomycin for mild CDI (OR = 0.99, 95% CI (0.40, 2.45, p = 0.98 or severe CDI (OR = 0.98, 95% CI (0.63, 1.53, p = 0.94 or between either monotherapy and combination therapy for CDI (OR = 0.91, 95% CI (0.66, 1.26, p = 0.56. In addition, there was no significant difference in the rate of adverse events (AEs between metronidazole and vancomycin (OR = 1.18, 95% CI (0.80, 1.74, p = 0.41. In contrast, the rate of AEs was significantly lower for either monotherapy than for combination therapy (OR = 0.30, 95% CI (0.17, 0.51, p < 0.0001.Metronidazole and vancomycin are equally effective for the

  12. Tumor necrosis factor-alpha inhibitor combined with methotrexate for ankylosing spondylitis: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Shaopeng Lin

    2014-06-01

    Full Text Available To evaluate the benefits and harms of combination of tumor necrosis factor-alpha (TNF-α inhibitor and methotrexate (MTX compared with TNF-α inhibitor monotherapy in the treatment of ankylosing spondylitis (AS. Randomized controlled trials were identified from Medline, Embase, Cinahl, Central and Clinical Trials Registry Platform, as well as from the reference sections of retrieved articles. The risk of bias was evaluated in all included trials. Data were extracted by two reviewers independently using a specially designed extraction form. The Cochrane Collaboration’s Review Manager 5.2 software was used for data analysis. The search retrieved 852 titles, of which 3 original trials were included, involving 187 participants. The overall risk of bias is low in all three trials. Only one study was placebo controlled, and all of them examined small samples. The analysis showed no significant advantage of the MTX combination versus monotherapy. Two trials assessed Assessment of Ankylosing Spondylitis (ASAS 40 and the pooled risk ratio (RR was 1.37 and 95% confidence interval 0.84 to 2.23. The RR for ASAS20 was 1.16 (0.88 to 1.52. Likewise, there were no significant difference between two groups in partial remission, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Magnetic resonance imaging activity score and other secondary outcomes. Withdrawals for side effects and for any reason were similar in two groups, RR were 1.89 (0.71 to 5.02 and 1.11 (0.67 to 1.84, respectively. The evidence available did not support any benefit of adding MTX to TNF-α inhibitor for the treatment of AS.

  13. Bupivacaine in combination with fentanyl or sufentanil in epidural/intrathecal analgesia for labor: a meta-analysis.

    Science.gov (United States)

    Li, Bo; Wang, Huixia; Gao, Chengjie

    2015-05-01

    This study is to compare the effectiveness of combinational use of bupivacaine with fentanyl (BUPI-FEN) and sufentanil (BUPI-SUF) in epidural/intrathecal analgesia for labor. Electronic databases were searched for relevant research papers published between 1985 and 2014. Meta-analyses of mean differences or odds ratios were performed and statistical heterogeneity between the studies tested by I(2) index. Ten studies recruiting a total of 728 women in labor were selected. Concentrations of the anesthetics used as mean ± sd were bupivacaine 0.115 ± 0.056%, fentanyl 0.0007 ± 0.001%, and sufentanil 0.00017 ± 0.00022%. Duration of analgesia was not significantly different between BUPI-SUF and BUPI-FEN administered mothers (mean difference [95%CI] of -33.55 [-74.94, 7.83] minutes; P = .11) under random effects. The onset of analgesia was also not significantly different between both groups (mean difference [95%CI] of -0.61 [-1.38, 0.16] minutes; P = .12). The number of neonates with Apgar score bupivacaine provide similar analgesic properties via the epidural or intrathecal routes for labor pain relief.

  14. Combined Effects of Aerobic Exercise and Diet on Lipids and Lipoproteins in Overweight and Obese Adults: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    George A. Kelley

    2012-01-01

    Full Text Available This study used the aggregate data meta-analytic approach to determine the combined effects of aerobic exercise and diet on lipids and lipoproteins in overweight and obese adults. Twelve studies representing 859 men and women (443 intervention, 416 control were included. Using random-effects models, statistically significant, intervention minus control reductions were found for TC (−12.8 mg/dL, 95% CI, −19.9 to −5.7, TC : HDL-C (−0.5 mg/dL, 95% CI, −0.8 to −0.1, LDL-C (−6.8 mg/dL, 95% CI, −11.8 to −1.8, and TG (−13.1 mg/dL, 95% CI, −21.2 to −5.0 but not HDL-C (−0.4 mg/dL, 95% CI, −2.3 to 1.6. Results remained robust when adjusted for publication bias, deleting each study from the model once, and collapsing results for multiple groups from the same study into one effect size. These findings suggest that concurrent aerobic exercise and diet improve TC, LDL-C, TC : HDL-C, and TG, but not HDL-C, in overweight and obese adults.

  15. Combined imaging markers dissociate Alzheimer’s disease and frontotemporal lobar degeneration – An ALE meta-analysis

    Directory of Open Access Journals (Sweden)

    Matthias L. Schroeter

    2011-07-01

    Full Text Available To compare and dissociate the neural correlates of Alzheimer's disease (AD and frontotemporal lobar degeneration (FTLD, we combine and synthesize here recent comprehensive meta-analyses. Systematic and quantitative meta-analyses were conducted according to the QUOROM statement by calculating anatomical likelihood estimates (ALE. AD (n=578 and the three subtypes of FTLD, frontotemporal dementia, semantic dementia and progressive non-fluent aphasia (n=229, were compared in conjunction analyses, separately for atrophy and reductions in glucose metabolism. Atrophy coincided in the amygdala and hippocampal head in AD and the FTLD subtype semantic dementia. The other brain regions did not show any overlap between AD and FTLD subtypes for both atrophy and changes in glucose metabolism. For AD alone (n=826, another conjunction analysis revealed a regional dissociation between atrophy and hypoperfusion/hypometabolism, whereby hypoperfusion and hypometabolism coincided in the angular/supramarginal gyrus and inferior precuneus/posterior cingulate gyrus. Our data together with other imaging studies suggest a specific dissociation of AD and FTLD if, beside atrophy, additional imaging markers in AD such as abnormally low parietal glucose utilization and perfusion are taken into account. Results support the incorporation of standardized imaging inclusion criteria into future diagnostic systems, which is crucial for early individual diagnosis and treatment in the future.

  16. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kwee, Thomas C. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Kwee, Robert M. [University Medical Center Maastricht, Department of Radiology, Maastricht (Netherlands)

    2009-03-15

    The aim of this study was to systematically review and meta-analyze published data on the diagnostic performance of combined 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of primary tumors in patients with cancer of unknown primary (CUP). A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Methodological quality of the included studies was assessed. Reported detection rates, sensitivities and specificities were meta-analyzed. Subgroup analyses were performed if results of individual studies were heterogeneous. The 11 included studies, comprising a total sample size of 433 patients with CUP, had moderate methodological quality. Overall primary tumor detection rate, pooled sensitivity and specificity of FDG-PET/CT were 37%, 84% (95% CI 78-88%) and 84% (95% CI 78-89%), respectively. Sensitivity was heterogeneous across studies (P = 0.0001), whereas specificity was homogeneous across studies (P = 0.2114). Completeness of diagnostic workup before FDG-PET/CT, location of metastases of unknown primary, administration of CT contrast agents, type of FDG-PET/CT images evaluated and way of FDG-PET/CT review did not significantly influence diagnostic performance. In conclusion, FDG-PET/CT can be a useful method for unknown primary tumor detection. Future studies are required to prove the assumed advantage of FDG-PET/CT over FDG-PET alone and to further explore causes of heterogeneity. (orig.)

  17. Treatment efficacy of anti-hypertensive drugs in monotherapy or combination: ATOM systematic review and meta-analysis of randomized clinical trials according to PRISMA statement.

    Science.gov (United States)

    Paz, Marco A; de-La-Sierra, Alejandro; Sáez, Marc; Barceló, María Antonia; Rodríguez, Juan José; Castro, Sonia; Lagarón, Cristina; Garrido, Josep M; Vera, Pilar; Coll-de-Tuero, Gabriel

    2016-07-01

    The relative efficacy of antihypertensive drugs/combinations is not well known. Identifying the most effective ones and the patients' characteristics associated with best performance of the drugs will improve management of hypertensive patients. To assess the blood pressure (BP) reduction attributed to antihypertensive drugs and identify characteristics associated with BP decrease. MEDLINE, Cochrane Central Register of Controlled Trials from inception through July 2012 and selected papers. Double-blind, randomized clinical trials whose main result was the reduction in BP by antihypertensive treatment, with study population ≥50 or ≥25 if the study was a crossover, follow-up of at least 8 weeks, and available required data. Study data were independently extracted by multiple observers and introduced in an electronic database. Inconsistencies were resolved by discussion and referral back to the original articles. Meta-analysis was performed according to PRISMA statement and using a Bayesian framework. Mean decrease in systolic (SBP) and diastolic blood pressure (DBP) achieved by each drug or combination. Two hundred eight trials including 94,305 patients were identified. In monotherapy, most drugs achieved 10 to 15 mm Hg SBP and 8 to 10 mm Hg DBP decreases.Olmesartan/amlodipine, olmesartan/hydrochlorothiazide, felodipine/metoprolol, and valsartan/hydrochlorothiazide were the combinations leading to the greatest mean SBP reductions (>20 mm Hg). Female sex and body mass index >25 kg/m were associated with more pronounced SBP and DBP reductions, whereas Afro-American ethnicity was associated with BP reductions smaller than the median. Results were adjusted by study duration, cardiovascular disease, and diabetes mellitus. Still, the estimation was performed using the mean administered doses, which do not exactly match those of the available drug formats. Data corresponded to those obtained in each of the included trials; the analysis of the combinations was

  18. Irinotecan or oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    LIANG Xiao-bo; HOU Sheng-huai; Li Yao-ping; WANG Li-chun; ZHANG Xin; YANG Jun

    2010-01-01

    Background To compare clinical efficacy and toxicity of irinotecan combined with 5-fluorouracil and leucovorin with those of oxaliplatin combined with 5-fiuorouracil and leucovorin as first-line therapy for advanced colorectal cancer.Methods Literature search was performed by keywords "irinotecan", "oxaliplatin" and "colorectal cancer" on all randomized controlled trails reported on irinotecan versus oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer in MEDLINE, OVID, Springer, Cochrane Controlled Trials Register (CCTR) and CBMdisc (Chinese Biology and Medicine disc) before January 2010. Two authors drew the details of trial design, characteristics of patients, outcomes, and toxicity from the studies included. Data analysis was performed by RevMan 4.2.Results According to the screening criteria, 7 clinical studies with 2095 participants of advanced colorectal cancer were included in this meta analysis. The baseline characteristics of irinotecan group were similar to those of oxaliplatin group.The response rate of oxaliplatin group was higher than that of irinotecan group (relative risk (RR)=0.82, 95% confidence interval (95%CI) (0.70, 0.96), P=0.01), and the median overall survival of oxaliplatin group was longer by 2.04 months than that of irinotecan group (95%CI (-3.54, -0.54), P=0.008). In the comparison of grade 3-4 toxicity between the two groups, the incidences of nausea, emesis, diarrhoea and alopecia in irinotecan group were higher than those in oxaliplatin group (RR=1.94, 95%CI(1.22, 3.09), P=0.005; 1.71, 95%CI (1.34, 2.18), P <0.001; 14.56, 95%CI (4.11,51.66), P <0.0001), respectively. However, the incidence of neurotoxicity, neutropenia and thrombocytopenia in irinotecan group were lower than those in oxaliplatin group (RR=0.06, 95%CI(0.03, 0.14), P <0.00001; 0.70, 95%CI(0.55, 0.91), P=0.006; 0.18, 95%CI(0.05, 0.61), P=0.006), respectively.Conclusions Both irinotecan and oxaliplatin combined

  19. Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Shao-Bo; Zhang, Yi-Bao; Wang, Sheng-Hong; Zhang, Hua; Liu, Peng; Zhang, Wei; Ma, Jing-Lin; Wang, Jing

    2017-04-01

    To compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture. We searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated. Nine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group. LIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  20. Combining risk estimates from observational studies with different exposure cutpoints: a meta-analysis on body mass index and diabetes type 2.

    NARCIS (Netherlands)

    Hartemink, Nienke; Boshuizen, Hendriek C; Nagelkerke, Nico J D; Jacobs, Monique A M; Houwelingen, Hans C van

    2006-01-01

    Studies on a dose-response relation often report separate relative risks for several risk classes compared with a referent class. When performing a meta-analysis of such studies, one has to convert these relative risks into an overall relative risk for a continuous effect. Apart from taking the depe

  1. [Bone substitutes augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly: a meta-analysis].

    Science.gov (United States)

    Wu, Jian-bin; Yang, Lei; Zhou, Fei-ya; Feng, Yong-zeng

    2016-06-01

    To systematically review the effectiveness of bone substitute augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly. Subject term and keywords were searched from Pubmed, Cochrane databases and CNKI from database foundation to August 2015. Randomized controlled studies and qusi-randomized controlled studies on bone substitutes augmentation combined with internal fixation versus internal fixation alone for the treatment of proximal femoral fractures in the elderly were chosen. Postoperative re-displacement, re-operation rate, complications (infection and bone ununion), functional outcome, quality of life scores and muscle strength were seen as outcome indicators. Enumeration data were statistical analyzed by risk difference and 95% confidence interval. Measurement data were analyzed by standardized mean difference and 95% confidence interval. If the same measurement data were evaluated by different standards in different studies, standardized mean differences and 95% confidence interval were used. The methods of statistical analysis were used by Cochrane databases. Eleven RCTs (677 patients) were included. Meta-analysis results indicated that bone substitutes augmentation combined with internal fixation occurred fewer re-displacement [SMD = -0.75, 95% CI (-1.03, -0.47)] and obtained better function [SMD = 0.40, 95% CI (0.20, 0.59)]. While there were no significant differences in reoperation rate [RD = 0.02, 95% CI (-0.05, -0.09)], pain at 1 week after operation [MD = -1.79, 95% CI (-13.55, -9.96)], pain ranged from 6 to 8 weeks [MD = -7.24, 95% CI (-20.07, -5.59)], postoperative pain at 12 weeks [MD = -0.32, 95% CI (-4.9, -3.55)], muscle strength [MD = 1.25, 95% CI (-6.98, -9.48)], bone ununion [RD = 0.02, 95% CI (-0.01, -0.05)] and postoperative complications [MD = 0.01, 95% CI (-0.03, -0.04)]. Compared with single internal fixation, bone substitutes augmentation combined with internal

  2. Teaching meta-analysis using MetaLight

    Directory of Open Access Journals (Sweden)

    Thomas James

    2012-10-01

    Full Text Available Abstract Background Meta-analysis is a statistical method for combining the results of primary studies. It is often used in systematic reviews and is increasingly a method and topic that appears in student dissertations. MetaLight is a freely available software application that runs simple meta-analyses and contains specific functionality to facilitate the teaching and learning of meta-analysis. While there are many courses and resources for meta-analysis available and numerous software applications to run meta-analyses, there are few pieces of software which are aimed specifically at helping those teaching and learning meta-analysis. Valuable teaching time can be spent learning the mechanics of a new software application, rather than on the principles and practices of meta-analysis. Findings We discuss ways in which the MetaLight tool can be used to present some of the main issues involved in undertaking and interpreting a meta-analysis. Conclusions While there are many software tools available for conducting meta-analysis, in the context of a teaching programme such software can require expenditure both in terms of money and in terms of the time it takes to learn how to use it. MetaLight was developed specifically as a tool to facilitate the teaching and learning of meta-analysis and we have presented here some of the ways it might be used in a training situation.

  3. Meta-analysis and its application in global change research

    Institute of Scientific and Technical Information of China (English)

    LEI XiangDong; PENG ChangHui; TIAN DaLun; SUN JianFeng

    2007-01-01

    Meta-analysis is a quantitative synthetic research method that statistically integrates results from individual studies to find common trends and differences. With increasing concern over global change, meta-analysis has been rapidly adopted in global change research. Here, we introduce the methodologies, advantages and disadvantages of meta-analysis, and review its application in global climate change research, including the responses of ecosystems to global warming and rising CO2 and O3 concentrations, the effects of land use and management on climate change and the effects of disturbances on biogeochemistry cycles of ecosystem. Despite limitation and potential misapplication, meta-analysis has been demonstrated to be a much better tool than traditional narrative review in synthesizing results from multiple studies. Several methodological developments for research synthesis have not yet been widely used in global climate change researches such as cumulative meta-analysis and sensitivity analysis. It is necessary to update the results of meta-analysis on a given topic at regular intervals by including newly published studies. Emphasis should be put on multi-factor interaction and long-term experiments. There is great potential to apply meta-analysis to global climate change research in China because research and observation networks have been established (e.g. ChinaFlux and CERN), which create the need for combining these data and results to provide support for governments' decision making on climate change. It is expected that meta-analysis will be widely adopted in future climate change research.

  4. Short- and Long-Term Patient Outcomes From Combined Coronary Endarterectomy and Coronary Artery Bypass Grafting: A Meta-Analysis of 63,730 Patients (PRISMA).

    Science.gov (United States)

    Wang, Jiayang; Gu, Chengxiong; Yu, Wenyuan; Gao, Mingxin; Yu, Yang

    2015-10-01

    This meta-analysis aimed to compare the short- and long-term outcomes in patients undergoing combined coronary endarterectomy and coronary artery bypass grafting (CE + CABG) versus isolated CABG, and particularly to examine subgroup patients with high-risk profile and patients with diffuse disease in the left anterior descending artery (LAD).Studies published between January 1, 1970 and May 31, 2015 were searched in the literature databases, including Ovid Medline, Embase, PubMed, and ISI Web of Science.A total of 30 eligible studies including 63,730 patients were analyzed.Five authors extracted data from the included studies independently.Meta-analysis on the total patients revealed that CE + CABG was associated with significantly increased 30-day postoperative all-cause mortality compared with isolated CABG (OR = 1.86, 95% CI: 1.66-2.08, z = 10.99, P < 0.0001). Subgroup analysis on patients with high-risk profile and patients with diffuse disease in the LAD showed that 30-day mortality after CE + CABG was 2.6 folds (OR = 2.60, 95% CI: 1.39-4.86, z = 2.99, P = 0.003) and 3.93 folds (OR = 3.93, 95% CI: 1.40-11.0, z = 2.60, P = 0.009) of that after isolated CABG in the respective subgroup. In contrast, the mortality was comparable in CE + off-pump CABG and CE + on-pump CABG groups (OR = 0.53, 95% CI: 0.18-1.55, z = 1.16, P = 0.248). In addition, the incidences of perioperative myocardial infarction (MI) and 30-day postoperative complications, including low output syndrome (LOS), MI, ventricular tachycardia (VT), and renal dysfunction after CE + CABG were significantly higher than those after isolated CABG (all P < 0.05). In high-risk patient subgroup, CE + CABG significantly increased the incidences of postoperative LOS, MI, and renal function compared with isolated CABG (all P < 0.05). The incidence of perioperative myocardial after CE + CABG was 2.86 and 2.92 times of that after isolated CABG in high

  5. Meta-analysis of the effects of laidlomycin propionate, fed alone or in combination with chlortetracycline, compared with monensin sodium, fed alone or in combination with tylosin, on growth performance, health, and carcass outcomes in finishing steers in North America.

    Science.gov (United States)

    Cernicchiaro, N; Corbin, M; Quinn, M; Prouty, F; Branine, M; Renter, D G

    2016-04-01

    The objective of this research was to use data from multiple studies to comprehensively quantify the effects of feeding 1) laidlomycin propionate (LP), alone and/or in combination with chlortetracycline, compared with 2) monensin sodium (MS), alone and/or in combination with tylosin, at commercially approved dosages, on ADG, DMI, feed efficiency (FE), mortality, and carcass characteristics (HCW and liver abscesses). A secondary objective was to explore potential sources of heterogeneity among the comparative effectiveness studies. A systematic review of peer-reviewed literature and industry reports was used to identify studies that included direct comparisons of these treatments in finishing steers in North America. Random-effects meta-analysis models of performance, carcass, and health-related outcomes were fitted with extracted data, consisting of a total of 17 data sets comprising a total of 135 pens and 13,603 steers. Results showed that pens of steers fed LP had increased ADG (live and carcass adjusted), DMI, and HCW compared with those fed monensin ( 0.05) were identified for FE or for health-related outcomes (overall and cause-specific mortality). There was a substantial amount of heterogeneity in outcomes among studies, and when pen size and type of production setting were included in mixed-effects meta-regression models, they accounted for only a small proportion of the between-study heterogeneity found in the meta-analysis models. Therefore, caution should be exercised when interpreting summary estimates in the presence of substantial heterogeneity. However, these results provide comprehensive information on the comparative effects of different ionophores across multiple studies and multiple years, states, and production settings. These unique results can enable quantitative and informed decisions by potential end users of these feed additives that are widely used in the U.S. beef industry for reducing the costs of beef production through enhanced cattle

  6. Angiotensin System Blockade Combined With Calcium Channel Blockers Is Superior to Other Combinations in Cardiovascular Protection With Similar Blood Pressure Reduction: A Meta-Analysis in 20,451 Hypertensive Patients.

    Science.gov (United States)

    Chi, Chen; Tai, Chenhui; Bai, Bin; Yu, Shikai; Karamanou, Marianna; Wang, Jiguang; Protogerou, Athanase; Blacher, Jacques; Safar, Michel E; Zhang, Yi; Xu, Yawei

    2016-08-01

    The authors aimed to investigate the superiority of angiotensin system blockade (angiotensin-converting enzyme [ACE] inhibitor/angiotensin receptor blocker [ARB]) plus a calcium channel blocker (CCB) (A+C) over other combination therapies in antihypertensive treatment. A meta-analysis in 20,451 hypertensive patients from eight randomized controlled trials was conducted to compare the A+C treatment with other combination therapies in terms of blood pressure (BP) reduction, clinical outcomes, and adverse events. The results showed that BP reduction did not differ significantly among the A+C therapy and other combination therapies in systolic and diastolic BP (P=.87 and P=.56, respectively). However, A+C therapy, compared with other combination therapies, achieved a significantly lower incidence of cardiovascular composite endpoints, including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.70-0.91; Pother combinations (Pother combination therapies (P=.34) but presented a significantly lower incidence of serious adverse events (RR, 0.85; 95% CI, 0.73-0.98; P=.03). In conclusion, A+C therapy is superior to other combinations of antihypertensive treatment as it shows a lower incidence of cardiovascular events and adverse events, while it has similar effects in lowering BP and preserving renal function.

  7. Is combined use of intravenous and intraarticular tranexamic acid superior to intravenous or intraarticular tranexamic acid alone in total knee arthroplasty? A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Mi, Bobin; Liu, Guohui; Lv, Huijuan; Liu, Yi; Zha, Kun; Wu, Qipeng; Liu, Jing

    2017-04-18

    Tranexamic acid (TXA) has been proven to be effective in reducing blood loss and transfusion rate after total knee arthroplasty (TKA) without increasing the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Recently, an increasing number of studies have been interested in applying combined intravenous (IV) with intraarticular (IA) tranexamic acid in total knee arthroplasty. The purpose of this meta-analysis was to compare the blood loss and complications of combined TXA with IV TXA or IA TXA on TKA. Systematic search of literatures were conducted to identify related articles that were published in PubMed, MEDLINE, Embase, the Cochrane Library, SpringerLink, ClinicalTrials.gov, and Ovid from their inception to September 2016. All studies that compare blood loss and complications of combined TXA and IV TXA or IA TXA on TKA were included. Main outcomes were collected and analyzed by the Review Manager 5.3. Five studies were included in the present meta-analysis. There was significant difference in total blood loss and blood volume of drainage when compared combined TXA group with IV TXA group or IA TXA group (P  0.05). Compared with administration of IA TXA or IV TXA alone on TKA, combined use of TXA has advantages in reducing total blood loss and blood volume of drainage without increasing the incidence of thromboembolic complications. We recommend combined TXA as the preferred option for patients undergoing TKA.

  8. Use of meta-analysis to combine candidate gene association studies: application to study the relationship between the ESR PvuII polymorphism and sow litter size

    Directory of Open Access Journals (Sweden)

    Alfonso Leopoldo

    2005-07-01

    Full Text Available Abstract This article investigates the application of meta-analysis on livestock candidate gene effects. The PvuII polymorphism of the ESR gene is used as an example. The association among ESR PvuII alleles with the number of piglets born alive and total born in the first (NBA1, TNB1 and later parities (NBA, TNB is reviewed by conducting a meta-analysis of 15 published studies including 9329 sows. Under a fixed effects model, litter size values were significantly lower in the "AA" genotype groups when compared with "AB" and "BB" homozygotes. Under the random effects model, the results were similar although differences between "AA" and "AB" genotype groups were not clearly significant for NBA and TNB. Nevertheless, the most noticeable result was the high and significant heterogeneity estimated among studies. This heterogeneity could be assigned to error sampling, genotype by environment interaction, linkage or epistasis, as referred to in the literature, but also to the hypothesis of population admixture/stratification. It is concluded that meta-analysis can be considered as a helpful analytical tool to synthesise and discuss livestock candidate gene effects. The main difficulty found was the insufficient information on the standard errors of the estimated genotype effects in several publications. Consequently, the convenience of publishing the standard errors or the concrete P-values instead of the test significance level should be recommended to guarantee the quality of candidate gene effect meta-analyses.

  9. Efficacy and Safety of rh-Endostatin Combined with Chemotherapy 
versus Chemotherapy Alone for Advanced NSCLC: A Meta-analysis Review

    Directory of Open Access Journals (Sweden)

    Jinzhong ZHANG

    2011-05-01

    Full Text Available Background and objective In recent years, there has been a large number of studies and reports about the efficacy and safety of recombinant human endostatin (rh-endostatin, an anti-angiogenic drug, in treatment of advanced lung cancer. Authentic assessment of rh-endostatin treatment in lung cancer is important. The aim of this study is to assess the clinical efficacy and safety of rh-endostatin combined with chemotherapy in the treatment of patients with non-small cell lung cancer (NSCLC. Methods Cochrane systematic review methods were used in the data selection, and data were selected from the Cochrane Library, EMBASE, Medline, SCI, CBM, CNKI, and etc electronic database to get all clinical controlled trials. The retrieval time was March 2010. The objects of these randomized controlled trials were advanced NSCLC patients and in the experimental group was rh-endostatin combination chemotherapy, in the control group was chemotherapy alone to compare the efficacy of two groups. The quality of included trials were evaluated by two reviewers independently. The software RevMan 5.0 was used for meta-analyses. Results Fifteen trials with 1,326 patients were included according to the including criterion. All trials were randomized controlled trials, and two trials were adequate in reporting randomization. Thirteen trials didn’t mention the blinding methods. Meta analysis indicated that the NPE arm (Vinorelbine+cisplatin+rh-endostatin had a different response rate compared with NP (Vinorelbine+cisplatin arm (OR=2.16, 95%CI: 1.57-2.99. The incidences of severe leukopenia (OR=0.94, 95%CI: 0.66-1.32 and severe thrombocytopenia (OR=1.00, 95%CI: 0.64-1.57 and nausea and vomiting (OR=0.85, 95%CI: 0.61-1.20 were similar in the NPE arm compared with those in the NP arm. The NPE plus radiotherapy (RT arm had a similar response rate compared with NP plus RT arm (OR=2.39, 95%CI: 0.99-5.79. The incidences of leukopenia (OR=0.83, 95%CI: 0.35-1.94 and

  10. Efficacy and safety of simeprevir in combination with peginterferon and ribavirin for patients with hepatitis C genotype 1 infection: a meta-analysis of randomized trials

    Directory of Open Access Journals (Sweden)

    Cui Xianghua

    Full Text Available Background and aim: A simeprevir (SMV-based regimen has shown promising results in treating chronic hepatitis C virus (HCV infection. This meta-analysis aimed to assess the efficacy and safety of simeprevir for treating HCV genotype 1 infection. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, along with the reference lists of retrieved articles. The meta-analysis only included randomized controlled trials (RCTs that compared the efficacy and safety of addition of SMV to peginterferon (PegIFN and ribavirin (RBV (triple regimen with PegIFN/RBV alone (dual regimen in treating chronic HCV genotype 1 infection. Results: A total of seven RCTs involving 2,301 patients were included. The triple regimen had a higher pooled sustained virologic response (SVR rate [odds ratio (OR = 4.57; 95% confidence interval (CI: 3.34-6.27; p < 0.001] and lower pooled relapse rate [relative risk (RR = 0.41; 95% CI: 0.33-0.50; p < 0.001] than the dual regimen had. The pooled incidence of adverse events (AEs was comparable between the two regimens (RR = 1.01; 95% CI: 0.99-1.03; p = 0.339, whereas the incidence of serious AEs in the triple regimen was lower (RR = 0.7; 95% CI: 0.50-0.98; p < 0.05. Conclusions: The meta-analysis demonstrates that the addition of SMV to pegIFN and RBV is effective and well-tolerated in treating chronic HCV genotype 1 infection, with a low incidence of AEs.

  11. Meta-analysis of prevalence.

    Science.gov (United States)

    Barendregt, Jan J; Doi, Suhail A; Lee, Yong Yi; Norman, Rosana E; Vos, Theo

    2013-11-01

    Meta-analysis is a method to obtain a weighted average of results from various studies. In addition to pooling effect sizes, meta-analysis can also be used to estimate disease frequencies, such as incidence and prevalence. In this article we present methods for the meta-analysis of prevalence. We discuss the logit and double arcsine transformations to stabilise the variance. We note the special situation of multiple category prevalence, and propose solutions to the problems that arise. We describe the implementation of these methods in the MetaXL software, and present a simulation study and the example of multiple sclerosis from the Global Burden of Disease 2010 project. We conclude that the double arcsine transformation is preferred over the logit, and that the MetaXL implementation of multiple category prevalence is an improvement in the methodology of the meta-analysis of prevalence.

  12. Systematic review and network meta-analysis of combination and monotherapy treatments in disease-modifying antirheumatic drug-experienced patients with rheumatoid arthritis: analysis of American College of Rheumatology criteria scores 20, 50, and 70

    Directory of Open Access Journals (Sweden)

    Orme ME

    2012-12-01

    Full Text Available Michelle E Orme,1 Katherine S MacGilchrist,2 Stephen Mitchell,2 Dean Spurden,3 Alex Bird31Icera Consulting, Swindon, Wiltshire, UK; 2Systematic Review Department, Abacus International, Bicester, Oxfordshire, UK; 3Pfizer UK Limited, Tadworth, Surrey, UKBackground: Biologic disease-modifying antirheumatic drugs (bDMARDs extend the treatment choices for rheumatoid arthritis patients with suboptimal response or intolerance to conventional DMARDs. The objective of this systematic review and meta-analysis was to compare the relative efficacy of EU-licensed bDMARD combination therapy or monotherapy for patients intolerant of or contraindicated to continued methotrexate.Methods: Comprehensive, structured literature searches were conducted in Medline, Embase, and the Cochrane Library, as well as hand-searching of conference proceedings and reference lists. Phase II or III randomized controlled trials reporting American College of Rheumatology (ACR criteria scores of 20, 50, and 70 between 12 and 30 weeks' follow-up and enrolling adult patients meeting ACR classification criteria for rheumatoid arthritis previously treated with and with an inadequate response to conventional DMARDs were eligible. To estimate the relative efficacy of treatments whilst preserving the randomized comparisons within each trial, a Bayesian network meta-analysis was conducted in WinBUGS using fixed and random-effects, logit-link models fitted to the binomial ACR 20/50/70 trial data.Results: The systematic review identified 10,625 citations, and after a review of 2450 full-text papers, there were 29 and 14 eligible studies for the combination and monotherapy meta-analyses, respectively. In the combination analysis, all licensed bDMARD combinations had significantly higher odds of ACR 20/50/70 compared to DMARDs alone, except for the rituximab comparison, which did not reach significance for the ACR 70 outcome (based on the 95% credible interval. The etanercept combination was

  13. Meta-analysis: Its role in psychological methodology

    Directory of Open Access Journals (Sweden)

    Andrej Kastrin

    2008-11-01

    Full Text Available Meta-analysis refers to the statistical analysis of a large collection of independent observations for the purpose of integrating results. The main objectives of this article are to define meta-analysis as a method of data integration, to draw attention to some particularities of its use, and to encourage researchers to use meta-analysis in their work. The benefits of meta-analysis include more effective exploitation of existing data from independent sources and contribution to more powerful domain knowledge. It may also serve as a support tool to generate new research hypothesis. The idea of combining results of independent studies addressing the same research question dates back to sixteenth century. Metaanalysis was reinvented in 1976 by Glass, to refute the conclusion of an eminent colleague, Eysenck, that psychotherapy was essentially ineffective. We review some major historical landmarks of metaanalysis and its statistical background. We present the concept of effect size measure, the problem of heterogeneity and two models which are used to combine individual effect sizes (fixed and random effect model in great details. Two visualization techniques, forest and funnel plot graphics are demonstrated. We developed RMetaWeb, simple and fast web server application to conduct meta-analysis online. RMetaWeb is the first web meta-analysis application and is completely based on R software environment for statistical computing and graphics.

  14. The role of induction and adjuvant chemotherapy in combination with concurrent chemoradiotherapy for nasopharyngeal cancer: a Bayesian network meta-analysis of published randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Yu HL

    2016-01-01

    Full Text Available Hongliang Yu,1,* Dayong Gu,1,* Xia He,1 Xianshu Gao,2 Xiuhua Bian1 1Department of Radiation Oncology, Jiangsu Cancer Hospital affiliated with Nanjing Medical University, Nanjing, 2Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, People’s Republic of China *These authors contributed equally to this work Abstract: Whether the addition of induction chemotherapy (IC or adjuvant chemotherapy (AC to concurrent chemoradiotherapy (CCRT is superior to CCRT alone for locally advanced nasopharyngeal cancer is unknown. A Bayesian network meta-analysis was performed to investigate the efficacy of CCRT, IC + CCRT, and CCRT + AC on locally advanced nasopharyngeal cancer. The overall survival (OS with hazard ratios (HRs and locoregional recurrence rates (LRRs and distant metastasis rates (DMRs with risk ratios (RRs were investigated. After a comprehensive database search, eleven studies involving 2,626 assigned patients were included in this network meta-analysis. Compared with CCRT alone, IC + CCRT resulted in no significant improvement in OS or LRR and a marginal improvement in DMR (OS: HR =0.67, 95% credible interval (CrI 0.32–1.18; LRR: RR =1.79, 95% CrI 0.80–3.51; DMR: RR =1.79, 95% CrI 0.24–1.04 and CCRT + AC exhibited no beneficial effects on any of the endpoints of OS, LRR, or DMR (OS: HR =0.99, 95% CrI 0.64–1.43; LRR: RR =0.78, 95% CrI 0.43–1.32; DMR: RR =0.85, 95% CrI 0.57–1.24. As a conclusion, for locally advanced nasopharyngeal cancer, no significant differences in the treatment efficacies of CCRT, IC + CCRT, and CCRT + AC were found, with the exception of a marginally significant improvement in distant control observed following IC + CCRT compared with CCRT alone. Keywords: concurrent chemotherapy, induction chemotherapy, adjuvant chemotherapy, radiotherapy, nasopharyngeal cancer, network meta-analysis

  15. Effectiveness and safety of traditional Chinese medical bath therapy combined with ultraviolet irradiation in the treatment of psoriasis: A systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Guan, Jingzhi; Yuan, Shaofei; Wu, Hanqimuge; Na, Risu; Wu, Xueqin; Wang, Xin; Bao, Shan

    2017-01-01

    To systematically evaluate the clinical effects and safety of traditional Chinese medical bath therapy (TCMBT) combined with ultraviolet irradiation in the treatment of psoriasis. Electronic database retrieval was utilized. The foreign retrieval databases consulted included those of the Cochrane Library, PubMed and EMBASE; the domestic retrieval databases included the Chinese Biomedical Literature Database (Sino-Med), the China National Knowledge Infrastructure (CNKI), VIP and the WangFang Database. Clinical randomized controlled trials were conducted to evaluate the effects of TCMBT combined with ultraviolet irradiation in the treatment of psoriasis; the language of the retrieved articles was Chinese or English. Each database was searched from its inception to August 1, 2015. Two researchers independently collected the data and analyzed the methodology of the documented literature. The researchers conducted a meta-analysis with RevMan 5.2.3 software. According to the available literature, 25 RCTs (randomized controlled trials) of low research quality were conducted. According to the meta-analysis, the total effective rate of TCMBT combined with ultraviolet irradiation was relatively higher than that of ultraviolet irradiation alone. The recurrence rate, incidence of adverse reactions and Psoriasis Area and Severity Index (PASI) for the combined therapy was lower than that of ultraviolet irradiation (Pultraviolet irradiation are generally better than those of ultraviolet irradiation alone. However, the original literature was written in Chinese, and the quality of the studies was not high. Thus, it is difficult to confirm the clinical effects and safety of TCMBT combined with ultraviolet irradiation. It is necessary to conduct a scientific, normalized and high-quality RCT with multiple large samples and centers.

  16. Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis

    Science.gov (United States)

    Kim, Hyun Jung; Sun, Hwa Yeon; Choi, Hoon; Park, Jae Young; Bae, Jae Hyun; Doo, Seung Whan; Yang, Won Jae; Song, Yun Seob; Ko, Young Myoung

    2017-01-01

    Background There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) Objective The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. Methods We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). Results In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14–0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 - -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 - -0.07), 0.00 (95% CI: -0.08–0.08), and 0.56 (95% CI: 0.23–0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. Conclusions Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/ LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function. PMID:28072862

  17. 针灸联合西药治疗阿尔茨海默病的Meta分析%Meta-analysis on Acupuncture Combined with Western Medicine for Treatment of Alzheimer's Disease

    Institute of Scientific and Technical Information of China (English)

    许小泰; 谢炜

    2015-01-01

    This study was aimed to evaluate efficacy of acupuncture combined with western medicine in treatment of Alzheimer's disease (AD) with meta-analysis of data came from randomized controlled trials (RCTs). Databases both at home and abroad were comprehensively searched to collect efficacy data of acupuncture combined with western medicine versus western medicine in RCTs. The data was extracted from each study to conduct a meta-analysis with RevMan 5.2. The results showed that 10 studies measured up to standard. Seven studies reported effective cases were carried out by meta-analysis. The total RR was 1.25 [1.14, 1.38]. The funnel plot was approximately symmetry. It was suggested that effect of the therapy group was better than the control group (Z = 4.66,P<0.01). Four studies reported mini-mental state examination (MMSE) scores were carried out by meta-analysis. The total MD was 2.87 [0.64, 5.10]. The funnel plot was approximately symmetry. It was suggested that the therapy group was better than the control group on AD treatment in cognitive function improvement (Z = 2.52,P= 0.01). It was concluded that from current study, acupuncture combined with western medicine in AD treatment was definitely effective. However, it still required further study.%目的:通过对随机对照试验的数据进行Meta分析,比较针灸联合西药和纯西药治疗阿尔茨海默病的疗效.方法:全面检索中文和外文有关数据库,收集比较针灸联合西药和纯西药治疗阿尔茨海默病的随机对照试验,提取数据后应用RevMan 5.2软件进行Meta分析.结果:共纳入10项符合标准的研究,将其中的7项报告了有效例数的研究进行Meta分析,合并RR=1.25[1.14,1.38],漏斗图基本对称,提示针灸联合西药对阿尔茨海默病的治疗效果优于对照组(Z=4.66,P<0.01);将其中的4项报告了治疗后简易智能精神状态量表(MMSE)评分的研究进行Meta分析,合并MD=2.87[0.64,5.10],漏斗图基本对称,提示针灸联合

  18. Causal Meta-Analysis : Methodology and Applications

    NARCIS (Netherlands)

    Bax, L.J.

    2009-01-01

    Meta-analysis is a statistical method to summarize research data from multiple studies in a quantitative manner. This dissertation addresses a number of methodological topics in causal meta-analysis and reports the development and validation of meta-analysis software. In the first (methodological) p

  19. Rethinking Meta-Analysis: Applications for Air Pollution Data and Beyond.

    Science.gov (United States)

    Goodman, Julie E; Petito Boyce, Catherine; Sax, Sonja N; Beyer, Leslie A; Prueitt, Robyn L

    2015-06-01

    Meta-analyses offer a rigorous and transparent systematic framework for synthesizing data that can be used for a wide range of research areas, study designs, and data types. Both the outcome of meta-analyses and the meta-analysis process itself can yield useful insights for answering scientific questions and making policy decisions. Development of the National Ambient Air Quality Standards illustrates many potential applications of meta-analysis. These applications demonstrate the strengths and limitations of meta-analysis, issues that arise in various data realms, how meta-analysis design choices can influence interpretation of results, and how meta-analysis can be used to address bias and heterogeneity. Reviewing available data from a meta-analysis perspective can provide a useful framework and impetus for identifying and refining strategies for future research. Moreover, increased pervasiveness of a meta-analysis mindset-focusing on how the pieces of the research puzzle fit together-would benefit scientific research and data syntheses regardless of whether or not a quantitative meta-analysis is undertaken. While an individual meta-analysis can only synthesize studies addressing the same research question, the results of separate meta-analyses can be combined to address a question encompassing multiple data types. This observation applies to any scientific or policy area where information from a variety of disciplines must be considered to address a broader research question.

  20. Quality of Life in Autism across the Lifespan: A Meta-Analysis

    Science.gov (United States)

    van Heijst, Barbara F. C.; Geurts, Hilde M.

    2015-01-01

    Autism is a lifelong neurodevelopmental disorder, with a known impact on quality of life. Yet the developmental trajectory of quality of life is not well understood. First, the effect of age on quality of life was studied with a meta-analysis. Our meta-analysis included 10 studies (published between 2004 and 2012) with a combined sample size of…

  1. General Framework for Meta-Analysis of Haplotype Association Tests.

    Science.gov (United States)

    Wang, Shuai; Zhao, Jing Hua; An, Ping; Guo, Xiuqing; Jensen, Richard A; Marten, Jonathan; Huffman, Jennifer E; Meidtner, Karina; Boeing, Heiner; Campbell, Archie; Rice, Kenneth M; Scott, Robert A; Yao, Jie; Schulze, Matthias B; Wareham, Nicholas J; Borecki, Ingrid B; Province, Michael A; Rotter, Jerome I; Hayward, Caroline; Goodarzi, Mark O; Meigs, James B; Dupuis, Josée

    2016-04-01

    For complex traits, most associated single nucleotide variants (SNV) discovered to date have a small effect, and detection of association is only possible with large sample sizes. Because of patient confidentiality concerns, it is often not possible to pool genetic data from multiple cohorts, and meta-analysis has emerged as the method of choice to combine results from multiple studies. Many meta-analysis methods are available for single SNV analyses. As new approaches allow the capture of low frequency and rare genetic variation, it is of interest to jointly consider multiple variants to improve power. However, for the analysis of haplotypes formed by multiple SNVs, meta-analysis remains a challenge, because different haplotypes may be observed across studies. We propose a two-stage meta-analysis approach to combine haplotype analysis results. In the first stage, each cohort estimate haplotype effect sizes in a regression framework, accounting for relatedness among observations if appropriate. For the second stage, we use a multivariate generalized least square meta-analysis approach to combine haplotype effect estimates from multiple cohorts. Haplotype-specific association tests and a global test of independence between haplotypes and traits are obtained within our framework. We demonstrate through simulation studies that we control the type-I error rate, and our approach is more powerful than inverse variance weighted meta-analysis of single SNV analysis when haplotype effects are present. We replicate a published haplotype association between fasting glucose-associated locus (G6PC2) and fasting glucose in seven studies from the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium and we provide more precise haplotype effect estimates.

  2. Comparison of prophylactic effect of UGIB and effects on platelet function between PPIs and H2RAs combined with DAPT: systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Yi Z

    2017-03-01

    inhibitors, histamine-2 receptor antagonists, dual-antiplatelet therapy, upper gastrointestinal bleeding, platelet function, meta-analysis

  3. Systematic review and network meta-analysis of the efficacy and safety of tumour necrosis factor inhibitor–methotrexate combination therapy versus triple therapy in rheumatoid arthritis

    Science.gov (United States)

    Fleischmann, Roy; Tongbram, Vanita; van Vollenhoven, Ronald; Tang, Derek H; Chung, James; Collier, David; Urs, Shilpa; Ndirangu, Kerigo; Wells, George; Pope, Janet

    2017-01-01

    Objective Clinical trials have not consistently demonstrated differences between tumour necrosis factor inhibitor (TNFi) plus methotrexate and triple therapy (methotrexate plus hydroxychloroquine plus sulfasalazine) in rheumatoid arthritis (RA). The study objective was to estimate the efficacy, radiographic benefits, safety and patient-reported outcomes of TNFi–methotrexate versus triple therapy in patients with RA. Methods A systematic review and network meta-analysis (NMA) of randomised controlled trials of TNFi–methotrexate or triple therapy as one of the treatment arms in patients with an inadequate response to or who were naive to methotrexate was conducted. American College of Rheumatology 70% response criteria (ACR70) at 6 months was the prespecified primary endpoint to evaluate depth of response. Data from direct and indirect comparisons between TNFi–methotrexate and triple therapy were pooled and quantitatively analysed using fixed-effects and random-effects Bayesian models. Results We analysed 33 studies in patients with inadequate response to methotrexate and 19 in patients naive to methotrexate. In inadequate responders, triple therapy was associated with lower odds of achieving ACR70 at 6 months compared with TNFi–methotrexate (OR 0.35, 95% credible interval (CrI) 0.19 to 0.64). Most secondary endpoints tended to favour TNFi–methotrexate in terms of OR direction; however, no clear increased likelihood of achieving these endpoints was observed for either therapy. The odds of infection were lower with triple therapy than with TNFi−methotrexate (OR 0.08, 95% CrI 0.00 to 0.57). There were no differences observed between the two regimens in patients naive to methotrexate. Conclusions In this NMA, triple therapy was associated with 65% lower odds of achieving ACR70 at 6 months compared with TNFi–methotrexate in patients with inadequate response to methotrexate. Although secondary endpoints numerically favoured TNFi–methotrexate, no

  4. 奥扎格雷钠联合川芎嗪注射液治疗急性脑梗死的Meta分析%Meta Analysis on Ozagrel Sodium Combined with Ligustrazine Injection for Treatment of Acute Cerebral Infarction

    Institute of Scientific and Technical Information of China (English)

    周晓玲; 王敏

    2015-01-01

    目的:应用Meta分析的方法评价奥扎格雷钠联合川芎嗪注射液治疗急性脑梗死的有效性和安全性。方法计算机检索 Cochrane 图书馆、PubMed、EMbase、万方数据、中国知识资源总库(CNKI)和维普期刊资源整合服务平台等,并辅以手工检索,纳入奥扎格雷钠联合川芎嗪注射液治疗急性脑梗死的随机对照试验( RCT )的相关文献,筛选文献并对纳入文献进行方法学质量评价,采用RevMan 5.2统计软件进行Meta分析。结果共纳入15个RCT,合计1519例患者。Meta分析显示,奥扎格雷钠联合川芎嗪注射液治疗急性脑梗死的神经功能缺损临床疗效比值比(OR)合并值为4.59(95%可信区间为3.33~6.34,P<0.00001);神经功能缺损评分疗效加权均数差(WMD)合并值为-3.80(95%可信区间为-4.10~-3.49,P<0.00001)。结论奥扎格雷钠联合川芎嗪注射液治疗急性脑梗死临床疗效确切,未见明显不良反应。由于现有的研究质量不高,仍需要更多大样本、多中心的 RCT 加以验证。%ObjectiveTo assess the effectiveness and safety of ozagrel sodium combined with ligustrazine injection in the treatment of acute cerebral infarction (ACI) through Meta analysis.MethodsCochrane library, PubMed, EMbase, Wanfang Data, CNKI and VIP were under computer retrieval combined with manual retrieval. Articles about randomized controlled trails (RCTs) about ozagrel sodium combined with ligustrazine injection in the treatment of ACI were included. Articles were screened and included articles were evaluated through methodology quality. Review Manager 5.2 was used for Meta analysis.Results Totally 15 articles about RCT were included, involving 1519 patients. Results of Meta analysis showed that ozagrel sodium combined with ligustrazine injection could improve clinical efficacy of ACI neurologic impairment with [OR=4.59, 95%CI (3.33, 6.34),P<0.000 01] and [WMD=-3.80, 95%CI (-4

  5. Regionally Smoothed Meta-Analysis Methods for GWAS Datasets.

    Science.gov (United States)

    Begum, Ferdouse; Sharker, Monir H; Sherman, Stephanie L; Tseng, George C; Feingold, Eleanor

    2016-02-01

    Genome-wide association studies are proven tools for finding disease genes, but it is often necessary to combine many cohorts into a meta-analysis to detect statistically significant genetic effects. Often the component studies are performed by different investigators on different populations, using different chips with minimal SNPs overlap. In some cases, raw data are not available for imputation so that only the genotyped single nucleotide polymorphisms (SNPs) results can be used in meta-analysis. Even when SNP sets are comparable, different cohorts may have peak association signals at different SNPs within the same gene due to population differences in linkage disequilibrium or environmental interactions. We hypothesize that the power to detect statistical signals in these situations will improve by using a method that simultaneously meta-analyzes and smooths the signal over nearby markers. In this study, we propose regionally smoothed meta-analysis methods and compare their performance on real and simulated data.

  6. Doing meta-analysis in research: A systematic approach

    Directory of Open Access Journals (Sweden)

    Vivek Jain

    2012-01-01

    Full Text Available Meta-analysis is an objective, systematic review that employs statistical methods to combine and summarize the results of several studies. It is a quantitative synthesis of all the unbiased evidence, meant for summarizing large volume of data, establishing and determining the magnitude of an effect, and to increase power and precision of studies. The steps to performing a meta-analysis include making a hypothesis and defining the domain of research, defining inclusion/exclusion criteria, literature search, selecting the final set of studies, extracting data on variables of interest, coding procedures, calculating effect sizes and interpretations, selecting potential moderators and examine their relationships, report writing, and critical evaluation. Meta-analysis has several strengths as well as weaknesses.

  7. Historical sketch of Slovak Haban (Hutterite) population based on autosomal STR analysis.

    Science.gov (United States)

    Soták, M; Petrejčíková, E; Siváková, D; Rębała, K; Bôžiková, A; Bernasovský, I; Carnogurská, J; Boronová, I; Mačeková, S; Homol'ová, L; Sovičová, A; Gabriková, D; Rusínová, L; Bernasovská, J

    2011-10-01

    According to the Hutterite chronicles, the Habans arrived from Austrian Tyrol, Switzerland, and northernmost Italy and stayed in four regions of Slovakia (Sobotište, Vel'ké Leváre, Moravský Svätý Ján, Trenčín). There are some communities in western Slovakia that retained their Haban cultural identity and still identify themselves as descendents of the Hutterite population with their own specific customs. Slovak Habans are typical founder population with significant social isolation for which high degree of inbreeding is typical. Present study investigated STR polymorphisms as a powerful genetic tool for population genetic studies. The aim was to perform a comparative, population genetic study based on 15 STR loci widely used in forensic genetics, of the Haban population, the Slovak majority population and the population of Tyrol. We analyzed allele frequencies and other statistical parameters in three selected populations in order to identify groups of specific ethnic origin and establish their genetic relationship. The data set included 110 unrelated Habans and 201 unrelated individuals from the Slovak majority population, as well as allelic frequencies for the population of Austrian Tyrol available in the literature. Population pairwise FST values used as a short term genetic distance between populations showed significant differentiation between the Habans and both reference populations (FST=0.0025 and 0.0042 for comparison with the Slovaks and Austrians, respectively; ppopulation, which may be at least partially explained by gene flow between neighboring Haban and Slovak populations.

  8. 白芍总苷联合甲氨蝶呤治疗类风湿关节炎疗效的Meta分析%Meta-analysis of total glucosides paeony combined with methorexate in the treatment of rheumatoid arthritis

    Institute of Scientific and Technical Information of China (English)

    麻璨琛

    2016-01-01

    Objective:To analyze the clinical efficacy of total glucosides paeony ( TGP ) combined with methorexate ( MTX ) in treatment of rheumatoid arthritis. Methods:Randomized controlled trials about the effect of TGP combined with MTX on patients were collected by searching PubMed,China National Knowledge Infrastructure,China Biology Medicine disc and Wan Fang Database. The quality of included studies was assessed according to the criteria recommended Cochrane Collaboration, Meta-analysis was performed using RevMan5. 3 software. Results:Ten randomized controlled trials involving 867 patients were included,484 in experimental group, and 383 in control group. Meta-analysis results were shown that the effective rate of experimental group was better than that of control group after 12 and 24 weeks(P 0. 05). Conclusions:TGP combined with MTX in the treatment of rheumatoid arthritis is much better than MTX alone in total effective rate.%目的::系统分析白芍总苷( TGP)联合甲氨蝶呤( MTX)治疗类风湿性关节炎( RA)的临床疗效。方法:计算机检索PubMed、中国知网全文数据库、中国生物医学文献数据库、万方数据库,收集关于TGP联合MTX治疗RA的随机对照试验,采用Cochrane系统评价法评价纳入研究的质量,使用RevMan5.3软件对纳入文献进行Meta分析。结果:共筛选符合要求者10项,合计患者867例,试验组484例,对照组383例。治疗4周及8周时,2组总有效率差异均无统计学意义(P>0.05);治疗12周及24周时,2组总有效率差异均有统计学意义(P<0.01)。结论:TGP联合MTX治疗RA总有效率优于单用MTX。

  9. 维生素D和钙剂治疗营养性佝偻病疗效的Meta分析%Meta-analysis of the efficacy of combined therapy vitamin D with calcium in nutritional rickets

    Institute of Scientific and Technical Information of China (English)

    于静; 李卫国; 李宇宁; 姜莉; 陶仲宾; 李湘津; 赵福林; 谢婧

    2014-01-01

    Objective To assess the efficacy of combined vitamin D with calcium and vitamin D or cal-cium alone in rickets of vitamin D deficiency by meta-analysis method. Methods Searches were made in Cochrance Library , Pubmed, Web of science, Scirus, CNKI, Chinese Biological Medical Literature Database, (CBM),Wangfang from the establishment of the data base till March 2013. All randomized controlled trials about combined with vitamin D and calcium in rickets of vitamin D deficiency were eligible. Serum 25-( OH) ritamin D,phosphate ,ALP,calcium,PTH,phosphate,albumin ,radiographic score were chosen as evaluation in-dex to evaluate the weighted mean diffreence ( WMD) and 95% confidence interval ( CI) for continuous data. RevMan 5. 0. 2 software was used to make meta-analysis. Results 437 literatures were reviewed. Three eligible trials were used for meta-analysis. Meta-analysis showed that:(1)the increase of Serum 25-(OH)vitamin D:Combined therapy group and vitamin D group (MD= -7. 88,95%CI:-12. 24~ -3. 52);Combined therapy group and calcium group (MD= -18. 32,95%CI:-22. 61~ -14. 04). (2)the increase of serum phosphate:Combined therapy group and vitamin D group ( MD= -0. 64 ( 95%CI:-0. 86 ~ -0. 42 );Combined therapy group and calcium group MD= -0. 16 ( 95%CI:-0. 84 ~0. 51 ) . ( 3 ) the decrease of Serum ALP:Combined therapy group and vitamin D group (MD= 109. 99,95%CI:20. 40 ~199. 58);Combined therapy group and calcium group (MD=59. 89,95%CI:10. 09~109. 59 ). (4)the increase of serum calcium :Combined therapy group and vitamin D group (MD= -0. 71,95%CI:-0. 91,-0. 52);the decrease of Radiographic score:Com-bined therapy group and vitamin D group( MD=0. 68,95%CI:0. 42~ 0. 95). Except that the increase of serum phosphate between combined therapy group and calcium group had no significant difference,the rest had signifi-cant difference. Conclusion The long term efficacy in combined therapy group is much effective than vitamin D group or calcium group.%目的:采用Meta分析对

  10. ADDIS : an automated way to do network meta-analysis

    NARCIS (Netherlands)

    Zhao, Jing; van Valkenhoef, Gert; de Brock, E.O.; Hillege, Hans

    2012-01-01

    In evidence-based medicine, meta-analysis is an important statistical technique for combining the findings from independent clinical trials which have attempted to answer similar questions about treatment's clinical eectiveness [1]. Normally, such meta-analyses are pair-wise treatment comparisons, w

  11. Multivariate Meta-Analysis Using Individual Participant Data

    Science.gov (United States)

    Riley, R. D.; Price, M. J.; Jackson, D.; Wardle, M.; Gueyffier, F.; Wang, J.; Staessen, J. A.; White, I. R.

    2015-01-01

    When combining results across related studies, a multivariate meta-analysis allows the joint synthesis of correlated effect estimates from multiple outcomes. Joint synthesis can improve efficiency over separate univariate syntheses, may reduce selective outcome reporting biases, and enables joint inferences across the outcomes. A common issue is…

  12. Treatment of Atrial Fibrillation with Amiodarone Combined with Simvastatin and Amiodarone: A Meta-analysis%胺碘酮联合辛伐他汀与单用胺碘酮治疗心房颤动的Meta分析

    Institute of Scientific and Technical Information of China (English)

    易欣; 黎明江

    2012-01-01

    目的 评价胺碘酮联合辛伐他汀与单用胺碘酮治疗心房颤动(房颤)的疗效.方法 计算机检索Cochrane图书馆、EMBASE及万方医学数据库等1990~2011年收录的文献,对其中胺碘酮联合辛伐他汀(试验组)与单用胺碘酮(对照组)治疗房颤的随机对照试验进行Meta分析.结果 共纳入12篇文献954例.经异质性检验发现各研究结果具有同质性(P=1.0,I2=0%),故选择固定效应模型合并进行两组疗效的Meta分析,求得OR=2.98,95%CI(2.21,4.02),对总体效应进行假设检验得Z=7.18,P<0.00001,提示试验组治疗房颤的效果较对照组好.漏斗图分析结果显示两组疗效Meta分析结果存在偏倚的可能性较小.Meta分析结果示两组治疗房颤不良反应发生率比较差异无统计学意义.结论 胺碘酮联合辛伐他汀治疗房颤较单用胺碘酮效果好.%Objective To evaluate the effectiveness of Amiodarone combined with Simvastatin and Amiodarone in treating atrial fibrillation. Methods We retrieved the literature of Cochrane Library, EMBASE and Wangfang medical Databases, etc, which were published during 1990 to 2011. A Meta-analysis was conducted on the outcomes of randomized controlled trials (RCT) of Amiodarone with simvastatin (experimental group) and Amiodarone (control group) in treating atrial fibrillation. Results We included 954 cases of 12 records in the analysis. The test for heterogeneity in all studies showed that various research results were of heterogeneity (P = 1.0,I2 =0% ) , so a fixed effect model of Meta-analysis was conducted. The total odds ratio was 2.95, 95% confidence interval (95% CI) was from 2.21 to 4.02. The test of hypothesis for overall effects: Z =7. 18, P < 0.00001. The results in treatment of atrial fibrillation were better in experimental group than in control group. There was little deflective possibility in Meta-analysis result of treatment effectiveness from infundibular schema in the two groups. Mela

  13. We rise out of the cradle into the grave: an ethnographic exploration of ritual, mourning, and death on a Hutterite colony.

    Science.gov (United States)

    Cacciatore, Joanne; Thieleman, Kara

    2014-01-01

    The Hutterites are a closed ethnoreligious community whose funeral traditions have remained unchanged for centuries. Few researchers have had the opportunity to study this unique group. This study is an ethnographic exploration into the experience of child death and ritual on a Hutterite colony utilizing participant-observation and interviewing. Three recurrent themes emerged: ritual/tradition, spirituality/faith, and social cohesion and integration/group identity. Observed rituals are situated within the broader framework. While some aspects of the response to death may resemble those of mainstream culture, a deeper evaluation of descriptive and structural specifics reveals some important differences. Most of the cultural contrast is contained in concrete social enactment of death rituals, shared identity, and the immutable faith in God at the center of the Hutterite mourning process. These factors may help account for the low rates of mental disorders seen among Hutterites, even following traumatic events, and would be worthy of further investigation.

  14. Critical review and meta-analysis on the combination of heart-type fatty acid binding protein (H-FABP) and troponin for early diagnosis of acute myocardial infarction.

    Science.gov (United States)

    Lippi, Giuseppe; Mattiuzzi, Camilla; Cervellin, Gianfranco

    2013-01-01

    An early diagnosis is crucial for effective triage and management of patients with suspected acute myocardial infarction (AMI). Although troponin testing is the cornerstone of diagnosis, the sensitivity of this biomarker is still suboptimal at patient admission. The heart-type fatty acid binding protein (H-FABP) is an early and sensitive biomarker of myocardial ischemia, whose appropriate setting is in combination with troponin testing. We performed a systematic review and meta-analysis of articles that have assessed the combination of troponin and H-FABP in the early diagnosis of AMI. Eight studies, totaling 2735 patients, met the inclusion criteria but none of them used a high-sensitivity troponin immunoassay. The between-study variation was high (98.5%), and attributable to heterogeneity. When considered alone, troponin exhibited a significantly greater pooled area under the curve (AUC) than H-FABP alone (0.820 versus 0.784; ptroponin alone than for H-FABP alone (0.94 versus 0.83; ptroponin than for H-FABP (0.73 versus 0.80; p=0.02). The combination of both biomarkers exhibited a greater AUC than troponin alone (0.881; ptroponin immunoassay seems advantageous for increasing the sensitivity of the former biomarker, at the expense of a lower specificity. The introduction of H-FABP testing would hence require careful assessment of laboratory data or clinical signs and symptoms for excluding sources of elevation different from AMI. Further studies are needed to assess the diagnostic effectiveness of combining H-FABP with a high-sensitivity troponin immunoassay.

  15. MetaEasy: A Meta-Analysis Add-In for Microsoft Excel

    Directory of Open Access Journals (Sweden)

    Evangelos Kontopantelis

    2009-04-01

    Full Text Available Meta-analysis is a statistical methodology that combines or integrates the results ofseveral independent clinical trials considered by the analyst to be `combinable' (Huque1988. However, completeness and user-friendliness are uncommon both in specialisedmeta-analysis software packages and in mainstream statistical packages that have to relyon user-written commands. We implemented the meta-analysis methodology in an Mi-crosoft Excel add-in which is freely available and incorporates more meta-analysis models(including the iterative maximum likelihood and prole likelihood than are usually avail-able, while paying particular attention to the user-friendliness of the package.

  16. Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: Systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    M.A. Martínez-Vázquez

    2012-04-01

    Conclusions: Antispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations.

  17. Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk--a meta-analysis

    DEFF Research Database (Denmark)

    Vestergaard, P; Jørgensen, Niklas R; Mosekilde, L

    2007-01-01

    AIM: The effects of parathyroid hormone (PTH) alone or in combination with antiresorptive therapy on changes in bone mineral density (BMD) and fracture risk were studied. MATERIALS AND METHODS: Randomised placebo controlled trials were retrieved from the PubMed, Web of Science or Embase databases....... RESULTS: PTH alone or in combination with antiresorptive drugs reduced vertebral [relative risk (RR)=0.36, 95% confidence interval (CI): 0.28-0.47, 2p

  18. Comparative efficacy of inhaled corticosteroid and long-acting beta agonist combinations in preventing COPD exacerbations: a Bayesian network meta-analysis

    OpenAIRE

    Oba, Yuji; Lone, Nazir

    2014-01-01

    Yuji Oba, Nazir A Lone University of Missouri, School of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, Columbia, MO, USA Background: A combination therapy with inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA) is recommended in severe chronic obstructive pulmonary disease (COPD) patients experiencing frequent exacerbations. Currently, there are five ICS/LABA combination products available on the market. The purpose of this study was to systematic...

  19. The Control Group and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    John E Hunter

    2014-09-01

    Full Text Available Social scientists use a mixture of different methodologies, which creates problems for researchers attempting to review the cumulative results of all studies.  Standard practice for review studies using meta-analysis is to adjust the findings of all studies that use control groups and to include studies not having control groups without adjustment for extraneous effects, or to not use studies that lack a control group, which could produce an erroneous result.  Our study develops a novel meta-analytic procedure that combines the evidence on control group change with evidence on change from the intervention, making it possible to adjust for the effects of extraneous factors in all studies and bridges the gap between control group studies and other types of studies. DOI: 10.2458/azu_jmmss.v5i1.18302

  20. Meta analysis of alpha lipoic acid combined with mecobalamin in the treatment of diabetic peripheral neuropathy%α-硫辛酸联合甲钴胺治疗糖尿病周围神经病变的Meta分析

    Institute of Scientific and Technical Information of China (English)

    刘慧竹

    2015-01-01

    Objective:To study the clinical curative effect of alpha lipoic acid combined with mecobalamin in diabetic peripheral neuropathy,and to do Meta analysis.Methods:512 patients with diabetic peripheral neuropathy were selected.They were randomly divided into the observation group and the control group.The observation group was given alpha lipoic acid combined with mecobalamin treatment.The control group was given mecobalamin monotherapy.The treatment effects of two groups were compared.Results:The clinical symptoms of the observation group were significantly reduced,the treatment total effective rate was higher,the curative effect was significantly better than that of the control group(P<0.05).Conclusion:Alpha lipoic acid combined with mecobalamin in the treatment of diabetic peripheral neuropathy has a significant clinical effect.%目的:研究α-硫辛酸联合甲钴胺对糖尿病周围神经病变的临床疗效,并对其做Meta分析。方法:收治糖尿病周围神经病变患者512例,随机分为观察组和对照组。观察组给予α-硫辛酸联合甲钴胺治疗,对照组给予甲钴胺单药治疗,分析两组治疗效果。结果:观察组临床症状明显减轻,治疗总有效率较高,疗效明显优于对照组(P<0.05)。结论:α-硫辛酸联合甲钴胺治疗糖尿病周围神经病变具有显著的临床效果。

  1. Interferon and lamivudine combination therapy versus lamivudine monotherapy for hepatitis B e antigen-negative hepatitis B treatment:a meta-analysis of randomized controlled trials

    Institute of Scientific and Technical Information of China (English)

    YuShi; Yi-HuaWu; Zhe-YueShu; Wan-JunZhang; JunYang; ZhiChen

    2010-01-01

    BACKGROUND: It has been demonstrated that only a minority of patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) obtain a sustained response after either interferon (IFN) or nucleos(t)ide analogue monotherapy. Therefore, combination therapy of drugs with synergistic antiviral effects was proposed to have a sustained response in these patients. We compared the effect and safety of lamivudine monotherapy and its combination with IFN including conventional interferon (CON-IFN) and pegylated interferon (PEG-IFN) for HBeAg-negative CHB patients. DATA  SOURCES: A group of three independent reviewers identified 9 eligible randomized controlled trials through electronic searches (MEDLINE, OVID, EMBASE, the Cochrane Library Clinical Trials Registry, and the Chinese Medical Database), manual searches, and contact with experts. Sustained virological and biochemical responses were defined as primary efficacy measures. We performed quantitative meta-analyses to assess differences between CON-IFN plus lamivudine combination and lamivudine monotherapy groups. RESULTS: No greater sustained virological and biochemical rates were found in patients receiving CON-IFN/lamivudine combination therapy [29.1% vs. 26.7%, odds ratio (OR)=0.98, 95% confidence interval (CI) 0.65-1.50, P=0.94, and 41.8%vs. 40.3%, OR=1.13, 95% CI 0.78-1.65, P=0.51, respectively], though a reduced YMDD mutation rate was achieved in the combination group [8.39% vs. 30.0%, OR=0.16, 95% CI 0.076-0.33, P CONCLUSIONS: Addition of CON-IFN to lamivudine did not improve treatment efficacy but suppressed YMDD mutation by lamivudine. Combination of PEG-IFN and lamivudine might increase the sustained response, and further clinical trials are needed for confirmation.

  2. 尼莫地平联合依达拉奉治疗高血压脑出血的Meta分析%Efficacy of nimodipine combined with edaravone in treatment of hypertensive intracerebral hemorrhage: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    陈谦学; 丁大成; 秦军

    2014-01-01

    Objective To systematically evaluate the clinical efficacy and safety of nimodipine combined with edaravone in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods The databases of PubMed,Cochrane Database of System Reviews,EMbase,CNKI,VIP,Wanfang Data,and CBM were searched for randomized controlled trials (RCTs) on the efficacy of nimodipine combined with edaravone in the treatment of HICH,which strictly met the inclusion and exclusion criteria.And a meta-analysis was performed using software RevMan (version 5.1).Results A total of 8 RCTs involving 610 patients with HICH were evaluated.The meta-analysis showed that the overall response rate of the combination therapy group was significantly higher than that of the control group (OR =3.15,95% CI:2.06-4.83).After treatment,both groups showed significantly reduced neurologic impairment score and volumes of cephalophyma and brain edema (P < 0.05),but the neurologic impairment score and volumes of cephalophyma and brain edema in the therapy group were significantly lower than those in the control group (P < 0.05),and the volume of cephalophyma in the therapy group was significantly reduced compared with that in the control group (SMD =-5.14,95% CI:-5.83-(-4.45)).Conclusions For patients with HICH,nimodipine combined with edaravone has significant clinical efficacy in the treatment of hypertensive cerebral hemorrhage,and can improve the functional rehabilitation of the nerves and effectively reduce the volumes of intracranial hematoma and peripheral edema.%目的 系统评价尼莫地平联合依达拉奉治疗高血压脑出血的临床疗效和安全性.方法 严格按照纳入、排除标准,检索PubMed、Cochrane Database of Systematic Reviews、EMbase、CNKI、VIP、Wanfang Data及CBM中关于尼莫地平联合依达拉奉治疗高血压脑出血的随机对照试验(RCT),采用RevMan 5.1软件进行Meta分析.结果 共纳入8篇文献,包括610例患者.Meta分析结果显示:尼莫地

  3. Traction Combined with Acupuncture and Moxibustion for Lumbar Intervertebral Disc Herniation:A Meta-analysis%针灸结合牵引治疗腰间盘突出症的 Meta分析

    Institute of Scientific and Technical Information of China (English)

    樊海龙; 赵凌; 梁繁荣

    2015-01-01

    目的:应用Meta分析系统评价针灸疗法结合牵引治疗腰间盘突出症的疗效。方法:检索国内外有关针灸疗法结合牵引治疗腰间盘突出症随机对照试验的中英文文献,筛选合格研究,应用改良Jadad量表评分法进行质量评价,运用异质性检验、Meta分析、漏斗图分析、敏感性分析等方法统计相关数据。结果:最终纳入10项研究,共1310例患者,文献研究质量均较低。9项研究的Meta分析结果显示,针灸疗法结合牵引治疗腰间盘突出症疗效优于牵引组,差异有统计学意义[RR =1.19,95%CI(1.14,1.25)]。结论:针灸疗法结合牵引对腰间盘突出症有一定疗效,但由于现有文献质量较低,尚需设计合理、远期随访的随机对照试验加以证实。%Objective:To determine the efficacy of traction combined with acupuncture and moxibustion in the treatment of lumbar intervertebral disc herniation ( LIDH ) by performing a Meta-analysis of randomized con-trolled clinical trials.Methods:Retrieve the literatures on the randomized controlled trials of traction combined with acupuncture and moxibustion for the treatment of LIDH.Screen the qualified trials.The revised Jadad score was used to evaluate the quality.The relative data were statistically analyzed by the difference examination, Metaanalysis, funnel diagram analysis and sensitivity analysis, etc.Results:Ten RCTs involving 1310 patients met the inclusion criteria.Ten trials were of low quality.The Meta analysis of nine trials showed that traction combined with acup-moxi was superior in total efficient rate with RR=1.19, 95%CI(1.14,1.25).Conclu-sion:Traction combined with acupuncture and moxibustion has a certain curative effect on LIDH.Because the quality of present researches is relatively low, these results await verification with reasonable design and long-term follow-up randomized control trials.

  4. 放化疗联合热疗治疗宫颈癌疗效和安全性的Meta分析%Efficacy and Safety Radio-chemotherapy Combined with Thermotherapy for Cervical Cancer: A Meta-Analysis

    Institute of Scientific and Technical Information of China (English)

    闫向勇; 刘文超; 燕忠生; 马骥

    2014-01-01

    目的 系统评价放化疗联合热疗治疗中晚期宫颈癌的疗效和安全性.方法 计算机检索The Cochrane Library(2013年7期)、PubMed、EMbase、CBM、VIP、CNKI和WanFang Data数据库,检索时限均为从建库至2013年7月,纳入有关放化疗联合热疗治疗中晚期宫颈癌的文献.由2名评价员按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析.结果 共纳入9个RCT,693例患者.Meta分析结果显示:与放化疗组相比,放化疗联合热疗组的1年生存率[OR=3.05,95%CI(1.70,6.68),P=0.005]、2年生存率[OR=2.29,95%CI(1.19,4.38),P=0.01]、总有效率[OR=3.66,95%CI (2.31,5.81),P<0.000 01]均明显上升,且差异有统计学意义,但两组不良反应发生率差异无统计学意义.结论 放化疗联合热疗能明显提高中晚期宫颈癌患者的远期和近期疗效.但受纳入研究数量和质量的限制,上述结论仍有待更多高质量的研究予以验证.%Objective To systematically review the efficacy and safety of radio-chemotherapy combined with thermotherapy for cervical cancer.Methods Literature about the efficacy and safety of radio-chemotherapy combined with thermotherapy for patients with cervical cancer at mid-term/advanced stage was retrieved from digital databases of The Cochrane Library (Issue 7,2013),PubMed,EMbase,CBM,VIP,CNKI,and WanFang Data,and from their established dates to July,2013.Data extraction and quality assessment of included studies were conducted by two reviewers independently.RevMan 5.2 software was then used to perform meta-analysis.Results A total of 9 randomized controlled trials involving 693 patients were included.The results of meta-analysis showed that,compared with the radio-chemotherapy alone group,the radio-chemotherapy combined with thermotherapy group had significant increased 1-year survival rates (OR=3.05,95%CI 1.70 to 6.68,P=0.005),2-year survival rates (OR=2.29,95%CI 1.19 to 4.38,P

  5. Bayesian Meta-Analysis of Coefficient Alpha

    Science.gov (United States)

    Brannick, Michael T.; Zhang, Nanhua

    2013-01-01

    The current paper describes and illustrates a Bayesian approach to the meta-analysis of coefficient alpha. Alpha is the most commonly used estimate of the reliability or consistency (freedom from measurement error) for educational and psychological measures. The conventional approach to meta-analysis uses inverse variance weights to combine…

  6. Bayesian Meta-Analysis of Coefficient Alpha

    Science.gov (United States)

    Brannick, Michael T.; Zhang, Nanhua

    2013-01-01

    The current paper describes and illustrates a Bayesian approach to the meta-analysis of coefficient alpha. Alpha is the most commonly used estimate of the reliability or consistency (freedom from measurement error) for educational and psychological measures. The conventional approach to meta-analysis uses inverse variance weights to combine…

  7. Meta-Analysis in Stata Using Gllamm

    Science.gov (United States)

    Bagos, Pantelis G.

    2015-01-01

    There are several user-written programs for performing meta-analysis in Stata (Stata Statistical Software: College Station, TX: Stata Corp LP). These include metan, metareg, mvmeta, and glst. However, there are several cases for which these programs do not suffice. For instance, there is no software for performing univariate meta-analysis with…

  8. Statistical Power in Meta-Analysis

    Science.gov (United States)

    Liu, Jin

    2015-01-01

    Statistical power is important in a meta-analysis study, although few studies have examined the performance of simulated power in meta-analysis. The purpose of this study is to inform researchers about statistical power estimation on two sample mean difference test under different situations: (1) the discrepancy between the analytical power and…

  9. Trial Sequential Methods for Meta-Analysis

    Science.gov (United States)

    Kulinskaya, Elena; Wood, John

    2014-01-01

    Statistical methods for sequential meta-analysis have applications also for the design of new trials. Existing methods are based on group sequential methods developed for single trials and start with the calculation of a required information size. This works satisfactorily within the framework of fixed effects meta-analysis, but conceptual…

  10. Statistical Power in Meta-Analysis

    Science.gov (United States)

    Liu, Jin

    2015-01-01

    Statistical power is important in a meta-analysis study, although few studies have examined the performance of simulated power in meta-analysis. The purpose of this study is to inform researchers about statistical power estimation on two sample mean difference test under different situations: (1) the discrepancy between the analytical power and…

  11. Online open neuroimaging mass meta-analysis

    DEFF Research Database (Denmark)

    Nielsen, Finn Årup; Kempton, Matthew J.; Williams, Steven C. R.

    We describe a system for meta-analysis where a wiki stores numerical data in a simple format and a web service performs the numerical computation. We initially apply the system on multiple meta-analyses of structural neuroimaging data results. The described system allows for mass meta-analysis, e...

  12. Lamivudine plus adefovir combination therapy versus entecavir monotherapy for lamivudine-resistant chronic hepatitis B: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Hu Peng

    2011-08-01

    Full Text Available Abstract Background Chronic hepatitis B virus (HBV infection represents a serious global health problem and resistance to lamivudine (LAM has become a serious clinical challenge. Previous rescue therapy for the treatment of chronic LAM-resistant hepatitis B infected patients included switching to entecavir (ETV and adding adefovir (ADV or tenofovir (TFV. At present, switching to ETV is not recommended for rescue therapy for LAM-resistant chronic hepatitis B (CHB. The aim of this report was to determine whether add-on ADV was a superior rescue strategy in the treatment of CHB patients with LAM resistance. Methods We searched Medline/PubMed, EMBASE, Web of Knowledge, and the Cochrane Library. Relative risks (RRs of virologic response, virologic breakthrough, normalization of serum alanine aminotransferase (ALT levels and HBeAg seroconversion rates were studied. Factors predicting virologic response, standardized mean differences (SMD in HBV DNA levels and safety were reviewed. Results Six eligible trials (451 patients in total were included in the analysis. The rate of virologic breakthrough in the ETV group was higher than that in the LAM plus ADV group. There were no statistical differences in virologic response, ALT normalization and HBeAg seroconversion in either group 48 weeks post treatment. LAM plus ADV combination therapy produced faster and greater HBV DNA reduction rates 24 weeks post therapy compared to ETV monotherapy. HBV DNA baseline levels and the initial virologic response (IVR were predictive of the virologic response. Additionally, combination therapy or monotherapy were both well tolerated. Conclusions LAM plus ADV combination therapy was more effective and produced longer-lasting effects than switching to ETV monotherapy in treating CHB patients with LAM resistance. However, considering the practical benefits and limitations of ADV, individualized therapy will be needed in patients with prior history of LAM resistant infections.

  13. Meta-analysis of Huoxue Jiedu Medicine Combined with Chemotherapy Treating Ad-vanced Gastric Cancer%活血解毒药联合化疗治疗中晚期胃癌的Meta分析

    Institute of Scientific and Technical Information of China (English)

    王晓妍; 曹志群

    2015-01-01

    Objective:To evaluate the effectiveness and safety of Huoxue Jiedu medicine combined with chemotherapy in the treatment of advanced gastric cancer. Methods:Using the evaluation method of Cochrane system,we have searched VIP,CNKI,CBM,WanFang database,collected randomized controlled trials about Huoxue Jiedu medicine combined with chemotherapy in the treatment of advanced gastric cancer. According to the inclusion and exclusion criteria,quality assessment,screening and extracting the effective data,Meta-! analysis was performed with RevMan 5.0 software. Results:In 14 articles,901 patients met the inclusion cri-teria and enter the study. The results of Meta-analysis showed,improving the clinical efficacy,clinical symp-tom and life quality,reduce the reaction of digestive tract,blood cell toxicity and liver and kidney toxicity, Huoxue Jiedu medicine combined with chemotherapy was better than alone western medicine chemotherapy for advanced gastric cancer , with significant difference ( P<0 . 01 ) . Conclusions:Huoxue Jiedu medicine has certain auxiliary therapeutic effect on patients with advanced gastric cancer. It could improve the clinical ef-ficacy,clinical symptom and life quality,reduce the reaction of digestive tract,blood cell toxicity and toxicity of liver and kidney.%目的:系统评价活血解毒药联合化疗治疗中晚期胃癌的有效性和安全性。方法:采用Cochrane系统评价方法,检索维普资讯中文科技期刊数据库、中国知网数据库、中国生物医学期刊引文数据库及万方医学网数据库相关文献,收集活血解毒药联合化疗治疗中晚期胃癌的临床随机对照试验。按纳入排除标准、文献质量评价、筛选并提取有效数据,采用RevMan 5.0软件进行Meta分析。结果:共有14篇文献,共计901名患者符合纳入标准而进入研究。 Meta分析显示,在提高中晚期胃癌患者临床疗效、改善临床证候、提高生活质量以及减少消化道

  14. Combining Whole-Brain Radiotherapy with Gefitinib/Erlotinib for Brain Metastases from Non-Small-Cell Lung Cancer: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Mao-hua Zheng

    2016-01-01

    Full Text Available Background. To comprehensively assess the efficacy and safety of whole-brain radiotherapy (WBRT combined with gefitinib/erlotinib for treatment of brain metastases (BM from non-small-cell lung cancer (NSCLC. Methods. Databases including PubMed, EMBASE.com, Web of Science, and Cochrane Library were searched from inception to April 12, 2015. Studies on randomized controlled trials (RCTs and case-control trials comparing WBRT combined with gefitinib/erlotinib versus WBRT alone for BM from NSCLC were included. Literature selection, data extraction, and quality assessment were performed independently by two trained reviewers. RevMan 5.3 software was used to analyze data. Results. A total of 7 trials involving 622 patients were included. Compared with WBRT alone or WBRT plus chemotherapy, WBRT plus gefitinib/erlotinib could significantly improve response rate (OR = 2.16, 95% CI: 1.35–3.47; P=0.001, remission rate of central nervous system (OR = 6.06, 95% CI: 2.57–14.29; P<0.0001, disease control rate (OR = 3.34, 95% CI: 1.84–6.07; P<0.0001, overall survival (HR = 0.72, 95% CI: 0.58–0.89; P=0.002, and 1-year survival rate (OR = 2.43, 95% CI: 1.51–3.91; P=0.0002. In adverse events (III-IV, statistically significant differences were not found, except for rash (OR = 7.96, 95% CI: 2.02–31.34; P=0.003 and myelosuppression (OR = 0.19, 95% CI: 0.07–0.51; P=0.0010. Conclusions. WBRT plus gefitinib/erlotinib was superior to WBRT alone and well tolerated in patients with BM from NSCLC.

  15. Androgen-deprivation therapy alone versus combined with radiation therapy or chemotherapy for nonlocalized prostate cancer: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Jun-Hao Lei

    2016-01-01

    Full Text Available In this paper, we reviewed the long-term survival outcomes, safety, and quality-of-life of androgen-deprivation therapy (ADT alone versus combined with radiation therapy (RT or chemotherapy for locally advanced and metastatic prostate cancer (PCa. A literature search was performed using OvidSP. Randomized controlled trials (RCTs that met the following criteria were included: including locally advanced or metastatic PCa, comparing ADT alone versus combined with any treatment method and reporting quantitative data of disease control or survival outcomes. Finally, eight RCTs met the inclusion criteria. Among these, three compared ADT versus ADT plus RT (n = 2344 and one compared ADT versus ADT plus docetaxel-estramustine (n = 413 in locally advanced PCa; two compared ADT versus ADT plus docetaxel (n = 1175 and two compared ADT versus ADT plus estramustine (n = 114 in metastatic PCa. For locally advanced PCa, the addition of RT to long-term ADT can improve the outcomes of survival and tumor control with fully acceptable adverse effects. Specially, the pooled odds ratio (OR of overall survival (OS was 1.43 (95% confidence interval 1.20-1.71 when compared ADT plus RT with ADT alone (P < 0.0001. For metastatic hormonally sensitive PCa, the concurrent use of docetaxel plus ADT was effective and safe (pooled OR of OS: 1.29 [1.01-1.65]: P = 0.04. In all, long-term ADT plus RT and long-term ADT plus docetaxel should be considered as proper treatment option in locally advanced and metastatic hormonally sensitive PCa, respectively. The major limitation for the paper was that only eight RCTs were available.

  16. Meta-analysis of Chicken – Salmonella infection experiments

    Directory of Open Access Journals (Sweden)

    te Pas Marinus FW

    2012-04-01

    Full Text Available Abstract Background Chicken meat and eggs can be a source of human zoonotic pathogens, especially Salmonella species. These food items contain a potential hazard for humans. Chickens lines differ in susceptibility for Salmonella and can harbor Salmonella pathogens without showing clinical signs of illness. Many investigations including genomic studies have examined the mechanisms how chickens react to infection. Apart from the innate immune response, many physiological mechanisms and pathways are reported to be involved in the chicken host response to Salmonella infection. The objective of this study was to perform a meta-analysis of diverse experiments to identify general and host specific mechanisms to the Salmonella challenge. Results Diverse chicken lines differing in susceptibility to Salmonella infection were challenged with different Salmonella serovars at several time points. Various tissues were sampled at different time points post-infection, and resulting host transcriptional differences investigated using different microarray platforms. The meta-analysis was performed with the R-package metaMA to create lists of differentially regulated genes. These gene lists showed many similarities for different chicken breeds and tissues, and also for different Salmonella serovars measured at different times post infection. Functional biological analysis of these differentially expressed gene lists revealed several common mechanisms for the chicken host response to Salmonella infection. The meta-analysis-specific genes (i.e. genes found differentially expressed only in the meta-analysis confirmed and expanded the biological functional mechanisms. Conclusions The meta-analysis combination of heterogeneous expression profiling data provided useful insights into the common metabolic pathways and functions of different chicken lines infected with different Salmonella serovars.

  17. Fixed combination of latanoprost and timolol vs the individual components for primary open angle glaucoma and ocular hypertension: a systematic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Yi; Xing; Fa-Gang; Jiang; Teng; Li

    2014-01-01

    AIM:To assess the effects of the fixed combination of0.005% latanoprost and 0.5% timolol(FCLT) vs their individual components for primary open angle glaucoma(POAG) and ocular hypertension(OHT).· METHODS:After searched PubMed, EMBASE, the Cochrane Library and SCI, all randomized controlled clinical trials(RCTs) and cross-over studies were included. The control groups were the monotherapy or the concomitant therapy of latanoprost and timolol. The outcomes were visual field defect, optic atrophy, mean intraocular pressure(IOP) and IOP fluctuation. The analysis was carried out in RevMan version 5.1 software.RESULTS:Thepost-interventionmeanIOPofFCLTwas significantly lower compared to timolol [mean difference(MD)-2.92, 95%CI-3.28 to-2.55, P <0.00001] and latanoprost(MD-1.11, 95%CI-1.51 to-0.72, P <0.00001). The postintervention IOP fluctuation was also significantly lower compared to timolol(MD-0.88, 95%CI-1.23 to-0.53, P <0. 00001) and latanoprost( MD- 0. 63, 95 % CI- 1. 04to-0.22, P =0.002). The mean IOP was higher in FCLT morning dose group than the one in unfixed combination of 0.005% latanoprost and 0.5% timolol(UFCLT)(MD1.10, 95% CI 0.81 to 1.39, P <0.00001). Otherwise, there was no difference between FCLT evening dose group and UFCLT(MD 0.34, 95% CI-0.01 to 0.69, P =0.06).There was no statistical difference for the incidence ofvisual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the monotherapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.visual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the monotherapy of components. The IOP lowering effect

  18. Combined metformin-clomiphene in clomiphene-resistant polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Abu Hashim, Hatem; Foda, Osama; Ghayaty, Essam

    2015-09-01

    Our objective was to compare the effectiveness of metformin plus clomiphene citrate vs. gonadotrophins, laparoscopic ovarian diathermy, aromatase inhibitors, N-acetyl-cysteine and other insulin sensitizers+clomiphene for improving fertility outcomes in women with clomiphene-resistant polycystic ovary syndrome. PubMed, SCOPUS and CENTRAL databases were searched until April 2014 with the key words: PCOS, polycystic ovary syndrome, metformin, clomiphene citrate, ovulation induction and pregnancy. The search was limited to articles conducted with humans and published in English. The PRISMA statement was followed. Twelve randomized controlled trials (n = 1411 women) were included. Ovulation and clinical pregnancy rates per woman randomized. Compared with gonadotrophins, the metformin+clomiphene combination resulted in significantly fewer ovulations (odds ratio 0.25; 95% confidence interval 0.15-0.41; p < 0.00001, 3 trials, I(2) = 85%, n = 323) and pregnancies (odds ratio 0.45; 95% confidence interval 0.27-0.75; p = 0.002, 3 trials, I(2) = 0%, n = 323). No significant differences were found when metformin+clomiphene was compared with laparoscopic ovarian diathermy (odds ratio 0.88; 95% confidence interval 0.53-1.47; p = 0.62, 1 trial, n = 282; odds ratio 0.96; 95% confidence interval 0.60-1.54; p = 0.88, 2 trials, I(2) = 0%, n = 332, for ovulation and pregnancy rates, respectively). Likewise, no differences were observed in comparison with aromatase inhibitors (odds ratio 0.88; 95% confidence interval 0.58-1.34; p = 0.55, 3 trials, I(2) = 3%, n = 409; odds ratio 0.85; 95% confidence interval 0.53-1.36; p = 0.50, 2 trials, n = 309, for ovulation and pregnancy rates, respectively). There is evidence for the superiority of gonadotrophins, but the metformin+clomiphene combination is mainly relevant for clomiphene-resistant polycystic ovary syndrome patients and, if not effective, a next step could be gonadotrophins. More attempts with metformin+clomiphene are only relevant

  19. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Katy A. van Galen

    2014-01-01

    Full Text Available Administering drugs as fixed-dose combinations (FDCs versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03–1.71. Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00–2.13. We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.

  20. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    van Galen, Katy A; Nellen, Jeannine F; Nieuwkerk, Pythia T

    2014-01-01

    Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03-1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00-2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.

  1. 联用都梁软胶囊治疗偏头痛疗效Meta分析%Meta Analysis of Clinical Efficacy of Combining Douliang Soft Capsules on Migraine

    Institute of Scientific and Technical Information of China (English)

    黄金路; 万丽丽; 郁静; 周蓉敏; 孟祥乐; 赵宁; 赵赟; 郭澄

    2015-01-01

    Objective To explore clinical efficacy of combining Douliang Soft Capsules with others drugs on migraine. Methods Search-ing CNKI database with typing keywords"Douliang Soft Capsules"and"migraine"from 1999 to June 20th, 2015. Data from included publications with the treatment of migraine with combining Douliang Soft Capsules were meta analyzed by Revman 5. 3 software. Results 6 pubilications were included from 99 retrieved results. 258 cases with migraine were orally given combined therapy with Douliang Soft Capsules and other drugs ( nimodipine or flunarizine ) , while 247 patients as the control group. Meta analysis reveals that combination of Douliang Soft Capsules with other drugs can effectively improve the symptoms of migraine [ OR=0. 27, 95% CI ( 0. 16, 0. 44 ) ] . The effectiveness was ( 90. 6 ± 2. 3 )% and ( 71. 3 ± 4. 4 )% , respectively ( P < 0. 01 ) . Conclusion Combination of Douliang Soft Capsules with other drugs ( eg. nimodipine, flunarizine, etc ) can significantly increases the clinical efficacy in patients with migraine.%目的 考察都梁软胶囊联合其他药物治疗偏头痛的临床疗效.方法 检索中国知网期刊数据库,关键词"都梁软胶囊""头痛",检索时间1999年至2015年,提取符合联合用药治疗偏头痛纳入标准的文献数据,运用Revman 5. 3版软件进行Meta分析.结果 共检索到99条结果,最终纳入6篇文献.都梁软胶囊联合其他药物(尼莫地平或氟桂利嗪)治疗偏头痛共258例,对照组247例.Meta分析结果显示,都梁软胶囊联合其他药物能有效治疗偏头痛[ OR=0. 27,95% CI(0. 16,0. 44)] ,有效率分别为(90. 6 ± 2. 3)%和(71. 3 ± 4. 4)%( P<0. 01).结论 都梁软胶囊与其他药物(如尼莫地平、氟桂利嗪等)联用治疗偏头痛,能显著增强临床疗效.

  2. Effectiveness of bromocriptine monotherapy or combination treatment with clomiphene for infertility in women with galactorrhea and normal prolactin: A systematic review and meta-analysis.

    Science.gov (United States)

    Xue, Tao; Li, Shang-Wei; Wang, Yan

    2010-08-01

    Among women with unexplained infertility, 28% to 55% of patients with galactorrhea are normoprolactinemic. Bromocriptine, a common treatment for infertile women with hyperprolactinemia, has been used in the treatment of unexplained subfertility in women with galactorrhea and normal prolactin; however, its effectiveness and safety profile have never been determined. The aim of this study was to determine the relative effectiveness and safety profile of bromocriptine monotherapy or as an adjunct to clomiphene citrate in women with galactorrhea and normal prolactin levels. We conducted a search of the Cochrane Subfertility Review Group specialized register of controlled trials (March 2010), CENTRAL (The Cochrane Library, Issue 3, 2010), MEDLINE (1950-March 2010), EMBASE (1980-March 2010), and the China Biological Medicine Database (inception to March 2010) for relevant randomized controlled trials (RCTs) using the following terms: controlled, randomized, blinded, clinical trials, humans, galactorrhea, prolactin, bromocriptine, infertility, and subfertility. Additionally, reference lists of identified articles were searched for relevant articles. Of the 8 studies identified, 5 were excluded after full-text review for the following reasons: lack of a placebo group (2); difference in cointerventions (1); difference in end points (1); and systematic review (1). Therefore, 3 RCTs were included in this review. Bromocriptine administered in combination with clomiphene was found to be associated with a higher accumulative pregnancy rate compared with clomiphene monotherapy (fixed odds ratio [OR], 5.33; 95% CI, 2.62-10.88), and a lower miscarriage rate (fixed OR, 0.20; 95% CI, 0.05-0.76). Only 1 trial reported live birth as an outcome, and multiple pregnancy rates were poorly reported. Patient-reported adverse effects were mentioned in the studies, but reports were often incomplete. This review suggests the effectiveness of bromocriptine with clomiphene for infertility in

  3. Intravenous combined with aerosolised polymyxin versus intravenous polymyxin alone in the treatment of pneumonia caused by multidrug-resistant pathogens: a systematic review and meta-analysis.

    Science.gov (United States)

    Liu, Dong; Zhang, Jing; Liu, Hai-Xia; Zhu, Ying-Gang; Qu, Jie-Ming

    2015-12-01

    Colistin has been used to treat nosocomial pneumonia (NP) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) via different administration routes. Whether patients may benefit from aerosolised colistin as adjunctive treatment was contradictory. We aimed to clarify the safety and efficacy of administering aerosolised and intravenous (IV-AS) colistin versus intravenous (IV) colistin alone in patients with NP caused by MDR-GNB. Two reviewers independently evaluated and extracted data from PubMed, EMBASE and Cochrane databases. Primary outcomes were clinical response rate, all-cause mortality (ICU or hospital), microbiological eradication and nephrotoxicity. Pooled odds ratios (ORs) were calculated and significance was determined by the Z test. Nine eligible studies involving 672 participants were included. The overall clinical response rate (improvement and cure) was significantly higher in the IV-AS group than that in the IV group [OR=1.81, 95% confidence interval (CI) 1.30-2.53; P=0.0005]. Patients treated with IV-AS colistin showed a higher rate of pathogen eradication (OR=1.66, 95% CI 1.11-2.49; P=0.01) and lower all-cause mortality compared with IV colistin (OR=0.69, 95% CI 0.50-0.95; P=0.02). Nephrotoxicity did not differ significantly between IV-AS and IV groups (five studies; 383 patients) (OR=1.11, 95% CI 0.69-1.80; P=0.67). These data indicate that IV-AS colistin has additional benefits compared with IV colistin alone. Clinicians should be encouraged to give combined administration routes in critically ill patients with NP caused by MDR-GNB. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  4. Effectiveness of fixed dose combination medication ('polypills') compared with usual care in patients with cardiovascular disease or at high risk : A prospective, individual patient data meta-analysis of 3140 patients in six countries

    NARCIS (Netherlands)

    Webster, Ruth; Patel, Anushka; Selak, Vanessa; Billot, Laurent; Bots, Michiel L.; Brown, Alex; Bullen, Chris; Cass, Alan; Crengle, Sue; Raina Elley, C.; Grobbee, Diederick E.; Neal, Bruce; Peiris, David; Poulter, Neil; Prabhakaran, Dorairaj; Rafter, Natasha; Stanton, Alice; Stepien, Sandrine; Thom, Simon; Usherwood, Tim; Wadham, Angela; Rodgers, Anthony

    2016-01-01

    Aims To conduct a prospective, individual participant data (IPD) meta-analysis of randomised controlled trials comparing a polypill-based approach with usual care in high risk individuals. Methods and results Three trials comparing polypill-based care with usual care in individuals with CVD or high

  5. Comparative efficacy of indacaterol 150 µg and 300 µg versus fixed-dose combinations of formoterol + budesonide or salmeterol + fluticasone for the treatment of chronic obstructive pulmonary disease – a network meta-analysis

    Directory of Open Access Journals (Sweden)

    Cope S

    2011-06-01

    Full Text Available Shannon Cope1, Gorana Capkun-Niggli2, Rupert Gale3, José R Jardim4, Jeroen P Jansen11Mapi Values, Boston, MA, USA; 2Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Switzerland; 3Novartis Horsham Research Centre, Horsham, UK; 4Respiratory Division, Federal University of São Paulo, BrazilObjective: To compare efficacy of indacaterol to that of fixed-dose combination (FDC formoterol and budesonide (FOR/BUD and FDC salmeterol and fluticasone (SAL/FP for the treatment of chronic obstructive pulmonary disease (COPD based on the available randomized clinical trials (RCTs.Methods: Fifteen placebo-controlled RCTs were included that evaluated: indacaterol 150 µg (n = 5 studies, indacaterol 300 µg (n = 4, FOR/BUD 9/160 µg (n = 2, FOR/BUD 9/320 µg (n = 3, SAL/FP 50/500 µg (n = 5, and SAL/FP 50/250 µg (n = 1. Outcomes of interest were trough forced expiratory volume in 1 second (FEV1, total scores for St. George's Respiratory Questionnaire (SGRQ, and transition dyspnea index (TDI. All trials were analyzed simultaneously using a Bayesian network meta-analysis and relative treatment effects between all regimens were obtained. Treatment-by-covariate interactions were included where possible to improve the similarity of the trials.Results: Indacaterol 150 µg resulted in a higher change from baseline (CFB in FEV1 at 12 weeks compared to FOR/BUD 9/160 µg (difference in CFB 0.11 L [95% credible intervals: 0.08, 0.13] and FOR/BUD 9/320 µg (0.09 L [0.06, 0.11] and was comparable to SAL/FP 50/250 µg (0.02 L [–0.04, 0.08] and SAL/FP 50/500 µg (0.03 L [0.00, 0.06]. Similar results were observed for indacaterol 300 µg at 12 weeks and indacaterol 150/300 µg at 6 months. Indacaterol 150 µg demonstrated comparable improvement in SGRQ total score at 6 months versus FOR/BUD (both doses, and SAL/FP 50/500 µg (–2.16 point improvement [–4.96, 0.95]. Indacaterol 150 and 300 µg demonstrated comparable TDI scores versus SAL/FP 50/250 µg

  6. Conducting Meta-Analysis Using SAS

    CERN Document Server

    Arthur, Winfried; Huffcutt, Allen I; Arthur, Winfred

    2001-01-01

    Conducting Meta-Analysis Using SAS reviews the meta-analysis statistical procedure and shows the reader how to conduct one using SAS. It presents and illustrates the use of the PROC MEANS procedure in SAS to perform the data computations called for by the two most commonly used meta-analytic procedures, the Hunter & Schmidt and Glassian approaches. This book serves as both an operational guide and user's manual by describing and explaining the meta-analysis procedures and then presenting the appropriate SAS program code for computing the pertinent statistics. The practical, step-by-step instru

  7. Meta-analysis: Problems with Russian Publications.

    Science.gov (United States)

    Verbitskaya, E V

    2015-01-01

    Meta-analysis is a powerful tool to identify Evidence Based medical technologies (interventions) for use in every day practice. Meta-analysis uses statistical approaches to combine results from multiple studies in an effort to increase power (over individual studies), improve estimates of the size of the effect and/or to resolve uncertainty when reports disagree. Meta-analysis is a quantitative, formal study design used to systematically assess previous research studies to derive conclusions from this research. Meta-analysis may provide more precise estimate of the effect of treatment or risk factor for a disease, or other outcomes, than any individual study contributing to the pooled analysis.We have quite a substantial number of Russian medical publications, but not so many Meta-Analyses published in Russian. Russian publications are cited in English language papers not so often. A total of 90% of clinical studies included in published Meta-Analyses incorporate only English language papers. International studies or papers with Russian co-authors are published in English language. The main question is: what is the problem with inclusion of Russian medical publications in Meta-Analysis? The main reasons for this are the following: 1) It is difficult to find Russian papers, difficult to work with them and to work with Russian journals:a. There are single Russian Biomedical Journals, which are translated into English and are included in databases (PubMed, Scopus and other), despite the fact that all of them have English language abstracts.b. The majority the meta-analyses authors use in their work different citation management software such as the Mendeley, Reference Manager, ProCite, EndNote, and others. These citation management systems allow scientists to organize their own literature databases with internet searches and have adds-on for the Office programs what makes process of literature citation very convenient. The Internet sites of the majority of

  8. Efficacy and Safety of Combined Androgen Deprivation Therapy (ADT and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Tobias Engel Ayer Botrel

    Full Text Available Prostate cancer is the most common nonskin cancer and second most common cause of cancer mortality in older men in the United States (USA and Western Europe. Androgen-deprivation therapy alone (ADT remains the first line of treatment in most cases, for metastatic disease. We performed a systematic review and meta-analysis of all randomized controlled trials (RCT that compared the efficacy and adverse events profile of a chemohormonal therapy (ADT ± docetaxel for metastatic hormone-naive prostate cancer (mHNPC.Several databases were searched, including MEDLINE, EMBASE, LILACS, and CENTRAL. The primary endpoint was overall survival. Data extracted from the studies were combined by using the hazard ratio (HR or risk ratio (RR with their corresponding 95% confidence intervals (95% CI.The final analysis included 3 trials comprising 2,264 patients (mHNPC. Patients who received the chemohormonal therapy had a longer clinical progression-free survival interval (HR = 0.64; 95% CI: 0.55 to 0.75; p<0.00001, and no heterogeneity (Chi2 = 0.64; df = 1 [p = 0.42]; I2 = 0%. The biochemical progression-free survival (bPFS also was higher in patients treated with ADT plus docetaxel (HR = 0.63; 95% CI: 0.57 to 0.69; p<0.00001, also with no heterogeneity noted (Chi2 = 0.48; df = 2 [p = 0.79]; I2 = 0%. Finally, the combination of ADT with docetaxel showed a superior overall survival (OS compared with ADT alone (HR = 0.73; 95% CI: 0.64 to 0.84; p<0.0001, with moderate heterogeneity (Chi2 = 3.84; df = 2 [p = 0.15]; I2 = 48%. A random-effects model analysis was performed, and the results remained favorable to the use of ADT plus docetaxel (HR = 0.73; 95% CI: 0.60 to 0.89; p = 0.002. In the final combined analysis of the high-volume disease patients, the use of the combination therapy also favored an increased overall survival (HR = 0.67; 95% CI: 0.54 to 0.83; p = 0.0003. Regarding adverse events and severe toxicity (grade ≥3, the group receiving the combined therapy

  9. MADAM - An open source meta-analysis toolbox for R and Bioconductor

    Directory of Open Access Journals (Sweden)

    Graber Armin

    2010-03-01

    Full Text Available Abstract Background Meta-analysis is a major theme in biomedical research. In the present paper we introduce a package for R and Bioconductor that provides useful tools for performing this type of work. One idea behind the development of MADAM was that many meta-analysis methods, which are available in R, are not able to use the capacities of parallel computing yet. In this first version, we implemented one meta-analysis method in such a parallel manner. Additionally, we provide tools for combining the results from a set of methods in an ensemble approach. Functionality for visualization of results is also provided. Results The presented package enables the carrying out of meta-analysis either by providing functions directly or by wrapping them to existing implementations. Overall, five different meta-analysis methods are now usable through MADAM, along with another three methods for combining the corresponding results. Visualizing the results is eased by three included functions. For developing and testing meta-analysis methods, a mock up data generator is integrated. Conclusions The use of MADAM enables a user to focus on one package, in turn enabling them to work with the same data types across a set of methods. By making use of the snow package, MADAM can be made compatible with an existing parallel computing infrastructure. MADAM is open source and freely available within CRAN http://cran.r-project.org.

  10. Clinical Effectiveness of Combined Treatment of Traditional Chinese Medicine and Western Medicine in Treatment of Hyperprolactinemia:A Meta-analysis%中西医结合治疗高催乳素血症临床效果meta分析

    Institute of Scientific and Technical Information of China (English)

    辛宇; 路甲鹏; 陈迪; 王斌

    2014-01-01

    目的:评价中西医结合治疗高催乳素血症( hyperprolactinemia,HPRL)的临床效果。方法检索1991年1月-2013年12月 PubMed、EMbase、Medline 和循证医学数据库( EBMR)、中国期刊全文数据库( CNKI)、中国科技期刊全文数据库( VIP)、万方数据库中有关中西医结合治疗 HPRL 的文献。运用系统评价和 meta 分析法对采用中西医结合治疗(治疗组)和单纯西医治疗(对照组)的 HPRL患者的临床效果、治疗后血清催乳素( PRL)水平及不良反应情况进行分析比较。结果本研究共纳入9篇文献,包括HPRL 816例,治疗组423例,对照组393例。meta分析结果显示,治疗组总体有效率显著高于对照组,差异有统计学意义(RR=1.06,95%CI 1.01~1.11,Z =2.32,P =0.02);停药时及停药后6个月血清 PRL水平显著低于对照组,差异均有统计学意义(SMD-1.82,95%CI -3.49~-0.16,Z =2.14,P=0.03;SMD-14.06,95%CI-19.24~-8.88,Z=5.32,P﹤0.00001);不良反应发生率明显低于对照组,差异亦具有统计学意义(RR=0.20,95%CI 0.10~0.42,Z =4.30,P ﹤0.0001)。结论中西医结合治疗 HPRL 效果显著优于单纯西医治疗,且不良反应发生率低。%Objective To evaluate the effect of combined treatment of traditional Chinese medicine and western medi-cine in treatment of hyperprolactinemia( HPRL). Methods Relevant literature of combined treatment of traditional Chinese medicine and western medicine in treatment of HPRL published during January 1991 and December 2013 was retrieved in Pubmed,EMbase,Medline,EMBR,CNKI,VIP and Wanfang database. The efficacy,post-treatment level of serum prolactin ( PRL)and adverse reaction were comparatively analyzed with system evaluation and meta-analysis between combined treat-ment of traditional Chinese medicine and western medicine group( treatment group ) and western medicine group( control group). Results A

  11. Traditional Chinese medicinal herbs combined with epidermal growth factor receptor tyrosine kinase inhibitor for advanced non-small cell lung cancer:a systematic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Zhong-liang Liu; Wei-rong Zhu; Wen-chao Zhou; Hai-feng Ying; Lan Zheng; Yuan-biao Guo; Jing-xian Chen; Xiao-heng Shen

    2014-01-01

    (KPS), and severe toxicity. RevMan 5.0 software was used for data syntheses and analyses. Risk ratio (RR) and 95% confidence interval (CI) were calculated; if the hypothesis of homogeneity was not rejected (P>0.1,I2<50%), the ifxed-effect model was used to calculate the summary RR and the 95% CI. Otherwise, a random-effect model was used. RESULTS: In this review, 19 studies were included based on the selection criteria. Of them, 13 studies were of high quality and 6 studies were of low quality, according to the modiifed Jadad scale. When the TCMH plus EGFR-TKI treatment groups were compared with the EGFR-TKI control groups the meta-analysis demonstrated a statistically signiifcant higher ORR (RR 1.34;95% CI 1.15 to 1.57;P=0.000 2), DCR (RR 1.18; 95% CI 1.09 to 1.27;P<0.000 1), one-year survival rate (RR 1.21; 95% CI 1.01 to 1.44;P=0.04), 2-year survival rate (RR 1.91; 95% CI 1.26 to 2.89;P=0.002) and improved or stable KPS (RR 1.38; 95% CI 1.26 to 1.51;P<0.000 01). Severe toxicity for rash was decreased (RR 0.55; 95% CI 0.32 to 0.94;P=0.03), as were nausea and vomiting (RR 0.17; 95% CI 0.04 to 0.72;P=0.02) and diarrhea (RR 0.46; 95% CI 0.24 to 0.89;P=0.02). Sensitivity analysis indicated that ifndings of the meta-analysis were robust to study quality. In the funnel plot analysis, asymmetry was observed, and publication bias was indicated by Egger’s test (P=0.03). CONCLUSION: TCMH intervention can increase efifcacy and reduce toxicity when combined with EGFR-TKI for advanced NSCLC, although this result requires further veriifcation by more well designed studies.

  12. Cancer risk in waterpipe smokers: a meta-analysis.

    Science.gov (United States)

    Mamtani, Ravinder; Cheema, Sohaila; Sheikh, Javaid; Al Mulla, Ahmad; Lowenfels, Albert; Maisonneuve, Patrick

    2017-01-01

    To quantify by meta-analysis the relationship between waterpipe smoking and cancer, including cancer of the head and neck, esophagus, stomach, lung and bladder. We performed a systematic literature search to identify relevant studies, scored their quality, used fixed and random-effect models to estimate summary relative risks (SRR), evaluated heterogeneity and publication bias. We retrieved information from 28 published reports. Considering only highquality studies, waterpipe smoking was associated with increased risk of head and neck cancer (SRR 2.97; 95 % CI 2.26-3.90), esophageal cancer (1.84; 1.42-2.38) and lung cancer (2.22; 1.24-3.97), with no evidence of heterogeneity or publication bias. Increased risk was also observed for stomach and bladder cancer but based mainly on poor-quality studies. For colorectum, liver and for all sites combined risk estimates were elevated, but there were insufficient reports to perform a meta-analysis. Contrary to the perception of the relative safety of waterpipe smoking, this meta-analysis provides quantitative estimates of its association with cancers of the head and neck, esophagus and lung. The scarcity and limited quality of available reports point out the need for larger carefully designed studies in well-defined populations.

  13. Multivariate meta-analysis using individual participant data.

    Science.gov (United States)

    Riley, R D; Price, M J; Jackson, D; Wardle, M; Gueyffier, F; Wang, J; Staessen, J A; White, I R

    2015-06-01

    When combining results across related studies, a multivariate meta-analysis allows the joint synthesis of correlated effect estimates from multiple outcomes. Joint synthesis can improve efficiency over separate univariate syntheses, may reduce selective outcome reporting biases, and enables joint inferences across the outcomes. A common issue is that within-study correlations needed to fit the multivariate model are unknown from published reports. However, provision of individual participant data (IPD) allows them to be calculated directly. Here, we illustrate how to use IPD to estimate within-study correlations, using a joint linear regression for multiple continuous outcomes and bootstrapping methods for binary, survival and mixed outcomes. In a meta-analysis of 10 hypertension trials, we then show how these methods enable multivariate meta-analysis to address novel clinical questions about continuous, survival and binary outcomes; treatment-covariate interactions; adjusted risk/prognostic factor effects; longitudinal data; prognostic and multiparameter models; and multiple treatment comparisons. Both frequentist and Bayesian approaches are applied, with example software code provided to derive within-study correlations and to fit the models. © 2014 The Authors. Research Synthesis Methods published by John Wiley & Sons, Ltd.

  14. Drivers of wetland conversion: a global meta-analysis.

    Directory of Open Access Journals (Sweden)

    Sanneke van Asselen

    Full Text Available Meta-analysis of case studies has become an important tool for synthesizing case study findings in land change. Meta-analyses of deforestation, urbanization, desertification and change in shifting cultivation systems have been published. This present study adds to this literature, with an analysis of the proximate causes and underlying forces of wetland conversion at a global scale using two complementary approaches of systematic review. Firstly, a meta-analysis of 105 case-study papers describing wetland conversion was performed, showing that different combinations of multiple-factor proximate causes, and underlying forces, drive wetland conversion. Agricultural development has been the main proximate cause of wetland conversion, and economic growth and population density are the most frequently identified underlying forces. Secondly, to add a more quantitative component to the study, a logistic meta-regression analysis was performed to estimate the likelihood of wetland conversion worldwide, using globally-consistent biophysical and socioeconomic location factor maps. Significant factors explaining wetland conversion, in order of importance, are market influence, total wetland area (lower conversion probability, mean annual temperature and cropland or built-up area. The regression analyses results support the outcomes of the meta-analysis of the processes of conversion mentioned in the individual case studies. In other meta-analyses of land change, similar factors (e.g., agricultural development, population growth, market/economic factors are also identified as important causes of various types of land change (e.g., deforestation, desertification. Meta-analysis helps to identify commonalities across the various local case studies and identify which variables may lead to individual cases to behave differently. The meta-regression provides maps indicating the likelihood of wetland conversion worldwide based on the location factors that have

  15. Meta-analysis of Vildagliptin Combined with Other Antidiabetic Drugs in the Treatment of Type 2 Diabetes%维格列汀联合其他降糖药治疗2型糖尿病的疗效与安全性的Meta分析

    Institute of Scientific and Technical Information of China (English)

    缪东军; 邓丽萍

    2016-01-01

    Objective:To discuss Meta analysis of type 2 diabetes mellitus by Vildagliptin combined with other antidiabetic drug.Method:Through the retrieval of the Wanfang,Hownet,VIP and CBM database,type 2 diabetes mellitus,Vildagliptin,combination,hypoglycemic drugs,efficacy,safety were used as the keywords, Meta analysis into the literature were utilized,summarized the efficacy and safety of Vildagliptin combined with other antidiabetic drugs for the treatment of type 2 diabetes.Result:The literature through the screening of this study were included in the final 9 by Meta analysis showed that vildagliptin combination therapy was superior in terms of reducing glycated hemoglobin α-glucosidase inhibitors(P0.05).Conclusion:Meta analysis showed that Vildagliptin in combination with other antidiabetic drugs to treat type 2 diabetes is not only effective and reliable,but also high security,it is worth of learning and using for reference.%目的:探讨2型糖尿病采取维格列汀联合其他降糖药治疗的疗效与安全性的Meta分析情况。方法:通过对万方、知网、维普、CBM等数据库进行检索,将2型糖尿病、维格列汀、联合、降糖药物、疗效、安全性等作为关键词,利用Meta分析纳入的文献,总结维格列汀联合其他降糖药物治疗2型糖尿病的疗效与安全性。结果:通过筛选后最终纳入本研究的文献研究有9个,经Meta分析显示维格列汀联合治疗在降低糖化血红蛋白方面优于α糖苷酶抑制剂(P0.05)。结论:经Meta分析显示维格列汀联合其他降糖药物治疗2型糖尿病不仅疗效可靠,且安全性高,值得借鉴。

  16. Meta-Analyst: software for meta-analysis of binary, continuous and diagnostic data

    Directory of Open Access Journals (Sweden)

    Schmid Christopher H

    2009-12-01

    Full Text Available Abstract Background Meta-analysis is increasingly used as a key source of evidence synthesis to inform clinical practice. The theory and statistical foundations of meta-analysis continually evolve, providing solutions to many new and challenging problems. In practice, most meta-analyses are performed in general statistical packages or dedicated meta-analysis programs. Results Herein, we introduce Meta-Analyst, a novel, powerful, intuitive, and free meta-analysis program for the meta-analysis of a variety of problems. Meta-Analyst is implemented in C# atop of the Microsoft .NET framework, and features a graphical user interface. The software performs several meta-analysis and meta-regression models for binary and continuous outcomes, as well as analyses for diagnostic and prognostic test studies in the frequentist and Bayesian frameworks. Moreover, Meta-Analyst includes a flexible tool to edit and customize generated meta-analysis graphs (e.g., forest plots and provides output in many formats (images, Adobe PDF, Microsoft Word-ready RTF. The software architecture employed allows for rapid changes to be made to either the Graphical User Interface (GUI or to the analytic modules. We verified the numerical precision of Meta-Analyst by comparing its output with that from standard meta-analysis routines in Stata over a large database of 11,803 meta-analyses of binary outcome data, and 6,881 meta-analyses of continuous outcome data from the Cochrane Library of Systematic Reviews. Results from analyses of diagnostic and prognostic test studies have been verified in a limited number of meta-analyses versus MetaDisc and MetaTest. Bayesian statistical analyses use the OpenBUGS calculation engine (and are thus as accurate as the standalone OpenBUGS software. Conclusion We have developed and validated a new program for conducting meta-analyses that combines the advantages of existing software for this task.

  17. Meta-analysis for Discovering Rare-Variant Associations: Statistical Methods and Software Programs.

    Science.gov (United States)

    Tang, Zheng-Zheng; Lin, Dan-Yu

    2015-07-02

    There is heightened interest in using next-generation sequencing technologies to identify rare variants that influence complex human diseases and traits. Meta-analysis is essential to this endeavor because large sample sizes are required for detecting associations with rare variants. In this article, we provide a comprehensive overview of statistical methods for meta-analysis of sequencing studies for discovering rare-variant associations. Specifically, we discuss the calculation of relevant summary statistics from participating studies, the construction of gene-level association tests, the choice of transformation for quantitative traits, the use of fixed-effects versus random-effects models, and the removal of shadow association signals through conditional analysis. We also show that meta-analysis based on properly calculated summary statistics is as powerful as joint analysis of individual-participant data. In addition, we demonstrate the performance of different meta-analysis methods by using both simulated and empirical data. We then compare four major software packages for meta-analysis of rare-variant associations-MASS, RAREMETAL, MetaSKAT, and seqMeta-in terms of the underlying statistical methodology, analysis pipeline, and software interface. Finally, we present PreMeta, a software interface that integrates the four meta-analysis packages and allows a consortium to combine otherwise incompatible summary statistics.

  18. A Meta -analysis of cetuximab combined with chemoradiotherapy in patients with e-sophageal cancer%西妥昔单抗联合放化疗治疗食管癌的 Meta 分析

    Institute of Scientific and Technical Information of China (English)

    樊璠; 白鸽; 张建清; 杨媚; 张莉

    2016-01-01

    Objective:To use Meta -analysis to evaluate the clinical efficacy and safety of cetuximab for esopha-geal cancer.Methods:Relevant literatures were searched through PubMed,Web of Science,Embase,abstract from the meeting of ASCO,The New England Oncology,The Lancet Oncology and JCO.Results:Five randomized controlled tri-als were included with a total of 823 patients with esophageal cancer.Meta -analysis suggested that cetuximab com-bined with chemoradiotherapy couldn't improve the objective effective rate[RR =1.08,95%CI(0.88,1.33),P >0.05]and OS[HR =1.02,95%CI(0.77,1.37),P >0.05],compared with the control group.Subgroup analysis showed that there was no differrence between these two groups for OS[HR =0.92,95%CI(0.76,1.11),P >0.05]. And the higher incidence of rash[RR =16.46,95%CI(3.22,84.07),P <0.05]was found.Conclusion:Cetuximab combined with chemoradiotherapy didn't improve the effective rate and overall survival rate for patients of adenocarci-noma and squamous esophageal cancer,and increased the incidence of rash,when the gene mutation condition is un-known.%目的:系统评价西妥昔单抗联合放化疗与单纯放化疗相比,治疗食管癌患者的疗效及安全性。方法:检索 PubMed,Web of Science,Embase,ASCO 等会议摘要内容,The New England Oncology 杂志,The Lancet Oncology 杂志及 JCO 杂志等,搜索截止至2015年10月。按纳入及排除标准筛选文献,应用 RevMan 5.3(Co-penhagen:The Nordic Cochrane Centre,The Cochrane Collaboration,2013)软件对数据进行 Meta 分析。结果:共纳入5项 RCTs,包含823例食管癌患者。Meta 分析显示,西妥昔单抗联合放化疗与单纯放化疗相比,对食管癌患者 ORR[RR =1.08,95%CI(0.88,1.33),P >0.05]、OS[HR =1.02,95%CI(0.77,1.37),P >0.05]的改善无显著统计学差异。亚组分析结果显示:不论是食管鳞癌或是腺癌,两组对 OS 的改善无显著统计学差异[HR

  19. Meta-analysis in Stata using gllamm.

    Science.gov (United States)

    Bagos, Pantelis G

    2015-12-01

    There are several user-written programs for performing meta-analysis in Stata (Stata Statistical Software: College Station, TX: Stata Corp LP). These include metan, metareg, mvmeta, and glst. However, there are several cases for which these programs do not suffice. For instance, there is no software for performing univariate meta-analysis with correlated estimates, for multilevel or hierarchical meta-analysis, or for meta-analysis of longitudinal data. In this work, we show with practical applications that many disparate models, including but not limited to the ones mentioned earlier, can be fitted using gllamm. The software is very versatile and can handle a wide variety of models with applications in a wide range of disciplines. The method presented here takes advantage of these modeling capabilities and makes use of appropriate transformations, based on the Cholesky decomposition of the inverse of the covariance matrix, known as generalized least squares, in order to handle correlated data. The models described earlier can be thought of as special instances of a general linear mixed-model formulation, but to the author's knowledge, a general exposition in order to incorporate all the available models for meta-analysis as special cases and the instructions to fit them in Stata has not been presented so far. Source code is available at http:www.compgen.org/tools/gllamm.

  20. Multivariate meta-analysis: potential and promise.

    Science.gov (United States)

    Jackson, Dan; Riley, Richard; White, Ian R

    2011-09-10

    The multivariate random effects model is a generalization of the standard univariate model. Multivariate meta-analysis is becoming more commonly used and the techniques and related computer software, although continually under development, are now in place. In order to raise awareness of the multivariate methods, and discuss their advantages and disadvantages, we organized a one day 'Multivariate meta-analysis' event at the Royal Statistical Society. In addition to disseminating the most recent developments, we also received an abundance of comments, concerns, insights, critiques and encouragement. This article provides a balanced account of the day's discourse. By giving others the opportunity to respond to our assessment, we hope to ensure that the various view points and opinions are aired before multivariate meta-analysis simply becomes another widely used de facto method without any proper consideration of it by the medical statistics community. We describe the areas of application that multivariate meta-analysis has found, the methods available, the difficulties typically encountered and the arguments for and against the multivariate methods, using four representative but contrasting examples. We conclude that the multivariate methods can be useful, and in particular can provide estimates with better statistical properties, but also that these benefits come at the price of making more assumptions which do not result in better inference in every case. Although there is evidence that multivariate meta-analysis has considerable potential, it must be even more carefully applied than its univariate counterpart in practice. Copyright © 2011 John Wiley & Sons, Ltd.

  1. 联用依维莫司治疗乳腺癌疗效与安全性的Meta分析%Efficacy and safety of adjuvant therapy combined with everolimus in treatment of breast cancer:a Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    李刚; 陈岷

    2016-01-01

    Objective To evaluate the efficacy and safety of adjuvant therapy combined with everolimus in theatment of breast cancer. Methods The related data-bases were searched. The RCTs in neoadjuvant therapy or adjunctive therapy for breast cancer in combination with everolimus( experimental group)or placebo( control group)were collected. The RCTs were Meta-analyzed using RevMan 5. 3 software. The efficacy and safety of the two groups were compared. The results were shown by relative risk ( RR),hazard ratio( HR)and 95%GI. Results Eight RCTs and 2 877 patients were enrolled into the Meta-analysis,including 1 679 patients in the experimental group and 1198 patients in the control group. Two RCTs applied neoadjuvant therapy and 6 RCTs applied adjunctive therapy. The results of quality evaluation of 8 reports showed 2 of low risk and 6 of unknown risk. Meta-analysis show the following results. The effective rate of the experimental group and the control group applying neoadjuvant therapy were 92. 6%(150/162)and 88. 7%(141/159),the difference was not statistically significant( RR=1. 04,95%GI:0. 97-1. 12,P = 0. 23 ). The effective rate of the experimental group and the control group applying adjunctive therapy were 83. 0%(1 081/1 303)and 76. 0%(623/820),the difference was not statistically significant(RR=1. 12,95%GI:0. 96-1. 29,P=0. 14). The progression-free survival of the patients in the experimental group applying adjunctive therapy were longer than that in the control group,the difference was statistically significant(HR=0. 60,95%GI:0. 44-0. 82,P=0. 001). The overall survival of the patients in the experimental group applying adjunctive therapy were longer than that in the control group,but the the difference was not statistically significant(HR =0. 74,95%GI:0. 48-1. 16,P =0. 19). The evaluation results of safety showed the following results. The incidence rates of erythra,fatigue,and anemia in the experimental group applying neoadjuvant therapy were higher than those in

  2. 联合接触噪声及甲苯与职业性听力损伤关系的Meta分析%Association between occupational hearing loss and combined exposure of noise and toluene:a Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    王璐; 焦建栋

    2014-01-01

    Objective:To assess the occupational hearing loss effects of workers between noise plus toluene group and one factor only group by Meta-analysis .Methods:Original English and Chinese articles on association between combined exposure of noise and toluene and occupational hearing loss (Jan.1990 to Dec.2013) were retrieved by such databases as Chinese CNKI , Wanfang , Medline and Pubmed .A random effect model was used to calculate pooled OR and their corresponding 95% CI.Potential sources of heterogeneity among studies were explored and publication bias was evaluated .Results: A total of 8 ( 2 in Chinese and 6 in English ) observational studies were identified.The prevalence rate of high frequency hearing loss in combined exposure group was higher than that in noise-only group and in toluene-only group, with pooled OR=1.98(95% CI:1.20-3.25) and 2.48(95% CI:1 .09-5 .65 ) ,respectively .The significant heterogeneity was found in subgroup analysis and publication bias was not significant among recruited studies .Conclusion:The results suggest that toluene exposure in noisy working places can exacerbate high frequency hearing loss in workers .%目的:用Meta分析方法探讨同时接触噪声及甲苯两种因素与单种因素暴露相比对劳动者职业性听力损伤的影响。方法:利用中国学术期刊全文数据库、万方全文数据库、Medline及Pubmed数据库检索国内外公开发表的从1990年1月至2013年12月的所有关于联合接触噪声及甲苯与职业性听力损伤关系的中英文文献;利用随机效应模型计算纳入文献的合并OR值及其95%CI 值;进行亚组分析探究异质性来源并分析出版偏倚。结果:纳入分析的文献共8篇(中文2篇,英文6篇)。经Meta分析,与单纯噪声暴露及单纯甲苯暴露相比,同时接触噪声和甲苯的高频听力损伤发生率分别增加1.98倍(95%CI:1.20~3.25)及2.48倍(95%CI:1.09~5.65)。亚组分析显

  3. Pro: Meta-analysis: the case for.

    Science.gov (United States)

    Mudge, David W; Webster, Angela C; Johnson, David W

    2016-06-01

    With ever-accumulating medical evidence for treatment benefits and harms, it is vital that clinicians are able to access and use up-to-date, best evidence in specific clinical scenarios involving individual patients-the primary goal of evidence-based medicine. In this article, we propose that meta-analysis, when properly conducted and reported in the context of a rigorous systematic review, is an indispensable tool for synthesis and interpretation of clinical evidence for the purpose of informing clinical decision-making by clinicians, patients and health care policy makers. Meta-analysis provides many benefits, including enhanced precision and statistical power, greater transparency, identification of bias, exploration of heterogeneity of effects, enhanced generalizability, efficient integration of clinical knowledge, identification of evidence gaps, better informed future trial design and avoidance of unnecessary research duplication and potential patient harm. The overall standard, clinical value and reach of meta-analysis has been further enhanced by the development of standards for registration, conduct and reporting, as well as advanced meta-analytic techniques, such as network meta-analysis. Of course, meta-analysis can at times be limited by poor quality studies, trial heterogeneity, publication bias and non-rigorous review and analysis, although through appraisal these issues are often able to be identified and explored, such that valuable clinical information can still be obtained. Consequently, meta-analysis is now the most highly cited form of research and is considered by many leading organizations to represent the highest level of clinical evidence. However, to maximize their considerable value, it is essential that all clinicians have the skills to critically appraise, carefully interpret and judiciously apply meta-analyses in their practice.

  4. Mass meta-analysis in Talairach space

    DEFF Research Database (Denmark)

    Nielsen, Finn Årup

    2004-01-01

    We provide a method for mass meta-analysis in a neuroinformatics database containing stereotaxic Talairach coordinates from neuroimaging experiments. Database labels are used to group the individual experiments, e.g., according to cognitive function, and the consistent pattern of the experiments...... of experiments, and the distances to the null hypotheses are used to sort the voxels across groups of experiments. This allows for mass meta-analysis, with the construction of a list with the most prominent associations between brain areas and group labels. Furthermore, the method can be used for functional...

  5. Effect of radical surgery combined with splenectomy in treatment of gastric cancer:a Meta-analysis%胃癌根治术联合脾脏切除治疗胃癌的Meta分析

    Institute of Scientific and Technical Information of China (English)

    刘启领

    2016-01-01

    Objective To evaluate the effect of radical gastrectomy (RG) combined with splenectomy (SE) on long-term outcomes of patients with gastric cancer by a Meta-analysis.Methods A search of databases to identify randomized controlled trials ( RCTs) in PubMed, Cochrane, Web of knowledge, Ovid, SpringerLink, CNKI, WanFang data were per-formed.Outcome measures were survival rate, operation-related events, postoperative mortality (30 days).The Meta-a-nalysis was performed by RevMan 5.3.Results Five RCT studies met the inclusion criteria, including 588 patients in SE group and 756 patients in splean-preserving group.There was no significant difference in the 5-year overall survival rate between SE group and spleen-preserving group (OR=0.80, 95%CI:0.60~1.06, P>0.05).Sensitivity analysis indi-cated the 5-year overall survival rate in SE group was lower than that in spleen-preserving group ( OR=0.72, 95%CI:0.53~0.97, P0.05).Conclusion SE did not show a beneficial effect on survival rate compared with splenic preservation.Routinely performing SE should not be recommended.%目的:评估胃癌根治术( radical gastrectomy, RG)联合脾脏切除术( splenectomy, SE)治疗进展期胃癌的长期效果。方法以PubMed、Cochrane、Web of knowledge、Ovid SpringerLink、中国知网、万方、维普为数据源,检索相关文献,采用RevMan对切脾与保脾的RG随机对照试验( RCT)进行Meta分析,结局变量为患者5年生存率、手术操作相关并发症、术后30 d死亡率。结果符合纳入标准的RCT研究共5篇,包括1344例病例,切脾组588例,保脾组756例,切脾组与保脾组5年生存率比较,差异无统计学意义(OR=0.80,95%CI:0.60~1.06,P>0.05),灵敏性分析切脾组患者5年生存率低于保脾组(OR=0.72,95%CI:0.53~0.97,P<0.05);切脾组操作相关并发症发生率明显高于保脾组(OR=2.51,95%CI:1.90~3.33,P<0.05

  6. Comparative efficacy of indacaterol 150 μg and 300 μg versus fixed-dose combinations of formoterol + budesonide or salmeterol + fluticasone for the treatment of chronic obstructive pulmonary disease – a network meta-analysis

    Science.gov (United States)

    Cope, Shannon; Capkun-Niggli, Gorana; Gale, Rupert; Jardim, José R; Jansen, Jeroen P

    2011-01-01

    Objective: To compare efficacy of indacaterol to that of fixed-dose combination (FDC) formoterol and budesonide (FOR/BUD) and FDC salmeterol and fluticasone (SAL/FP) for the treatment of chronic obstructive pulmonary disease (COPD) based on the available randomized clinical trials (RCTs). Methods: Fifteen placebo-controlled RCTs were included that evaluated: indacaterol 150 μg (n = 5 studies), indacaterol 300 μg (n = 4), FOR/BUD 9/160 μg (n = 2), FOR/BUD 9/320 μg (n = 3), SAL/FP 50/500 μg (n = 5), and SAL/FP 50/250 μg (n = 1). Outcomes of interest were trough forced expiratory volume in 1 second (FEV1), total scores for St. George’s Respiratory Questionnaire (SGRQ), and transition dyspnea index (TDI). All trials were analyzed simultaneously using a Bayesian network meta-analysis and relative treatment effects between all regimens were obtained. Treatment-by-covariate interactions were included where possible to improve the similarity of the trials. Results: Indacaterol 150 μg resulted in a higher change from baseline (CFB) in FEV1 at 12 weeks compared to FOR/BUD 9/160 μg (difference in CFB 0.11 L [95% credible intervals: 0.08, 0.13]) and FOR/BUD 9/320 μg (0.09 L [0.06, 0.11]) and was comparable to SAL/FP 50/250 μg (0.02 L [−0.04, 0.08]) and SAL/FP 50/500 μg (0.03 L [0.00, 0.06]). Similar results were observed for indacaterol 300 μg at 12 weeks and indacaterol 150/300 μg at 6 months. Indacaterol 150 μg demonstrated comparable improvement in SGRQ total score at 6 months versus FOR/BUD (both doses), and SAL/FP 50/500 μg (−2.16 point improvement [−4.96, 0.95]). Indacaterol 150 and 300 μg demonstrated comparable TDI scores versus SAL/FP 50/250 μg (0.21 points (−0.57, 0.99); 0.39 [−0.39, 1.17], respectively) and SAL/FP 50/500 μg at 6 months. Conclusion: Indacaterol monotherapy is expected to be at least as good as FOR/BUD (9/320 and 9/160 μg) and comparable to SAL/FP (50/250 and 50/500 μg) in terms of lung function. Indacaterol is also

  7. Comparative efficacy of indacaterol 150 μg and 300 μg versus fixed-dose combinations of formoterol + budesonide or salmeterol + fluticasone for the treatment of chronic obstructive pulmonary disease--a network meta-analysis.

    Science.gov (United States)

    Cope, Shannon; Capkun-Niggli, Gorana; Gale, Rupert; Jardim, José R; Jansen, Jeroen P

    2011-01-01

    To compare efficacy of indacaterol to that of fixed-dose combination (FDC) formoterol and budesonide (FOR/BUD) and FDC salmeterol and fluticasone (SAL/FP) for the treatment of chronic obstructive pulmonary disease (COPD) based on the available randomized clinical trials (RCTs). Fifteen placebo-controlled RCTs were included that evaluated: indacaterol 150 μg (n = 5 studies), indacaterol 300 μg (n = 4), FOR/BUD 9/160 μg (n = 2), FOR/BUD 9/320 μg (n = 3), SAL/FP 50/500 μg (n = 5), and SAL/FP 50/250 μg (n = 1). Outcomes of interest were trough forced expiratory volume in 1 second (FEV(1)), total scores for St. George's Respiratory Questionnaire (SGRQ), and transition dyspnea index (TDI). All trials were analyzed simultaneously using a Bayesian network meta-analysis and relative treatment effects between all regimens were obtained. Treatment-by-covariate interactions were included where possible to improve the similarity of the trials. Indacaterol 150 μg resulted in a higher change from baseline (CFB) in FEV(1) at 12 weeks compared to FOR/BUD 9/160 μg (difference in CFB 0.11 L [95% credible intervals: 0.08, 0.13]) and FOR/BUD 9/320 μg (0.09 L [0.06, 0.11]) and was comparable to SAL/FP 50/250 μg (0.02 L [-0.04, 0.08]) and SAL/FP 50/500 μg (0.03 L [0.00, 0.06]). Similar results were observed for indacaterol 300 μg at 12 weeks and indacaterol 150/300 μg at 6 months. Indacaterol 150 μg demonstrated comparable improvement in SGRQ total score at 6 months versus FOR/BUD (both doses), and SAL/FP 50/500 μg (-2.16 point improvement [-4.96, 0.95]). Indacaterol 150 and 300 μg demonstrated comparable TDI scores versus SAL/FP 50/250 μg (0.21 points (-0.57, 0.99); 0.39 [-0.39, 1.17], respectively) and SAL/FP 50/500 μg at 6 months. Indacaterol monotherapy is expected to be at least as good as FOR/BUD (9/320 and 9/160 μg) and comparable to SAL/FP (50/250 and 50/500 μg) in terms of lung function. Indacaterol is also expected to be comparable to FOR/BUD (9/320 and 9

  8. "Nobody Told Me They Didn't Speak English!": Teacher Language Views and Student Linguistic Repertoires in Hutterite Colony Schools in Canada

    Science.gov (United States)

    Sterzuk, Andrea; Nelson, Cynthia A.

    2016-01-01

    This article presents a qualitative study of five monolingual teachers' understandings of the linguistic repertoires of their multilingual students. These teachers deliver the Saskatchewan provincial curricula in English to Hutterite colony students who are users of three languages: (a) spoken Hutterisch as a home and community language, (b)…

  9. 化疗联合局部热疗治疗晚期胃癌疗效与安全性的Meta分析%Chemotherapy combined with hyperthermia for advanced gastric cancer:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    冯莉; 刘巍; 洪雷; 吕雅蕾; 王玉栋; 左静; 王龙; 韩晶; 单玉洁

    2014-01-01

    Objective To assess the effectiveness and safety of hyperthermia combined with chemotherapy for advanced gastric cancer.Methods We searched English databases as Cochrane Library,PubMed,EMBASE and Chinese ones as CBM,CNKI,VIP and Wangfang data with com-puter and also retrieved other sources as supplying,such as tracing related references,besides we al-so communicated with authors to obtain some certain information that has not been found.All relevant randomized controlled trials (RCTs)were collected to compare hyperthermia combined with chemo-therapy and chemotherapy alone.The quality of included trials were assessed by Cochrane Handbook 5.0 for systematic reviews.Meta-analyses were conducted by STATA SE 12.0 software.Results Five RCTs involving 35 1 patients with advanced gastric cancer were included.The results of meta-analysis showed that:a)as for effectiveness,the hyperthermia combined with chemotherapy group was supe-rior to the chemotherapy group in the complete response (CR)rate (OR=2.13,95%CI 1.17 to 3.86,P =0.013)and the total efficiency rate(OR=1.37,95%CI 1.09 to 1.73,P=0.006),with significant differences;b )as for safety,the hyperthermia combined with chemotherapy group was similar to the chemotherapy group in the incidence of adverse reactions.Conclusion Compared with chemotherapy,hyperthermia combined with chemotherapy in the treatment of advanced gastric cancer can significantly improve the complete response rate and the total efficiency rate,and mean-while not increased the incidence of adverse reactions.Due to the limitation of the included studies, large sample size,multicenter,high quality studies are needed to verify the above conclusion.We recommend that chemotherapy combined with hyperthermia therapy could be applied to clinic combi-ning individual conditions of patients.%目的:系统评价热疗联合化疗(热化)与单纯化疗(单化)比较治疗晚期胃癌的疗效和安全性。方法计算机检索Cochrane Library、PubMed

  10. 地佐辛复合舒芬太尼术后静脉自控镇痛疗效的Meta分析%Meta-analysis of Efficacy Dezocine Combined with Sufentanil for Patient-controlled Intravenous Anal-gesia

    Institute of Scientific and Technical Information of China (English)

    李晓晶; 纪筠; 杨改生

    2015-01-01

    Objective To evaluate the efficacy of dezocine combined with sufentanil for patient-controlled intravenous analgesia (PCIA), so as to provide evidence for rational drug use in clinic. Methods The random⁃ized controlled trials of dezocine combined with sufentanil for PCIA were gathered from PubMed, Embase, and Cochrane database of Systematic Reviews, CNKI and VIP. The data analyses were performed with The Cochrane Collaborations software RevMan 5.0. Results 16 RCTs were included with a total of 1277 cases. The meta-analysis results showed as follows: as for visual analog scale (VAS) score, compared with the sufentanil group, the postoperative VAS at 2-hour was decreased in the combined drug group[WMD=-0.16,95%CI (-0.27,-0.06)]. There was no significance in Ramsay score between combined group and sufentnil group. As for bruggrmann comfort scale (BCS) score, compared with the sufentanil group, the BCS at 2-hour and 48-hour was increased in the combined drug group [WMD=-0.15,95%CI (-0.26,-0.05);WMD=0.24 ,95%CI(0.10,0.37)]. The incidence of adverse reactions in the combination group, compared with the single drug group, such as nausea, vomiting, dizzi⁃ness, was significantly reduced. As for patients’satisfactory degree compared with the sufentanil group, the com⁃bined drug group showed better outcomes [OR=2.56,95%CI(1.36,4.80)]. Conclusion Dezocine combined with sufentanil for PCIA can effectively alleviate postoperative pain compared with single drug group, and reduce the incidence of adverse reactions.%目的:采用Meta分析评价地佐辛复合舒芬太尼用于腹部手术术后患者静脉自控镇痛(PCIA)的临床疗效。方法:系统检索PubMed、Embase、Cochrane图书馆、CNKI、维普、万方等数据库,收集地佐辛复合舒芬太尼用于术后镇痛的临床研究文献,采用RevMan5.0软件进行Meta分析。结果:共纳入16项临床试验,1277例患者。舒芬太尼复合地佐辛组在术后2 h患者的VAS评分较单

  11. 引导组织再生联合植骨修复根分叉病变的Meta分析%Combined use of guided tissue regeneration and bone grafting in the treatment of root furcation defects:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    李丹丹; 玛丽亚木古丽·帕塔尔; 黄萍; 赵今

    2016-01-01

    BACKGROUND:Numerous experimental and clinical observations have shown new attachment formation in the periodontium by guided tissue regeneration. OBJECTIVE:To evaluate the efficacy of guided tissue regeneration combined with bone grafting for the treatment of root furcation defects. METHODS:A computer-based online search combined with manual retrieval was conducted up to 2015 to screen the relevant English and Chinese literatures addressing guided tissue regeneration, bone grafting, and root furcation defects. Vertical and horizontal probing depth and attachment loss were analyzed. Meta-analysis was performed using Stata/SE version 12.0 software by extracting data from the relevant articles. Moreover, the publication bias was tested. RESULTS AND CONCLUSION:The meta-analysis results showed that at 6 months after treatment, the alterations in vertical probing depth and periodontal attachment were significantly increased after guided tissue regeneration compared with open-flap debridement (P  类型的再生膜以及植骨术应用的不同材料对疗效的影响加以分析,仍需做进一步的循证研究,以明确根分叉病变的治疗方案。

  12. TACE combined with Sorafenib in the treatment of advanced HCC:a Meta-analysis%TACE联合索拉非尼治疗晚期肝癌的Meta分析

    Institute of Scientific and Technical Information of China (English)

    张明娟; 刘佳; 向晓星; 邓登豪; 王甦

    2015-01-01

    目的 评价肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合靶向多激酶抑制剂索拉非尼治疗晚期肝癌的疗效.方法 使用计算机检索1989-01-2013-07公开发表在PubMed数据库、Springer Link、ElsevierSciencedirect、Cochrane、中文科技期刊全文数据库、万方数据库和中国学术期刊数据库,有关TACE联合索拉非尼治疗晚期肝癌的研究,并使用Cochrane协作网提供的RevMan 5.0对所纳入的研究进行Meta分析,发表偏倚用漏斗图评估.结果 最终有12项研究纳入分析,TACE联合索拉非尼治疗晚期肝癌的客观有效率(objective response rate,ORR)及疾病控制率(disease control rate,DCR)分别为26.23%和74.86%,均优于单独使用TACE的13.67%和53.48%,P<0.05;TACE联合索拉非尼治疗晚期肝癌的半年及1年生存率分别为94.81%和66.13%,与单独使用TACE的82.98%和41.53%相比,联合索拉非尼可以提高晚期肝癌的半年及1年生存率,P<0.05.联合索拉非尼治疗组的不良反应高于单独使用TACE组,不良反应以手足综合征、乏力和腹泻等较为常见,予对症处理后好转,无其他严重不良反应.结论 TACE联合索拉非尼治疗晚期肝癌有效且安全.%OBJECTIVE To assess the effectiveness of transcatheter arterial chemoembolization (TACE) combined sorafenib in the treatment of advanced hepatocellular carcinoma (HCC).METHODS Clinical data of advanced HCC treated by TACE and sorafenib were collected from computer literature searching,tracing January 1989 to July 2013,with carried out in PubMed,Springer Link,Elsevier Sciencedirect,Cochrane,China Science and Technology Journal Database (CSTJ),Wanfang and China Academic Journal Network Publishing Database (CAJD).RevMan5.0 software,which was recommended by the Cochrane Collaboration,was used for meta-analysis.Publication bias was assessed by using a funnel plot.RESULTS There were 12 studies included in the final analysis.The objective

  13. Efficacy of vasopressin combined with epinephrine during adult cardiopulmonary resuscitation:a meta-analysis%成人 CPR 中血管加压素联合肾上腺素疗效的 Meta分析

    Institute of Scientific and Technical Information of China (English)

    邹勤华; 钱会银; 徐波; 朱建良; 周保纯; 刘一韡; 朱凌霞; 刘励军

    2016-01-01

    目的:在成人心肺复苏术( CPR)中,血管加压素联合肾上腺素的应用是否优于肾上腺素尚未定论,本研究针对现有的临床研究资料进行荟萃分析。方法在Pub Med、万方数据库检索关于成人CPR联合或单独应用肾上腺素的所有随机对照临床研究。观察指标包括复苏后自主循环恢复( ROSC)率、入院存活率(或短期存活率)、出院存活率(或长期存活率)和神经功能预后。结果在检索到的191篇文献中,最终纳入分析的有8项随机对照研究(共5740例患者),其中5项为院外心脏骤停( OHCA,5172例患者)研究,3项为院内心脏骤停( IHCA,568例患者)研究。依据患者心脏骤停( CA)最初检测到的心律,分为室颤/室速( VF/VT),无脉性电活动和心室停顿进行亚组分析。结果表明,与单用肾上腺素组比较,血管加压素联合肾上腺素组能提高成人心脏骤停患者入院存活率(短期存活率)(RR=1.15,95%CI=1.01~1.32,P=0.04),而ROSC率、出院存活率及神经功能预后比较差异无统计学意义(P>0.05)。亚组分析发现,联合用药组对于IHCA患者ROSC率(RR 1.30,95%CI=1.11~1.51,P=0.001)及短期存活率(RR1.23,95%CI=1.05~1.44,P=0.01)效果优于肾上腺素组。结论血管加压素联合肾上腺素较单用肾上腺素可明显提高CA患者入院存活率(短期存活率);对于IHCA患者,联合应用可提高患者ROSC率和短期存活率。%Objective During adult cardiopulmonary resuscitation, the efficacy of vasopressin combined with epinephrine versus epinephrine alone remains controversial. This meta - analysis was conducted on the existing clinical research data. Methods PubMed and WANFANG databases were searched for randomized controlled clinical studies on the combination or the use of epinephrine alone during adult cardiopulmonary resuscitation. The observation outcomes included the return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation, admission survival

  14. Gene Level Meta-Analysis of Quantitative Traits by Functional Linear Models.

    Science.gov (United States)

    Fan, Ruzong; Wang, Yifan; Boehnke, Michael; Chen, Wei; Li, Yun; Ren, Haobo; Lobach, Iryna; Xiong, Momiao

    2015-08-01

    Meta-analysis of genetic data must account for differences among studies including study designs, markers genotyped, and covariates. The effects of genetic variants may differ from population to population, i.e., heterogeneity. Thus, meta-analysis of combining data of multiple studies is difficult. Novel statistical methods for meta-analysis are needed. In this article, functional linear models are developed for meta-analyses that connect genetic data to quantitative traits, adjusting for covariates. The models can be used to analyze rare variants, common variants, or a combination of the two. Both likelihood-ratio test (LRT) and F-distributed statistics are introduced to test association between quantitative traits and multiple variants in one genetic region. Extensive simulations are performed to evaluate empirical type I error rates and power performance of the proposed tests. The proposed LRT and F-distributed statistics control the type I error very well and have higher power than the existing methods of the meta-analysis sequence kernel association test (MetaSKAT). We analyze four blood lipid levels in data from a meta-analysis of eight European studies. The proposed methods detect more significant associations than MetaSKAT and the P-values of the proposed LRT and F-distributed statistics are usually much smaller than those of MetaSKAT. The functional linear models and related test statistics can be useful in whole-genome and whole-exome association studies.

  15. Meta-Analysis at Middle Age: A Personal History

    Science.gov (United States)

    Glass, Gene V.

    2015-01-01

    The 40-year history of meta-analysis is traced from the vantage point of one of its originators. Research syntheses leading to the first examples of meta-analysis are identified. Early meta-analyses of the literature on psychotherapy outcomes and school class size are recounted. The influence on the development of meta-analysis of several…

  16. A Bayesian Nonparametric Meta-Analysis Model

    Science.gov (United States)

    Karabatsos, George; Talbott, Elizabeth; Walker, Stephen G.

    2015-01-01

    In a meta-analysis, it is important to specify a model that adequately describes the effect-size distribution of the underlying population of studies. The conventional normal fixed-effect and normal random-effects models assume a normal effect-size population distribution, conditionally on parameters and covariates. For estimating the mean overall…

  17. 中药离子导入联合常规疗法治疗小儿弱视的meta分析%Meta-Analysis on Chinese Herbs Iontophoresis Combined with Moderate Comprehensive Therapy for Children with Amblyopia

    Institute of Scientific and Technical Information of China (English)

    张奥; 严兴科; 刘安国

    2016-01-01

    quality of the included trials was assessed based on the advanced Jadad scale. Data synthesis was facilitated using Reviewer Manager 5.1.Results 10 trials involving 1809 participants satisfied the minimum criteria for meta-analysis. The evidence showed that the total effective rate of treatment within the group receiving Chinese Herbs Iontophoresis Combined with Moderate Methods was higher than that in moderate group; there were statistically significant differences between groups [polled fixed effects model(OR)=5.90, 95%confidence interval (4.06,8.57) , Z=9.32,P<0.00001].Conclusions The total effective rate of Chinese Herbs iontophoresis combined with moderate methods for children's amblyopia was significantly superior to moderate treatment without Chinese herbs, indicating that Chinese herbs was a promising treatment for children's amblyopia. However, due to the limited number of CCTs and RCTs, especially those of large sample size and multicenter randomized controlled studies that were quantitatively insufficient, more well-designed randomized controlled clinical trials are needed to confirm the effect.

  18. The potential for meta-analysis to support decision analysis in ecology.

    Science.gov (United States)

    Mengersen, Kerrie; MacNeil, M Aaron; Caley, M Julian

    2015-06-01

    Meta-analysis and decision analysis are underpinned by well-developed methods that are commonly applied to a variety of problems and disciplines. While these two fields have been closely linked in some disciplines such as medicine, comparatively little attention has been paid to the potential benefits of linking them in ecology, despite reasonable expectations that benefits would be derived from doing so. Meta-analysis combines information from multiple studies to provide more accurate parameter estimates and to reduce the uncertainty surrounding them. Decision analysis involves selecting among alternative choices using statistical information that helps to shed light on the uncertainties involved. By linking meta-analysis to decision analysis, improved decisions can be made, with quantification of the costs and benefits of alternate decisions supported by a greater density of information. Here, we briefly review concepts of both meta-analysis and decision analysis, illustrating the natural linkage between them and the benefits from explicitly linking one to the other. We discuss some examples in which this linkage has been exploited in the medical arena and how improvements in precision and reduction of structural uncertainty inherent in a meta-analysis can provide substantive improvements to decision analysis outcomes by reducing uncertainty in expected loss and maximising information from across studies. We then argue that these significant benefits could be translated to ecology, in particular to the problem of making optimal ecological decisions in the face of uncertainty. Copyright © 2013 John Wiley & Sons, Ltd.

  19. Internal fixation of mandibular angle fractures: a meta-analysis.

    Science.gov (United States)

    Regev, Eran; Shiff, Jacob S; Kiss, Alex; Fialkov, Jeffrey A

    2010-06-01

    The degree of rigidity of internal fixation required for the treatment of mandibular angle fractures has long been at the center of debate in the literature. A statistical comparison between rigid fixation and monocortical fixation has been difficult because of multiple terms, definitions, and technical variations. The purpose of this study was to use the meta-analysis tool to combine information from multiple studies and to compare complication rates for different fixation methods. An English language literature search was conducted for articles on mandibular angle fractures. Information was collected on four variables of interest: compression/noncompression technique, monocortical/bicortical screws, number of plates, and location of plates. Five outcome rates were analyzed: infection, reoperation, hardware removal, malunion, and nonunion. Meta-analyses were run using Comprehensive Meta Analysis, version 2.2.03. Twenty-four studies with relevant data on the variables and outcomes of interest met the inclusion criteria. Significantly higher rates of infection, reoperation, and hardware removal were found for compression compared with noncompression, two plates compared with one plate, and for plates located on both the inferior and superior borders as compared with superior or inferior only. There were also significantly higher infection rates for bicortical screws compared with monocortical screws and higher malunion rates for compression compared with noncompression plating techniques. The results of this meta-analysis found lower complication rates with the use of noncompression, monocortical, and single-plate fixation, supporting the trend toward a single, superiorly placed, monocortical miniplate for fixation of mandibular angle fractures.

  20. Maternal Sensitivity in Parenting Preterm Children: A Meta-analysis.

    Science.gov (United States)

    Bilgin, Ayten; Wolke, Dieter

    2015-07-01

    Preterm birth is a significant stressor for parents and may adversely impact maternal parenting behavior. However, findings have been inconsistent. The objective of this meta-analysis was to determine whether mothers of preterm children behave differently (eg, less responsive or sensitive) in their interactions with their children after they are discharged from the hospital than mothers of term children. Medline, PsychInfo, ERIC, PubMed, and Web of Science were searched from January 1980 through May 2014 with the following keywords: "premature", "preterm", "low birth weight" in conjunction with "maternal behavio*r", "mother-infant interaction", "maternal sensitivity", and "parenting". Both longitudinal and cross-sectional studies that used an observational measure of maternal parenting behavior were eligible. Study results relating to parenting behaviors defined as sensitivity, facilitation, and responsivity were extracted, and mean estimates were combined with random-effects meta-analysis. Thirty-four studies were included in the meta-analysis. Mothers of preterm and full-term children did not differ significantly from each other in terms of their behavior toward their children (Hedges' g = -0.07; 95% confidence interval: -0.22 to 0.08; z = -0.94; P = .35). The heterogeneity between studies was significant and high (Q = 156.42; I(2) = 78.9, P = .001) and not explained by degree of prematurity, publication date, geographical area, infant age, or type of maternal behavior. Mothers of preterm children were not found to be less sensitive or responsive toward their children than mothers of full-term children. Copyright © 2015 by the American Academy of Pediatrics.

  1. Meta-analysis of genome-wide expression patterns associated with behavioral maturation in honey bees

    Directory of Open Access Journals (Sweden)

    Southey Bruce R

    2008-10-01

    -analyses confirmed previously reported genes and helped identify genes (e.g. Tomosyn, Chitinase 5, Adar, Innexin 2, Transferrin 1, Sick, Oatp26F and Gene Ontology categories (e.g. purine nucleotide binding not previously associated with maturation in honey bees. Conclusion This study demonstrated that a combination of meta-analytical approaches best addresses the highly dimensional nature of genome-wide microarray studies. As expected, the integration of gene expression information from microarray studies using meta-analysis enhanced the characterization of the transcriptome of complex biological processes.

  2. Efficacy of combination therapy of mycoplasma pneumonia: a Meta analysis%中西医结合治疗小儿肺炎支原体肺炎效果的Meta分析

    Institute of Scientific and Technical Information of China (English)

    黄玉瑛; 邱钟燕; 朱思刚

    2014-01-01

    Objective To discuss the clinical efficacy of Chinese and Western medicine inmycoplasma pneumonia in children.Methods Randomized controlled trials (RCTs) on western medicine versus traditional Chinese combined with Western medicine treating children mycoplasma pneumonia were identified according to the inclusion and exclusion criteria.Methodological quality of included studies was accessed.Meta-analysis was then performed using RevMan 4.2 software.Pooled odds ratio (OR),weighted mean difference (WMD) and 95% confidence interval (CI) were calculated.20 randomized controlled domestic researches were gathered.Results Cure rate and effective rate in the experimental group were better than those in the control group(OR =2.92,95% CI:2.29 to 3.74,P <0.01).Inefficiency in the experimental group was lower than in control group; the difference was statistically significant (OR =0.20,95% CI:0.12 to 0.34,P < 0.01) ; rale disappearance time,cough disappearance time and cooling time in the experimental group were shorter than those in control group(WMD =-2.22,95% CI:-2.43 to-2.01,P<0.01),(WMD =-1.61,95% CI:-2.35 to-0.86,P<0.01),(OR=-0.90,95% CI:-1.43 to-0.37,P =0.0008).The incidence of adverse reactions in the experimental group was lower than that in the control group; the difference was statistically significant,(WMD =0.16,95% CI:0.05 to 0.48,P =0.001).Conclusion Treatment of mycoplasma pneumonia in children with Chinese and Western Medicine can significantly increase the efficiency of recovery; the non-efficiency and the incidence of adverse reactions can be significantly reduced.%目的 评价中西医结合治疗小儿肺炎支原体肺炎的临床效果.方法 收集国内关于中西医结合治疗和单纯西医治疗小儿肺炎支原体肺炎的随机对照研究文献,对结果进行Meta分析.其中,试验组进行中西医结合治疗,在应用抗生素的基础上服用各式中药煎剂;对照组进行抗生素治疗.疗效及差异评价指

  3. A framework for meta-analysis of veterinary drug pharmacokinetic data using mixed effect modeling.

    Science.gov (United States)

    Li, Mengjie; Gehring, Ronette; Lin, Zhoumeng; Riviere, Jim

    2015-04-01

    Combining data from available studies is a useful approach to interpret the overwhelming amount of data generated in medical research from multiple studies. Paradoxically, in veterinary medicine, lack of data requires integrating available data to make meaningful population inferences. Nonlinear mixed-effects modeling is a useful tool to apply meta-analysis to diverse pharmacokinetic (PK) studies of veterinary drugs. This review provides a summary of the characteristics of PK data of veterinary drugs and how integration of these data may differ from human PK studies. The limits of meta-analysis include the sophistication of data mining, and generation of misleading results caused by biased or poor quality data. The overriding strength of meta-analysis applied to this field is that robust statistical analysis of the diverse sparse data sets inherent to veterinary medicine applications can be accomplished, thereby allowing population inferences to be made.

  4. Model-Based Network Meta-Analysis: A Framework for Evidence Synthesis of Clinical Trial Data.

    Science.gov (United States)

    Mawdsley, D; Bennetts, M; Dias, S; Boucher, M; Welton, N J

    2016-08-01

    Model-based meta-analysis (MBMA) is increasingly used in drug development to inform decision-making and future trial designs, through the use of complex dose and/or time course models. Network meta-analysis (NMA) is increasingly being used by reimbursement agencies to estimate a set of coherent relative treatment effects for multiple treatments that respect the randomization within the trials. However, NMAs typically either consider different doses completely independently or lump them together, with few examples of models for dose. We propose a framework, model-based network meta-analysis (MBNMA), that combines both approaches, that respects randomization, and allows estimation and prediction for multiple agents and a range of doses, using plausible physiological dose-response models. We illustrate our approach with an example comparing the efficacies of triptans for migraine relief. This uses a binary endpoint, although we note that the model can be easily modified for other outcome types.

  5. Meta-analysis for orthodontists: Part I--How to choose effect measure and statistical model.

    Science.gov (United States)

    Papageorgiou, Spyridon N

    2014-12-01

    Systematic reviews ideally provide a comprehensive and unbiased summary of existing evidence from clinical studies, whilst meta-analysis combines the results of these studies to produce an overall estimate. Collectively, this makes them invaluable for clinical decision-making. Although the number of published systematic reviews and meta-analyses in orthodontics has increased, questions are often raised about their methodological soundness. In this primer, the first steps of meta-analysis are discussed, namely the choice of an effect measure to express the results of included studies, and the choice of a statistical model for the meta-analysis. Clinical orthodontic examples are given to explain the various options available, the thought process behind the choice between them and their interpretation.

  6. The R Package metaLik for Likelihood Inference in Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Annamaria Guolo

    2012-08-01

    Full Text Available Meta-analysis is a statistical method for combining information from different studies about the same issue of interest. Meta-analysis is widely diffuse in medical investigation and more recently it received a growing interest also in social disciplines. Typical applications involve a small number of studies, thus making ordinary inferential methods based on first-order asymptotics unreliable. More accurate results can be obtained by exploiting the theory of higher-order asymptotics. This paper describes the metaLik package which provides an R implementation of higher-order likelihood methods in meta-analysis. The extension to meta-regression is included. Two real data examples are used to illustrate the capabilities of the package.

  7. Data extraction for complex meta-analysis (DECiMAL) guide.

    Science.gov (United States)

    Pedder, Hugo; Sarri, Grammati; Keeney, Edna; Nunes, Vanessa; Dias, Sofia

    2016-12-13

    As more complex meta-analytical techniques such as network and multivariate meta-analyses become increasingly common, further pressures are placed on reviewers to extract data in a systematic and consistent manner. Failing to do this appropriately wastes time, resources and jeopardises accuracy. This guide (data extraction for complex meta-analysis (DECiMAL)) suggests a number of points to consider when collecting data, primarily aimed at systematic reviewers preparing data for meta-analysis. Network meta-analysis (NMA), multiple outcomes analysis and analysis combining different types of data are considered in a manner that can be useful across a range of data collection programmes. The guide has been shown to be both easy to learn and useful in a small pilot study.

  8. Meta-analysis on Efficacy and Safety of Cinobufacini Combined with Transcatheter Arterial Chemoembolization for Primary Liver Cancer%华蟾素联合肝动脉化疗栓塞治疗原发性肝癌的疗效与安全性Meta分析

    Institute of Scientific and Technical Information of China (English)

    田怀平; 高蕙敏; 杨萍; 唐跃年

    2016-01-01

    Objective: To assess the efficacy and safety of cinobufacini combined with transcatheter arterial chemoembolization (TACE) on patients with primary liver cancer by Meta-analysis.Methods:Databases, such as PubMed, The Cochrane Library, EMbase, VIP, WanFang Data, CBM and CNKI from to October, 2015 were searched for clinical trials on cinobufacini combined with transcatheter arterial chemoembolization for primary liver cancer .Two reviewers independently screened literature according to the inclusion and exclusion criteria , extracted data , and assessed methodological quality .Meta-analysis was performed by RevMan 5.2.Results:Nineteen trials were included with a total of 1481 patients.The results of meta-analysis showed that the treatment group was superior to the TACE group in terms of short-term efficacy and long-term efficacy, improving the quality of life and cau-sing less adverse reaction partly .Conclusion: Cinobufacini combined with TACE are comparatively more efficient and safer for primary liver cancer .%目的:采用Meta分析的方法,评价华蟾素联合肝动脉化疗栓塞治疗原发性肝癌的疗效及安全性.方法:计算机检索PubMed、The Cochrane Library、EMbase、VIP、WanFang Data、CBM和CNKI数据库,检索时限为从建库至2015年10月,收集华蟾素联合肝动脉化疗栓塞治疗原发性肝癌的临床试验.由两位研究者按照纳入与排除标准,独立进行文献筛选、资料提取和评价纳入研究的方法学质量,采用RevMan 5.2软件进行Meta分析,并对发表偏倚进行检验.结果:共纳入19项研究,1481例肝癌患者.Meta分析结果显示:华蟾素联合肝动脉化疗栓塞治疗原发性肝癌,可以提高近期疗效和远期疗效,改善生活质量,部分减少不良反应.结论:华蟾素联合肝动脉化疗栓塞治疗原发性肝癌优于单纯TACE治疗.

  9. 促红细胞生成素联合琥珀酸亚铁治疗尿毒症贫血患者的Meta分析%Meta analysis of erythropoietin combined with ferrous succinate in the treatment of uremia patients with anemia

    Institute of Scientific and Technical Information of China (English)

    林作清

    2016-01-01

    目的:研究促血红细胞生长素联合琥珀酸亚铁治疗尿毒症贫血的Meta分析。方法:收集有关“促红细胞生长素”“琥珀酸亚铁”“尿毒症贫血”等关键词的文献资料,涵盖病案60例,以结论观点、现实病案表现做Meta分析。结果:Meta分析结果证实促血红细胞生长素联合琥珀酸亚铁治疗尿毒症贫血有效,在疗效及安全保障上优势明显,治疗有效率高达91.67%。结论:促血红细胞生长素联合琥珀酸亚铁治疗尿毒症贫血受到了广泛认可,在治疗效果结论中,大部分参考文献所持观点相同。%Objective:To study the Meta analysis of erythropoietin combined with ferrous succinate in the treatment of uremia anemia.Methods:The literature data of the key words "erythropoietin","ferrous succinate" and "uremia anemia" were collected, including 60 cases of medical records.Meta analysis was made to the conclusion view and the realistic medical record.Results:Meta analysis result confirmed that erythropoietin combined with ferrous succinate in the treatment of uremia anemia was effective.The advantages were obvious in efficacy and safety,and the treatment effective rate was 91.67% .Conclusion:Erythropoietin combined with ferrous succinate in the treatment of uremia anemia has been widely recognized.In the treatment effect conclusion,most of the references are the same.

  10. Meta-analysis using Dirichlet process.

    Science.gov (United States)

    Muthukumarana, Saman; Tiwari, Ram C

    2016-02-01

    This article develops a Bayesian approach for meta-analysis using the Dirichlet process. The key aspect of the Dirichlet process in meta-analysis is the ability to assess evidence of statistical heterogeneity or variation in the underlying effects across study while relaxing the distributional assumptions. We assume that the study effects are generated from a Dirichlet process. Under a Dirichlet process model, the study effects parameters have support on a discrete space and enable borrowing of information across studies while facilitating clustering among studies. We illustrate the proposed method by applying it to a dataset on the Program for International Student Assessment on 30 countries. Results from the data analysis, simulation studies, and the log pseudo-marginal likelihood model selection procedure indicate that the Dirichlet process model performs better than conventional alternative methods.

  11. A Bayesian nonparametric meta-analysis model.

    Science.gov (United States)

    Karabatsos, George; Talbott, Elizabeth; Walker, Stephen G

    2015-03-01

    In a meta-analysis, it is important to specify a model that adequately describes the effect-size distribution of the underlying population of studies. The conventional normal fixed-effect and normal random-effects models assume a normal effect-size population distribution, conditionally on parameters and covariates. For estimating the mean overall effect size, such models may be adequate, but for prediction, they surely are not if the effect-size distribution exhibits non-normal behavior. To address this issue, we propose a Bayesian nonparametric meta-analysis model, which can describe a wider range of effect-size distributions, including unimodal symmetric distributions, as well as skewed and more multimodal distributions. We demonstrate our model through the analysis of real meta-analytic data arising from behavioral-genetic research. We compare the predictive performance of the Bayesian nonparametric model against various conventional and more modern normal fixed-effects and random-effects models.

  12. Bayesian inference on risk differences: an application to multivariate meta-analysis of adverse events in clinical trials.

    Science.gov (United States)

    Chen, Yong; Luo, Sheng; Chu, Haitao; Wei, Peng

    2013-05-01

    Multivariate meta-analysis is useful in combining evidence from independent studies which involve several comparisons among groups based on a single outcome. For binary outcomes, the commonly used statistical models for multivariate meta-analysis are multivariate generalized linear mixed effects models which assume risks, after some transformation, follow a multivariate normal distribution with possible correlations. In this article, we consider an alternative model for multivariate meta-analysis where the risks are modeled by the multivariate beta distribution proposed by Sarmanov (1966). This model have several attractive features compared to the conventional multivariate generalized linear mixed effects models, including simplicity of likelihood function, no need to specify a link function, and has a closed-form expression of distribution functions for study-specific risk differences. We investigate the finite sample performance of this model by simulation studies and illustrate its use with an application to multivariate meta-analysis of adverse events of tricyclic antidepressants treatment in clinical trials.

  13. A Review and Meta-Analysis of Country-of-Origin Research

    NARCIS (Netherlands)

    Verlegh, P.W.J.; Steenkamp, J.E.B.M.

    1999-01-01

    Despite a large body of research, country-of-origin effects are still poorly understood. Combining the strengths of a narrative review with those of a quantitative meta-analysis, our study seeks to establish a firm grounding for country-of-origin research. We review previous country-of-origin

  14. Medicinal plants with promising antileishmanial activity in Iran: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Masoud Soosaraei

    2017-09-01

    Conclusion: The most Iranian plants used as anti-leishmanial activity were Artemisia species, Allium sativum, Achilleamille folium, Peganum harmala and Thymus vulgaris. The present systematic and meta-analysis review provide valuable information about natural products with anti-Leishmania activity, which would be examined in the future experimental and clinical trials and herbal combination therapy.

  15. Using Meta-Analysis to Inform the Design of Subsequent Studies of Diagnostic Test Accuracy

    Science.gov (United States)

    Hinchliffe, Sally R.; Crowther, Michael J.; Phillips, Robert S.; Sutton, Alex J.

    2013-01-01

    An individual diagnostic accuracy study rarely provides enough information to make conclusive recommendations about the accuracy of a diagnostic test; particularly when the study is small. Meta-analysis methods provide a way of combining information from multiple studies, reducing uncertainty in the result and hopefully providing substantial…

  16. Methods for meta-analysis of genome-wide association studies

    Science.gov (United States)

    A limitation of many genome-wide association studies (GWA) in animal breeding is that there are many loci with small effect sizes; thus, larger sample sizes (N) are required to guarantee suitable power of detection. For increasing N, results from different GWA can be combined in a meta-analysis (MA-...

  17. Meta-analysis of genome wide association studies for pork quality traits

    Science.gov (United States)

    Given the importance of pork quality in the meat processing industry, genome-wide association studies were performed for eight meat quality traits and also, a meta-analysis (MA) of GWA was implemented combining independent results from pig populations. Data from three pig datasets (USMARC, Commercia...

  18. Methods for meta-analysis in genetic association studies: a review of their potential and pitfalls.

    Science.gov (United States)

    Kavvoura, Fotini K; Ioannidis, John P A

    2008-02-01

    Meta-analysis offers the opportunity to combine evidence from retrospectively accumulated or prospectively generated data. Meta-analyses may provide summary estimates and can help in detecting and addressing potential inconsistency between the combined datasets. Application of meta-analysis in genetic associations presents considerable potential and several pitfalls. In this review, we present basic principles of meta-analytic methods, adapted for human genome epidemiology. We describe issues that arise in the retrospective or the prospective collection of relevant data through various sources, common traps to consider in the appraisal of evidence and potential biases that may interfere. We describe the relative merits and caveats for common methods used to trace inconsistency across studies along with possible reasons for non-replication of proposed associations. Different statistical models may be employed to combine data and some common misconceptions may arise in the process. Several meta-analysis diagnostics are often applied or misapplied in the literature, and we comment on their use and limitations. An alternative to overcome limitations arising from retrospective combination of data from published studies is to create networks of research teams working in the same field and perform collaborative meta-analyses of individual participant data, ideally on a prospective basis. We discuss the advantages and the challenges inherent in such collaborative approaches. Meta-analysis can be a useful tool in dissecting the genetics of complex diseases and traits, provided its methods are properly applied and interpreted.

  19. A Review and Meta-Analysis of Country-of-Origin Research

    NARCIS (Netherlands)

    Verlegh, P.W.J.; Steenkamp, J.E.B.M.

    1999-01-01

    Despite a large body of research, country-of-origin effects are still poorly understood. Combining the strengths of a narrative review with those of a quantitative meta-analysis, our study seeks to establish a firm grounding for country-of-origin research. We review previous country-of-origin resear

  20. No relationship between TNF-α genetic variants and combination antiretroviral therapy-related lipodystrophy syndrome in HIV type 1-infected patients: a case-control study and a meta-analysis.

    Science.gov (United States)

    Veloso, Sergi; Olona, Montserrat; Peraire, Joaquim; Viladés, Consuelo; Pardo, Pedro; Domingo, Pere; Asensi, Victor; Broch, Montserrat; Aguilar, Carmen; López-Dupla, Miguel; Aragonés, Gerard; Garcia-Pardo, Graciano; Sirvent, Joan-Josep; Vendrell, Joan; Richart, Cristóbal; Vidal, Francesc

    2011-02-01

    Tumor necrosis factor alpha (TNF-α) is thought to be involved in the pathogenic and metabolic events associated with HIV-1 infection. We assessed whether carriage of the TNF-α gene promoter single nucleotide polymorphism (SNP) is associated with lipodystrophy and metabolic derangements in HIV-1-infected patients treated with cART. We also assessed variations in TNF-α receptor plasma levels. The study group comprised 286 HIV-1-infected patients (133 with and 153 without lipodystrophy) and 203 uninfected controls (UC). TNF-α -238G > A, -308G > A, and -863 C > A SNP were assessed using PCR-RFLPs on white cell DNA. Plasma sTNF-α R1 and R2 levels were measured by ELISA. Student's t test, the χ(2) test, Pearson correlations, and the logistic regression test were performed for statistical analysis. The TNF-α -308G > A SNP was significantly associated with lipodystrophy in the univariate analysis (p = 0.04). This association, however, was no longer significant in the multivariate analysis. A meta-analysis of the published literature and our own data, which included 284 patients with lipodystrophy and 338 without lipodystrophy, showed that there was no relationship between the TNF-α -238G > A and -308G > A SNP and lipodystrophy (p > 0.05 for all comparisons). HIV-1-infected patients had greater sTNF-α R2 plasma levels than UC (p = 0.001) whereas sTNF-α R1 and R2 levels were not significantly different in both the HIV-1-infected cohorts, lipodystrophy vs. nonlipodystrophy (p = NS). In our cohort of white Spaniards the TNF-α -238G > A, -308G > A, and -863C > A SNP were not associated with lipodystrophy in HIV-1-infected patients treated with cART. This finding was replicated in a meta-analysis of the published data, which showed no associations between the TNF-α -238G > A and -308G > A SNP and lipodystrophy. In HIV-1-infected patients under cART there is a systemic overproduction of sTNF-α R2, which is unrelated to

  1. Tea consumption and leukemia risk: a meta-analysis.

    Science.gov (United States)

    Zhong, Shanliang; Chen, Zhiyuan; Yu, Xinnian; Chen, Weixian; Lv, Mengmeng; Ma, Tengfei; Zhao, Jianhua

    2014-06-01

    Epidemiologic findings concerning the association between tea consumption and leukemia risk yielded mixed results. We aimed to investigate the association by performing a meta-analysis of all available studies. One cohort studies and six case-control studies with 1,019 cases were identified using PubMed, Web of Science, and EMBASE. We computed summary relative risks (RRs) and 95 % confidence intervals (CIs) using random effect model applied to the relative risk associated with ever, moderate, or highest drinkers vs. non/lowest drinkers. Subgroup analyses were performed based on country (China and USA). Compared with non/lowest drinkers, the combined RR for ever drinkers was 0.76 (95 % CI=0.65-0.89). In subgroup analyses, significant inverse associations were found for both China and USA studies. The summary RR was 0.57 (95 % CI=0.41-0.78) for highest drinkers. Same results were only found in China studies. No significant associations were found for moderate drinkers in overall analysis or in subgroup analyses. There was some evidence of publication bias. In conclusion, this meta-analysis suggests a significant inverse association of high tea consumption and leukemia risk. Results should be interpreted cautiously given the potential publication bias.

  2. Dietary Factors Affecting Thyroid Cancer Risk: A Meta-Analysis.

    Science.gov (United States)

    Cho, Young Ae; Kim, Jeongseon

    2015-01-01

    Some dietary factors are proposed to affect thyroid carcinogenesis, but previous studies have reported inconsistent findings. Therefore, we performed a meta-analysis, including 18 eligible studies, to clarify the role of dietary factors in the risk of thyroid cancer. The relative risks (RRs) with 95% confidence intervals (95% CIs) were estimated to assess the association and heterogeneity tests and subgroup and sensitivity analyses, and bias assessments were performed. When the results from all studies were combined, dietary iodine, fish, and cruciferous vegetable intake were not associated with thyroid cancer. However, when the data were divided by geographic location based on iodine availability, a slight increase in the risk of thyroid cancer was observed among those consuming a high total amount of fish in iodine nondeficient areas (RR: 1.18; 95% CI: 1.03-1.35; P for heterogeneity = 0.282). When excluding the studies examining a single food item and hospital-based controls, a high intake of cruciferous vegetables was associated with an increased risk of thyroid cancer in iodine-deficient areas (RR: 1.43; 95% CI: 1.18-1.74; P for heterogeneity = 0.426). This meta-analysis implies that the role of dietary factors, such as fish and cruciferous vegetables, in thyroid cancer risk can differ based on iodine availability.

  3. Multiple Sclerosis Increases Fracture Risk: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Guixian Dong

    2015-01-01

    Full Text Available Purpose. The association between multiple sclerosis (MS and fracture risk has been reported, but results of previous studies remain controversial and ambiguous. To assess the association between MS and fracture risk, a meta-analysis was performed. Method. Based on comprehensive searches of the PubMed, Embase, and Web of Science, we identified outcome data from all articles estimating the association between MS and fracture risk. The pooled risk ratios (RRs with 95% confidence intervals (CIs were calculated. Results. A significant association between MS and fracture risk was found. This result remained statistically significant when the adjusted RRs were combined. Subgroup analysis stratified by the site of fracture suggested significant associations between MS and tibia fracture risk, femur fracture risk, hip fracture risk, pelvis fracture risk, vertebrae fracture risk, and humerus fracture risk. In the subgroup analysis by gender, female MS patients had increased fracture risk. When stratified by history of drug use, use of antidepressants, hypnotics/anxiolytics, anticonvulsants, and glucocorticoids increased the risk of fracture risk in MS patients. Conclusions. This meta-analysis demonstrated that MS was significantly associated with fracture risk.

  4. Multivariate meta-analysis: a robust approach based on the theory of U-statistic.

    Science.gov (United States)

    Ma, Yan; Mazumdar, Madhu

    2011-10-30

    Meta-analysis is the methodology for combining findings from similar research studies asking the same question. When the question of interest involves multiple outcomes, multivariate meta-analysis is used to synthesize the outcomes simultaneously taking into account the correlation between the outcomes. Likelihood-based approaches, in particular restricted maximum likelihood (REML) method, are commonly utilized in this context. REML assumes a multivariate normal distribution for the random-effects model. This assumption is difficult to verify, especially for meta-analysis with small number of component studies. The use of REML also requires iterative estimation between parameters, needing moderately high computation time, especially when the dimension of outcomes is large. A multivariate method of moments (MMM) is available and is shown to perform equally well to REML. However, there is a lack of information on the performance of these two methods when the true data distribution is far from normality. In this paper, we propose a new nonparametric and non-iterative method for multivariate meta-analysis on the basis of the theory of U-statistic and compare the properties of these three procedures under both normal and skewed data through simulation studies. It is shown that the effect on estimates from REML because of non-normal data distribution is marginal and that the estimates from MMM and U-statistic-based approaches are very similar. Therefore, we conclude that for performing multivariate meta-analysis, the U-statistic estimation procedure is a viable alternative to REML and MMM. Easy implementation of all three methods are illustrated by their application to data from two published meta-analysis from the fields of hip fracture and periodontal disease. We discuss ideas for future research based on U-statistic for testing significance of between-study heterogeneity and for extending the work to meta-regression setting.

  5. A Guide to Conducting a Meta-Analysis.

    Science.gov (United States)

    Cheung, Mike W-L; Vijayakumar, Ranjith

    2016-06-01

    Meta-analysis is widely accepted as the preferred method to synthesize research findings in various disciplines. This paper provides an introduction to when and how to conduct a meta-analysis. Several practical questions, such as advantages of meta-analysis over conventional narrative review and the number of studies required for a meta-analysis, are addressed. Common meta-analytic models are then introduced. An artificial dataset is used to illustrate how a meta-analysis is conducted in several software packages. The paper concludes with some common pitfalls of meta-analysis and their solutions. The primary goal of this paper is to provide a summary background to readers who would like to conduct their first meta-analytic study.

  6. Teaching tools in Evidence Based Practice: evaluation of reusable learning objects (RLOs for learning about Meta-analysis

    Directory of Open Access Journals (Sweden)

    Wharrad Heather

    2011-05-01

    Full Text Available Abstract Background All healthcare students are taught the principles of evidence based practice on their courses. The ability to understand the procedures used in systematically reviewing evidence reported in studies, such as meta-analysis, are an important element of evidence based practice. Meta-analysis is a difficult statistical concept for healthcare students to understand yet it is an important technique used in systematic reviews to pool data from studies to look at combined effectiveness of treatments. In other areas of the healthcare curricula, by supplementing lectures, workbooks and workshops with pedagogically designed, multimedia learning objects (known as reusable learning objects or RLOs we have shown an improvement in students' perceived understanding in subjects they found difficult. In this study we describe the development and evaluation of two RLOs on meta-analysis. The RLOs supplement associated lectures and aim to improve students' understanding of meta-analysis in healthcare students. Methods Following a quality controlled design process two RLOs were developed and delivered to two cohorts of students, a Master in Public Health course and Postgraduate diploma in nursing course. Students' understanding of five key concepts of Meta-analysis were measured before and after a lecture and again after RLO use. RLOs were also evaluated for their educational value, learning support, media attributes and usability using closed and open questions. Results Students rated their understanding of meta-analysis as improved after a lecture and further improved after completing the RLOs (Wilcoxon paired test, p Conclusions Meta-analysis RLOs that are openly accessible and unrestricted by usernames and passwords provide flexible support for students who find the process of meta-analysis difficult.

  7. A meta-analysis study of the effect of chilling on prevalence of Salmonella on pig carcasses.

    Science.gov (United States)

    Gonzales Barron, U; Bergin, D; Butler, F

    2008-07-01

    In the field of food safety, meta-analysis can be used to combine results of prevalence studies of pathogens at critical stages within the food processing chain so that policy makers can access reliable and concise information on the effectiveness of interventions for controlling and preventing foodborne illnesses in humans. The objective of this work was to demonstrate the applicability of a parametric approach of meta-analysis to the specific case of determining the overall effect of chilling on Salmonella prevalence on pig carcasses. A meta-analysis was performed on each of two parameters measuring effect size for binary outcomes (relative risk and risk difference). Both meta-analyses confirmed that the chilling operation has a significant beneficial effect (P pig carcasses. Because risk difference is a parameter sensitive to the differences across studies in carcass swab areas and Salmonella detection methods, its meta-analysis highly reflected this heterogeneity (P meta-analysis solution, which is deemed more suitable for compilations based on a small number of individual studies (n = 9). Because of the systematic approach of meta-analysis (i.e., individual studies are weighed according to precision) and its reliance for actual data, the output distribution of the relative risk effect size (approximately eN(-0.868,0.166)) merits consideration for inclusion in the chilling stage of quantitative risk assessments modeling the prevalence of this pathogen along the pork production chain.

  8. Effectiveness of amniotic membrane transplantation combined with mitomycin C in the treatment of pterygium: a meta-analysis%羊膜移植联合丝裂霉素C治疗翼状胬肉的Meta分析

    Institute of Scientific and Technical Information of China (English)

    宋寅伟; 于爱华; 蔡小军

    2010-01-01

    目的:比较羊膜移植联合丝裂霉素C(mitomycin C,MMC)与羊膜移植在翼状胬肉治疗中的有效性和安全性.方法:我们进行Meta分析进行比较.计算机扩大检索Cochrane图书馆,MEDLINE,EMBASE,CBMdisc,CNKI.等数据库获得数据.通过Cochrane协作网提供的RevMan4.2软件进行数据统计分析.结果:羊膜移植联合MMC显著降低了翼状胬肉的复发率.但是否会增加术后的并发症仍需更多的临床试验证实.入选的6项临床试验均报道了翼状胬肉术后的复发率,包括882眼,3项临床试验报道了术后并发症情况.Meta分析的结果显示羊膜移植联合MMC组复发率为5.41%,只进行羊膜移植组复发率为16.89%,相对危险度为0.32,95%可信区间为0.19-0.56,Z值为4.06,P<0.001.2项研究报道了术后早期点状角膜炎的发生情况,羊膜移植联合MMC组与羊膜移植组的发病率分别为17.14%和0.00%,相对危险度为12.11,95%可信区间为1.62-90.76.结论:与羊膜移植相比,羊膜移植联合MMC联合治疗翼状胬肉显著降低了术后复发率.%·AIM: To evaluate the recurrence rate and safety of amniotic membrane transplantation (AMT) augmented with mitomycin C (MMC) compared with amniotic membrane transplantation alone during the pterygium excision.·METHODS: We took a meta-analysis on this program.Pertinent studies were selected through extensive searches of the Cochrane Library, MEDLINE, EMBASE,CBMdisc, CNKI. Pooled estimates were carried out in RevMan software V4.2.·RESULTS: Six trials reported postoperative recurrence rate of pterygium, included 882 eyes, three trials reported the complications. The results of meta-analysis showed that recurrence rate of AMT plus MMC group was 5.41%,AMT alone group was 16.89%, relative risk (RR) was 0.32, 95%CI ranged from 0.19 to 0.56, Zwas 4.06, P< 0.001. Two trials reported early complication as punctata keratitis, the incidence rate of AMT plus MMC group and AMT alone group were 17.14% and 0.00

  9. Meta-analysis a structural equation modeling approach

    CERN Document Server

    Cheung, Mike W-L

    2015-01-01

    Presents a novel approach to conducting meta-analysis using structural equation modeling. Structural equation modeling (SEM) and meta-analysis are two powerful statistical methods in the educational, social, behavioral, and medical sciences. They are often treated as two unrelated topics in the literature. This book presents a unified framework on analyzing meta-analytic data within the SEM framework, and illustrates how to conduct meta-analysis using the metaSEM package in the R statistical environment. Meta-Analysis: A Structural Equation Modeling Approach begins by introducing the impo

  10. Introduction to systematic reviews and meta-analysis.

    Science.gov (United States)

    McKenzie, Joanne E; Beller, Elaine M; Forbes, Andrew B

    2016-05-01

    Systematic reviews provide a method for collating and synthesizing research, and are used to inform healthcare decision making by clinicians, consumers and policy makers. A core component of many systematic reviews is a meta-analysis, which is a statistical synthesis of results across studies. In this review article, we introduce meta-analysis, focusing on the different meta-analysis models, their interpretation, how a model should be selected and discuss potential threats to the validity of meta-analyses. We illustrate the application of meta-analysis using data from a review examining the effects of early use of inhaled corticosteroids in the emergency department treatment of acute asthma.

  11. Systematic review with meta-analysis

    DEFF Research Database (Denmark)

    Kimer, N; Krag, A; Møller, Søren;

    2014-01-01

    BACKGROUND: Rifaximin is recommended for prevention of hepatic encephalopathy (HE). The effects of rifaximin on overt and minimal HE are debated. AIM: To perform a systematic review and meta-analysis of randomised controlled trials (RCTs) on rifaximin for HE. METHODS: We performed electronic....... Overall, rifaximin had a beneficial effect on secondary prevention of HE (RR: 1.32; 95% CI 1.06-1.65), but not in a sensitivity analysis on rifaximin after TIPSS (RR: 1.27; 95% CI 1.00-1.53). Rifaximin increased the proportion of patients who recovered from HE (RR: 0.59; 95% CI: 0.46-0.76) and reduced...

  12. Bayesian meta-analysis models for microarray data: a comparative study

    Directory of Open Access Journals (Sweden)

    Song Joon J

    2007-03-01

    Full Text Available Abstract Background With the growing abundance of microarray data, statistical methods are increasingly needed to integrate results across studies. Two common approaches for meta-analysis of microarrays include either combining gene expression measures across studies or combining summaries such as p-values, probabilities or ranks. Here, we compare two Bayesian meta-analysis models that are analogous to these methods. Results Two Bayesian meta-analysis models for microarray data have recently been introduced. The first model combines standardized gene expression measures across studies into an overall mean, accounting for inter-study variability, while the second combines probabilities of differential expression without combining expression values. Both models produce the gene-specific posterior probability of differential expression, which is the basis for inference. Since the standardized expression integration model includes inter-study variability, it may improve accuracy of results versus the probability integration model. However, due to the small number of studies typical in microarray meta-analyses, the variability between studies is challenging to estimate. The probability integration model eliminates the need to model variability between studies, and thus its implementation is more straightforward. We found in simulations of two and five studies that combining probabilities outperformed combining standardized gene expression measures for three comparison values: the percent of true discovered genes in meta-analysis versus individual studies; the percent of true genes omitted in meta-analysis versus separate studies, and the number of true discovered genes for fixed levels of Bayesian false discovery. We identified similar results when pooling two independent studies of Bacillus subtilis. We assumed that each study was produced from the same microarray platform with only two conditions: a treatment and control, and that the data sets

  13. Identification of potential transcriptomic markers in developing ankylosing spondylitis: a meta-analysis of gene expression profiles.

    Science.gov (United States)

    Fang, Fang; Pan, Jian; Xu, Lixiao; Li, Gang; Wang, Jian

    2015-01-01

    The goal of this study was to identify potential transcriptomic markers in developing ankylosing spondylitis by a meta-analysis of multiple public microarray datasets. Using the INMEX (integrative meta-analysis of expression data) program, we performed the meta-analysis to identify consistently differentially expressed (DE) genes in ankylosing spondylitis and further performed functional interpretation (gene ontology analysis and pathway analysis) of the DE genes identified in the meta-analysis. Three microarray datasets (26 cases and 29 controls in total) were collected for meta-analysis. 905 consistently DE genes were identified in ankylosing spondylitis, among which 482 genes were upregulated and 423 genes were downregulated. The upregulated gene with the smallest combined rank product (RP) was GNG11 (combined RP=299.64). The downregulated gene with the smallest combined RP was S100P (combined RP=335.94). In the gene ontology (GO) analysis, the most significantly enriched GO term was "immune system process" (P=3.46×10(-26)). The most significant pathway identified in the pathway analysis was antigen processing and presentation (P=8.40×10(-5)). The consistently DE genes in ankylosing spondylitis and biological pathways associated with those DE genes identified provide valuable information for studying the pathophysiology of ankylosing spondylitis.

  14. Identification of Potential Transcriptomic Markers in Developing Ankylosing Spondylitis: A Meta-Analysis of Gene Expression Profiles

    Science.gov (United States)

    Fang, Fang; Pan, Jian; Xu, Lixiao; Li, Gang; Wang, Jian

    2015-01-01

    The goal of this study was to identify potential transcriptomic markers in developing ankylosing spondylitis by a meta-analysis of multiple public microarray datasets. Using the INMEX (integrative meta-analysis of expression data) program, we performed the meta-analysis to identify consistently differentially expressed (DE) genes in ankylosing spondylitis and further performed functional interpretation (gene ontology analysis and pathway analysis) of the DE genes identified in the meta-analysis. Three microarray datasets (26 cases and 29 controls in total) were collected for meta-analysis. 905 consistently DE genes were identified in ankylosing spondylitis, among which 482 genes were upregulated and 423 genes were downregulated. The upregulated gene with the smallest combined rank product (RP) was GNG11 (combined RP = 299.64). The downregulated gene with the smallest combined RP was S100P (combined RP = 335.94). In the gene ontology (GO) analysis, the most significantly enriched GO term was “immune system process” (P = 3.46 × 10−26). The most significant pathway identified in the pathway analysis was antigen processing and presentation (P = 8.40 × 10−5). The consistently DE genes in ankylosing spondylitis and biological pathways associated with those DE genes identified provide valuable information for studying the pathophysiology of ankylosing spondylitis. PMID:25688367

  15. Matrix Metalloproteinase-2 Polymorphisms and Incident Coronary Artery Disease: A Meta-Analysis.

    Science.gov (United States)

    Shi, Yujie; Zhang, Jian; Tan, Chen; Xu, Wei; Sun, Qi; Li, Junxia

    2015-07-01

    Previous studies have yielded controversial results related to the contribution of matrix metalloproteinase-2 (MMP-2) -1306 C/T and -735 C/T polymorphisms in the progression of coronary artery disease (CAD). This study aimed to provide strong evidence for the role of the 2 polymorphisms in genetic risk of CAD.The human case-control studies regarding the association of MMP-2 polymorphisms with CAD risk were systematically identified through online databases (PubMed, Embase, the Cochrane Library, and CNKI) and manual search. Inclusion criteria were defined for the eligible studies. The fixed-effects meta-analysis was performed to combine the values when homogeneity was indicated. Alternatively, the random-effects meta-analysis was utilized.A total of 2118 samples were analyzed in the meta-analysis of -1306 C/T. The odds ratio for the initially tested genetic model was 0.93 (95% confidence interval: 0.78-1.10 under TT + CT vs CC). The remaining comparisons similarly showed -1306 C/T genotypes were not significantly associated with the risk of CAD. We noted the same trend when data were retrained to myocardial infarction studies. Meta-analysis of -735 C/T suggested no clear association with the development of CAD.The results of the current work fail to support a significant involvement of MMP-2 -1306 C/T and -735 C/T polymorphisms in the risk of developing CAD.

  16. Overstating the evidence – double counting in meta-analysis and related problems

    Directory of Open Access Journals (Sweden)

    Senn Stephen J

    2009-02-01

    Full Text Available Abstract Background The problem of missing studies in meta-analysis has received much attention. Less attention has been paid to the more serious problem of double counting of evidence. Methods Various problems in overstating the precision of results from meta-analyses are described and illustrated with examples, including papers from leading medical journals. These problems include, but are not limited to, simple double counting of the same studies, double counting of some aspects of the studies, inappropriate imputation of results, and assigning spurious precision to individual studies. Results Some suggestions are made as to how the quality and reliability of meta-analysis can be improved. It is proposed that the key to quality in meta-analysis lies in the results being transparent and checkable. Conclusion Existing quality check lists for meta-analysis do little to encourage an appropriate attitude to combining evidence and to statistical analysis. Journals and other relevant organisations should encourage authors to make data available and make methods explicit. They should also act promptly to withdraw meta-analyses when mistakes are found.

  17. Handling incomplete correlated continuous and binary outcomes in meta-analysis of individual participant data.

    Science.gov (United States)

    Gomes, Manuel; Hatfield, Laura; Normand, Sharon-Lise

    2016-09-20

    Meta-analysis of individual participant data (IPD) is increasingly utilised to improve the estimation of treatment effects, particularly among different participant subgroups. An important concern in IPD meta-analysis relates to partially or completely missing outcomes for some studies, a problem exacerbated when interest is on multiple discrete and continuous outcomes. When leveraging information from incomplete correlated outcomes across studies, the fully observed outcomes may provide important information about the incompleteness of the other outcomes. In this paper, we compare two models for handling incomplete continuous and binary outcomes in IPD meta-analysis: a joint hierarchical model and a sequence of full conditional mixed models. We illustrate how these approaches incorporate the correlation across the multiple outcomes and the between-study heterogeneity when addressing the missing data. Simulations characterise the performance of the methods across a range of scenarios which differ according to the proportion and type of missingness, strength of correlation between outcomes and the number of studies. The joint model provided confidence interval coverage consistently closer to nominal levels and lower mean squared error compared with the fully conditional approach across the scenarios considered. Methods are illustrated in a meta-analysis of randomised controlled trials comparing the effectiveness of implantable cardioverter-defibrillator devices alone to implantable cardioverter-defibrillator combined with cardiac resynchronisation therapy for treating patients with chronic heart failure. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  18. Multivariate meta-analysis for non-linear and other multi-parameter associations

    Science.gov (United States)

    Gasparrini, A; Armstrong, B; Kenward, M G

    2012-01-01

    In this paper, we formalize the application of multivariate meta-analysis and meta-regression to synthesize estimates of multi-parameter associations obtained from different studies. This modelling approach extends the standard two-stage analysis used to combine results across different sub-groups or populations. The most straightforward application is for the meta-analysis of non-linear relationships, described for example by regression coefficients of splines or other functions, but the methodology easily generalizes to any setting where complex associations are described by multiple correlated parameters. The modelling framework of multivariate meta-analysis is implemented in the package mvmeta within the statistical environment R. As an illustrative example, we propose a two-stage analysis for investigating the non-linear exposure–response relationship between temperature and non-accidental mortality using time-series data from multiple cities. Multivariate meta-analysis represents a useful analytical tool for studying complex associations through a two-stage procedure. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22807043

  19. Comparing Active Pediatric Obesity Treatments Using Meta-Analysis

    Science.gov (United States)

    Gilles, Allyson; Cassano, Michael; Shepherd, Elizabeth J.; Higgins, Diana; Hecker, Jeffrey E.; Nangle, Douglas W.

    2008-01-01

    The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways:…

  20. A Review of Meta-Analysis Packages in R

    Science.gov (United States)

    Polanin, Joshua R.; Hennessy, Emily A.; Tanner-Smith, Emily E.

    2017-01-01

    Meta-analysis is a statistical technique that allows an analyst to synthesize effect sizes from multiple primary studies. To estimate meta-analysis models, the open-source statistical environment R is quickly becoming a popular choice. The meta-analytic community has contributed to this growth by developing numerous packages specific to…

  1. Systematic reviews with meta-analysis: Why, when, and how?

    NARCIS (Netherlands)

    Crocetti, E.|info:eu-repo/dai/nl/371750946

    2016-01-01

    Systematic reviews with meta-analysis represent the gold standard for conducting reliable and transparent reviews of the literature. The purpose of this article is threefold: (a) to address why and when it is worthwhile to conduct a systematic review with meta-analysis, covering advantages of this a

  2. Meta-analysis in a nutshell: Techniques and general findings

    DEFF Research Database (Denmark)

    Paldam, Martin

    2015-01-01

    The purpose of this article is to introduce the technique and main findings of meta-analysis to the reader, who is unfamiliar with the field and has the usual objections. A meta-analysis is a quantitative survey of a literature reporting estimates of the same parameter. The funnel showing...

  3. Comprehensive School Reform and Student Achievement: A Meta-Analysis.

    Science.gov (United States)

    Borman, Geoffrey D.; Hewes, Gina M.; Overman, Laura T.; Brown, Shelly

    Using 232 studies, this meta analysis reviewed the research on the achievement effects of the nationally disseminated and externally developed school improvement programs known as "whole-school" or "comprehensive" reforms. In addition to reviewing the overall achievement effects of comprehensive school reform (CSR), the meta analysis considered…

  4. Psychotherapy for chronic major depression and dysthymia: A meta analysis.

    NARCIS (Netherlands)

    Cuijpers, P.; Straten, van A.; Schuurmans, J.; Oppen, van P.C.; Hollon, S.D.; Andersson, G.

    2009-01-01

    Abstract Although several studies have examined the effects of psychotherapy on chronic depression and dysthymia, no meta-analysis has been conducted to integrate results of these studies. We conducted a meta-analysis of 16 randomized trials examining the effects of psychotherapy on chronic depressi

  5. Sodium Tanshinone ⅡA Sulfonate Combined with Low Molecular Weight Heparin in Treating Unstable Angina: A Meta-analysis%丹参酮ⅡA磺酸钠联合低分子肝素治疗不稳定型心绞痛Meta分析

    Institute of Scientific and Technical Information of China (English)

    赵劲波; 李元红; 江洪

    2012-01-01

    目的 评价丹参酮ⅡA磺酸钠联合低分子肝素治疗不稳定型心绞痛的效果.方法 计算机检索中国学术期刊网络出版总库、CNKI( 1994-2011)、万方医学数据库(1999-2011)、维普中文科技期刊全文数据库(1989-2011年)中关于丹参酮ⅡA磺酸钠联合低分子肝素治疗不稳定型心绞痛的随机对照试验,对符合标准的随机对照试验进行Meta分析.结果 共命中7篇符合条件文献.Meta分析结果显示,治疗2周后试验组疗效优于对照组,总效应Z=6.12(P <0.00001),OR及其95%可信区间4.48(2.77,7.24),其中3项研究对心电图进行评价,治疗2周后心电图改善情况试验组亦显著优于对照组,总效应Z =3.80(P =0.0001),OR及其95%可信区间2.83(1.65,4.84).结论 不稳定型心绞痛患者在常规治疗基础上联合应用丹参酮ⅡA磺酸钠和低分子肝素可明显改善心绞痛症状,有效控制心绞痛发作.%Objective To evaluate the effectiveness of Sodium Tanshinone DA Sulfonate combined with Low Molecular Weight Heparin in treating unstable angina (UA). Methods We conducted Meta-analysis by the randomized controlled trails (RCT) for patients with Sodium Tanshinone DA Sulfonate combined with l>ow Molecular Weight Heparin in treating unstable angina ( UA) from CNKI database (1994—2012) , Wan Fang medicine database (1999—2012), VIP full-text data base (1989—2012) and Medline. Results There were 7 trials. After two weeks treatment Meta-analysis indicated that the rurative effect of combination therapy was better than that of regular group in treating angina pectoris. The total effect was Z =6. 12 (P <0.00001), and the total effect of therapy group was better than that of control group [OR =4.48, 95% CI (2.77, 7.24), P <0.00001 ]. Three items showed that the curative efficiency and significant efficiency in the improvement of electrocardiogram were dramatically better than that of control group, and the total effect was Z = 3.80 [OR = 2. 83

  6. Biological risk factors for suicidal behaviors: a meta-analysis.

    Science.gov (United States)

    Chang, B P; Franklin, J C; Ribeiro, J D; Fox, K R; Bentley, K H; Kleiman, E M; Nock, M K

    2016-09-13

    Prior studies have proposed a wide range of potential biological risk factors for future suicidal behaviors. Although strong evidence exists for biological correlates of suicidal behaviors, it remains unclear if these correlates are also risk factors for suicidal behaviors. We performed a meta-analysis to integrate the existing literature on biological risk factors for suicidal behaviors and to determine their statistical significance. We conducted a systematic search of PubMed, PsycInfo and Google Scholar for studies that used a biological factor to predict either suicide attempt or death by suicide. Inclusion criteria included studies with at least one longitudinal analysis using a biological factor to predict either of these outcomes in any population through 2015. From an initial screen of 2541 studies we identified 94 cases. Random effects models were used for both meta-analyses and meta-regression. The combined effect of biological factors produced statistically significant but relatively weak prediction of suicide attempts (weighted mean odds ratio (wOR)=1.41; CI: 1.09-1.81) and suicide death (wOR=1.28; CI: 1.13-1.45). After accounting for publication bias, prediction was nonsignificant for both suicide attempts and suicide death. Only two factors remained significant after accounting for publication bias-cytokines (wOR=2.87; CI: 1.40-5.93) and low levels of fish oil nutrients (wOR=1.09; CI: 1.01-1.19). Our meta-analysis revealed that currently known biological factors are weak predictors of future suicidal behaviors. This conclusion should be interpreted within the context of the limitations of the existing literature, including long follow-up intervals and a lack of tests of interactions with other risk factors. Future studies addressing these limitations may more effectively test for potential biological risk factors.

  7. A resampling-based meta-analysis for detection of differential gene expression in breast cancer

    Directory of Open Access Journals (Sweden)

    Ergul Gulusan

    2008-12-01

    Full Text Available Abstract Background Accuracy in the diagnosis of breast cancer and classification of cancer subtypes has improved over the years with the development of well-established immunohistopathological criteria. More recently, diagnostic gene-sets at the mRNA expression level have been tested as better predictors of disease state. However, breast cancer is heterogeneous in nature; thus extraction of differentially expressed gene-sets that stably distinguish normal tissue from various pathologies poses challenges. Meta-analysis of high-throughput expression data using a collection of statistical methodologies leads to the identification of robust tumor gene expression signatures. Methods A resampling-based meta-analysis strategy, which involves the use of resampling and application of distribution statistics in combination to assess the degree of significance in differential expression between sample classes, was developed. Two independent microarray datasets that contain normal breast, invasive ductal carcinoma (IDC, and invasive lobular carcinoma (ILC samples were used for the meta-analysis. Expression of the genes, selected from the gene list for classification of normal breast samples and breast tumors encompassing both the ILC and IDC subtypes were tested on 10 independent primary IDC samples and matched non-tumor controls by real-time qRT-PCR. Other existing breast cancer microarray datasets were used in support of the resampling-based meta-analysis. Results The two independent microarray studies were found to be comparable, although differing in their experimental methodologies (Pearson correlation coefficient, R = 0.9389 and R = 0.8465 for ductal and lobular samples, respectively. The resampling-based meta-analysis has led to the identification of a highly stable set of genes for classification of normal breast samples and breast tumors encompassing both the ILC and IDC subtypes. The expression results of the selected genes obtained through real

  8. Prevalence of Oral Lichen Planus in Diabetes Mellitus: a Meta-Analysis Study

    Science.gov (United States)

    Mozaffari, Hamid Reza; Sharifi, Roohollah; Sadeghi, Masoud

    2016-01-01

    Background: Oral lichen planus (OLP) is associated with various other systemic conditions such as hypertension, diabetes mellitus (DM). This study evaluated the prevalence of OLP in DM patients compared with non-diabetic control subjects in a meta-analysis study. Methods: In this study from January 1973 to August 2016, we searched the studies in Web of Science, Medline/PubMed, Scopus, Science direct, SID (Scientific Information Database), Cochrane and Embase databases. Strategy search was the Medical Subject Heading (MeSH) term oral lichen planus or oral mucosa combined with diabetes in PubMed and this search in other databases. Heterogeneity between estimates was evaluated by the Q and I2 statistic. Also, publication bias was assessed through funnel plot analysis with the Kendall’s and Egger’s tests. Results: From 831 studies were identified with different search strategies, 11 studies met the criteria to be included in meta-analysis (11 case-control studies). The overall prevalence of OLP in 11 studies with 4937 DM patients and 3698 control subjectswas 1.5% and 0.75%, respectively. In this meta-analysis, the OR in prevalence of OLP in DM patients compared with control subjects was 1.584 (95%CI1.013-2.477; P=0.044) with a low level of heterogeneity (I2 = 0%) that the result showed the prevalence of OLP in DM patients is significantly more than control subjects. Conclusions: This meta-analysis study showed an association between OLP with DM, whereas this association was no significant in previous studies, it was probably because different selecting of age, sex, type of DM, medications and criteria. Totally, the meta-analysis showed the risk of OLP in DM was higher compared with control subjects. PMID:28077900

  9. Coffee or tea consumption and the risk of rheumatoid arthritis: a meta-analysis.

    Science.gov (United States)

    Lee, Young Ho; Bae, Sang-Cheol; Song, Gwan Gyu

    2014-11-01

    Meta-analysis of the cohort studies revealed a trend of an association between total coffee intake and RA incidence (RR of the highest vs. the lowest group = 1.309, 95 % confidence interval [CI] = 0.967-1.771, p = 0.085). Meta-analysis of case-control studies showed a significant association between total coffee intake and RA incidence (RR = 1.201, 95 % CI =1.058-1.361, p = 0.005). There were differences in the reference groups (all categories of coffee) between the case-control meta-analysis that showed a significant association and the cohort studies where meta-analysis results were non-significant. In addition, the highest category of coffee intake varied between Heliovaara et al. cohort study from Finland where the highest category included drinking up to 13 cups per day, compared to US studies where it was very unusual to have > 4 cups coffee intake per day. Combining the data of the cohort and case-control studies showed a significant association between total coffee intake and RA incidence (RR = 1.217, 95 % CI = 1.083-1.368,p = 0.001). Meta-analysis stratified by seropositivity indicated a significant association between coffee consumption and seropositive RA risk (RR=1.309, 95 % CI=1.142-1.499, p=1.1x10-5), but not seronegative RA risk (RR=1.097, 95 % CI=0.886-1.357, p=0.396). There was no significant association between decaffeinated coffee consumption and RA incidence (RR=1.709, 95 % CI 0.786-3.715), or between caffeinated coffee consumption and RA incidence (RR=1.055, 95 % CI 0.782-1.421). [corrected].

  10. Likelihood ratio meta-analysis: New motivation and approach for an old method.

    Science.gov (United States)

    Dormuth, Colin R; Filion, Kristian B; Platt, Robert W

    2016-03-01

    A 95% confidence interval (CI) in an updated meta-analysis may not have the expected 95% coverage. If a meta-analysis is simply updated with additional data, then the resulting 95% CI will be wrong because it will not have accounted for the fact that the earlier meta-analysis failed or succeeded to exclude the null. This situation can be avoided by using the likelihood ratio (LR) as a measure of evidence that does not depend on type-1 error. We show how an LR-based approach, first advanced by Goodman, can be used in a meta-analysis to pool data from separate studies to quantitatively assess where the total evidence points. The method works by estimating the log-likelihood ratio (LogLR) function from each study. Those functions are then summed to obtain a combined function, which is then used to retrieve the total effect estimate, and a corresponding 'intrinsic' confidence interval. Using as illustrations the CAPRIE trial of clopidogrel versus aspirin in the prevention of ischemic events, and our own meta-analysis of higher potency statins and the risk of acute kidney injury, we show that the LR-based method yields the same point estimate as the traditional analysis, but with an intrinsic confidence interval that is appropriately wider than the traditional 95% CI. The LR-based method can be used to conduct both fixed effect and random effects meta-analyses, it can be applied to old and new meta-analyses alike, and results can be presented in a format that is familiar to a meta-analytic audience.

  11. Sequential Stereotype Priming: A Meta-Analysis.

    Science.gov (United States)

    Kidder, Ciara K; White, Katherine R; Hinojos, Michelle R; Sandoval, Mayra; Crites, Stephen L

    2017-08-01

    Psychological interest in stereotype measurement has spanned nearly a century, with researchers adopting implicit measures in the 1980s to complement explicit measures. One of the most frequently used implicit measures of stereotypes is the sequential priming paradigm. The current meta-analysis examines stereotype priming, focusing specifically on this paradigm. To contribute to ongoing discussions regarding methodological rigor in social psychology, one primary goal was to identify methodological moderators of the stereotype priming effect-whether priming is due to a relation between the prime and target stimuli, the prime and target response, participant task, stereotype dimension, stimulus onset asynchrony (SOA), and stimuli type. Data from 39 studies yielded 87 individual effect sizes from 5,497 participants. Analyses revealed that stereotype priming is significantly moderated by the presence of prime-response relations, participant task, stereotype dimension, target stimulus type, SOA, and prime repetition. These results carry both practical and theoretical implications for future research on stereotype priming.

  12. Early Start DENVER Model: A Meta - analysis

    Directory of Open Access Journals (Sweden)

    Jane P. Canoy

    2015-11-01

    Full Text Available Each child with Autism Spectrum Disorder has different symptoms, skills and types of impairment or disorder with other children. This is why the word “spectrum” is included in this disorder. Eapen, Crncec, and Walter, 2013 claimed that there was an emerging evidence that early interventions gives the greatest capacity of child’s development during their first years of life as “brain plasticity” are high during this period. With this, the only intervention program model for children as young as 18 months that has been validated in a randomized clinical trial is “Early Start Denver Model” (ESDM. This study aimed to determine the effectiveness of the outcome of “Early Start Denver Model” (ESDM towards young children with Autism Spectrum Disorders. This study made use of meta-analysis method. In this study, the researcher utilized studies related to “Early Start Denver Model (ESDM” which is published in a refereed journal which are all available online. There were five studies included which totals 149 children exposed to ESDM. To examine the “pooled effects” of ESDM in a variety of outcomes, a meta-analytic procedure was performed after the extraction of data of the concrete outcomes. Comprehensive Meta Analysis Version 3.3.070 was used to analyze the data.  The effectiveness of the outcome of “Early Start Denver Model” towards young children with Autism Spectrum Disorders (ASD highly depends on the intensity of intervention and the younger child age. This study would provide the basis in effectively implementing an early intervention to children with autism such as the “Early Start Denver Model” (ESDM that would show great outcome effects to those children that has “Autism Spectrum Disorder”.

  13. A meta-analysis of parton distribution functions

    Science.gov (United States)

    Gao, Jun; Nadolsky, Pavel

    2014-07-01

    A "meta-analysis" is a method for comparison and combination of nonperturbative parton distribution functions (PDFs) in a nucleon obtained with heterogeneous procedures and assumptions. Each input parton distribution set is converted into a "meta-parametrization" based on a common functional form. By analyzing parameters of the meta-parametrizations from all input PDF ensembles, a combined PDF ensemble can be produced that has a smaller total number of PDF member sets than the original ensembles. The meta-parametrizations simplify the computation of the PDF uncertainty in theoretical predictions and provide an alternative to the 2010 PDF4LHC convention for combination of PDF uncertainties. As a practical example, we construct a META ensemble for computation of QCD observables at the Large Hadron Collider using the next-to-next-to-leading order PDF sets from CTEQ, MSTW, and NNPDF groups as the input. The META ensemble includes a central set that reproduces the average of LHC predictions based on the three input PDF ensembles and Hessian eigenvector sets for computing the combined PDF+α s uncertainty at a common QCD coupling strength of 0.118.

  14. Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, X; Yan, S; Liu, C; Xu, Y; Wan, L; Wang, Y; Gao, W; Meng, S; Liu, Y; Liu, R; Xu, D

    2016-04-01

    Previous studies suggested possible bone loss and fracture risk in patients with systemic lupus erythematosus (SLE). The aim of this systematic review and meta-analysis was to assess the strength of the relationship of SLE with fracture risk and the mean difference of bone mineral density (BMD) levels between SLE patients and controls. Literature search was undertaken in multiple indexing databases on September 26, 2015. Studies on the relationship of SLE with fracture risk and the mean difference of BMD levels between SLE patients and controls were included. Data were combined using standard methods of meta-analysis. Twenty-one studies were finally included into the meta-analysis, including 15 studies on the mean difference of BMD levels between SLE patients and controls, and 6 studies were on fracture risk associated with SLE. The meta-analysis showed that SLE patients had significantly lower BMD levels than controls in the whole body (weighted mean difference [WMD] = -0.04; 95 % CI -0.06 to -0.02; P systematic review and meta-analysis provides strong evidence for the relationship of SLE with bone loss and fracture risk.

  15. A Systematic Review and Meta-analysis of the Association Between Giardia lamblia and Endemic Pediatric Diarrhea in Developing Countries

    Science.gov (United States)

    Muhsen, Khitam; Levine, Myron M.

    2012-01-01

    We performed a systematic literature review and meta-analysis examining the association between diarrhea in young children in nonindustrialized settings and Giardia lamblia infection. Eligible were case/control and longitudinal studies that defined the outcome as acute or persistent (>14 days) diarrhea, adjusted for confounders and lasting for at least 1 year. Data on G. lamblia detection (mainly in stools) from diarrhea patients and controls without diarrhea were abstracted. Random effects model meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Twelve nonindustrialized-setting acute pediatric diarrhea studies met the meta-analysis inclusion criteria. Random-effects model meta-analysis of combined results (9774 acute diarrhea cases and 8766 controls) yielded a pooled OR of 0.60 (95% CI, .38–.94; P = .03), indicating that G. lamblia was not associated with acute diarrhea. However, limited data suggest that initial Giardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a pooled OR of 3.18 (95% CI, 1.50–6.76; P Giardia with that syndrome. The well-powered Global Enteric Multicenter Study (GEMS) is prospectively addressing the association between G. lamblia infection and diarrhea in children in developing countries. PMID:23169940

  16. Meta-analysis of nasopharyngeal carcinoma microarray data explores mechanism of EBV-regulated neoplastic transformation

    OpenAIRE

    Liao ZhiJun; Zheng WenLing; Liang Shuang; Chen Xia; Shang Tao; Ma WenLi

    2008-01-01

    Abstract Background Epstein-Barr virus (EBV) presumably plays an important role in the pathogenesis of nasopharyngeal carcinoma (NPC), but the molecular mechanism of EBV-dependent neoplastic transformation is not well understood. The combination of bioinformatics with evidences from biological experiments paved a new way to gain more insights into the molecular mechanism of cancer. Results We profiled gene expression using a meta-analysis approach. Two sets of meta-genes were obtained. Meta-A...

  17. Meta-analysis of nasopharyngeal carcinoma microarray data explores mechanism of EBV-regulated neoplastic transformation

    OpenAIRE

    Chen, Xia; Liang, Shuang; ZHENG, WENLING; Liao, Zhijun; Shang, Tao; Ma, WenLi

    2008-01-01

    Background Epstein-Barr virus (EBV) presumably plays an important role in the pathogenesis of nasopharyngeal carcinoma (NPC), but the molecular mechanism of EBV-dependent neoplastic transformation is not well understood. The combination of bioinformatics with evidences from biological experiments paved a new way to gain more insights into the molecular mechanism of cancer. Results We profiled gene expression using a meta-analysis approach. Two sets of meta-genes were obtained. Meta-A genes we...

  18. Bayesian network meta-analysis for cluster randomized trials with binary outcomes.

    Science.gov (United States)

    Uhlmann, Lorenz; Jensen, Katrin; Kieser, Meinhard

    2017-06-01

    Network meta-analysis is becoming a common approach to combine direct and indirect comparisons of several treatment arms. In recent research, there have been various developments and extensions of the standard methodology. Simultaneously, cluster randomized trials are experiencing an increased popularity, especially in the field of health services research, where, for example, medical practices are the units of randomization but the outcome is measured at the patient level. Combination of the results of cluster randomized trials is challenging. In this tutorial, we examine and compare different approaches for the incorporation of cluster randomized trials in a (network) meta-analysis. Furthermore, we provide practical insight on the implementation of the models. In simulation studies, it is shown that some of the examined approaches lead to unsatisfying results. However, there are alternatives which are suitable to combine cluster randomized trials in a network meta-analysis as they are unbiased and reach accurate coverage rates. In conclusion, the methodology can be extended in such a way that an adequate inclusion of the results obtained in cluster randomized trials becomes feasible. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  19. Determining The Factors Affecting Fruit Hardness of Different Peach Types with Meta Analysis

    Directory of Open Access Journals (Sweden)

    Hande Küçükönder

    2014-09-01

    Full Text Available The aim of this study is to determine the factor effective in determining the hardness of Caterina, Suidring, Royal Glory and Tirrenia peach types using meta analysis. In the study, the impact force (Fi and the contact time (tc were detected and the impulse values (I that are expressed as independent variable in the area under the curve were calculated in the measurements performed using the technique of a low-mass lateral impactor multiplicated with peach. Using the theory of elasticity, the independent variables were determined as Fmax (maximum impact force, contact time (tmax, Fmax/tmax, 1/tmax, 1/tmax2,5, Fmax/tmax 1.25 and Fmax2.5 parameters. The correlation coefficient values showing the relationship between these parameters and the dependent variable Magness-Taylor force (MT were calculated and were combined with meta-analysis by using the Hunter-Schmid and Fisher’s Z methods. The Cohen’s classification criterion was used in evaluating the resulting mean effect size (combined correlation value and in determining its direction. As a result of the meta-analysis, the mean effect size according to Hunter-Schmid method was found 0.436 (0.371-0.497 positively directed in 95% confidence interval, while it was found 0.468 (0.390-0.545 according to Fisher’s Z method. The effect sizes in both methods were determined “mid-level” according to the Cohen’s classification. When the significance level of the studies was analyzed with the Z test, all of the ones that taken into the meta analysis has been found statistically significant. As a result of the meta analysis in this study evaluating the relationship of peach types with the fruit hardness, the mean effect size has been found to reach “strong level”. Consequently, “maximum shock acceleration” was found to be a more effective factor comparing to the other factors in determining the the fruit hardness according to the results of meta analysis applied in both methods.

  20. A meta-analysis of parton distribution functions

    CERN Document Server

    Gao, Jun

    2014-01-01

    A "meta-analysis" is a method for comparison and combination of nonperturbative parton distribution functions (PDFs) in a nucleon obtained with heterogeneous procedures and assumptions. Each input parton distribution set is converted into a "meta-parametrization" based on a common functional form. By analyzing parameters of the meta-parametrizations from all input PDF ensembles, a combined PDF ensemble can be produced that has a smaller total number of PDF member sets than the original ensembles. The meta-parametrizations simplify the computation of the PDF uncertainty in theoretical predictions and provide an alternative to the 2010 PDF4LHC convention for combination of PDF uncertainties. As a practical example, we construct a META ensemble for computation of QCD observables at the Large Hadron Collider using the next-to-next-to-leading order PDF sets from CTEQ, MSTW, and NNPDF groups as the input. The META ensemble includes a central set that reproduces the average of LHC predictions based on the three inpu...

  1. A systematic review of the effectiveness of CBT/ERP group therapy of OCD: A meta-analysis

    DEFF Research Database (Denmark)

    Jónsson, Hjalti; Hougaard, Esben; Bennedsen, Birgit;

    , as well as reviewers of the literature have focused on within single treatments effect sizes rather between group effect sizes. OBJECTIVES To make a systematic review, and by methods of meta analysis compute a pooled within effect size of studies of group CBT of OCD and compare these to previously.......05 and 1.25 respectively, with an overall combined pooled within effect size across the categories at 1.18. Finally a between effect sizes of the four studies comparing group therapy to waitlist control group was reported at.1.12 CONCLUSION The reported within effect sizes in this meta-analysis (range 1...

  2. 光动力学疗法联合雷珠单抗对比雷珠单抗治疗湿性AMD有效性和安全性的Meta分析%A comparison of the efficacy and safety of ranibizumab combined with photodynamic therapy (PDT) versus ranibizumab monotherapy for the treatment of wet age-related macular degeneration: a meta analysis

    Institute of Scientific and Technical Information of China (English)

    蒋璐; 陶继伟; 洪明胜; 余心洁; 沈丽君

    2014-01-01

    Objective To evaluate the efficacy and safety of ranibizumab combined with photodynamic therapy versus ranibizumab monotherapy for the treatment of wet age-related macular degeneration (AMD).Methods In this meta analysis,searches were conducted in Pubmed,EMbase,Cochrane Library,CNKI,and Wanfang databases.Six randomized control trials (RCT) in the literature were selected for meta-analysis,a total of 626 eyes:a monotherapy group (323 eyes) and a combined treatment group (303 eyes).The methodological quality was conducted according to evidence-based medicine (EBM).The qualities of the RTCs were evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions,Version 5.0.The Cochrane Collaboration's software RevMan 5.0 was used for meta-analysis.Results The results of the meta-analysis showed the following:①Best corrected visual acuity(BCVA):the monotherapy group showed greater improvement in BCVA compared with the combined treatment group [WMD=-2.84,95%CI(0.25-5.43),P<0.05].The incidence of people who gained ≥ 15 letters in the monotherapy group was higher than the combined treatment group [WMD=0.66,95%CI(0.45-0.96),P<0.05].However,there was no significant difference between the two groups in the incidence of people who lost ≥15 letters [WMD=1.37,95%CI(0.78-2.41),P>0.05].②Central retinal thickness (CRT):There was no significant difference between the two groups [WMD=-3.17,95%CI(-25.64-31.97),P>0.05].③Lesion size (LZ):There was no significant difference between the two groups [WMD=0.24,95%CI(-0.38-0.86),P>0.05].④Injection times:There was no significant difference between the two groups [WMD=-1.00,95%CI(-2.56~0.56),P>0.05].⑤Complications:The combined treatment group had a higher probability of retinal hemorrhage than the monotherapy group [RR=2.65,95%CI(1.04-6.71),P<0.05].Conclusion Meta-analysis shows that ranibizumab monotherapy is effective in achieving a BCVA gain comparable to the combined treatment

  3. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis

    Science.gov (United States)

    D'Souza, Aloysius L; Rajkumar, Chakravarthi; Cooke, Jonathan; Bulpitt, Christopher J

    2002-01-01

    Objective To evaluate efficacy of probiotics in prevention and treatment of diarrhoea associated with the use of antibiotics. Design Meta-analysis; outcome data (proportion of patients not getting diarrhoea) were analysed, pooled, and compared to determine odds ratios in treated and control groups. Identification Studies identified by searching Medline between 1966 and 2000 and the Cochrane Library. Studies reviewed Nine randomised, double blind, placebo controlled trials of probiotics. Results Two of the nine studies investigated the effects of probiotics in children. Four trials used a yeast (Saccharomyces boulardii), four used lactobacilli, and one used a strain of enterococcus that produced lactic acid. Three trials used a combination of probiotic strains of bacteria. In all nine trials, the probiotics were given in combination with antibiotics and the control groups received placebo and antibiotics. The odds ratio in favour of active treatment over placebo in preventing diarrhoea associated with antibiotics was 0.39 (95% confidence interval 0.25 to 0.62; P<0.001) for the yeast and 0.34 (0.19 to 0.61; P<0.01 for lactobacilli. The combined odds ratio was 0.37 (0.26 to 0.53; P<0.001) in favour of active treatment over placebo. Conclusions The meta-analysis suggests that probiotics can be used to prevent antibiotic associated diarrhoea and that S boulardii and lactobacilli have the potential to be used in this situation. The efficacy of probiotics in treating antibiotic associated diarrhoea remains to be proved. A further large trial in which probiotics are used as preventive agents should look at the costs of and need for routine use of these agents. What is already known on this topicProbiotics are well known for their microbiological properties and have been used to treat gastrointestinal and vaginal mucosal infectionsConflicting results have prevented probiotics from being accepted as viable alternatives to conventional treatments for antibiotic associated

  4. Microbiota of the indoor environment: a meta-analysis.

    Science.gov (United States)

    Adams, Rachel I; Bateman, Ashley C; Bik, Holly M; Meadow, James F

    2015-10-13

    As modern humans, we spend the majority of our time in indoor environments. Consequently, environmental exposure to microorganisms has important implications for human health, and a better understanding of the ecological drivers and processes that impact indoor microbial assemblages will be key for expanding our knowledge of the built environment. In the present investigation, we combined recent studies examining the microbiota of the built environment in order to identify unifying community patterns and the relative importance of indoor environmental factors. Ultimately, the present meta-analysis focused on studies of bacteria and archaea due to the limited number of high-throughput fungal studies from the indoor environment. We combined 16S ribosomal RNA (rRNA) gene datasets from 16 surveys of indoor environments conducted worldwide, additionally including 7 other studies representing putative environmental sources of microbial taxa (outdoor air, soil, and the human body). Combined analysis of subsets of studies that shared specific experimental protocols or indoor habitats revealed community patterns indicative of consistent source environments and environmental filtering. Additionally, we were able to identify several consistent sources for indoor microorganisms, particularly outdoor air and skin, mirroring what has been shown in individual studies. Technical variation across studies had a strong effect on comparisons of microbial community assemblages, with differences in experimental protocols limiting our ability to extensively explore the importance of, for example, sampling locality, building function and use, or environmental substrate in structuring indoor microbial communities. We present a snapshot of an important scientific field in its early stages, where studies have tended to focus on heavy sampling in a few geographic areas. From the practical perspective, this endeavor reinforces the importance of negative "kit" controls in microbiome studies

  5. Meta-analysis of the relationship between psychosocial indexes with mental health

    Directory of Open Access Journals (Sweden)

    Ayaub Faizy

    2015-09-01

    Full Text Available Background: The expansion of studies that done in the demand of effective factors such as social factors on mental health provides the ground work for the combination of these studies. So, this meta-analysis was implemented to determine the summary effect size of the relationship between social indexes and mental health measures Material and Methods: The method used in this study is a Meta-Analysis. To achieve above aim used of quantitative findings from 46 studies, that computed 77 effect sizes from these. The studies that were used in this study collected from databases such as magiran, noormags, Scientific Information Database and proceeding articles that published in the Seminars of college student’s Mental Health. After reviewing the inclusion and exclusion criteria, the correlation effect sizes in selected studies were analyzed with the CMA2 software. In this study, were calculated both random and fixed models, that selected random model, according to the results of the heterogeneity analysis of the Q and I2 factors. Results: The results showed that the combinational effect size of the studies obtained 0.139, after eliminated 10 effect sizes. The combined effect size of studies was calculated low based on Cohen's criteria. Also, the results of heterogeneity analysis indicated that there are moderating variables in the studies. The evidence of this meta-analysis associated with prior theoretical and empirical foundations, indicates the relationship between social support and mental health. Conclusion: According to the results of this meta-analysis for successful mental health programs due to cultural and social issues will be necessary.

  6. Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis

    National Research Council Canada - National Science Library

    Kim, Hyun Jung; Sun, Hwa Yeon; Choi, Hoon; Park, Jae Young; Bae, Jae Hyun; Doo, Seung Whan; Yang, Won Jae; Song, Yun Seob; Ko, Young Myoung; Kim, Jae Heon

    2017-01-01

    ...)/lower urinary tract symptoms (LUTS) Objective The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic...

  7. Comparative effectiveness of combined therapy inhibiting EGFR and VEGF pathways in patients with advanced non-small-cell lung cancer: a meta-analysis of 16 phase II/III randomized trials

    Science.gov (United States)

    Cai, Shangli; Wu, Tongwei; Yan, Guangyue; Cheng, Sijin; Cui, Kang; Xi, Ying; Qi, Xiaolong; Zhang, Jie; Ma, Wang

    2017-01-01

    Background & Aims Combined therapy inhibiting EGFR and VEGF pathways is becoming a promising therapy in the treatment of advanced non-small-cell lung cancer (NSCLC), however, with controversy. The study aims to compare the efficacy of combined inhibition therapy versus control therapy (including placebo, single EGFR inhibition and single VEGF inhibition) in patients with advanced NSCLC. Materials and Methods An adequate literature search in EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO) was conducted. Phase II or III randomized controlled trials (RCTs) that compared effectiveness between combined inhibition therapy and control therapy in patients with advanced NSCLC were eligible. The endpoint was overall response rate (ORR), progression free survival (PFS) and overall survival (OS). Results Sixteen phase II or III RCTs involving a total of 7,109 patients were included. The results indicated that the combined inhibition therapy significantly increased the ORR (OR = 1.59, 95% CI = 1.36-1.87, panalysis, the combined inhibition therapy clearly increased the ORR (OR = 2.04, 95% CI = 1.60-2.60, p<0.00001; I2 = 0%) and improved the PFS (HR = 0.78, 95% CI = 0.71-0.85, p<0.00001;I2 = 0%) when compared with the placebo, and similar results was detected when compared with the single EGFR inhibition in terms of ORR (OR = 1.39, 95% CI = 1.12-1.74, p = 0.003; I2 = 30%) and PFS (HR = 0.73, 95% CI = 0.67-0.81, p<0.0001; I2 = 50%). No obvious difference was found between the combined inhibition therapy and single VEGF inhibition in term of ORR, however, combined inhibition therapy significantly decreased the PFS when compared to the single VEGF inhibition therapy (HR = 1.70, 95% CI = 1.34-2.17, p<0.0001; I2 = 50%). Besides, no significant difference was observed between the combined inhibition therapy and control therapy in term of OS (including placebo, single EGFR

  8. Ischiofemoral impingement syndrome: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Adam D.; Subhawong, Ty K.; Jose, Jean; Tresley, Jonathan; Clifford, Paul D. [Jackson Memorial Hospital, Department of Diagnostic Radiology, Section of Musculoskeletal Imaging, Miami, FL (United States)

    2015-06-01

    The aims of this article are to review the imaging characteristics of ischiofemoral impingement (IFI), summarize measurement thresholds for radiologic diagnosis based on a meta-analysis of the literature and raise awareness among radiologists and clinicians of this entity. A PubMed search restricted to the English language containing the keywords ''ischiofemoral impingement'' and ''quadratus femoris MRI'' was performed, and citations in these articles were also used to identify a total of 27 studies discussing ischiofemoral impingement. After excluding case reports and non-representative studies, there were five remaining articles including 193 hip MRIs of IFI in 154 subjects (133 female, 21 male) and 135 asymptomatic control hip MRIs from 74 subjects (55 female, 19 male). Additionally, we performed a retrospective database search of pelvic and hip MRI reports from our institution including the terms ''quadratus femoris'' or ''ischiofemoral impingement'' from a 9-year period and 24 hip MRIs from 21 patients (18 female, 3 male) with IFI with 5 asymptomatic contralateral control hip MRIs identified. In all, 217 hip MRIs of IFI and 140 control cases were included. A meta-analysis of these hip MRIs was conducted to determine optimal thresholds of the ischiofemoral space (IFS) and quadratus femoris space (QFS) for identifying IFI. Cases of IFI showed significantly smaller IFS and QFS compared to controls (14.91 ± 4.8 versus 26.01 ± 7.98 and 9.57 ± 3.7 versus 15.97 ± 6.07, measured in mm, respectively, p < 0.0001 for both). Pooled analysis revealed that for IFS, using a cutoff of ≤15 mm yielded a sensitivity of 76.9 %, specificity of 81.0 % and overall accuracy of 78.3 %. For QFS, a cutoff of ≤ 10.0 mm resulted in 78.7 % sensitivity, 74.1 % specificity and 77.1 % overall accuracy. IFI is a potential cause of hip pain that can be accurately diagnosed with MRI in conjunction with

  9. The meta-analysis of response ratios in experimental ecology

    Energy Technology Data Exchange (ETDEWEB)

    Hedges, L.V. [Univ. of Chicago, IL (United States). Dept. of Education; Gurevitch, J. [State Univ. of New York, Stony Brook, NY (United States). Dept. of Ecology and Evolution; Curtis, P.S. [Ohio State Univ., Columbus, OH (United States). Dept. of Plant Biology

    1999-06-01

    Meta-analysis provides formal statistical techniques for summarizing the results of independent experiments and is increasingly being used in ecology. The response ratio (the ratio of mean outcome in the experimental group to that in the control group) and closely related measures of proportionate change are often used as measures of effect magnitude in ecology. Using these metrics for meta-analysis requires knowledge of their statistical properties, but these have not been previously derived. The authors give the approximate sampling distribution of the log response ratio, discuss why it is a particularly useful metric for many applications in ecology, and demonstrate how to use it in meta-analysis. The meta-analysis of response-ratio data is illustrated using experimental data on the effects of increased atmospheric CO{sub 2} on plant biomass responses.

  10. Graphical tools for network meta-analysis in STATA.

    Directory of Open Access Journals (Sweden)

    Anna Chaimani

    Full Text Available Network meta-analysis synthesizes direct and indirect evidence in a network of trials that compare multiple interventions and has the potential to rank the competing treatments according to the studied outcome. Despite its usefulness network meta-analysis is often criticized for its complexity and for being accessible only to researchers with strong statistical and computational skills. The evaluation of the underlying model assumptions, the statistical technicalities and presentation of the results in a concise and understandable way are all challenging aspects in the network meta-analysis methodology. In this paper we aim to make the methodology accessible to non-statisticians by presenting and explaining a series of graphical tools via worked examples. To this end, we provide a set of STATA routines that can be easily employed to present the evidence base, evaluate the assumptions, fit the network meta-analysis model and interpret its results.

  11. Sparse meta-analysis with high-dimensional data.

    Science.gov (United States)

    He, Qianchuan; Zhang, Hao Helen; Avery, Christy L; Lin, D Y

    2016-04-01

    Meta-analysis plays an important role in summarizing and synthesizing scientific evidence derived from multiple studies. With high-dimensional data, the incorporation of variable selection into meta-analysis improves model interpretation and prediction. Existing variable selection methods require direct access to raw data, which may not be available in practical situations. We propose a new approach, sparse meta-analysis (SMA), in which variable selection for meta-analysis is based solely on summary statistics and the effect sizes of each covariate are allowed to vary among studies. We show that the SMA enjoys the oracle property if the estimated covariance matrix of the parameter estimators from each study is available. We also show that our approach achieves selection consistency and estimation consistency even when summary statistics include only the variance estimators or no variance/covariance information at all. Simulation studies and applications to high-throughput genomics studies demonstrate the usefulness of our approach.

  12. Graphical tools for network meta-analysis in STATA.

    Science.gov (United States)

    Chaimani, Anna; Higgins, Julian P T; Mavridis, Dimitris; Spyridonos, Panagiota; Salanti, Georgia

    2013-01-01

    Network meta-analysis synthesizes direct and indirect evidence in a network of trials that compare multiple interventions and has the potential to rank the competing treatments according to the studied outcome. Despite its usefulness network meta-analysis is often criticized for its complexity and for being accessible only to researchers with strong statistical and computational skills. The evaluation of the underlying model assumptions, the statistical technicalities and presentation of the results in a concise and understandable way are all challenging aspects in the network meta-analysis methodology. In this paper we aim to make the methodology accessible to non-statisticians by presenting and explaining a series of graphical tools via worked examples. To this end, we provide a set of STATA routines that can be easily employed to present the evidence base, evaluate the assumptions, fit the network meta-analysis model and interpret its results.

  13. 昂丹司琼单用与联用地塞米松预防腹部术后恶心呕吐效果的Meta分析%Meta-analysis of Ondansetron and Ondansetron combined with Dexamethasone for preventing postoperative nausea and vomiting after abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    黄轶婷

    2013-01-01

    目的 评价昂丹司琼单用与联用地塞米松预防腹部术后恶心、呕吐的效果.方法 通过检索PubMed、中国知网和万方数据库,搜集以昂丹司琼单用与联用地塞米松预防腹部术后恶心呕吐的随机对照试验研究(random controlled trial,RCT).以昂丹司琼单用组为对照组,以昂丹司琼单用与联用地塞米松组为试验组,采用Meta分析评价昂丹司琼联用地塞米松预防术后恶心、呕吐的效果.结果 共纳入11篇文献,共1 021例腹部手术患者,其中试验组509例,对照组512例.Meta分析结果显示,试验组预防腹部术后恶心、呕吐效果均优于对照组(P < 0.05).预防恶心和呕吐合并效应比值比(odd ratio,OR)及95%可信区间(confidence interval,CI)分别为2.73(1.71,4.34)和3.20(1.86,4.92).结论 昂丹司琼联用地塞米松能够有效预防腹部术后恶心、呕吐的发生,但是仍需要严格、标准、高质量、大样本、长期随访证实昂丹司琼联用地塞米松的安全性和有效性.%Objective To evaluate the efficacy of Ondansetron combined with Dexamethasone for preventing postoperative nausea and vomiting after abdominal surgery. Methods PubMed, CNKI and Wanfang electronic databases were searched to collected randomized controlled trials (RCT) that were interfere in Ondansetron or Ondansetron combined with Dexamethasone in controlling postoperative nausea and vomiting, Ondansetron was taken as control group, Ondansetron combined with Dexamethasone was taken as test group, The efficacy of Ondansetron combined with Dexamethasone for preventing postoperative nausea and vomiting after abdominal surgery with Meta-analysis was evaluated. Results 11 RCT and 1 021 patients with abdominal surgery were included. There was 509 cases in test groups and 512 cases in control group, Meta analysis showed that the test group was better than the control group in improving the incidence of the total postoperative nausea and vomiting (P < 0

  14. Efficacy of Bortezomib Combined with Thalidomide and Dexamethasone in the Treat-ment of Autologous Stem Cell Transplantation in Multiple Myeloma:A Meta-analysis%硼替佐米联合沙利度胺和地塞米松治疗自体造血干细胞移植多发性骨髓瘤的Meta分析

    Institute of Scientific and Technical Information of China (English)

    王海雪; 叶云

    2016-01-01

    目的:综合评价硼替佐米联合沙利度胺和地塞米松( VTD)治疗自体造血干细胞移植( ASCT)的多发性骨髓瘤( MM)的有效性和安全性。方法计算机检索Pubmed、Medline、the Cochrane Library、CNKI、VIP和万方等数据库,检索时间从建库至2014年12月。纳入VTD治疗 ASCT 的MM的随机对照试验,按Cochrane系统评价的方法评价纳入研究的质量,采用Review Manager 5.3.5版软件进行Meta分析。结果共纳入5项研究,1271例患者。 Meta分析结果显示,在有效性方面,VTD的完全缓解率与接近完全缓解率(CR+nCR)[RR=1.50,95%CI(1.16,1.94),P=0.002]和总有效率[RR=1.13,95%CI(1.03,1.24),P=0.009]优于其他联合方案,差异有统计学意义;在安全性方面,3~4度总不良反应发生率[RR=1.29,95%CI(1.05,1.59),P=0.02]高于其他联合方案,差异有统计学意义。结论 VTD能够显著提高ASCT的MM患者的CR+nCR和总有效率,但总不良反应发生率增加。%Objective To evaluate the efficacy and safety of bortezomib combined with dexamethasone and thalidomide in the treatment of autologous stem cell transplantation ( ASCT) in multiple myeloma ( MM) . Methods The randomized con-trolled trials ( RCTs) on combined therapy with bortezomib,dexamethasone and thalidomide for ASCT in MM were retrieved from Pubmed,Medline,the Cochrane Library,CNKI,VIP and Wanfang databases (published until December 2014).The method of the Cochrane systematic review was used to evaluate the quality of the included RCTs and the Review Manager 5.3.5 software was em-ployed for Meta-analysis. Results Five RCTs involving 1 271 patients were included.The meta analysis results showed that the complete remission ( CR) rate,near-CR rate and total effective rate were significantly higher after combined treatment with borte-zomib,dexamethasone and thalidomide when compared with those in other combination therapies [CR+nCR, RR=1.50,95%CI (1

  15. [Development of an Excel spreadsheet for meta-analysis of indirect and mixed treatment comparisons].

    Science.gov (United States)

    Tobías, Aurelio; Catalá-López, Ferrán; Roqué, Marta

    2014-01-01

    Meta-analyses in clinical research usually aimed to evaluate treatment efficacy and safety in direct comparison with a unique comparator. Indirect comparisons, using the Bucher's method, can summarize primary data when information from direct comparisons is limited or nonexistent. Mixed comparisons allow combining estimates from direct and indirect comparisons, increasing statistical power. There is a need for simple applications for meta-analysis of indirect and mixed comparisons. These can easily be conducted using a Microsoft Office Excel spreadsheet. We developed a spreadsheet for indirect and mixed effects comparisons of friendly use for clinical researchers interested in systematic reviews, but non-familiarized with the use of more advanced statistical packages. The use of the proposed Excel spreadsheet for indirect and mixed comparisons can be of great use in clinical epidemiology to extend the knowledge provided by traditional meta-analysis when evidence from direct comparisons is limited or nonexistent.

  16. Meta-analysis of Huangqi injection for the adjunctive therapy of aplastic anemia.

    Science.gov (United States)

    Zhu, Changtai; Gao, Yulu; Jiang, Ting; Hao, Cao; Gao, Zongshuai; Sun, Yongning

    2015-01-01

    Aplastic anemia therapy remains difficult, due to lack of effective treatment regimens. In recent years, Huangqi injection for the adjunctive therapy of aplastic anemia has been reported in many clinical trials. Considering that Huangqi injection may be a novel approach to aplastic anemia treatment, we conducted a meta-analysis of clinical controlled trials to assess the clinical value of Huangqi injection in the treatment of aplastic anemia. We searched the Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Full-text Database (VIP), Wanfang Database, PubMed and EMBASE database to collect the data about the trials of Huangqi injection combined with androgens for treating aplastic anemia. A total of ten studies involving 720 patients with aplastic anemia were included in this study. The meta-analysis showed significant increases in the pool effectiveness rate, white blood cells (WBC), haematoglobin (Hb), platelets (PLT), and reticulocytes (Ret) between the experimental group versus the control group. No severe side effects were found in this study. However, the lower Jadad scores and asymmetric funnel plot degrades the validity of the meta-analysis as the clinical evidence. Therefore, Huangqi injection may significantly enhance the efficacy of androgens for aplastic anemia, suggesting that the novel approach of Chinese traditional medicine combined with Western medicine is promising. The exact outcome required confirmation with rigorously well-designed multi-center trials.

  17. Association of psoriasis with stroke and myocardial infarction: meta-analysis of cohort studies.

    Science.gov (United States)

    Xu, T; Zhang, Y-H

    2012-12-01

    Psoriasis is a common, chronic, relapsing, inflammatory skin disorder. Observational studies suggest an association between psoriasis and the incidence of stroke or myocardial infarction (MI). However, whether psoriasis is an independent risk factor for these two vascular events remains controversial. To evaluate the association of psoriasis with stroke and MI by conducting a meta-analysis of cohort studies. Cohort studies were searched in MEDLINE (Pubmed), EMBASE and Cochrane Library from their inception to March 2012. Stroke and MI were considered as a composite endpoint. Two authors independently extracted information on the characteristics of the study participants, follow-up range and control for potential confounding factors. A random-effects model was used to calculate the overall combined risk estimates. Seven cohort studies were included in the meta-analysis. On the basis of cohort characteristics, five of them were considered good quality and two were fair. The overall combined relative risk for psoriasis and composite vascular endpoint was 1·2 (95% confidence interval 1·1-1·31). Subgroup analysis maintained this significance with respect to stroke and MI individually. Sensitivity analysis and 'trim and fill' method yielded similar results. No evidence of publication bias was observed. This meta-analysis of cohort studies suggests that psoriasis significantly increases the risk of stroke and MI. The increase is probably independent of conventional cardiovascular risk factors. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

  18. Systematic Review and Meta-Analysis of Randomized Controlled Trials of Xingnaojing Treatment for Stroke

    Directory of Open Access Journals (Sweden)

    Weijun Peng

    2014-01-01

    Full Text Available Objective. Xingnaojing injection (XNJ is a well-known traditional Chinese patent medicine (TCPM for stroke. The aim of this study is to assess the efficacy of XNJ for stroke including ischemic stroke, intracerebral hemorrhage (ICH, and subarachnoid hemorrhage (SAH. Methods. An extensive search was performed within using eight databases up to November 2013. Randomized controlled trials (RCTs on XNJ for treatment of stroke were collected. Study selection, data extraction, quality assessment, and meta-analysis were conducted according to the Cochrane standards, and RevMan5.0 was used for meta-analysis. Results. This review included 13 RCTs and a total of 1,514 subjects. The overall methodological quality was poor. The meta-analysis showed that XNJ combined with conventional treatment was more effective for total efficacy, neurological deficit improvement, and reduction of TNF-α levels compared with those of conventional treatment alone. Three trials reported adverse events, of these one trial reported mild impairment of kidney and liver function, whereas the other two studies failed to report specific adverse events. Conclusion. Despite the limitations of this review, we suggest that XNJ in combination with conventional medicines might be beneficial for the treatment of stroke. Currently there are various methodological problems in the studies. Therefore, high-quality, large-scale RCTs are urgently needed.

  19. A meta-analysis of the effectiveness of individually oriented Cognitive Behavioral Treatment (CBT) for severe agressive behavior in adolescents

    NARCIS (Netherlands)

    Hoogsteder, L.M.; Stams, G.J.J.M.; Figge, M.A.; Changoe, K.; van Horn, J.E.; Hendriks, J.; Wissink, I.B.

    2015-01-01

    This meta-analysis, including six studies (13 effect sizes) and 164 adolescents, examined the effectiveness of individually oriented treatment (which means that the intervention contained at least an individual component, possibly in combination with group and/or family therapy) with CBT-elements

  20. Small and inconsistent effects of whole body vibration on athletic performance : a systematic review and meta-analysis

    NARCIS (Netherlands)

    Hortobagyi, Tibor; Lesinski, Melanie; Fernandez-del-Olmo, Miguel; Granacher, Urs

    2015-01-01

    We quantified the acute and chronic effects of whole body vibration on athletic performance or its proxy measures in competitive and/or elite athletes. Systematic literature review and meta-analysis. Whole body vibration combined with exercise had an overall 0.3 % acute effect on maximal voluntary l

  1. Small and inconsistent effects of whole body vibration on athletic performance : a systematic review and meta-analysis

    NARCIS (Netherlands)

    Hortobagyi, Tibor; Lesinski, Melanie; Fernandez-del-Olmo, Miguel; Granacher, Urs

    2015-01-01

    We quantified the acute and chronic effects of whole body vibration on athletic performance or its proxy measures in competitive and/or elite athletes. Systematic literature review and meta-analysis. Whole body vibration combined with exercise had an overall 0.3 % acute effect on maximal voluntary l

  2. Planning Skills in Autism Spectrum Disorder across the Lifespan: A Meta-Analysis and Meta-Regression

    Science.gov (United States)

    Olde Dubbelink, Linda M. E.; Geurts, Hilde M.

    2017-01-01

    Individuals with an autism spectrum disorder (ASD) are thought to encounter planning difficulties, but experimental research regarding the mastery of planning in ASD is inconsistent. By means of a meta-analysis of 50 planning studies with a combined sample size of 1755 individuals with and 1642 without ASD, we aim to determine whether planning…

  3. Meta-analysis of 701 published cases of sinonasal neuroendocrine carcinoma : The importance of differentiation grade in determining treatment strategy

    NARCIS (Netherlands)

    van der Laan, Tom P; Iepsma, René; Witjes, Max J H; van der Laan, Bernard F A M; Plaat, Boudewijn E C; Halmos, Gyorgy B

    2016-01-01

    The aim of this meta-analysis was to provide treatment guidelines for sinonasal neuroendocrine carcinoma (SNC) by combining all available data in the literature. A literature search for all studies concerning SNC was performed against the MEDLINE and EMBASE databases. Available clinical data was nor

  4. Network Meta-Analysis of Onychomycosis Treatments

    Science.gov (United States)

    Gupta, Aditya K.; Daigle, Deanne; Foley, Kelly A.

    2015-01-01

    Background Many onychomycosis treatments have not been directly compared in head-to-head clinical trials. Objective: To determine the relative efficacy of onychomycosis treatments using network meta-analysis (NMA). Methods We conducted a systematic review and NMA of mycological cure rates. Results Nineteen trials were included in the network. Terbinafine 250 mg was significantly superior to all treatments except itraconazole 400 mg pulse therapy. The itraconazole 400 mg pulse regimen was significantly superior to all topicals except efinaconazole 10% nail solution. Itraconazole 200 mg was significantly superior to all topical treatments, while fluconazole 150-450 mg, efinaconazole 10% nail solution, tavaborole 5% nail solution, ciclopirox nail lacquer 8%, terbinafine nail solution, and amorolfine 5% nail lacquer were significantly superior to placebo. Conclusions Newly developed topicals have improved the odds ratios (ORs) of mycological cure, yet these ORs were not significantly greater than preexisting topical treatments. Further experience with these agents will reveal their clinical significance, and head-to-head trials are warranted. © 2015 S. Karger AG, Basel PMID:27170937

  5. Infrastructure and Trade: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Guney Celbis

    2015-01-01

    Full Text Available Low levels of infrastructure quality and quantity can create trade impediments through increased transport costs. Since the late 1990s an increasing number of trade studies have taken infrastructure into account. The purpose of the present paper is to quantify the importance of infrastructure for trade by means of meta-analysis and meta-regression techniques that synthesize various studies. The type of infrastructure that we focus on is mainly public infrastructure in transportation and communication. We examine the impact of infrastructure on trade by means of estimates obtained from 36 primary studies that yielded 542 infrastructure elasticities of trade. We explicitly take into account that infrastructure can be measured in various ways and that its impact depends on the location of the infrastructure. We estimate several meta-regression models that control for observed heterogeneity in terms of variation across different methodologies, infrastructure types, geographical areas and their economic features, model specifications, and publication characteristics. Additionally, random effects account for between-study unspecified heterogeneity, while publication bias is explicitly addressed by means of the Hedges model.  After controlling for all these issues we find that a 1 percent increase in own infrastructure increases exports by about 0.6 percent and imports by about 0.3 percent. Such elasticities are generally larger for developing countries, land infrastructure, IV or panel data estimation, and macro-level analyses. They also depend on the inclusion or exclusion of various common covariates in trade regressions.

  6. Cardiac Surgery: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Evangelos Polymeropoulos

    2016-06-01

    Full Text Available Purpose: Several studies have investigated the administration of vitamin C (vitC for the prevention of postoperative atrial fibrillation (AF after cardiac surgery. However, their findings were inconsistent. The purpose of this meta-analysis was to evaluate the efficacy of vitC as prophylaxis for the prevention of postoperative AF in cardiac surgery. Methods: A systematic search of PubMed, EMBASE, Google Scholar, the Cochrane Library, and clinical trial registries, was performed. 9 studies, published from August 2001 to May 2015, were included, with a total of 1,037 patients. Patients were randomized to receive vitC, or placebo. Results: Cardiac surgery patients who received vitC as prophylaxis, had a significantly lower incidence of postoperative AF (random effects OR=0.478, 95% CI 0.340 – 0.673, P < 10-4. No significant heterogeneity was detected across the analyzed studies (I2=21.7%, and no publication bias or other small study-related bias was found. Conclusion: Our findings suggest that VitC is effective as prophylaxis for the prevention of postoperative AF. The administration of vitC may be considered in all patients undergoing cardiac surgery.

  7. Network meta-analysis of longitudinal data using fractional polynomials.

    Science.gov (United States)

    Jansen, J P; Vieira, M C; Cope, S

    2015-07-10

    Network meta-analysis of randomized controlled trials (RCTs) are often based on one treatment effect measure per study. However, many studies report data at multiple time points. Furthermore, not all studies measure the outcomes at the same time points. As an alternative to a network meta-analysis based on a synthesis of the results at one time point, a network meta-analysis method is presented that allows for the simultaneous analysis of outcomes at multiple time points. The development of outcomes over time of interventions compared in an RCT is modeled with fractional polynomials, and the differences between the parameters of these polynomials within a trial are synthesized across studies with a Bayesian network meta-analysis. The proposed models are illustrated with an analysis of RCTs evaluating interventions for osteoarthritis of the knee. Fixed and random effects second order fractional polynomials were applied to the case study. Network meta-analysis with models that represent the treatment effects in terms of several parameters using fractional polynomials can be considered a useful addition to models for network meta-analysis of repeated measures previously proposed. When RCTs report treatment effects at multiple follow-up times, these models can be used to synthesize the results even if reporting times differ across the studies.

  8. A Meta-Analysis of Studies and Research on Gender and Social Capital

    Directory of Open Access Journals (Sweden)

    Khadijeh Safiri

    2012-10-01

    Full Text Available The purpose of this study, the sociological approach to the study of gender roles and relationships with social capital and its components, the framework deals with social capital theorists. Methods : The study combined quantitative research methods, the meta-analysis, the primary sources of data are extracted and combined, the result is a new whole ; This means that the primary analysis (Preliminary analysis of data to analyze the secondary (re-analysis data to be paid. The meta-analysis method for each of two[ levels significantly (significant Level , size effect (Effect size ] should be extracted and recorded. The extraction of other information (including the theory and research / statistical population and sample size / measuring instruments or questionnaires / evaluation methods such as reliability and validity / conclusions and recommendations of the identified research objective function is achieved. Results : The meta-analysis using the framework document based on a senior thesis (79% and PhD (21%, at public universities (94% and Azad (6%, and the distribution of performed (Thesis / Research, respectively, in the area of ​​ social capital (43%, social trust (32%, and social participation (25% would back such that the meta-analysis of research hypotheses ; First : the relationship between gender and social capital: evidence from the data assimilation and acceptance, while an acceptable correlation between gender and social capital (H1 is in the research. Secondly, the relationship between gender and social trust: evidence from the data assimilation and acceptance, while an acceptable correlation between gender and social trust (H1 is in the research. Thirdly, the relationship between gender and social participation : evidence of heterogeneous data while rejection of acceptable correlation between gender and social participation (H0 is in the research.

  9. Standardizing effect size from linear regression models with log-transformed variables for meta-analysis.

    Science.gov (United States)

    Rodríguez-Barranco, Miguel; Tobías, Aurelio; Redondo, Daniel; Molina-Portillo, Elena; Sánchez, María José

    2017-03-17

    Meta-analysis is very useful to summarize the effect of a treatment or a risk factor for a given disease. Often studies report results based on log-transformed variables in order to achieve the principal assumptions of a linear regression model. If this is the case for some, but not all studies, the effects need to be homogenized. We derived a set of formulae to transform absolute changes into relative ones, and vice versa, to allow including all results in a meta-analysis. We applied our procedure to all possible combinations of log-transformed independent or dependent variables. We also evaluated it in a simulation based on two variables either normally or asymmetrically distributed. In all the scenarios, and based on different change criteria, the effect size estimated by the derived set of formulae was equivalent to the real effect size. To avoid biased estimates of the effect, this procedure should be used with caution in the case of independent variables with asymmetric distributions that significantly differ from the normal distribution. We illustrate an application of this procedure by an application to a meta-analysis on the potential effects on neurodevelopment in children exposed to arsenic and manganese. The procedure proposed has been shown to be valid and capable of expressing the effect size of a linear regression model based on different change criteria in the variables. Homogenizing the results from different studies beforehand allows them to be combined in a meta-analysis, independently of whether the transformations had been performed on the dependent and/or independent variables.

  10. 尼莫地平联合吡拉西坦治疗脑梗死后血管性痴呆的Meta分析%Meta analysis of Nimodipine combined with piracetam in the treatment of vascular dementia after cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    郝敏锋; 任秀; 吴中亮

    2016-01-01

    目的:系统评价尼莫地平联合吡拉西坦对比尼莫地平治疗脑梗死后血管性痴呆的疗效与安全性。方法检索自2000年1月~2016年1月期间维普期刊全文数据库(VIP)、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、中国生物医学期刊引文数据库(CMCI)、web of science (SCI)、PubMed、Springerlink等数据库内关于脑梗死后血管性痴呆的随机对照试验(RCT),用改良后的Jadad量表进行评价并提取资料,然后运用Review Manager 5.3软件及Stata软件对纳入文献进行系统评价。结果最终纳入5篇RCT,共346例患者,其中172例给予尼莫地平(对照组),172例给予尼莫地平和吡拉西坦联合治疗(观察组)。 Meta结果显示,与对照组比较,观察组经6个月治疗后,MMSE评分增高(95%CI:4.40~5.82,Z=14.12,P0.05)。结论尼莫地平联合吡拉西坦治疗脑梗死后血管性痴呆疗效优于单用尼莫地平,不良反应无明显增加。%Objective To evaluate therapeutic efficacy and safety of nimodipine combined with piracetam vs nimodip-ine in the treatment of vascular dementia after cerebral infarction. Methods By searching the randomized controlled tri-al (RCT) about vascular dementia after cerebral infarction from VIP, CNKI, CBM, CMCI, SCI, PubMed, Springerlink database from January 2000 to January 2016. Review Manager 5.3 software and Stata software was used to extract the data after evaluating the quality of documents by modified Jadad scale and conducting Meta-analysis. Results 5 RCT was included, involving 346 patients, of which 172 patients were treated with nimodipine (the observation group), the others was treated with nimodipine combined with piracetam (the control group). Meta-analysis showed that nimodipine combined piracetam increased MMSE score (95%CI4.40-5.82,Z=14.12,P 0.05). Conclusion The efficacy of nimodipine combined with piracetam is better

  11. Nitroglycerin alone and its combination with other drugs for treatment of unstable angina pectoris:A meta-analysis%硝酸甘油单用与联用治疗不稳定性心绞痛疗效的Meta分析

    Institute of Scientific and Technical Information of China (English)

    关秀萍; 黎明丽; 杨柳

    2011-01-01

    about the studies. After the quality of RCTs was evaluated, a meta-analysis was performed by RevMan 5.0.0 for clinical and electrocardiogram (ECG) efficacy.RESULTS AND CONCLUSION: A total of eight RCTs about 715 patients were included, the quality of RCTs are all B level.Meta-analysis indicates that nitroglycerin combined with other drugs is superior to nitroglycerin alone in terms of clinical and ECG efficacy in treating unstable angina pectoris (RR = 0.79, 95%CI: 1.56-3.08, P < 0.01; RR = 0.72, 95%CI: 0.64-0.81, P < 0.01).However, various biases may exist in the above results, so the combined drugs should be chosen according to clinical symptoms and evidence-based guidelines.

  12. Effectiveness and safety of traditional Chinese medical bath therapy combined with ultraviolet irradiation in the treatment of psoriasis: A systematic review and meta-analysis of randomized controlled trials

    OpenAIRE

    Guan, Jingzhi; Yuan, Shaofei; Wu, Hanqimuge; Na, Risu; Wu, Xueqin; Wang, Xin; Bao, Shan

    2017-01-01

    Background and objective To systematically evaluate the clinical effects and safety of traditional Chinese medical bath therapy (TCMBT) combined with ultraviolet irradiation in the treatment of psoriasis. Methods Electronic database retrieval was utilized. The foreign retrieval databases consulted included those of the Cochrane Library, PubMed and EMBASE; the domestic retrieval databases included the Chinese Biomedical Literature Database (Sino-Med), the China National Knowledge Infrastructur...

  13. Meta分析联合运动与有氧运动对2型糖尿病患者血糖控制及并发症危险因素的影响%Effects of combined training versus aerobic training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    侯云英; 汪小华; 李伟; 仇静波

    2013-01-01

    Objective To compare the effects of combined aerobic and resistance training(RT)versus aerobic training (AT) alone on glucose control and risk factors for complications in type 2 diabetic patients.Methods The database was retrieved from PubMed,EMBASE,the Cochrane Library and SportDicus.The randomized controlled trials (RCTs) of CT versus AT on type 2 diabetic patients were included.The data were analyzed with RevMan5.1.Results Six RCTs were included.The meta-analysis showed that compared with AT,CT improved glucose control,blood lipids,and decreased abdoninal fat.The difference of CT versus AT on blood pressure was not found.Conclusions The impact of CT on type 2 diabetic patients is better than AT.%目的 比较有氧运动联合抗阻训练(combined training,CT)与单纯有氧运动(aerobic training,AT)改善2型糖尿病患者血糖控制和并发症危险因素的效果.方法 检索PubMed、EMBASE 等资源,收集比较CT与AT应用于2型糖尿病患者的效果的随机对照实验,以RevMan5.1软件进行统计处理.结果 纳入文献6篇.CT在控制血糖、减少腹部脂肪、改善血脂方面的作用优于AT,两者对血压的影响差异无统计学意义.结论 CT对2型糖尿病患者的干预效果优于AT.

  14. Increased Consumption of Fruit and Vegetables Is Related to a Reduced Risk of Cognitive Impairment and Dementia: Meta-Analysis

    Science.gov (United States)

    Jiang, Xian; Huang, Jiang; Song, Daqiang; Deng, Ru; Wei, Jicheng; Zhang, Zhuo

    2017-01-01

    Background: Increased consumption of fruit and vegetables has been shown to be associated with a reduced risk of cognitive impairment and dementia in many epidemiological studies. The purpose of this study was to assess the strength of this association in a meta-analysis. Methods: We identified relevant studies by searching Medline, Embase, and Cochrane Library electronic databases (from 1970 to January 2016). Study were included if they reported relative risks and corresponding 95% confidence intervals (CIs) of cognitive impairment and dementia with respect to frequency of fruit and vegetable intake. Results: Nine studies (five cohort studies and four cross-sectional studies) met the inclusion criteria and were included in the meta-analysis. There were a total of 31,104 participants and 4,583 incident cases of cognitive impairment and dementia. The meta-analysis showed that an increased consumption of fruit and vegetables was associated with a significant reduction in the risk of cognitive impairment and dementia (OR = 0.80, 95% CI 0.71–0.89). Subgroup analysis indicated this inverse association was only found among participants with mean age over 65 years and combined sexes. Dose–response meta-analysis showed that an increment of 100 g per day of fruit and vegetable consumption was related to an approximately 13% (OR = 0.87, 95% CI 0.77–0.99) reduction in cognitive impairment and dementia risk. There was no potential publication bias in the meta-analysis and the dose–response meta-analysis. Conclusion: The increased consumption of fruit and vegetables is associated with a reduced risk of cognitive impairment and dementia. PMID:28223933

  15. Paramedic determinations of medical necessity: a meta-analysis.

    Science.gov (United States)

    Brown, Lawrence H; Hubble, Michael W; Cone, David C; Millin, Michael G; Schwartz, Brian; Patterson, P Daniel; Greenberg, Brad; Richards, Michael E

    2009-01-01

    Reducing unnecessary ambulance transports may have operational and economic benefits for emergency medical services (EMS) agencies and receiving emergency departments. However, no consensus exists on the ability of paramedics to accurately and safely identify patients who do not require ambulance transport. Objective. This systematic review and meta-analysis evaluated studies reporting U.S. paramedics' ability to determine medical necessity of ambulance transport. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library databases were searched using Cochrane Prehospital and Emergency Care Field search terms combined with the Medical Subject Headings (MeSH) terms "triage"; "utilization review"; "health services misuse"; "severity of illness index," and "trauma severity indices." Two reviewers independently evaluated each title to identify relevant studies; each abstract then underwent independent review to identify studies requiring full appraisal. Inclusion criteria were original research; emergency responses; determinations of medical necessity by U.S. paramedics; and a reference standard comparison. The primary outcome measure of interest was the negative predictive value (NPV) of paramedic determinations. For studies reporting sufficient data, agreement between paramedic and reference standard determinations was measured using kappa; sensitivity, specificity, and positive predictive value (PPV) were also calculated. From 9,752 identified titles, 214 abstracts were evaluated, with 61 studies selected for full review. Five studies met the inclusion criteria (interrater reliability, kappa = 0.75). Reference standards included physician opinion (n = 3), hospital admission (n = 1), and a composite of physician opinion and patient clinical circumstances (n = 1). The NPV ranged from 0.610 to 0.997. Results lacked homogeneity across studies; meta-analysis using a random-effects model produced an aggregate NPV of 0.912 (95

  16. Comparative efficacy of indacaterol 150 µg and 300 µg versus fixed-dose combinations of formoterol + budesonide or salmeterol + fluticasone for the treatment of chronic obstructive pulmonary disease – a network meta-analysis

    OpenAIRE

    Cope, Shannon; Capkun-Niggli,Gorana; Gale,Rupert; Jardim, Jose; Jansen, Jeroen

    2011-01-01

    Shannon Cope1, Gorana Capkun-Niggli2, Rupert Gale3, José R Jardim4, Jeroen P Jansen11Mapi Values, Boston, MA, USA; 2Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Switzerland; 3Novartis Horsham Research Centre, Horsham, UK; 4Respiratory Division, Federal University of São Paulo, BrazilObjective: To compare efficacy of indacaterol to that of fixed-dose combination (FDC) formoterol and budesonide (FOR/BUD) and FDC salmeterol and fluticasone (SAL/FP) for...

  17. Comparative efficacy of indacaterol 150 μg and 300 μg versus fixed-dose combinations of formoterol + budesonide or salmeterol + fluticasone for the treatment of chronic obstructive pulmonary disease – a network meta-analysis

    OpenAIRE

    Cope, Shannon; Capkun-Niggli,Gorana; Gale,Rupert; Jardim, José R; Jansen, Jeroen P

    2011-01-01

    Objective: To compare efficacy of indacaterol to that of fixed-dose combination (FDC) formoterol and budesonide (FOR/BUD) and FDC salmeterol and fluticasone (SAL/FP) for the treatment of chronic obstructive pulmonary disease (COPD) based on the available randomized clinical trials (RCTs). Methods: Fifteen placebo-controlled RCTs were included that evaluated: indacaterol 150 μg (n = 5 studies), indacaterol 300 μg (n = 4), FOR/BUD 9/160 μg (n = 2), FOR/BUD 9/320 μg (n = 3), SAL/FP 50/500 μg (n ...

  18. Smoking and Suicide: A Meta-Analysis

    Science.gov (United States)

    Poorolajal, Jalal; Darvishi, Nahid

    2016-01-01

    Background Many studies have reported a positive association between smoking and suicide, but the results are inconsistent. This meta-analysis was carried out to estimate the association between smoking and suicidal ideation, suicide plan, suicide attempt, and suicide death. Methods Major electronic databases including PubMed, Web of Science, Scopus, and ScienceDirect were searched until May 2015. The reference lists of included studies were screened too. Epidemiological studies addressing the association between smoking and suicidal behaviors were enrolled. The heterogeneity across studies was explored by Q-test and I2 statistic. The possibility of publication bias was assessed using Begg's and Egger's tests and Trim & Fill analysis. The results were reported based on risk ratio (RR) and odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model. Results We identified a total of 8062 references and included 63 studies with 8,063,634 participants. Compared to nonsmokers, the current smokers were at higher risk of suicidal ideation (OR = 2.05; 95% CI: 1.53, 2.58; 8 studies; I2 = 80.8%; P<0.001), suicide plan (OR = 2.36; 95% CI: 1.69, 3.02; 6 studies; I2 = 85.2%; P<0.001), suicide attempt (OR = 2.84; 95% CI: 1.49, 4.19; 5 studies; I2 = 89.6%; (P<0.001), and suicide death (RR = 1.83; 95% CI: 1.64, 2.02; 14 studies; I2 = 49.7%; P = 0.018). Conclusions There is sufficient evidence that smoking is associated with an increased risk of suicidal behaviors. Therefore, smoking is a contributing factor for suicide. Although this association does not imply causation, however, smoking prevention and cessation should be the target of suicide prevention programs. PMID:27391330

  19. Dietary fiber intake reduces risk of inflammatory bowel disease: result from a meta-analysis.

    Science.gov (United States)

    Liu, Xiaoqin; Wu, Yili; Li, Fang; Zhang, Dongfeng

    2015-09-01

    Several epidemiological investigations have been conducted to evaluate the relationship between dietary fiber intake and inflammatory bowel diseases, but the results are inconsistent. This meta-analysis was performed to quantitatively summarize the evidence from observational studies. PubMed, Embase, and Web of Knowledge were searched for relevant articles published up to November 2014. The combined relative risks were calculated with the fixed- or random-effects model. Dose-response relationship was assessed using restricted cubic spline model. We hypothesized that the meta-analysis could yield a summary effect, which would indicate that dietary fiber intake could decrease the risk of ulcerative colitis and Crohn disease (CD). Overall, 8 articles involving 2 cohort studies, 1 nested case-control study, and 5 case-control studies were finally included in this study. The pooled relative risks with 95% confidence intervals of ulcerative colitis and CD for the highest vs lowest categories of dietary fiber intake were 0.80 (0.64-1.00) and 0.44 (0.29-0.69), respectively. A linear dose-response relationship was found between dietary fiber and CD risk, and the risk of CD decreased by 13% (P fiber intake. The results from this meta-analysis indicated that the intake of dietary fiber was significantly associated with a decreased risk of inflammatory bowel disease.

  20. Diagnosis of lower gastrointestinal bleeding by multi-slice CT angiography: A meta-analysis.

    Science.gov (United States)

    He, Bosheng; Yang, Jushun; Xiao, Jing; Gu, Jinhua; Chen, Feixiang; Wang, Lin; Zhao, Chengjin; Qian, Junbo; Gong, Shenchu

    2017-08-01

    To estimate the diagnostic value of multi-slice spiral CT angiography (CTA) in lower gastrointestinal bleeding by a meta-analysis. The relevant clinical studies on the diagnostic value of CTA were searched on PubMed, Embase and other electronic documents databases with the deadline of 2016 September. Language was limited to English. A diagnostic meta-analysis was performed by using Meta-DiSc software. The effect sizes included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) and 95% confidence interval (CI). The Cochran-Q test and I(2) statistic based on χ(2) test were used for estimation of the heterogeneity. Meta-regression was performed to explore the source of heterogeneity. SROC curve was established. A total of 14 articles including 549 patients with lower gastrointestinal bleeding were enrolled in the meta-analysis. The combined PLR, NLR and DOR were respectively 8.149, 0.158 and 56.213. There were significant heterogeneities in all estimations but we could not find the sources by meta-regression based on study design, study location, CT slices and sample size. The AUC and Q index under the fixed effect model was respectively 0.9463 and 0.8856. The multi-slice CTA has high diagnostic value for lower gastrointestinal bleeding. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. The Seroprevalence of Human Cystic Echinococcosis in Iran: A Systematic Review and Meta-Analysis Study

    Directory of Open Access Journals (Sweden)

    Reza Shafiei

    2016-01-01

    Full Text Available Human cystic echinococcosis (HCE, a zoonotic infection of the larval stage of Echinococcus granulosus, has high effect on public health in human population all around the world. Iran is one of the most important endemic areas in the Middle East. This systematic review and meta-analysis was performed to evaluate the seroprevalence of HCE in Iranian population. An electronic search for articles from 1985 until April 2015 was performed using data bases PubMed, Scopus, Google Scholar, Magiran, IranMedex, Iran Doc, and Scientific Information Database (SID both in English and in Persian. A random-effects meta-analysis was used to combine results from individual studies. The information was analyzed by STATA version 11.1. A total of 33 articles met our eligibility criteria and were included in a meta-analysis. The pooled estimate of the prevalence of HCE based on random-effects model was estimated 6.0% (95% CI: 4.0%, 7.0%. The prevalence of the disease significantly increased with age and prevalence rate in males was significantly lower than females (p<0.001. The using of CIE or CCIEP method was also significantly greater than the other methods (p<0.001. There was a publication bias in prevalence of studies. HCE is highly prevalent in Iran. Public education for preventive strategies and finally reducing transmission of the parasite and infection in population is needed.

  2. A random effects variance shift model for detecting and accommodating outliers in meta-analysis.

    Science.gov (United States)

    Gumedze, Freedom N; Jackson, Dan

    2011-02-16

    Meta-analysis typically involves combining the estimates from independent studies in order to estimate a parameter of interest across a population of studies. However, outliers often occur even under the random effects model. The presence of such outliers could substantially alter the conclusions in a meta-analysis. This paper proposes a methodology for identifying and, if desired, downweighting studies that do not appear representative of the population they are thought to represent under the random effects model. An outlier is taken as an observation (study result) with an inflated random effect variance. We used the likelihood ratio test statistic as an objective measure for determining whether observations have inflated variance and are therefore considered outliers. A parametric bootstrap procedure was used to obtain the sampling distribution of the likelihood ratio test statistics and to account for multiple testing. Our methods were applied to three illustrative and contrasting meta-analytic data sets. For the three meta-analytic data sets our methods gave robust inferences when the identified outliers were downweighted. The proposed methodology provides a means to identify and, if desired, downweight outliers in meta-analysis. It does not eliminate them from the analysis however and we consider the proposed approach preferable to simply removing any or all apparently outlying results. We do not however propose that our methods in any way replace or diminish the standard random effects methodology that has proved so useful, rather they are helpful when used in conjunction with the random effects model.

  3. Prevalence of nontuberculous mycobacteria isolated from environmental samples in Iran: A meta-analysis

    Science.gov (United States)

    Khaledi, Azad; Bahador, Abbas; Esmaeili, Davood; Tafazoli, Alireza; Ghazvini, Kiarash; Mansury, Davood

    2016-01-01

    Background: While the most nontuberculous mycobacteria (NTMs) species are considered as opportunistic pathogens, some of them are related to several human infections. It is believed that environment is the main source for these infections. Distribution and scattering pattern of NTMs has not been well studied in Iran and a few studies about this subject have been done, so the aim of this study was to determine prevalence of NTMs in environmental samples from Iran. Materials and Methods: Data about prevalence of NTMs in environmental samples from Iran were obtained by searching databases. The studies presenting cross-sectional or cohort and the papers with sample size ≥30 were included. Then, the meta-analysis was performed using Comprehensive Meta-Analysis software and Cochran's Q and I2 tests. The strategy search was based PRISMA protocol is available online (PRISMA, http://www.prisma-statement.org). Results: The results of this meta-analysis showed that overall combined prevalence of NTMs in environmental samples from Iran was 38.3%. The frequency of NTM was higher in the north of Iran (73.2%). The most prevalent rapid-growing mycobacterium was Mycobacterium fortuitum (19.8%), and the most dominant slow-growing mycobacterium was Mycobacterium flavescens (16.8%). Conclusion: In regard to increasing incidence of disease in immunocompromised patients and existence of different types of mycobacteria species in environmental samples, efforts should be focused on measures that will specifically remove NTMs from habitats where susceptible individuals are exposed. PMID:27904603

  4. Prognosis value of MGMT promoter methylation for patients with lung cancer: a meta-analysis.

    Science.gov (United States)

    Chen, Chao; Hua, Haiqing; Han, Chenglong; Cheng, Yuan; Cheng, Yin; Wang, Zhen; Bao, Jutao

    2015-01-01

    The role of MGMT promoter methylation in lung cancer (LC) remains controversial. To clarify the association of MGMT promoter methylation with survival in LC, we performed a meta-analysis of the literature with meta-analysis. Trials were selected for further analysis if they provided an independent assessment of MGMT promoter methylation in LC and reported the survival data in the context of MGMT promoter methylation status. Subgroup analyses were conducted according to the study characteristic. A total of 9 trials, which comprised 859 patients, were included in the meta-analysis. The combined hazard ratio (HR) of 1.27 [95% CI 0.88-1.82; test for heterogeneity P = 0.027] suggests that MGMT promoter methylation has none impact on patient survival. In Stage I-III or younger populations, a significant association was found for MGMT promoter methylation in the prognosis of LC. In addition, the heterogeneity disappeared when the analysis was restricted to Stage I-III LC. Our analysis indicates that MGMT promoter methylation in stage I-III or younger patients was significantly correlated with wore survival. Further study is needed to determine these specific subgroups of LC patients.

  5. Meta-analysis: Association of Helicobacter pylori infection with Parkinson's diseases.

    Science.gov (United States)

    Shen, Xiaoli; Yang, Huazhen; Wu, Yili; Zhang, Dongfeng; Jiang, Hong

    2017-10-01

    The results from observational studies on the relationship between helicobacter pylori (H. pylori) infection and Parkinson's disease remain controversial. A meta-analysis was conducted to evaluate the association between helicobacter pylori infection and Parkinson's disease. A comprehensive literature search was performed on relevant studies published from January 1983 to January 2017 in PubMed, Web of Science and EMBASE databases. The fixed or random effects model was used to pool the odds ratio with 95% confidence interval from individual studies. Publication bias was estimated by Egger's test and the funnel plot. Eight eligible studies involving 33 125 participants were included in this meta-analysis. Compared with the no helicobacter pylori infected person, the pooled odds ratio of Parkinson's disease in helicobacter pylori infected person was 1.59 (95% confidence interval: 1.37-1.85). In subgroup analyzes, the combined odds ratios were 1.96 (1.23-3.12) in Asia, 1.55 (1.32-1.82) in Europe, 1.59 (1.35-1.88) in case-control studies, 1.56 (1.01-2.39) in cross-sectional studies, 1.56 (1.32-1.85) in studies with confounders adjusted, and 1.71 (1.21-2.43) in studies with no confounder adjusted, respectively. This meta-analysis indicated that H. pylori infection might be associated with the risk of Parkinson's disease. © 2017 John Wiley & Sons Ltd.

  6. Red meat and processed meat consumption and all-cause mortality: a meta-analysis.

    Science.gov (United States)

    Larsson, Susanna C; Orsini, Nicola

    2014-02-01

    High consumption of red meat and processed meat has been associated with increased risk of several chronic diseases. We conducted a meta-analysis to summarize the evidence from prospective studies on red meat and processed meat consumption in relationship to all-cause mortality. Pertinent studies were identified by searching PubMed through May 2013 and by reviewing the reference lists of retrieved articles. Prospective studies that reported relative risks with 95% confidence intervals for the association of red meat or processed meat consumption with all-cause mortality were eligible. Study-specific results were combined by using a random-effects model. Nine prospective studies were included in the meta-analysis. The summary relative risks of all-cause mortality for the highest versus the lowest category of consumption were 1.10 (95% confidence interval (CI): 0.98, 1.22; n = 6 studies) for unprocessed red meat, 1.23 (95% CI: 1.17, 1.28; n = 6 studies) for processed meat, and 1.29 (95% CI: 1.24, 1.35; n = 5 studies) for total red meat. In a dose-response meta-analysis, consumption of processed meat and total red meat, but not unprocessed red meat, was statistically significantly positively associated with all-cause mortality in a nonlinear fashion. These results indicate that high consumption of red meat, especially processed meat, may increase all-cause mortality.

  7. Meta-Analysis of Low Density Lipoprotein Receptor (LDLR rs2228671 Polymorphism and Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Huadan Ye

    2014-01-01

    Full Text Available Low density lipoprotein receptor (LDLR can regulate cholesterol metabolism by removing the excess low density lipoprotein cholesterol (LDL-C in blood. Since cholesterol metabolism is often disrupted in coronary heart disease (CHD, LDLR as a candidate gene of CHD has been intensively studied. The goal of our study is to evaluate the overall contribution of LDLR rs2228671 polymorphism to the risk of CHD by combining the genotyping data from multiple case-control studies. Our meta-analysis is involved with 8 case-control studies among 7588 cases and 9711 controls to test the association between LDLR rs2228671 polymorphism and CHD. In addition, we performed a case-control study of LDLR rs2228671 polymorphism with the risk of CHD in Chinese population. Our meta-analysis showed that rs2228671-T allele was significantly associated with a reduced risk of CHD (P=0.0005, odds ratio (OR = 0.83, and 95% confidence interval (95% CI = 0.75–0.92. However, rs2228671-T allele frequency was rare (1% and was not associated with CHD in Han Chinese (P=0.49, suggesting an ethnic difference of LDLR rs2228671 polymorphism. Meta-analysis has established rs2228671 as a protective factor of CHD in Europeans. The lack of association in Chinese reflects an ethnic difference of this genetic variant between Chinese and European populations.

  8. Association of Helicobacter pylori with Chronic Kidney Diseases: A Meta-Analysis.

    Science.gov (United States)

    Wijarnpreecha, Karn; Thongprayoon, Charat; Nissaisorakarn, Pitchaphon; Jaruvongvanich, Veeravich; Nakkala, Kiran; Rajapakse, Ridhmi; Cheungpasitporn, Wisit

    2017-08-01

    The reported risk of chronic kidney disease (CKD) in patients with Helicobacter pylori infection is conflicting. This meta-analysis was conducted to summarize all available data and to estimate the prevalence and association between H. pylori and kidney disease and CKD. Comprehensive literature review was conducted using MEDLINE and EMBASE database through October 2016 to identify studies that reported the prevalence or the association between H. pylori infection and non-dialysis-dependent kidney diseases or CKD. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Of 4546 studies, nine cross-sectional studies met the eligibility criteria and were included in the meta-analysis. The estimated prevalence of H. pylori infection among subjects with kidney disease was 53% (95% CI 45-61%). The pooled OR of H. pylori in patients with non-dialysis-dependent kidney diseases was 1.20 (95% CI 0.73-1.97) when compared with the patients without kidney diseases. The meta-analysis was then limited to only studies evaluating the risk of H. pylori in CKD; the pooled OR of H. pylori in patients with CKD was 1.00 (95% CI 0.58-1.71). The estimated prevalence of H. pylori in patients with non-dialysis-dependent kidney diseases is 53%. This study does not support the association between H. pylori infection and non-dialysis-dependent kidney diseases nor CKD.

  9. Five-factor model personality traits and inflammatory markers: new data and a meta-analysis.

    Science.gov (United States)

    Luchetti, Martina; Barkley, James M; Stephan, Yannick; Terracciano, Antonio; Sutin, Angelina R

    2014-12-01

    The purpose of this research is to examine the association between five major dimensions of personality and systemic inflammation through (a) new data on C-reactive protein (CRP) from three large national samples of adults that together cover most of the adult lifespan and (b) a meta-analysis of published studies on CRP and interleukin-6 (IL-6). New data (total N=26,305) were drawn from the National Longitudinal Study of Adolescent Health, the Midlife in the United States study, and the Health and Retirement Study. PRISMA guidelines were used for the meta-analysis to combine results of up to seven studies on CRP (N=34,067) and six on IL-6 (N=7538). Across the three new samples, higher conscientiousness was associated with lower CRP. The conscientiousness-CRP relation was virtually identical controlling for smoking; controlling for body mass index attenuated this association but did not eliminate it. Compared to participants in the highest quartile of conscientiousness, participants in the lowest quartile had an up to 50% increased risk of CRP levels that exceeded the clinical threshold (≥3 mg/l). The meta-analysis supported the association between conscientiousness and both CRP and IL-6 and also suggested a negative association between openness and CRP; no associations were found for neuroticism, extraversion and agreeableness. The present work indicates a modest, but consistent, association between conscientiousness and a more favorable inflammatory profile, which may contribute to the role of conscientiousness in better health across the lifespan.

  10. P53 codon 72 polymorphism and ovarian cancer risk: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Zhizhong Zhang; Cuangbo Fu; Meilin Wang; Na Tong; Shizhi Wang; Zhengdong Zhang

    2008-01-01

    Objective: p53 is a tumor suppressor gene and is involved in the etiology of ovarian cancer. Studies investigating the associations between the p53 codon 72 polymorphism and ovarian cancer risk showed conflicting results. We performed this meta-analysis from eligible studies to evaluate this purported relationship. Methods: This meta-analysis was performed from 9 case-control studies, including 825 ovarian cases and 1073 controls. The fixed and random effect models were used to estimate the odds ratios(ORs) for various contrasts of this polymorphism. Results: The combined results based on all studies showed that a significantly decreased risk was associated with the variant Pro/Pro genotype, compared with Arg/Pro+Arg/Arg genotypes(OR, 0.70; 95%CI, 0.51-0.95). When stratifying the studies by ethnicity, we found that individuals with the variant genotype Pro/Pro had a significantly decreased risk of ovarian cancer compared with Arg/Arg genotype(OR, 0.43; 95%CI, 0.20-0.89) and Arg/Pro+Arg/Arg genotypes(OR, 0.61; 95%CI, 0.37-0.99) among Africans. Conclusion: This meta-analysis suggests that the p53 codon 72 polymorphism may contribute to genetic susceptibility to ovarian cancer. More studies based on larger sample size should be performed to confirm the findings.

  11. Opioids contribute to fracture risk: a meta-analysis of 8 cohort studies.

    Science.gov (United States)

    Teng, Zhaowei; Zhu, Yun; Wu, Feihu; Zhu, Yanhong; Zhang, Xiguang; Zhang, Chuanlin; Wang, Shuangneng; Zhang, Lei

    2015-01-01

    To evaluate the association between chronic opioid use for non-cancer pain and fracture risk by conducting a meta-analysis of cohort studies. Cohort studies were identified by searching PubMed and EMBASE from their inception to July 2014. A fracture was considered an endpoint. The information was extracted by two authors independently. When the heterogeneity was significant, a random-effects model was used to calculate the overall pooled risk estimates. Eight cohort studies were included in the final meta-analysis. On the basis of the Newcastle-Ottawa Scale (NOS), six studies were considered to be of high quality. The overall combined relative risk for the use of opioids and fractures was 1.88 (95% confidence interval [CI] 1.51-2.34). A subgroup analysis revealed the sources of heterogeneity. The sensitivity analysis indicated stable results, and no publication bias was observed. This meta-analysis of cohort studies demonstrates that opioids significantly increase the risk of fractures.

  12. Interleukin 1 Polymorphisms Contribute to Intervertebral Disc Degeneration Risk: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Zheng Wang

    Full Text Available We performed a meta-analysis to assess association between interleukin 1 (IL-1 polymorphisms and the risk of Intervertebral Disc Degeneration (IDD.A series of studies have investigated the association between common single nucleotide polymorphisms in IL-1 and IDD risk; however, the overall results are inconclusive.Two independent investigators conducted a systematic search for relevant available studies. Allele frequencies were extracted from each study. The association between the IL-1α (+889C/T or IL-1β (+3954C/T polymorphism and IDD risk was measured by odds ratios (OR with 95% confidence intervals (95% CI.Five and six studies, respectively, were ultimately included in the meta-analysis for the IL-1α (+889C/T and IL-1β (+3954C/T polymorphism. The combined results showed that the IL-1α (+889C/T polymorphism was significantly associated with increased susceptibility to IDD, particularly in Caucasians (TT versus CC: OR = 2.95, 95% CI: 1.45, 6.04; Pheterogeneity = 0.82; TT versusOR = 2.29, 95% CI: 1.18, 4.47; Pheterogeneity = 0.20. In contrast, the IL-1β (+3954C/T polymorphism showed a trend towards increased risk in Caucasians but no association in Asians.This meta-analysis suggested that the IL-1α (+889C/T polymorphism is significantly associated with risk of IDD, especially in Caucasian populations.

  13. The efficacy of trimetazidine on stable angina pectoris: a meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Peng, Song; Zhao, Min; Wan, Jing; Fang, Qi; Fang, Dong; Li, Kaiyong

    2014-12-20

    This meta-analysis aimed to evaluate the efficacy of trimetazidine in combination with other anti-anginal drugs versus other anti-anginal drugs in the treatment of stable angina pectoris (SAP). Randomized controlled trials (RCTs) published in English and Chinese were retrieved from computerized databases: Embase, PubMed, and CNKI. Primary outcomes consist of clinical parameters (numbers of weekly angina attacks and nitroglycerin use) and ergometric parameters (time to 1mm ST-segment depression, and total work (in Mets) and exercise duration (in seconds) at peak exercise) in stable angina pectoris treated by trimetazidine or not. The quality of studies was evaluated using Jadad score. Data analysis of 13 studies was performed using Stata 12.0 software. Results showed that treatment of trimetazidine and other anti-anginal drugs was associated with a smaller weekly mean number of angina attacks (WMD=-0.95, 95%CI: -1.30 to -0.61, Z=5.39, Pangina pectoris. Sensitivity analysis was performed. Sub-group analysis showed that treatment duration was not a significant moderator and patients treated within 8 weeks and above 12 weeks had no difference in the outcomes addressed in this meta-analysis. No publish bias was detected. This meta-analysis confirms the efficacy of trimetazidine in the treatment of stable angina pectoris, in comparison with conventional antianginal agents, regardless of treatment duration.

  14. Combined Application of Gadoxetic Acid Disodium-Enhanced Magnetic Resonance Imaging (MRI and Diffusion-Weighted Imaging (DWI in the Diagnosis of Chronic Liver Disease-Induced Hepatocellular Carcinoma: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Xiang Li

    Full Text Available Gadoxetic acid disodium (Gd-EOB-DTPA is a magnetic resonance imaging (MRI contrast agent to target the liver cells with normal function. In clinical practice, the Gd-EOB-DTPA produces high quality hepatocyte specific image 20 minutes after intravenous injection, so DWI sequence is often performed after the conventional dynamic scanning. However, there are still some disputes about whether DWI sequence will provide more effective diagnostic information in clinical practice. This study aimed to explore the diagnostic value of combining Gd-EOB-DTPA-enhanced MRI and DWI in the detection of hepatocellular carcinoma (HCC in patients with chronic liver disease.A systematic literature search was performed in the PubMed and Cochrane library database up to March 2015. The quality assessment of diagnostic accuracy studies (QUADAS was used to evaluate the quality of studies. Heterogeneous test on the included literature was performed by using the software Review Manager 5.3. The MetaDiSc 1.4 software was used to calculate the pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio; meanwhile the summary receiver operating characteristics (SROC curve was drawn to compare the diagnostic performance.A total of 13 literatures were included in this study. In 8 literatures regarding HCC diagnosis based on Gd-EOB-DTPA-enhanced MRI, the pooled sensitivity: 0.90 (95% confidence interval (CI: 0.88-0.93; specificity: 0.89 (95% CI: 0.85-0.92; positive likelihood ratio: 8.60 (95% CI: 6.20-11.92; negative likelihood ratio: 0.10 (95% CI: 0.08-0.14 were obtained. The area under curve (AUC and Q values were 0.96 and 0.90, respectively. In 5 literatures relating to HCC diagnosis by combination of Gd-EOB-DTPA-enhanced MRI and DWI sequence, the pooled sensitivity: 0.88 (95% CI: 0.85-0.91, specificity: 0.96 (0.94-0.97, positive likelihood ratio: 19.63 (12.77-30.16, negative likelihood ratio: 0.10 (0.07-0.14 were obtained. The AUC value was 0

  15. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.

    Science.gov (United States)

    Franklin, Joseph C; Ribeiro, Jessica D; Fox, Kathryn R; Bentley, Kate H; Kleiman, Evan M; Huang, Xieyining; Musacchio, Katherine M; Jaroszewski, Adam C; Chang, Bernard P; Nock, Matthew K

    2017-02-01

    Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  16. Implementing informative priors for heterogeneity in meta-analysis using meta-regression and pseudo data.

    Science.gov (United States)

    Rhodes, Kirsty M; Turner, Rebecca M; White, Ian R; Jackson, Dan; Spiegelhalter, David J; Higgins, Julian P T

    2016-12-20

    Many meta-analyses combine results from only a small number of studies, a situation in which the between-study variance is imprecisely estimated when standard methods are applied. Bayesian meta-analysis allows incorporation of external evidence on heterogeneity, providing the potential for more robust inference on the effect size of interest. We present a method for performing Bayesian meta-analysis using data augmentation, in which we represent an informative conjugate prior for between-study variance by pseudo data and use meta-regression for estimation. To assist in this, we derive predictive inverse-gamma distributions for the between-study variance expected in future meta-analyses. These may serve as priors for heterogeneity in new meta-analyses. In a simulation study, we compare approximate Bayesian methods using meta-regression and pseudo data against fully Bayesian approaches based on importance sampling techniques and Markov chain Monte Carlo (MCMC). We compare the frequentist properties of these Bayesian methods with those of the commonly used frequentist DerSimonian and Laird procedure. The method is implemented in standard statistical software and provides a less complex alternative to standard MCMC approaches. An importance sampling approach produces almost identical results to standard MCMC approaches, and results obtained through meta-regression and pseudo data are very similar. On average, data augmentation provides closer results to MCMC, if implemented using restricted maximum likelihood estimation rather than DerSimonian and Laird or maximum likelihood estimation. The methods are applied to real datasets, and an extension to network meta-analysis is described. The proposed method facilitates Bayesian meta-analysis in a way that is accessible to applied researchers. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  17. A Western Dietary Pattern Increases Prostate Cancer Risk: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Roberto Fabiani

    2016-10-01

    Full Text Available Dietary patterns were recently applied to examine the relationship between eating habits and prostate cancer (PC risk. While the associations between PC risk with the glycemic index and Mediterranean score have been reviewed, no meta-analysis is currently available on dietary patterns defined by “a posteriori” methods. A literature search was carried out (PubMed, Web of Science to identify studies reporting the relationship between dietary patterns and PC risk. Relevant dietary patterns were selected and the risks estimated were calculated by a random-effect model. Multivariable-adjusted odds ratios (ORs, for a first-percentile increase in dietary pattern score, were combined by a dose-response meta-analysis. Twelve observational studies were included in the meta-analysis which identified a “Healthy pattern” and a “Western pattern”. The Healthy pattern was not related to PC risk (OR = 0.96; 95% confidence interval (CI: 0.88–1.04 while the Western pattern significantly increased it (OR = 1.34; 95% CI: 1.08–1.65. In addition, the “Carbohydrate pattern”, which was analyzed in four articles, was positively associated with a higher PC risk (OR = 1.64; 95% CI: 1.35–2.00. A significant linear trend between the Western (p = 0.011 pattern, the Carbohydrate (p = 0.005 pattern, and the increment of PC risk was observed. The small number of studies included in the meta-analysis suggests that further investigation is necessary to support these findings.

  18. Food and drug cues activate similar brain regions: a meta-analysis of functional MRI studies.

    Science.gov (United States)

    Tang, D W; Fellows, L K; Small, D M; Dagher, A

    2012-06-06

    In healthy individuals, food cues can trigger hunger and feeding behavior. Likewise, smoking cues can trigger craving and relapse in smokers. Brain imaging studies report that structures involved in appetitive behaviors and reward, notably the insula, striatum, amygdala and orbital frontal cortex, tend to be activated by both visual food and smoking cues. Here, by carrying out a meta-analysis of human neuro-imaging studies, we investigate the neural network activated by: 1) food versus neutral cues (14 studies, 142 foci) 2) smoking versus neutral cues (15 studies, 176 foci) 3) smoking versus neutral cues when correlated with craving scores (7 studies, 108 foci). PubMed was used to identify cue-reactivity imaging studies that compared brain response to visual food or smoking cues to neutral cues. Fourteen articles were identified for the food meta-analysis and fifteen articles were identified for the smoking meta-analysis. Six articles were identified for the smoking cue correlated with craving analysis. Meta-analyses were carried out using activation likelihood estimation. Food cues were associated with increased blood oxygen level dependent (BOLD) response in the left amygdala, bilateral insula, bilateral orbital frontal cortex, and striatum. Smoking cues were associated with increased BOLD signal in the same areas, with the exception of the insula. However, the smoking meta-analysis of brain maps correlating cue-reactivity with subjective craving did identify the insula, suggesting that insula activation is only found when craving levels are high. The brain areas identified here are involved in learning, memory and motivation, and their cue-induced activity is an index of the incentive salience of the cues. Using meta-analytic techniques to combine a series of studies, we found that food and smoking cues activate comparable brain networks. There is significant overlap in brain regions responding to conditioned cues associated with natural and drug rewards.

  19. A Western Dietary Pattern Increases Prostate Cancer Risk: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Fabiani, Roberto; Minelli, Liliana; Bertarelli, Gaia; Bacci, Silvia

    2016-01-01

    Dietary patterns were recently applied to examine the relationship between eating habits and prostate cancer (PC) risk. While the associations between PC risk with the glycemic index and Mediterranean score have been reviewed, no meta-analysis is currently available on dietary patterns defined by “a posteriori” methods. A literature search was carried out (PubMed, Web of Science) to identify studies reporting the relationship between dietary patterns and PC risk. Relevant dietary patterns were selected and the risks estimated were calculated by a random-effect model. Multivariable-adjusted odds ratios (ORs), for a first-percentile increase in dietary pattern score, were combined by a dose-response meta-analysis. Twelve observational studies were included in the meta-analysis which identified a “Healthy pattern” and a “Western pattern”. The Healthy pattern was not related to PC risk (OR = 0.96; 95% confidence interval (CI): 0.88–1.04) while the Western pattern significantly increased it (OR = 1.34; 95% CI: 1.08–1.65). In addition, the “Carbohydrate pattern”, which was analyzed in four articles, was positively associated with a higher PC risk (OR = 1.64; 95% CI: 1.35–2.00). A significant linear trend between the Western (p = 0.011) pattern, the Carbohydrate (p = 0.005) pattern, and the increment of PC risk was observed. The small number of studies included in the meta-analysis suggests that further investigation is necessary to support these findings. PMID:27754328

  20. Trait and social anxiety in adults with chronic stuttering: conclusions following meta-analysis.

    Science.gov (United States)

    Craig, Ashley; Tran, Yvonne

    2014-06-01

    The relationship between chronic stuttering and anxiety has been a matter of some debate over the past two decades, with a major emphasis of research focused on examining whether people who stutter have abnormally elevated levels of trait or social anxiety. The major goal of this paper was to perform a systematic literature review and perform meta-analyses on research that has assessed (i) trait anxiety and (ii) social anxiety, in adults who stutter. Only studies that met strict inclusion criteria were selected for the meta-analyses. Two meta-analyses were conducted, the first for trait anxiety, and the second for social anxiety. Meta-analysis combines statistically the results of selected studies that meet strict design criteria, thereby clarifying the size of differences in trait and social anxiety between adults who stutter and adults who do not stutter. Meta-analytic results confirmed that adults with chronic stuttering do have substantially elevated trait and social anxiety. The overall effect size for trait and social anxiety was calculated to be .57 and .82, respectively. Trait and social anxiety are definite problems for many adults who stutter. Clinical implications of these findings for the diagnosis and treatment of adult who stutter are discussed. The reader will be able to: (a) describe the process of conducting a systematic review and meta-analysis; (b) describe the possible impact of publication bias on meta-analysis results; (c) explain the impact of a chronic disorder like stuttering on levels of trait anxiety; (d) explain the impact of stuttering on levels of social anxiety; (e) interpret the results of meta-analysis when applied to differences in anxiety between adult people who stutter and those who do not stutter; and (f) describe implications for fluency enhancing treatments. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Interaction between the FTO gene, body mass index and depression: meta-analysis of 13701 individuals.

    Science.gov (United States)

    Rivera, Margarita; Locke, Adam E; Corre, Tanguy; Czamara, Darina; Wolf, Christiane; Ching-Lopez, Ana; Milaneschi, Yuri; Kloiber, Stefan; Cohen-Woods, Sara; Rucker, James; Aitchison, Katherine J; Bergmann, Sven; Boomsma, Dorret I; Craddock, Nick; Gill, Michael; Holsboer, Florian; Hottenga, Jouke-Jan; Korszun, Ania; Kutalik, Zoltan; Lucae, Susanne; Maier, Wolfgang; Mors, Ole; Müller-Myhsok, Bertram; Owen, Michael J; Penninx, Brenda W J H; Preisig, Martin; Rice, John; Rietschel, Marcella; Tozzi, Federica; Uher, Rudolf; Vollenweider, Peter; Waeber, Gerard; Willemsen, Gonneke; Craig, Ian W; Farmer, Anne E; Lewis, Cathryn M; Breen, Gerome; McGuffin, Peter

    2017-08-01

    BackgroundDepression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.AimsTo confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.MethodThe sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.ResultsIn the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β = 0.12, P = 2.7 × 10(-4)) and with the Han/Eskin random effects method (P = 1.4 × 10(-7)) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10(-8)). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTOConclusionsThis meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression. © The Royal College of Psychiatrists 2017.

  2. Beta-binomial model for meta-analysis of odds ratios.

    Science.gov (United States)

    Bakbergenuly, Ilyas; Kulinskaya, Elena

    2017-01-25

    In meta-analysis of odds ratios (ORs), heterogeneity between the studies is usually modelled via the additive random effects model (REM). An alternative, multiplicative REM for ORs uses overdispersion. The multiplicative factor in this overdispersion model (ODM) can be interpreted as an intra-class correlation (ICC) parameter. This model naturally arises when the probabilities of an event in one or both arms of a comparative study are themselves beta-distributed, resulting in beta-binomial distributions. We propose two new estimators of the ICC for meta-analysis in this setting. One is based on the inverted Breslow-Day test, and the other on the improved gamma approximation by Kulinskaya and Dollinger (2015, p. 26) to the distribution of Cochran's Q. The performance of these and several other estimators of ICC on bias and coverage is studied by simulation. Additionally, the Mantel-Haenszel approach to estimation of ORs is extended to the beta-binomial model, and we study performance of various ICC estimators when used in the Mantel-Haenszel or the inverse-variance method to combine ORs in meta-analysis. The results of the simulations show that the improved gamma-based estimator of ICC is superior for small sample sizes, and the Breslow-Day-based estimator is the best for n⩾100. The Mantel-Haenszel-based estimator of OR is very biased and is not recommended. The inverse-variance approach is also somewhat biased for ORs≠1, but this bias is not very large in practical settings. Developed methods and R programs, provided in the Web Appendix, make the beta-binomial model a feasible alternative to the standard REM for meta-analysis of ORs. © 2017 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  3. Bacterial infection and Alzheimer's disease: a meta-analysis.

    Science.gov (United States)

    Maheshwari, Priya; Eslick, Guy D

    2015-01-01

    The possibility of an infectious etiology for Alzheimer's disease (AD) has been repeatedly postulated over the past three decades. We provide the first meta-analysis to address the relationship between bacterial infection and AD. Studies examining the association between AD and spirochetal bacteria or Chlamydophila pneumoniae (Cpn) were identified through a systematic search of the databases MEDLINE, EMBASE, PubMed, and Google Scholar. Data combined from 25 relevant, primarily case-control studies demonstrated a statistically significant association between AD and detectable evidence of infection of either bacterial group. We found over a ten-fold increased occurrence of AD when there is detectable evidence of spirochetal infection (OR: 10.61; 95% CI: 3.38-33.29) and over a four-fold increased occurrence of AD in a conservative risk estimate (OR: 4.45; 95% CI: 2.33-8.52). We found over a five-fold increased occurrence of AD with Cpn infection (OR: 5.66; 95% CI: 1.83-17.51). This study shows a strongly positive association between bacterial infection and AD. Further detailed investigation of the role of bacterial infection is warranted.

  4. Abreaction for conversion disorder: systematic review with meta-analysis.

    Science.gov (United States)

    Poole, Norman A; Wuerz, Axel; Agrawal, Niruj

    2010-08-01

    The value of drug interviews in the treatment of conversion disorder is at present unknown. To review all the available papers published in English that report on the use of drug interviews for treating conversion/dissociative disorder. Databases (including EMBASE, MEDLINE and PsycINFO) were searched from 1920 to 2009. Selected publications had to report on the use of drug interviews in people diagnosed with a conversion/dissociative disorder. Qualitative and quantitative data were extracted. Predictors of a positive response were ascertained using meta-analytic techniques. Fifty-five papers meeting inclusion criteria were identified. No studies compared the intervention with a suitable control group. However, two studies reported high response rates when drug interview was used in individuals with treatment-resistant conversion disorder. In the meta-analysis, the use of suggestion and occurrence of emotional catharsis during the interview were positively associated with recovery. Combining two medications and comorbid psychiatric disorder were negatively associated with recovery. The evidence for effectiveness of drug interviews is of poor quality but it may be of benefit in the treatment of acute and treatment-resistant conversion disorder. A proactive approach during the interview, making suggestions the individual will respond, could influence outcome. Comorbid psychiatric disorder should be treated conventionally. Experimental studies to determine efficacy are required.

  5. 铝碳酸镁片联合莫沙必利治疗胆汁反流性胃炎疗效的Meta分析%Meta Analysis of Hydrotalcite Tablets Combined with Mosapride for Treating Bile Reflux Gastritis

    Institute of Scientific and Technical Information of China (English)

    谢日升; 曾光

    2016-01-01

    目的:利用循证医学方法,系统评价铝碳酸镁片联合莫沙必利治疗胆汁反流性胃炎的疗效及上腹部饱胀不适缓解率。方法通过计算机检索中文数据库,收集铝碳酸镁片联合莫沙必利片治疗胆汁反流性胃炎临床研究。按纳入及排除标准筛选文献,由2位评价者筛选文献、提取资料并行方法学质量评价,数据分析采用Revman 5.1软件,通过检验异质性,并根据异质性结果选择相应的效应模型,最后绘制漏斗图评定有无发表偏倚。结果治疗组临床治疗有效率[ RR=1.20,95% CI (1.15,1.25)]、上腹饱胀不适缓解率[ MD=-0.38,95% CI (-0.71,-0.05)]方面均优于对照组,两组差异均有统计学意义。结论现有证据表明,铝碳酸镁片联合莫沙必利在治疗胆汁反流性胃炎上有一定疗效。%Objective To systematically evaluate the efficacy and improvement of bloating remission rate of Hydrotalcite Tablets combined with mosapride in the treatment of bile reflux gastritis. Methods The data of the Chinese database were retrieved for clinical trials of hydrotalcite combined with mosapride in treating bile reflux gastritis. According to inclusion and exclusion criteria, 2 reviewers performed the screening, data extraction, and methodological quality assessment. Revman 5. 1 software was used to perform data analysis, by checking the heterogeneity and heterogeneity of the results based on selection the corresponding effects model, to finally draw the funnel for as-sessing whether the publication bias. Results According to the results of meta-analyses, the trial groups were better than the control groups in terms of overall efficacy [ RR=1. 20, 95% CI:1. 15, 1. 25 ] , rate of bloating remission [ MD= -0. 38, 95% CI: -0. 71, -0. 05 ] , with statistically significant difference. Conclusion The results show that Hydrotalcite Tablets combined with mosapride is effective in the treatment of

  6. Effect of combination of valsartan and alprostadil on diabetic nephropathy: A meta-analysis%缬沙坦联合前列地尔治疗糖尿病肾病的meta分析

    Institute of Scientific and Technical Information of China (English)

    卞丽丽; 尚文斌

    2015-01-01

    The randomized controlled trials (RCTs) of treating diabetic nephropathy (DN) with alprostadil and valsartan were collected from CNKI,Wan fang date,VIP,PubMed,Embase,and Cochrane Library.The selected data was analyzed with RevMan 5.1 software.The effect of combination of valsartan and alprostadil in treating DN was evaluated.In 19 RCTs,675 cases were co-treated with alprostadil and valsartan and 670 were treated with valsartan.The results indicated that 24 h urine microalbumin excretion [WMD =-53.23,95% CI (-67.55,-38.91),P<0.01] and24 h urine protein[WMD=-0.38,95% CI(-0.69,-0.07),P=0.02] in patients treated with combination of valsartan and alprostadil were reduced more markedly than in those treated with valsartan alone.There was no significant difference in blood urea nitrogen [WMD =-0.791,95 % CI (-20.62,4.79),P =0.22] and serum creatinine[WMD=-5.82,95% CI(-19.22,7.58),P=0.39] between two kinds of treatment.These results suggest that combined treatment with valsartan and alprostadil shows advantageous effect on reducing urinary protein in DN.%检索中国期刊全文数据库(CNKI)、万方数据在线知识服务平台、中文科技期刊全文数据库(VIP)、Pubmed、Cochrane、Embase公开发表的缬沙坦联合前列地尔治疗糖尿病肾病(DN)的随机对照临床试验(RCT)资料,采用RevMan 5.1软件对纳入资料进行meta分析,评价缬沙坦联合前列地尔对DN的治疗效果.纳入meta分析的文献共19篇,缬沙坦联合前列地尔治疗组675例,缬沙坦组670例.结果显示与单用缬沙坦相比,缬沙坦联合前列地尔治疗降低24 h尿微量白蛋白[WMD=-53.23,95% CI(-67.55,-38.91),P<0.01]和24 h尿蛋白[WMD=-0.38,95% CI(-0.69,-0.07),P=0.02]更显著,而对于尿素氮[WMD=-0.791,95% CI(-20.62,4.79),P=0.22]和血肌酐[WMD=-5.82,95% CI(-19.22,7.58),P=0.39]的影响,两者之间无显著性差异.提示缬沙坦联合前列地尔在降低DN尿蛋白上具有一定的优势.

  7. 小针刀联合玻璃酸钠治疗膝关节骨性关节炎的相关作用机制与Meta分析%Meta analysis and mechanism of small needle knife combined with sodium hyaluronate in the treatment of knee osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    王文献

    2015-01-01

    目的:探讨小针刀联合玻璃酸钠在膝关节骨性关节炎中的临床效果及其相关因素的Meta分析。方法对来我院诊治的80例患者入院资料进行分析,将其随机分为两组。对照组采用玻璃酸钠治疗,实验组联合小针刀治疗,比较两组临床治疗效果及其Meta分析。结果实验组95.0%治疗效果理想,高于对照组(85.0%),差异有统计学意义(P <0.05);实验组95.0%对我院治疗总体满意,高于对照组(P<0.05);实验组关节疼痛指数为(8.6±0.5)分,关节肿胀指数为(9.0±0.3)分,低于对照组(P<0.05);实验组关节活动指数为(9.4±0.1)分,高于对照组(P<0.05);实验组PI-NRS平均分值为3.48,低于对照组(P<0.05);对相关数据采用Meta分析可以看出,小针刀联合玻璃酸钠治疗效果高于常规方法,相关数据分析可知几乎呈现漏斗形,圈中的点呈漏斗形,且OR=4.18大致分布比较均匀,但偏倚较小。结论膝关节骨性关节炎发病率较高,临床上采用小针刀联合玻璃酸钠治疗效果理想,值得推广使用。%Objective To explore the clinical effects of small needle knife combined with sodium hyaluronate in the treatment of knee osteoarthritis and make Meta analysis of relevant factors of that. Methods80 cases of knee osteoarthritis in our hospital were collected and analyzed, and they were randomly allocated to two groups. 40 patients in the control group were treated with sodium hyaluronate, and the another 40 patients in the experimental group ware treated with small needle knife combined with sodium hyaluronate. Clinical effect and Meta analysis between the two groups were compared.Results Ideal treatment effect rate in the experimental group is 95.0%, significantly higher than that of 85.0% in the control group (P<0.05). 95.0% patients in the experimental group were satisfied with the treatment in our hospital, higher

  8. Peginterferon α-2a and adefovir dipivoxil combination therapy for chronic hepatitisB:a Meta-analysis%聚乙二醇干扰素α-2a联合阿德福韦酯治疗慢性乙型肝炎的Meta分析

    Institute of Scientific and Technical Information of China (English)

    吴发玲; 丁洋; 窦晓光

    2012-01-01

    Chronic hepatitis B is caused by hepatitis B virus( HBV) . Antiviral therapy is the key point of delaying the development of the disease. Naive monotherapy with either interferon ( IFN) or nucleotide analogue ( NUC ) failed to achieve sustained remission because of the poor response, YMDD mutation and drug resistance after long-term use. Recently, the notion of combination therapy of IFN and NUC during naive-treatment or on-treatment has been proposed. The clinical trial shows no different short-term efficacy between the combination therapy of peg-IFN ct-2a with lamivudine and the monotherapy of peg-IFN a-2a alone. The combination of Peg-IFN a-2a with telbivudine possibly resulted in peripheral neuropathy. It is necessary to choose different drugs for combination therapy in different stages of treatment. Based on the clinical trials of the combination therapy of peg-IFN a-2a and adefovir dipivoxil( ADV) , controversial results of the efficacy and safety are showed. We performed the meta-analysis to evaluate the efficacy and safety of large sample.%慢性乙型肝炎由乙型肝炎病毒感染所致,首选干扰素(IFN)或核苷(酸)类似物(NUC)单药抗病毒治疗,但IFN单药治疗往往应答率低,NUC长期用药易发生病毒变异,产生耐药,影响疗效,因此提倡联合治疗.目前,联合治疗分为初始联合及治疗中联合,联合药物有NUC联合NUC,或IFN联合NUC.临床试验发现,聚乙二醇干扰素α-2a(Peg-IFNα-2a)联合拉米夫定短期疗效不佳,联合替比夫定可能出现周围神经病变,因此,寻找新的联合治疗方案十分必要.笔者查阅Peg-IFN α-2a联合阿德福韦酯(ADV)治疗CHB的临床试验发现,其疗效和安全性各方评价不一.本文就Peg-IFN α-2a联合ADV治疗CHB有效性和安全性的随机对照试验进行Meta分析,以期为临床用药提供参考.

  9. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls

    Science.gov (United States)

    Simone, B; De Stefano, V; Leoncini, E; Zacho, J; Martinelli, I; Emmerich, J; Rossi, E; Folsom, AR; Almawi, WY; Scarabin, PY; den Heijer, M; Cushman, M; Penco, S; Vaya, A; Angchaisuksiri, P; Okumus, G; Gemmati, D; Cima, S; Akar, N; Oguzulgen, KI; Ducros, V; Lichy, C; Fernandez-Miranda, C; Szczeklik, A; Nieto, JA; Torres, JD; Le Cam-Duchez, V; Ivanov, P; Cantu, C; Shmeleva, VM; Stegnar, M; Ogunyemi, D; Eid, SS; Nicolotti, N; De Feo, E; Ricciardi, W; Boccia, S

    2014-01-01

    BACKGROUND Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden,FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. METHODS We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). RESULTS We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95% confidence intervals [CI]: 0.98–1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR=4.22; 95% CI: 3.35–5.32; and OR=2.79;95% CI: 2.25–3.46, respectively), in double hterozygotes (OR=3.42; 95%CI 1.64-7.13), and in homozygous FVL or PT20210A (OR=11.45; 95%CI: 6.79-19.29; and OR: 2.79; 95%CI: 2.25 – 3.46, respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤45 years (p-value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). CONCLUSIONS In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought. PMID:23900608

  10. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls.

    Science.gov (United States)

    Simone, Benedetto; De Stefano, Valerio; Leoncini, Emanuele; Zacho, Jeppe; Martinelli, Ida; Emmerich, Joseph; Rossi, Elena; Folsom, Aaron R; Almawi, Wassim Y; Scarabin, Pierre Y; den Heijer, Martin; Cushman, Mary; Penco, Silvana; Vaya, Amparo; Angchaisuksiri, Pantep; Okumus, Gulfer; Gemmati, Donato; Cima, Simona; Akar, Nejat; Oguzulgen, Kivilcim I; Ducros, Véronique; Lichy, Christoph; Fernandez-Miranda, Consuelo; Szczeklik, Andrzej; Nieto, José A; Torres, Jose Domingo; Le Cam-Duchez, Véronique; Ivanov, Petar; Cantu-Brito, Carlos; Shmeleva, Veronika M; Stegnar, Mojka; Ogunyemi, Dotun; Eid, Suhair S; Nicolotti, Nicola; De Feo, Emma; Ricciardi, Walter; Boccia, Stefania

    2013-08-01

    Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.

  11. Estimation of the Effect Size of Lactation Sequence and Calving Season on 305-Day Lactation Milk Yield with Meta Analysis Approach

    Directory of Open Access Journals (Sweden)

    Hande Küçükönder

    2014-08-01

    Full Text Available In this study, the effect of the lactation sequence and the calving season, which are one of the factors influencing the milk yield in Holstein Friesian breed cows, were studied with meta-analysis method. Meta-analysis is a statistical technique that allows a re-evaluation of the studies conducted by other researchers for the same purpose by bringing them together. Meta-analysis combines and summarizes the results of the studies conducted on various fields, and contributes in making a common judgment among researchers. For these reasons, the studies of 7 different researchers that have been made in this field were brought together and it was aimed to create a common view about the studied parameters. In addition, the heterogeneity in this study was investigated by Chi-Square and I2 test statistics, and these values were found as ×^2=50.205 and I2= 88%, respectively. Therefore, for combining the studies, the fixed effect model wasn’t used in meta-analysis. In this study, the results of the researchers’ studies’ regarding the subject in question were scanned with meta-analytical screening method, and were combined by using the odds ratio (OR which is the effect size criterion in meta-analysis. As a result of the meta-analysis, the Odds ratio value was found as 0.759 and the effect level was determined middle. With this study conducted, as a result of this meta-analysis conducted, it was found that the contribution done by the lactation sequence on 305-day lactation milk yield in Holstein Friesian cattles in obtaining high milk yield was 0.759 times more compared to the calving season.

  12. Radiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    An-an Yin

    Full Text Available BACKGROUND: Many physicians are reluctant to treat elderly glioblastoma (GBM patients as aggressively as younger patients, which is not evidence based due to the absence of validated data from primary studies. We conducted a meta-analysis to provide valid evidence for the use of the aggressive combination of radiotherapy (RT and temozolomide (TMZ in elderly GBM patients. METHODS: A systematic literature search was conducted using the PubMed, EMBASE and Cochrane databases. Studies comparing combined RT/TMZ with RT alone in elderly patients (≥65 years with newly diagnosed GBM were eligible for inclusion. RESULTS: No eligible randomized trials were identified. Alternatively, a meta-analysis of nonrandomized studies (NRSs was performed, with 16 studies eligible for overall survival (OS analysis and nine for progression-free survival (PFS analysis. Combined RT/TMZ was shown to reduce the risk of death and progression in elderly GBM patients compared with RT alone (OS hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.48-0.72; PFS: HR 0.58, 95% CI 0.41-0.84. Evaluable patients were reported to tolerate combined treatment but certain toxicities, and especially hematological toxicities, were more frequently observed. Limited data on O6-methylguanine-DNA methyltransferase (MGMT promoter status and quality of life were reported. CONCLUSION: The meta-analysis of NRSs provided level 2a evidence (Oxford Centre for Evidence-Based Medicine that combined RT/TMZ conferred a clear survival benefit on a selection of elderly GBM patients who had a favorable prognosis (e.g., extensive resection, favorable KPS. Toxicities were more frequent but acceptable. Future randomized trials are warranted to justify a definitive conclusion.

  13. Formalizing the definition of meta-analysis in Molecular Ecology.

    Science.gov (United States)

    ArchMiller, Althea A; Bauer, Eric F; Koch, Rebecca E; Wijayawardena, Bhagya K; Anil, Ammu; Kottwitz, Jack J; Munsterman, Amelia S; Wilson, Alan E

    2015-08-01

    Meta-analysis, the statistical synthesis of pertinent literature to develop evidence-based conclusions, is relatively new to the field of molecular ecology, with the first meta-analysis published in the journal Molecular Ecology in 2003 (Slate & Phua 2003). The goal of this article is to formalize the definition of meta-analysis for the authors, editors, reviewers and readers of Molecular Ecology by completing a review of the meta-analyses previously published in this journal. We also provide a brief overview of the many components required for meta-analysis with a more specific discussion of the issues related to the field of molecular ecology, including the use and statistical considerations of Wright's FST and its related analogues as effect sizes in meta-analysis. We performed a literature review to identify articles published as 'meta-analyses' in Molecular Ecology, which were then evaluated by at least two reviewers. We specifically targeted Molecular Ecology publications because as a flagship journal in this field, meta-analyses published in Molecular Ecology have the potential to set the standard for meta-analyses in other journals. We found that while many of these reviewed articles were strong meta-analyses, others failed to follow standard meta-analytical techniques. One of these unsatisfactory meta-analyses was in fact a secondary analysis. Other studies attempted meta-analyses but lacked the fundamental statistics that are considered necessary for an effective and powerful meta-analysis. By drawing attention to the inconsistency of studies labelled as meta-analyses, we emphasize the importance of understanding the components of traditional meta-analyses to fully embrace the strengths of quantitative data synthesis in the field of molecular ecology. © 2015 John Wiley & Sons Ltd.

  14. A genome-wide meta-analysis identifies novel loci associated with schizophrenia and bipolar disorder.

    Science.gov (United States)

    Wang, Ke-Sheng; Liu, Xue-Feng; Aragam, Nagesh

    2010-12-01

    Schizophrenia and bipolar disorder both have strong inherited components. Recent studies have indicated that schizophrenia and bipolar disorder may share more than half of their genetic determinants. In this study, we performed a meta-analysis (combined analysis) for genome-wide association data of the Affymetrix Genome-Wide Human SNP array 6.0 to detect genetic variants influencing both schizophrenia and bipolar disorder using European-American samples (653 bipolar cases and 1034 controls, 1172 schizophrenia cases and 1379 controls). The best associated SNP rs11789399 was located at 9q33.1 (p=2.38 × 10(-6), 5.74 × 10(-4), and 5.56 × 10(-9), for schizophrenia, bipolar disorder and meta-analysis of schizophrenia and bipolar disorder, respectively), where one flanking gene, ASTN2 (220kb away) has been associated with attention deficit/hyperactivity disorder and schizophrenia. The next best SNP was rs12201676 located at 6q15 (p=2.67 × 10(-4), 2.12 × 10(-5), 3.88 × 10(-8) for schizophrenia, bipolar disorder and meta-analysis, respectively), near two flanking genes, GABRR1 and GABRR2 (15 and 17kb away, respectively). The third interesting SNP rs802568 was at 7q35 within CNTNAP2 (p=8.92 × 10(-4), 1.38 × 10(-5), and 1.62 × 10(-7) for schizophrenia, bipolar disorder and meta-analysis, respectively). Through meta-analysis, we found two additional associated genes NALCN (the top SNP is rs2044117, p=4.57 × 10(-7)) and NAP5 (the top SNP is rs10496702, p=7.15 × 10(-7)). Haplotype analyses of above five loci further supported the associations with schizophrenia and bipolar disorder. These results provide evidence of common genetic variants influencing schizophrenia and bipolar disorder. These findings will serve as a resource for replication in other populations to elucidate the potential role of these genetic variants in schizophrenia and bipolar disorder.

  15. No association between COMT val158met polymorphism and suicidal behavior: meta-analysis and new data

    Directory of Open Access Journals (Sweden)

    Genis Mendoza Alma D

    2011-09-01

    Full Text Available Abstract Background The polymorphism COMTval158met has been associated with suicidal behavior in case-control and meta-analysis studies, but results and conclusions remain controversial. The objective of this study was to examine the association between COMT val158met with suicidal behavior in a case-control study and to assess the combined evidence -this case-control study and available data from other related studies- we carried out a meta-analysis. Methods We conducted a case-control study with 105 patients with suicide attempts and 236 controls. Subsequently, we performed a meta-analysis of published genetic association studies by searching through Medline, PubMed and Web of Science databases. Results No significant differences were found in the distribution of alleles (χ2 = 0.33, 1 df, p = 0.56 or genotypes (χ2 = 2.36, 2 df, p = 0.26. The meta-analysis comprising 12 association studies (including the present one showed that the risk COMTmet allele of COMTval158/met is not associated with suicidal behavior (OR: 1.09, 95% CI: 0.97-1.23, even in the absence of heterogeneity (OR: 1.09, 95% CI: 0.97-1.23. Conclusion Our results showed no association between COMTval158/met and suicidal behavior. However, more studies are necessary to determine conclusively an association between COMT and suicidal behavior.

  16. Two polymorphisms in the Fractalkine receptor CX3CR1 gene influence the development of atherosclerosis: a meta-analysis.

    Science.gov (United States)

    Wu, Jian; Yin, Rui-Xing; Lin, Quan-Zhen; Guo, Tao; Shi, Guang-Yuan; Sun, Jia-Qi; Shen, Shao-Wen; Li, Qing

    2014-01-01

    The associations between the Fractalkine receptor (CX3CR1) gene T280M (rs3732378) and V249I (rs3732379) polymorphisms and atherosclerosis (AS) risk are conflicting. The aim of this meta-analysis was undertaken to assess their associations. PubMed, Embase, Web of Science, Medline, Cochrane database, and CNKI were searched to get the genetic association studies. All statistical analyses were done with Stata 11.0. Twenty-five articles involving 49 studies were included in the final meta-analysis. The analysis showed that the 280M allele carriers of the CX3CR1 T280M polymorphism decreased the risk of AS and coronary artery disease (CAD) in the heterozygous state but increased the risk of ischemic cerebrovascular disease (ICVD) in the homozygote state. The 249I allele carriers of the CX3CR1 V249I polymorphism decreased the risk of AS and CAD in the heterozygous state. The V249I-T280M combined genotype VITM and IITM also decreased the risk of AS. The present meta-analysis suggests that the CX3CR1 T280M and V249I polymorphisms are associated with the susceptibility to AS. However, the results should be interpreted with caution because of the high heterogeneity in the meta-analysis.

  17. Two Polymorphisms in the Fractalkine Receptor CX3CR1 Gene Influence the Development of Atherosclerosis: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Jian Wu

    2014-01-01

    Full Text Available Background. The associations between the Fractalkine receptor (CX3CR1 gene T280M (rs3732378 and V249I (rs3732379 polymorphisms and atherosclerosis (AS risk are conflicting. The aim of this meta-analysis was undertaken to assess their associations. Methods. PubMed, Embase, Web of Science, Medline, Cochrane database, and CNKI were searched to get the genetic association studies. All statistical analyses were done with Stata 11.0. Results. Twenty-five articles involving 49 studies were included in the final meta-analysis. The analysis showed that the 280M allele carriers of the CX3CR1 T280M polymorphism decreased the risk of AS and coronary artery disease (CAD in the heterozygous state but increased the risk of ischemic cerebrovascular disease (ICVD in the homozygote state. The 249I allele carriers of the CX3CR1 V249I polymorphism decreased the risk of AS and CAD in the heterozygous state. The V249I-T280M combined genotype VITM and IITM also decreased the risk of AS. Conclusions. The present meta-analysis suggests that the CX3CR1 T280M and V249I polymorphisms are associated with the susceptibility to AS. However, the results should be interpreted with caution because of the high heterogeneity in the meta-analysis.

  18. Serum Uric Acid Levels and Diabetic Peripheral Neuropathy in Type 2 Diabetes: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Yu, Shuai; Chen, Ying; Hou, Xu; Xu, Donghua; Che, Kui; Li, Changgui; Yan, Shengli; Wang, Yangang; Wang, Bin

    2016-03-01

    Previous studies suggested a possible association between serum uric acid levels and peripheral neuropathy in patients with type 2 diabetes, but no definite evidence was available. A systematic review and meta-analysis of relevant studies were performed to comprehensively estimate the association. Pubmed, Web of Science, Embase, and China Biology Medicine (CBM) databases were searched for eligible studies. Study-specific data were combined using random-effect or fixed-effect models of meta-analysis according to between-study heterogeneity. Twelve studies were finally included into the meta-analysis, which involved a total of 1388 type 2 diabetic patients with peripheral neuropathy and 4746 patients without peripheral neuropathy. Meta-analysis showed that there were obvious increased serum uric acid levels in diabetic patients with peripheral neuropathy (weighted mean difference [WMD] = 50.03 μmol/L, 95% confidence interval [95%CI] 22.14-77.93, P = 0.0004). Hyperuricemia was also significantly associated with increased risk of peripheral neuropathy in patients with type 2 diabetes (risk ratio [RR] = 2.83, 95%CI 2.13-3.76, P peripheral neuropathy in type 2 diabetic patients (RR = 1.95, 95%CI 1.23-3.11, P = 0.005). Type 2 diabetic patients with peripheral neuropathy have obvious increased serum uric acid levels, and hyperuricemia is associated with increased risk of peripheral neuropathy. Further prospective cohort studies are needed to validate the impact of serum uric acid levels on peripheral neuropathy risk.

  19. Using structural equation modeling for network meta-analysis.

    Science.gov (United States)

    Tu, Yu-Kang; Wu, Yun-Chun

    2017-07-14

    Network meta-analysis overcomes the limitations of traditional pair-wise meta-analysis by incorporating all available evidence into a general statistical framework for simultaneous comparisons of several treatments. Currently, network meta-analyses are undertaken either within the Bayesian hierarchical linear models or frequentist generalized linear mixed models. Structural equation modeling (SEM) is a statistical method originally developed for modeling causal relations among observed and latent variables. As random effect is explicitly modeled as a latent variable in SEM, it is very flexible for analysts to specify complex random effect structure and to make linear and nonlinear constraints on parameters. The aim of this article is to show how to undertake a network meta-analysis within the statistical framework of SEM. We used an example dataset to demonstrate the standard fixed and random effect network meta-analysis models can be easily implemented in SEM. It contains results of 26 studies that directly compared three treatment groups A, B and C for prevention of first bleeding in patients with liver cirrhosis. We also showed that a new approach to network meta-analysis based on the technique of unrestricted weighted least squares (UWLS) method can also be undertaken using SEM. For both the fixed and random effect network meta-analysis, SEM yielded similar coefficients and confidence intervals to those reported in the previous literature. The point estimates of two UWLS models were identical to those in the fixed effect model but the confidence intervals were greater. This is consistent with results from the traditional pairwise meta-analyses. Comparing to UWLS model with common variance adjusted factor, UWLS model with unique variance adjusted factor has greater confidence intervals when the heterogeneity was larger in the pairwise comparison. The UWLS model with unique variance adjusted factor reflects the difference in heterogeneity within each comparison

  20. A meta-analysis of cerebrovascular disease and hyperhomocysteinaemia

    DEFF Research Database (Denmark)

    Nielsen, G M; Tvedegaard, K C; Andersen, Niels Trolle;

    2000-01-01

    Hyperhomocysteinaemia has been identified as a risk factor for stroke and cerebrovascular disease in several studies. To evaluate the evidence we performed a meta-analysis. We found 21 studies searching Medline from 1966-July 1999 using the key words homocysteine, homocystine and cerebrovascular...... was used. The reports on 8 cross-sectional and 4 longitudinal studies gave data on the mean and standard deviations of plasma or serum homocysteine for both cases and controls, and these studies were included in the meta-analysis. The results of the 5 excluded studies all pointed to a positive relationship...

  1. [Meta-analysis on acupoint sticking therapy for facial paralysis].

    Science.gov (United States)

    Zhou, Xian-Gang; Yang, Chuang; Yang, Li-Xia; Zhong, Qu

    2005-11-01

    To evaluate the therapeutic effect and safety of acupoint sticking therapy for facial paralysis. Search the literatures in the whole paper databank of China figure medical library (Jan. 1994-Dec. 2004) and China Biomedical Literature Disk Databank (Jan. 1995-Dec. 2004). Meta-analysis was conducted with RevMan 4. 2. 5 software. Sixteen controlled trials involving 2 157 patients were included. Meta-analysis indicated that there was high statistically difference between the acupoint sticking therapy and simple acupuncture therapy or Western medicine therapy. The acupoint sticking therapy is effective and safe for facial paralysis.

  2. Fixed-dose lercanidipine and enalapril in field practice: a meta-analysis.

    Science.gov (United States)

    Rizzoni, Damiano

    2016-10-01

    This meta-analysis evaluates the efficacy and safety of lercanidipine/enalapril fixed-dose combination in patients with mild to moderate essential hypertension. Four observational studies on patients with sitting diastolic blood pressure (SDBP) between 95 and 109 mmHg, treated with lercanidipine/enalapril fixed-dose combination, were analyzed. The Random-Effect Model was used to limit heterogeneity across the studies. Weights were applied to determine the influence of each study on the combined results. The efficacy outcome measure was the reduction from baseline to endpoint in systolic and diastolic blood pressure (SBP and DBP, respectively). The incidence of treatment-emergent adverse events (TEAEs) was also investigated. The total number of patients analyzed for efficacy and safety was 9565. No differences between study groups in demographics characteristics were observed. Mean blood pressure in the pooled population of the four studies was 162/94 mmHg at baseline. Overall, the lercanidipine/enalapril fixed-dose combination reduced SBP by 26 mmHg (95% CI, 23-29), and DBP by 13 mmHg (12-15), p < 0.05 for both. No safety concerns were reported. This meta-analysis supports the use of the lercanidipine/enalapril fixed-dose combination for the treatment of mild-to-moderate hypertension.

  3. Clinical results of biologic prosthesis: A systematic review and meta-analysis of comparative studies

    Directory of Open Access Journals (Sweden)

    Chumpon Wilasrusmee

    2017-03-01

    Conclusions: Our first meta-analysis indicated that the biosynthetic prosthesis might be benefit over PTFE by increasing graft patency. An updated meta-analysis or a large scale randomized control trial is required to confirm this benefit.

  4. Meta Analysis of Gene Expression Data within and Across Species.

    Science.gov (United States)

    Fierro, Ana C; Vandenbussche, Filip; Engelen, Kristof; Van de Peer, Yves; Marchal, Kathleen

    2008-12-01

    Since the second half of the 1990s, a large number of genome-wide analyses have been described that study gene expression at the transcript level. To this end, two major strategies have been adopted, a first one relying on hybridization techniques such as microarrays, and a second one based on sequencing techniques such as serial analysis of gene expression (SAGE), cDNA-AFLP, and analysis based on expressed sequence tags (ESTs). Despite both types of profiling experiments becoming routine techniques in many research groups, their application remains costly and laborious. As a result, the number of conditions profiled in individual studies is still relatively small and usually varies from only two to few hundreds of samples for the largest experiments. More and more, scientific journals require the deposit of these high throughput experiments in public databases upon publication. Mining the information present in these databases offers molecular biologists the possibility to view their own small-scale analysis in the light of what is already available. However, so far, the richness of the public information remains largely unexploited. Several obstacles such as the correct association between ESTs and microarray probes with the corresponding gene transcript, the incompleteness and inconsistency in the annotation of experimental conditions, and the lack of standardized experimental protocols to generate gene expression data, all impede the successful mining of these data. Here, we review the potential and difficulties of combining publicly available expression data from respectively EST analyses and microarray experiments. With examples from literature, we show how meta-analysis of expression profiling experiments can be used to study expression behavior in a single organism or between organisms, across a wide range of experimental conditions. We also provide an overview of the methods and tools that can aid molecular biologists in exploiting these public data.

  5. Breastfeeding and childhood asthma: systematic review and meta-analysis.

    Science.gov (United States)

    Dogaru, Cristian M; Nyffenegger, Denise; Pescatore, Aniña M; Spycher, Ben D; Kuehni, Claudia E

    2014-05-15

    Asthma and wheezing disorders are common chronic health problems in childhood. Breastfeeding provides health benefits, but it is not known whether or how breastfeeding decreases the risk of developing asthma. We performed a systematic review and meta-analysis of studies published between 1983 and 2012 on breastfeeding and asthma in children from the general population. We searched the PubMed and Embase databases for cohort, cross-sectional, and case-control studies. We grouped the outcomes into asthma ever, recent asthma, or recent wheezing illness (recent asthma or recent wheeze). Using random-effects meta-analyses, we estimated pooled odds ratios of the association of breastfeeding with the risk for each of these outcomes. We performed meta-regression and stratified meta-analyses. We included 117 of 1,464 titles identified by our search. The pooled odds ratios were 0.78 (95% confidence interval: 0.74, 0.84) for 75 studies analyzing "asthma ever," 0.76 (95% confidence interval: 0.67, 0.86) for 46 studies analyzing "recent asthma," and 0.81 (95% confidence interval: 0.76, 0.87) for 94 studies analyzing recent wheezing illness. After stratification by age, the strong protective association found at ages 0-2 years diminished over time. We found no evidence for differences by study design or study quality or between studies in Western and non-Western countries. A positive association of breastfeeding with reduced asthma/wheezing is supported by the combined evidence of existing studies.

  6. Seasonality of cryptosporidiosis: A meta-analysis approach.

    Science.gov (United States)

    Jagai, Jyotsna S; Castronovo, Denise A; Monchak, Jim; Naumova, Elena N

    2009-05-01

    We developed methodology for and conducted a meta-analysis to examine how seasonal patterns of cryptosporidiosis, a primarily waterborne diarrheal illness, relate to precipitation and temperature fluctuations worldwide. Monthly cryptosporidiosis data were abstracted from 61 published epidemiological studies that cover various climate regions based on the Köppen Climate Classification. Outcome data were supplemented with monthly aggregated ambient temperature and precipitation for each study location. We applied a linear mixed-effect model to relate the monthly normalized cryptosporidiosis incidence with normalized location-specific temperature and precipitation data. We also conducted a sub-analysis of associations between the Normalized Difference Vegetation Index (NDVI), a remote sensing measure for the combined effect of temperature and precipitation on vegetation, and cryptosporidiosis in Sub-Saharan Africa. Overall, and after adjusting for distance from the equator, increases in temperature and precipitation predict an increase in cryptosporidiosis; the strengths of relationship vary by climate subcategory. In moist tropical locations, precipitation is a strong seasonal driver for cryptosporidiosis whereas temperature is in mid-latitude and temperate climates. When assessing lagged relationships, temperature and precipitation remain strong predictors. In Sub-Saharan Africa, after adjusting for distance from the equator, low NDVI values are predictive of an increase in cryptosporidiosis in the following month. In this study we propose novel methodology to assess relationships between disease outcomes and meteorological data on a global scale. Our findings demonstrate that while climatic conditions typically define a pathogen habitat area, meteorological factors affect timing and intensity of seasonal outbreaks. Therefore, meteorological forecasts can be utilized to develop focused prevention programs for waterborne cryptosporidiosis.

  7. Psoriasis and suicidality: A systematic review and meta-analysis.

    Science.gov (United States)

    Singh, Sanminder; Taylor, Catherine; Kornmehl, Heather; Armstrong, April W

    2017-09-01

    Psoriasis is associated with psychiatric comorbidities; however, the relationship between psoriasis and suicidality is not well understood. To perform a systematic review and meta-analysis that elucidates the relationship between psoriasis and suicidality. Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched the PubMed, EMBASE, PsycINFO, and Cochrane databases. We searched literature published between 1946 and 2017. We identified 18 studies with a total of 1,767,583 participants, of whom 330,207 had psoriasis. On the basis of random effects modeling, the pooled odds ratio (OR) for suicidal ideation among patients with psoriasis was 2.05 (95% confidence interval [CI], 1.54-2.74). Patients with psoriasis were more likely to exhibit suicidal behaviors (combined attempted and completed suicides) with a pooled OR of 1.26 (95% CI, 1.13-1.40). Subgroup analysis showed that patients with psoriasis were more likely to attempt suicides (OR, 1.32; 95% CI, 1.14-1.54) and complete suicide (OR, 1.20; 95% CI, 1.04-1.39) than those without psoriasis. More severe psoriasis and younger age were associated with greater likelihood of suicidality. There are few studies examining suicidality in conjunction with psoriasis severity. Patients with psoriasis have a significantly higher likelihood of suicidal ideation, suicide attempts, and completed suicides. Among patients with psoriasis, those who are younger and whose psoriasis is more severe are at particular risk for suicidality. Copyright © 2017. Published by Elsevier Inc.

  8. Impact of Instructional Decisions on the Effectiveness of Cooperative Learning in Chemistry through Meta-Analysis

    Science.gov (United States)

    Apugliese, Andrew; Lewis, Scott E.

    2017-01-01

    Meta-analysis can provide a robust description of the impact of educational reforms and also offer an opportunity to explore the conditions where such reforms are more or less effective. This article describes a meta-analysis on the impact of cooperative learning on students' chemistry understanding. Modifiers in the meta-analysis are purposefully…

  9. Impact of Instructional Decisions on the Effectiveness of Cooperative Learning in Chemistry through Meta-Analysis

    Science.gov (United States)

    Apugliese, Andrew; Lewis, Scott E.

    2017-01-01

    Meta-analysis can provide a robust description of the impact of educational reforms and also offer an opportunity to explore the conditions where such reforms are more or less effective. This article describes a meta-analysis on the impact of cooperative learning on students' chemistry understanding. Modifiers in the meta-analysis are purposefully…

  10. Instructional Animation versus Static Pictures: A Meta-Analysis

    Science.gov (United States)

    Hoffler, Tim N.; Leutner, Detlev

    2007-01-01

    A meta-analysis of 26 primary studies, yielding 76 pair-wise comparisons of dynamic and static visualizations, reveals a medium-sized overall advantage of instructional animations over static pictures. The mean weighted effect size on learning outcome is d = 0.37 (95% CI 0.25-0.49). Moderator analyses indicate even more substantial effect sizes…

  11. A meta-analysis of the equity premium

    NARCIS (Netherlands)

    C. van Ewijk; H.L.F. de Groot; A.J. Santing

    2012-01-01

    The equity premium is a key parameter in asset allocation policies. There is a vigorous debate in the literature regarding the actual measurement of the equity premium, its size and the determinants of its variation. This study aims to take stock of this literature by means of a meta-analysis. We id

  12. Formative Assessment and Writing: A Meta-Analysis

    Science.gov (United States)

    Graham, Steve; Hebert, Michael; Harris, Karen R.

    2015-01-01

    To determine whether formative writing assessments that are directly tied to everyday classroom teaching and learning enhance students' writing performance, we conducted a meta-analysis of true and quasi-experiments conducted with students in grades 1 to 8. We found that feedback to students about writing from adults, peers, self, and computers…

  13. Body mass index in Parkinson's disease: a meta-analysis.

    NARCIS (Netherlands)

    Marck, M.A. van der; Dicke, H.C.; Uc, E.Y.; Kentin, Z.H.; Borm, G.F.; Bloem, B.R.; Overeem, S.; Munneke, M.

    2012-01-01

    Prior work suggested that patients with Parkinson's disease (PD) have a lower Body Mass Index (BMI) than controls, but evidence is inconclusive. We therefore conducted a meta-analysis on BMI in PD. We searched MEDLINE, EMBASE, Cinahl and Scopus to identify cohort studies on BMI in PD, published befo

  14. The effectiveness of Multisystemic Therapy (MST) : A meta-analysis

    NARCIS (Netherlands)

    van der Stouwe, Trudy; Asscher, Jessica J.; Stams, Geert Jan J. M.; Dekovic, Maja; van der Laan, Peter H.

    2014-01-01

    Multisystemic Therapy (MST) is a well-established intervention for juvenile delinquents and/or adolescents showing social, emotional and behavioral problems. A multilevel meta-analysis of k = 22 studies, containing 332 effect sizes, consisting of N = 4066 juveniles, was conducted to examine the effe

  15. The relation between empathy and offending: a meta-analysis

    NARCIS (Netherlands)

    M.A.M. van Langen; I.B. Wissink; E.S. van Vugt; T. van der Stouwe; G.J.J.M. Stams

    2014-01-01

    A meta-analysis of k = 38 studies (60 independent effect sizes), including 6631 participants, was conducted to investigate whether differences in cognitive and affective empathy exist between offenders and non-offenders. Cognitive empathy was more strongly associated with offending (d = .43) than af

  16. The effectiveness of Multisystemic Therapy (MST): a meta-analysis

    NARCIS (Netherlands)

    T. van der Stouwe; J.J. Asscher; G.J.J.M. Stams; M. Deković; P.H. van der Laan

    2014-01-01

    Multisystemic Therapy (MST) is a well-established intervention for juvenile delinquents and/or adolescents showing social, emotional and behavioral problems. A multilevel meta-analysis of k = 22 studies, containing 332 effect sizes, consisting of N = 4066 juveniles, was conducted to examine the effe

  17. The Psychological Effects of Meditation: A Meta-Analysis

    Science.gov (United States)

    Sedlmeier, Peter; Eberth, Juliane; Schwarz, Marcus; Zimmermann, Doreen; Haarig, Frederik; Jaeger, Sonia; Kunze, Sonja

    2012-01-01

    In this meta-analysis, we give a comprehensive overview of the effects of meditation on psychological variables that can be extracted from empirical studies, concentrating on the effects of meditation on nonclinical groups of adult meditators. Mostly because of methodological problems, almost 3/4 of an initially identified 595 studies had to be…

  18. The Process Writing Approach: A Meta-Analysis

    Science.gov (United States)

    Graham, Steve; Sandmel, Karin

    2011-01-01

    The process approach to writing instruction is one of the most popular methods for teaching writing. The authors conducted meta-analysis of 29 experimental and quasi-experimental studies conducted with students in Grades 1-12 to examine if process writing instruction improves the quality of students' writing and motivation to write. For students…

  19. Attitudes and Achievement in Statistics: A Meta-Analysis Study

    Science.gov (United States)

    Emmioglu, Esma; Capa-Aydin, Yesim

    2012-01-01

    This study examined the relationships among statistics achievement and four components of attitudes toward statistics (Cognitive Competence, Affect, Value, and Difficulty) as assessed by the SATS. Meta-analysis results revealed that the size of relationships differed by the geographical region in which the studies were conducted as well as by the…

  20. Financial liberalization and economic growth : A meta-analysis

    NARCIS (Netherlands)

    Bumann, Silke; Hermes, Niels; Lensink, Robert

    2013-01-01

    This study provides a systematic analysis of the empirical literature on the relationship between financial liberalization and economic growth by conducting a meta-analysis, based on 441 t-statistics reported in 60 empirical studies. We focus on explaining the heterogeneity of results in our sample

  1. Updated Meta-Analysis of Learner Control within Educational Technology

    Science.gov (United States)

    Karich, Abbey C.; Burns, Matthew K.; Maki, Kathrin E.

    2014-01-01

    Giving a student control over their learning has theoretical and intuitive appeal, but its effects are neither powerful nor consistent in the empirical literature base. This meta-analysis updated previous meta-analytic research by Niemiec, Sikorski, and Walberg by studying the overall effectiveness of providing learner control within educational…

  2. A Meta-analysis of Attachment to Parents and Delinquency

    NARCIS (Netherlands)

    Hoeve, M.; Stams, G.J.J.M.; Put, C.E. van der; Dubas, J.S.; Laan, P.H. van der; Gerris, J.R.M.

    2012-01-01

    To investigate the link between attachment to parents and delinquency, and the potential moderating effects of age and sex, 74 published and unpublished manuscripts (N = 55,537 participants) were subjected to a multilevel meta-analysis. A mean small to moderate effect size was found (r = 0.18). Poor

  3. A meta-analysis of attachment to parents and delinquency

    NARCIS (Netherlands)

    Hoeve, M.; Stams, G.J.J.M.; van der Put, C.E.; Dubas, J.S.; van der Laan, P.H.; Gerris, J.R.M.

    2012-01-01

    To investigate the link between attachment to parents and delinquency, and the potential moderating effects of age and sex, 74 published and unpublished manuscripts (N = 55,537 participants) were subjected to a multilevel meta-analysis. A mean small to moderate effect size was found (r = 0.18). Poor

  4. [The meta-analysis of data from individual patients].

    NARCIS (Netherlands)

    Rovers, M.M.; Reitsma, J.B.

    2012-01-01

    - An IPD (Individual Participant Data) meta-analysis requires collecting original individual patient data and calculating an estimated effect based on these data.- The use of individual patient data has various advantages: the original data and the results of published analyses are verified, compara

  5. The Categorical Perception Deficit in Dyslexia: A Meta-Analysis

    Science.gov (United States)

    Noordenbos, Mark W.; Serniclaes, Willy

    2015-01-01

    Speech perception in dyslexia is characterized by a categorical perception (CP) deficit, demonstrated by weaker discrimination of acoustic differences between phonemic categories in conjunction with better discrimination of acoustic differences within phonemic categories. We performed a meta-analysis of studies that examined the reliability of the…

  6. Contemporary management of frontal sinus mucoceles: a meta-analysis.

    Science.gov (United States)

    Courson, Andy M; Stankiewicz, James A; Lal, Devyani

    2014-02-01

    To analyze trends in the surgical management of frontal and fronto-ethmoid mucoceles through meta-analysis. Meta-analysis and case series. A systematic literature review on surgical management of frontal and fronto-ethmoid mucoceles was conducted. Studies were divided into historical (1975-2001) and contemporary (2002-2012) groups. A meta-analysis of these studies was performed. The historical and contemporary cohorts were compared (surgical approach, recurrence, and complications). To study evolution in surgical management, a senior surgeon's experience over 28 years was analyzed separately. Thirty-one studies were included for meta-analysis. The historical cohort included 425 mucoceles from 11 studies. The contemporary cohort included 542 mucoceles from 20 studies. More endoscopic techniques were used in the contemporary versus historical cohort (53.9% vs. 24.7%; P = contemporary). In the historical cohort, higher recurrence was noted in the external group (P = 0.03). Results from endoscopic and open approaches are comparable. Although endoscopic techniques are being increasingly adopted, comparison with our series shows that more cases could potentially be treated endoscopically. Frequent use of open approaches may reflect efficacy, or perhaps lack of expertise and equipment required for endoscopic management. Most contemporary authors favor endoscopic management, limiting open approaches for specific indications (unfavorable anatomy, lateral disease, and scarring). N/A. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Online Open Neuroimaging Mass Meta-Analysis with a Wiki

    DEFF Research Database (Denmark)

    Nielsen, Finn Arup; Kempton, Matthew J.; Williams, Steven C. R.

    2015-01-01

    We describe a system for meta-analysis where a wiki stores numerical data in a simple comma-separated values format and a web service performs the numerical statistical computation. We initially apply the system on multiple meta-analyses of structural neuroimaging data results. The described system...

  8. Does College Teach Critical Thinking? A Meta-Analysis

    Science.gov (United States)

    Huber, Christopher R.; Kuncel, Nathan R.

    2016-01-01

    Educators view critical thinking as an essential skill, yet it remains unclear how effectively it is being taught in college. This meta-analysis synthesizes research on gains in critical thinking skills and attitudinal dispositions over various time frames in college. The results suggest that both critical thinking skills and dispositions improve…

  9. Lead and Conduct Problems: A Meta-Analysis

    Science.gov (United States)

    Marcus, David K.; Fulton, Jessica J.; Clarke, Erin J.

    2010-01-01

    This meta-analysis examined the association between conduct problems and lead exposure. Nineteen studies on 8,561 children and adolescents were included. The average "r" across all 19 studies was 0.19 (p less than 0.001), which is considered a medium effect size. Studies that assessed lead exposure using hair element analysis yielded…

  10. A Meta-analysis of School Effectiveness Studies

    NARCIS (Netherlands)

    Scheerens, Jaap; Witziers, Bob; Steen, Rien

    2013-01-01

    A meta-analysis was carried out on the basis of 155 research studies on school effectiveness, comprising a total of 1.211 associations between school effectiveness enhancing factors and student outcome variables. The original studies were carried out between 1984 and 2005. The school effectiveness e

  11. The Psychological Effects of Meditation: A Meta-Analysis

    Science.gov (United States)

    Sedlmeier, Peter; Eberth, Juliane; Schwarz, Marcus; Zimmermann, Doreen; Haarig, Frederik; Jaeger, Sonia; Kunze, Sonja

    2012-01-01

    In this meta-analysis, we give a comprehensive overview of the effects of meditation on psychological variables that can be extracted from empirical studies, concentrating on the effects of meditation on nonclinical groups of adult meditators. Mostly because of methodological problems, almost 3/4 of an initially identified 595 studies had to be…

  12. A Meta-analysis of School Effectiveness Studies

    NARCIS (Netherlands)

    Scheerens, Jaap; Witziers, Bob; Steen, Rien

    2013-01-01

    A meta-analysis was carried out on the basis of 155 research studies on school effectiveness, comprising a total of 1.211 associations between school effectiveness enhancing factors and student outcome variables. The original studies were carried out between 1984 and 2005. The school effectiveness e

  13. Effectiveness of Online Discussion Strategies: A Meta-Analysis

    Science.gov (United States)

    Darabi, Aubteen; Liang, Xinya; Suryavanshi, Rinki; Yurekli, Hulya

    2013-01-01

    This study addressed the argument that online courses rarely use discussion strategies that are specifically designed and constructed for soliciting learners' cognitive presence and higher-order thinking. Prompted by this argument, the authors conducted a meta-analysis of the empirical studies that examined the effectiveness of discussion…

  14. Visuo-Spatial Performance in Autism: A Meta-Analysis

    Science.gov (United States)

    Muth, Anne; Hönekopp, Johannes; Falter, Christine M.

    2014-01-01

    Visuo-spatial skills are believed to be enhanced in autism spectrum disorders (ASDs). This meta-analysis tests the current state of evidence for Figure Disembedding, Block Design, Mental Rotation and Navon tasks in ASD and neurotypicals. Block Design (d = 0.32) and Figure Disembedding (d = 0.26) showed superior performance for ASD with large…

  15. Meta-Analysis and Inadequate Responders to Intervention: A Reply

    Science.gov (United States)

    Swanson, H. Lee

    2012-01-01

    A meta-analysis by Tran, Sanchez, Arellano, and Swanson (2011) of the published RTI literature found that the magnitude of effect size (ES) between responders and low responders at posttest was significantly moderated by the pretest ES and the type of dependent measure administered, whereas no significant moderating effects were found in the mixed…

  16. A Meta-Analysis of Extensive Reading Research

    Science.gov (United States)

    Nakanishi, Takayuki

    2015-01-01

    The purposes of this study were to investigate the overall effectiveness of extensive reading, whether learners' age impacts learning, and whether the length of time second language learners engage in extensive reading influences test scores. The author conducted a meta-analysis to answer research questions and to identify future research…

  17. Intervention Studies on Forgiveness: A Meta-Analysis

    Science.gov (United States)

    Baskin, Thomas W.; Enright, Robert D.

    2004-01-01

    In this meta-analysis, 9 published studies (N = 330) that investigated the efficacy of forgiveness interventions within counseling were examined. After a review of theories of forgiveness, it was discovered that the studies could logically be grouped into 3 categories: decision-based, process-based group, and process-based individual…

  18. A Noncentral "t" Regression Model for Meta-Analysis

    Science.gov (United States)

    Camilli, Gregory; de la Torre, Jimmy; Chiu, Chia-Yi

    2010-01-01

    In this article, three multilevel models for meta-analysis are examined. Hedges and Olkin suggested that effect sizes follow a noncentral "t" distribution and proposed several approximate methods. Raudenbush and Bryk further refined this model; however, this procedure is based on a normal approximation. In the current research literature, this…

  19. Illustration of a Multilevel Model for Meta-Analysis

    Science.gov (United States)

    de la Torre, Jimmy; Camilli, Gregory; Vargas, Sadako; Vernon, R. Fox

    2007-01-01

    In this article, the authors present a multilevel (or hierarchical linear) model that illustrates issues in the application of the model to data from meta-analytic studies. In doing so, several issues are discussed that typically arise in the course of a meta-analysis. These include the presence of non-zero between-study variability, how multiple…

  20. The Relationship Between Parenting and Delinquency: A Meta-analysis

    NARCIS (Netherlands)

    Hoeve, M.; Dubas, J.S.; Eichelsheim, V.I.; Laan, P.H. van der; Smeenk, W.H.; Gerris, J.R.M.

    2009-01-01

    This meta-analysis of 161 published and unpublished manuscripts was conducted to determine whether the association between parenting and delinquency exists and what the magnitude of this linkage is. The strongest links were found for parental monitoring, psychological control, and negative aspects

  1. The relationship between parenting and delinquency: A meta-analysis

    NARCIS (Netherlands)

    Hoeve, M.; Dubas, J.S.; Eichelsheim, V.I.; van der Laan, P.H.; Smeenk, W.; Gerris, J.R.M.

    2009-01-01

    This meta-analysis of 161 published and unpublished manuscripts was conducted to determine whether the association between parenting and delinquency exists and what the magnitude of this linkage is. The strongest links were found for parental monitoring, psychological control, and negative aspects

  2. Achievement Goals and Achievement Emotions: A Meta-Analysis

    Science.gov (United States)

    Huang, Chiungjung

    2011-01-01

    This meta-analysis synthesized 93 independent samples (N = 30,003) in 77 studies that reported in 78 articles examining correlations between achievement goals and achievement emotions. Achievement goals were meaningfully associated with different achievement emotions. The correlations of mastery and mastery approach goals with positive achievement…

  3. The Psychophysiology of Posttraumatic Stress Disorder: A Meta-Analysis

    Science.gov (United States)

    Pole, Nnamdi

    2007-01-01

    This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure.…

  4. Identifying Effective Psychological Treatments of Insomnia: A Meta-Analysis.

    Science.gov (United States)

    Murtagh, Douglas R. R.; Greenwood, Kenneth M.

    1995-01-01

    Clarified efficacy of psychological treatments for insomnia through a meta-analysis of 66 outcome studies representing 139 treatment groups. Psychological treatments produced considerable enhancement of both sleep patterns and the subjective experience of sleep. Participants who were clinically referred and who did not regularly use sedatives…

  5. The Categorical Perception Deficit in Dyslexia: A Meta-Analysis

    Science.gov (United States)

    Noordenbos, Mark W.; Serniclaes, Willy

    2015-01-01

    Speech perception in dyslexia is characterized by a categorical perception (CP) deficit, demonstrated by weaker discrimination of acoustic differences between phonemic categories in conjunction with better discrimination of acoustic differences within phonemic categories. We performed a meta-analysis of studies that examined the reliability of the…

  6. Digital Simulation-Based Training: A Meta-Analysis

    Science.gov (United States)

    Gegenfurtner, Andreas; Quesada-Pallarès, Carla; Knogler, Maximilian

    2014-01-01

    This study examines how design characteristics in digital simulation-based learning environments moderate self-efficacy and transfer of learning. Drawing on social cognitive theory and the cognitive theory of multimedia learning, the meta-analysis psychometrically cumulated k?=?15 studies of 25 years of research with a total sample size of…

  7. Creativity and Academic Achievement: A Meta-Analysis

    Science.gov (United States)

    Gajda, Aleksandra; Karwowski, Maciej; Beghetto, Ronald A.

    2017-01-01

    This article reports on a meta-analysis of 120 studies (total N = 52,578; 782 effects) examining the relationship between creativity and academic achievement in research conducted since the 1960s. Average correlation between creativity and academic achievement was r = 0.22, 95% CI [0.19, 0.24]. An analysis of moderators revealed that this…

  8. Lead and Conduct Problems: A Meta-Analysis

    Science.gov (United States)

    Marcus, David K.; Fulton, Jessica J.; Clarke, Erin J.

    2010-01-01

    This meta-analysis examined the association between conduct problems and lead exposure. Nineteen studies on 8,561 children and adolescents were included. The average "r" across all 19 studies was 0.19 (p less than 0.001), which is considered a medium effect size. Studies that assessed lead exposure using hair element analysis yielded…

  9. A Meta-Analysis of Father Involvement in Parent Training

    Science.gov (United States)

    Lundahl, Brad W.; Tollefson, Derrik; Risser, Heather; Lovejoy, M. Christine

    2008-01-01

    Objective: Investigate (a) whether including fathers in parent training enhances outcomes and (b) whether mothers and fathers benefit equally from parent training. Method: Using traditional meta-analysis methodology, 26 studies that could answer the research questions were identified and meta-analyzed. Results: Studies that included fathers,…

  10. Attitudes and Achievement in Statistics: A Meta-Analysis Study

    Science.gov (United States)

    Emmioglu, Esma; Capa-Aydin, Yesim

    2012-01-01

    This study examined the relationships among statistics achievement and four components of attitudes toward statistics (Cognitive Competence, Affect, Value, and Difficulty) as assessed by the SATS. Meta-analysis results revealed that the size of relationships differed by the geographical region in which the studies were conducted as well as by the…

  11. Creativity and Academic Achievement: A Meta-Analysis

    Science.gov (United States)

    Gajda, Aleksandra; Karwowski, Maciej; Beghetto, Ronald A.

    2017-01-01

    This article reports on a meta-analysis of 120 studies (total N = 52,578; 782 effects) examining the relationship between creativity and academic achievement in research conducted since the 1960s. Average correlation between creativity and academic achievement was r = 0.22, 95% CI [0.19, 0.24]. An analysis of moderators revealed that this…

  12. A Meta-Analysis of Massage Therapy Research

    Science.gov (United States)

    Moyer, Christopher A.; Rounds, James; Hannum, James W.

    2004-01-01

    Massage therapy (MT) is an ancient form of treatment that is now gaining popularity as part of the complementary and alternative medical therapy movement. A meta-analysis was conducted of studies that used random assignment to test the effectiveness of MT. Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single…

  13. 肌钙蛋白单独与联合和肽素早期诊断非ST段抬高型心肌梗死临床价值的Meta分析%Meta-analysis for Clinical Values of Troponin Alone and Troponin Combining Copeptin in Early Diagnosis of Non-ST Segment Elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    杨靓淇; 谭向宇; 沈文; 庄力钦; 姜宇; 吴清华

    2016-01-01

    目的:采用Meta分析评价肌钙蛋白单独与联合和肽素早期诊断非ST段抬高型心肌梗死(NSTEMI)的临床价值。方法:计算机检索Medline、EMBASE、Cochrane、Pubmed,中国知网、万方数据库自1995-01起至2015-10公开发表的肌钙蛋白单独及联合和肽素诊断早期NSTEMI的文献,按纳入与排除标准筛选文献,并通过诊断性研究的质量表(QUADAS)评价纳入文献的质量。通过Manager 5.2及Meta-DiSc 1.4软件分析计算肌钙蛋白单独及联合和肽素诊断早期NSTEMI的总敏感性、总特异性,并绘制综合受试者工作曲线(SROC),计算SROC下面积(AUC)。结果:纳入文献11篇,中文1篇。相对于肌钙蛋白对NSTEMI的早期诊断,肌钙蛋白联合和肽素对NSTEMI的早期诊断的总敏感性明显增高(90% vs 75%),但总特异性较低(60% vs 87%)。在SROC曲线中,两种检测方法的AUC均>0.7,但肌钙蛋白联合和肽素对NSTEMI早期诊断的AUC低于肌钙蛋白(0.805 vs 0.891)。结论:肌钙蛋白联合和肽素早期诊断NSTEMI具有更好的敏感性,虽然特异性相对降低,但联合和肽素升高,可提示患者可能合并有其他疾病,如心力衰竭、卒中等,具有重要的临床价值。%Objective: To evaluate the clinical effects of troponin alone and troponin combining copeptin in early diagnosis of Non-ST segment elevation myocardial infarction (NSTEMI) by meta-analysis. Methods: We searched Medline, EMBASE, Cochrane, Pubmed, CNKI and Wanfang database (1995-01 to 2015-10) for the publications of troponin alone and troponin combining copeptin in early diagnosis of NSTEMI. Based on inclusion and exclusion criteria, we screened the literatures and evaluated their quality by QUADAS items. Manager 5.2 and Meta-DiSc 1.4 software were used to study the pooled sensitivity and speciifcity for troponin alone and troponin combining copeptin in NSTEMI early diagnosis, and to calculate the

  14. 吡格列酮联合胰岛素治疗2型糖尿病疗效和安全性的 meta分析%Efficacy of pioglitazone combined with insulin in the trea tment of type 2 diabetes mellitus:a meta-analysis of randomized controlled trials

    Institute of Scientific and Technical Information of China (English)

    王娟; 陈莉明

    2015-01-01

    系统评价联合使用吡格列酮和胰岛素治疗2型糖尿病的疗效和安全性。计算机检索CENTRAL、MEDLINE、EMBASE、CBM、中国知网共5个数据库,截止时间至2014年9月。按照 Cochrane 系统评价方法筛选检索到的所有随机对照试验(RCT),采用 Stata 12.0软件进行 meta 分析。共纳入9篇文献。 meta 分析结果显示:服用吡格列酮联合胰岛素的患者 HbA1C 水平明显低于对照组[SMD 效应值为-0.48,95% CI(-0.55,-0.40),I2=0.0%,P =0.531],而低血糖症发生率略高于对照组[RR 效应值为1.33,95% CI(1.21,1.46),I2=75.4%,P=0.00]。%The efficacy and safety of pioglitazone in combination with insulin in type 2 diabetic patient were evaluated. CENTRAL, MEDLINE, EMBASE, CBM, CNKI(up to September 2014) were searched by computer. The quality of included randomized controlled trials(RCTs)was assessed according to the Cochrane Collaboration system review, and then meta-analysis was performed using Stata 12. 0. A total of 9 RCTs were included. The results of meta-analyses showed that HbA1C value was lower in the group taking pioglitazone plus insulin than in the group taking insulin without pioglitazone[standard mean difference -0. 48, 95% CI( -0. 55, -0. 40),I2 = 0. 0% ,P = 0. 531], but there were more patients with hypoglycaemic in the pioglitazone plus insulin groups than with insulin without pioglitazone[relative risk 1. 33, 95% CI(1. 21, 1. 46), I2 =75. 4% , P=0. 00].

  15. A Meta-analysis on treatment of acute myocardial infarction with Shenmai Injection combining routine therapeutic plan%参麦注射液联合常规治疗方案治疗急性心肌梗死的Meta分析

    Institute of Scientific and Technical Information of China (English)

    马志远; 孙钰; 金艳玲; 蒋林; 王文进

    2013-01-01

    Objective To review the curative effect and safety of Shenmai Injection combining routine therapeutic plan in treatment of ST-segment elevation myocardial infarction (STEMI).Methods The databases of Cochrane Library, PubMed, Embase, CBM, CNKI, and CSJD were retrieved with computers from establishing time of these databases to Jan. 2013, and at the same time other retrieving methods were applied for collecting randomized controlled trials (RCT) about Shenmai Injection combining routine therapeutic plan in treatment of STEMI. The quality of all RCT was reviewed and data was extracted by two researchers independently. A Meta-analysis was conducted by using RevMan 5.2 software.Results There were totally 16 RCT included involving 1886 cases. The results of Meta-analysis showed as follows: compared with routine therapeutic plan, Shenmai Injection combining routine therapeutic plan reduced mortality (OR=0.46, 95%CI: 0.33-0.63,P<0.00001) and incidences of shock (OR=0.56, 95%CI: 0.35~0.89,P=0.01) and heart failure (OR=0.51, 95%CI: 0.37~0.71,P<0.0001), and there was statistical difference in the decrease of incidence of arrhythmia secondary to STEMI (OR=0.37, 95%CI:0.22~0.63,P=0.0003).Conclusion Shenmai Injection combining routine therapeutic plan can reduced mortality and incidences of shock, heart failure and arrhythmia secondary to STEMI in the treatment of STEMI.%目的:系统评价参麦注射液联合常规治疗方案治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效和安全性。方法计算机检索Cochrane Library、PubMed、Embase、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、检索时间从各数据库建库至2013年1月;同时辅助其他检索,纳入参麦注射液联合常规治疗方案治疗STEMI的随机对照实验(RCTs)。两名评价者独立评价纳入研究的质量并提取资料,并用RevMan 5.2软件进行统计分析。结果共纳入16篇RCTs,共1886例患者

  16. Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care: Systematic Review And Meta-analysis.

    Science.gov (United States)

    Chung, Vincent C H; Wu, Xinyin; Lu, Ping; Hui, Edwin P; Zhang, Yan; Zhang, Anthony L; Lau, Alexander Y L; Zhao, Junkai; Fan, Min; Ziea, Eric T C; Ng, Bacon F L; Wong, Samuel Y S; Wu, Justin C Y

    2016-02-01

    Use of Chinese herbal medicines (CHM) in symptom management for cancer palliative care is very common in Chinese populations but clinical evidence on their effectiveness is yet to be synthesized. To conduct a systematic review with meta-analysis to summarize results from CHM randomized controlled trials (RCTs) focusing on symptoms that are undertreated in conventional cancer palliative care.Five international and 3 Chinese databases were searched. RCTs evaluating CHM, either in combination with conventional treatments or used alone, in managing cancer-related symptoms were considered eligible. Effectiveness was quantified by using weighted mean difference (WMD) using random effect model meta-analysis. Fourteen RCTs were included. Compared with conventional intervention alone, meta-analysis showed that combined CHM and conventional treatment significantly reduced pain (3 studies, pooled WMD: -0.90, 95% CI: -1.69 to -0.11). Six trials comparing CHM with conventional medications demonstrated similar effect in reducing constipation. One RCT showed significant positive effect of CHM plus chemotherapy for managing fatigue, but not in the remaining 3 RCTs. The additional use of CHM to chemotherapy does not improve anorexia when compared to chemotherapy alone, but the result was concluded from 2 small trials only. Adverse events were infrequent and mild. CHM may be considered as an add-on to conventional care in the management of pain in cancer patients. CHM could also be considered as an alternative to conventional care for reducing constipation. Evidence on the use of CHM for treating anorexia and fatigue in cancer patients is uncertain, warranting further research.

  17. Hearing impairment and risk of Alzheimer's disease: a meta-analysis of prospective cohort studies.

    Science.gov (United States)

    Zheng, Yuqiu; Fan, Shengnuo; Liao, Wang; Fang, Wenli; Xiao, Songhua; Liu, Jun

    2017-02-01

    Observational studies suggested an association between hearing impairment and cognitive disorders. However, whether hearing impairment is an independent risk factor or a harbinger of Alzheimer's disease remains controversial. Our goal was to assess the association between hearing impairment (HI) and the risk of Alzheimer's disease (AD) by conducting a meta-analysis of prospective cohort studies. We comprehensively searched the PubMed, Embase, Web of Science and Cochrane Library databases on January 19, 2016 to incorporate all the prospective cohort studies meeting the inclusion criteria to perform a systematic review and meta-analysis. Four prospective cohort studies with comparison between hearing impairment and normal hearing were incorporated, with 7461 participants. The outcomes of three studies were the incidence of Alzheimer's disease and the outcome of the fourth study was the incidence of mild cognitive impairment. The overall combined relative risk of people with hearing impairment to develop Alzheimer's disease was 4.87 (95% CI 0.90-26.35; p = 0.066), compared with the control group. Since both Alzheimer's disease and mild cognitive impairment are cognitive disorders, we incorporated all the four studies and the overall combined relative risk was 2.82 (95% CI 1.47-5.42; p = 0.002), indicating that the difference was significant. This meta-analysis suggests that hearing impairment significantly increases the risk of cognitive disorders and future well-designed prospective cohort studies are awaited to confirm the association between hearing impairment and risk of Alzheimer's disease.

  18. Statistical Models and Methods for Network Meta-Analysis.

    Science.gov (United States)

    Madden, L V; Piepho, H-P; Paul, P A

    2016-08-01

    Meta-analysis, the methodology for analyzing the results from multiple independent studies, has grown tremendously in popularity over the last four decades. Although most meta-analyses involve a single effect size (summary result, such as a treatment difference) from each study, there are often multiple treatments of interest across the network of studies in the analysis. Multi-treatment (or network) meta-analysis can be used for simultaneously analyzing the results from all the treatments. However, the methodology is considerably more complicated than for the analysis of a single effect size, and there have not been adequate explanations of the approach for agricultural investigations. We review the methods and models for conducting a network meta-analysis based on frequentist statistical principles, and demonstrate the procedures using a published multi-treatment plant pathology data set. A major advantage of network meta-analysis is that correlations of estimated treatment effects are automatically taken into account when an appropriate model is used. Moreover, treatment comparisons may be possible in a network meta-analysis that are not possible in a single study because all treatments of interest may not be included in any given study. We review several models that consider the study effect as either fixed or random, and show how to interpret model-fitting output. We further show how to model the effect of moderator variables (study-level characteristics) on treatment effects, and present one approach to test for the consistency of treatment effects across the network. Online supplemental files give explanations on fitting the network meta-analytical models using SAS.

  19. Short-term Efficacy and Safety of Paclitaxel Combined with Cisplatin in the Treatment of Advanced Cervix Cancer:a Meta-analysis%紫杉醇联合顺铂辅助治疗中晚期宫颈癌近期疗效与安全性的Meta分析

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    OBJECTIVE:To systematically review the short-term efficacy and safety of paclitaxel combined with cisplatin in the treatment of advanced cervix cancer,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from CJFD,Wanfang database,VIP datebase,Cochrane library and EMBase,the randomized controlled trials(RCT)of paclitaxel+cisplatin(test group)versus surgery alone and/or combined with cisplatin(control group)in the treatment of advanced cervix can-cer were collected,and Meta-analysis was performed by using Rev Man 5.0 statistics software after extracting data and evaluating quality. RESULTS:A total of 9 RCTs were enrolled,involving 1 097 patients. Results of Meta-analysis showed total effective rate [OR=4.12,95%CI(2.91,5.83),P<0.001] in test group was significantly higher than control group,incidence of gastrointestinal re-actions [OR=0.22,95%CI(0.10,0.47),P<0.001] and incidence of alopecia [OR=0.48,95%CI(0.24,0.95),P=0.03] were signifi-cantly lower than control group;there were no significant differences in the incidence of myelosuppression [RR=1.02,95%CI (0.37,2.79),P=0.97] and incidence of allergic reaction[OR=1.87,95%CI(0.18,19.18),P=0.60] between 2 groups. CONCLU-SIONS:Paclitaxel combined with cisplatin has good short-term efficacy in the treatment of advanced cervix cancer,can reduce the incidence of adverse reactions and complications,with good safety. Due to the limit of research methodological quality,high quali-ty and large-scale RCTs are required for further validation of the conclusions.%目的:系统评价紫杉醇联合顺铂辅助治疗中、晚期宫颈癌的近期疗效和安全性,以为临床治疗提供循证参考。方法:计算机检索中国期刊全文数据库、万方数据库、中文科技期刊数据库、Cochrane图书馆、EMBase,收集紫杉醇联合顺铂+手术治疗(试验组)对比其他方式(对照组)治疗中、晚期宫颈癌的随机对照试验(RCT),提取资料

  20. Meta analysis:influence of Ginkgo biloba extract in combination with statins treatment on blood lipid levels in patients with hyperlipidemia%银杏叶制剂联合他汀类药物对高脂血症患者血脂水平影响的Meta分析

    Institute of Scientific and Technical Information of China (English)

    陈盼盼; 李晓艳; 刘杨; 李君

    2014-01-01

    Objective To systematically evaluate the influence of Ginkgo biloba extract (GBE) in combina-tion with statins treatment on blood lipid levels in patients with hyperlipidemia. Methods MEDLINE, EMbase, CENTRAL, Ovid, Wanfang Data, VIP, CNKI and CBM were searched for researches of Randomized Controlled Trials (RCTs) on GBE in combination with statins treatment in patients with hyperlipidemia, with time limited from the data-bases' establishment dates to December 2012. The bibliographies of the included researches were searched as well. Evaluated the included researches basing on the GRADE system, then performed Meta-analysis on the qualified re-searches by adopting RevMan 5.1. Results There was no relevant foreign research since GBE belongs to Chinese medicine. Therefore nine articles were included, with a total of 798 cases. In these researches, patients in the control group were treated with just statins, while patients in the experimental group were treated with statins and GBE. The result of Meta analysis showed that there were statistically significant differences between the lipid levels (TC, TG, LDL-C, HDL-C) of experimental group and those of the control group after treatment [WMD (95%CI) were respec-tively-0.39(-0.49,-0.29),-0.06(-0.08,-0.05),-0.26(-0.34,-0.17), and 0.19(0.16, 0.23)]. Conclusion The Ginkgo biloba extract in combination with statins treatment for hyperlipidemia can significantly reduce the patients' blood lip-id levels, and it had a better clinical effect than that of the statins only treatment.%目的:系统评价银杏叶制剂联合他汀类药物对高脂血症患者血脂水平的影响。方法计算机检索MEDLINE、EMbase、Cochrane Central Register of Controlled Trials (CENTRAL)、Ovid、万方数据库(Wanfang Data)、维普数据库(VlP)、中国知网(CNKI)和中国生物医学文献数据库(CBM)中关于银杏叶制剂联合他汀类药物协同作用于高脂血症患者的研究,同时追索纳入其参考文献。

  1. 复方苦参注射液联合GP方案治疗晚期非小细胞肺癌的Meta分析%Meta-analysis on treatment of advanced non-small cell lung cancer with compound matrine injection in combination with Gemcitabine and Cisplatin chemotherapy

    Institute of Scientific and Technical Information of China (English)

    丰育来; 潘守杰; 杨宁娟; 殷长春

    2015-01-01

    目的:系统评价复方苦参注射液联合GP方案治疗晚期非小细胞肺癌的有效性及安全性。方法计算机检索Cochrane Library、PubMed、中国生物医学文献数据库、中国期刊全文数据库、万方数据库、中文科技期刊全文数据库,检索时限为各数据库建库时间至2012年9月,搜索复方苦参注射液联合GP方案化疗对比单纯GP方案治疗晚期非小细胞肺癌的临床随机对照试验,任何语言的文献都在检索范围之内,由2名评价者独立评价并交叉核对纳入研究质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入12篇随机对照试验。 Meta分析结果显示:与单纯GP方案化疗相比,复方苦参注射液联合GP方案治疗晚期非小细胞肺癌能提高近期疗效[OR=1.39,95%CI(1.08,1.79),P=0.01],改善患者的生活质量[OR=3.29,95%CI(2.30,4.71),P<0.00001],减少白细胞下降[RR=0.45,95%CI(0.31,0.65),P<0.0001],减轻呕吐反应[RR=0.38,95%CI(0.26,0.56),P<0.00001]。结论复方苦参注射液联合GP方案治疗晚期非小细胞肺癌能提高近期疗效,改善患者的生活质量,减少严重的化疗毒副反应。但需要更大样本的临床随机对照试验来进一步证实。%Objective It is to systematically evaluate the effectiveness and safety in the treatment of advanced non-small cell lung cancer (NSCLC).Methods Cochrane library, PubMed, CBM, CNKI, VIP, WANFANG DATA and Traditional Chinese Medicine Database System were searched through computers.The search was finished in September 2012.Random-ized controlled trials ( RCTs) of CMI combining Gemcitabine and Cisplatin chemotherapy ( versus chemotherapy alone) in any language were included.Two researchers extracted data and assess literature quality separately, and made meta-analysis by RevMan 5.2 software.Results Totally 12 RCTs were included.The Meta-analysis

  2. Consumption of red and processed meat and esophageal cancer risk: meta-analysis.

    Science.gov (United States)

    Choi, Yuni; Song, Sujin; Song, Yoonju; Lee, Jung Eun

    2013-02-21

    To summarize the evidence about the association between red and processed meat intake and the risk of esophageal cancer, we systematically searched the PubMed and EMBASE databases up to May 2012, with a restriction to English publications, and the references of the retrieved articles. We combined the study-specific relative risks (RRs) and 95%CI, comparing the highest with the lowest categories of consumption by using a random-effects model. A total of 4 cohort studies and 23 case-control studies were included in the meta-analysis. The combined RRs (95%CI) of the cohort studies comparing the highest and lowest categories were 1.26 (1.00-1.59) for red meat and 1.25 (0.83-1.86) for processed meat. For the case-control studies, the combined RRs (95%CI) comparing the highest and lowest categories were 1.44 (1.16-1.80) for red meat and 1.36 (1.07-1.74) for processed meat. Findings from this meta-analysis suggest that a higher consumption of red meat was associated with a greater risk of esophageal cancer.

  3. Rostral and caudal prefrontal contribution to creativity: A meta-analysis of functional imaging data

    Directory of Open Access Journals (Sweden)

    Gil eGonen-Yaacovi

    2013-08-01

    Full Text Available Creativity is of central importance for human civilization, yet its neurocognitive bases are poorly understood. The aim of the present study was to integrate existing functional imaging data by using the meta-analysis approach. We reviewed 34 functional imaging studies that reported activation foci during tasks assumed to engage creative thinking in healthy adults. A coordinate-based meta-analysis using Activation Likelihood Estimation (ALE first showed a set of predominantly left-hemispheric regions shared by the various creativity tasks examined. These regions included the caudal lateral prefrontal cortex (PFC, the medial and lateral rostral PFC, and the inferior parietal and posterior temporal cortices. Further analyses showed that tasks involving the combination of remote information (combination tasks activated more anterior areas of the lateral PFC than tasks involving the free generation of unusual responses (unusual generation tasks, although both types of tasks shared caudal prefrontal areas. In addition, verbal and non-verbal tasks involved the same regions in the left caudal prefrontal, temporal, and parietal areas, but also distinct domain-oriented areas. Taken together, these findings suggest that several frontal and parieto-temporal regions may support cognitive processes shared by diverse creativity tasks, and that some regions may be specialized for distinct types of processes. In particular, the lateral PFC appeared to be organized along a rostro-caudal axis, with rostral regions involved in combining ideas creatively and more posterior regions involved in freely generating novel ideas.

  4. A novel random effect model for GWAS meta-analysis and its application to trans-ethnic meta-analysis.

    Science.gov (United States)

    Shi, Jingchunzi; Lee, Seunggeun

    2016-09-01

    Meta-analysis of trans-ethnic genome-wide association studies (GWAS) has proven to be a practical and profitable approach for identifying loci that contribute to the risk of complex diseases. However, the expected genetic effect heterogeneity cannot easily be accommodated through existing fixed-effects and random-effects methods. In response, we propose a novel random effect model for trans-ethnic meta-analysis with flexible modeling of the expected genetic effect heterogeneity across diverse populations. Specifically, we adopt a modified random effect model from the kernel regression framework, in which genetic effect coefficients are random variables whose correlation structure reflects the genetic distances across ancestry groups. In addition, we use the adaptive variance component test to achieve robust power regardless of the degree of genetic effect heterogeneity. Simulation studies show that our proposed method has well-calibrated type I error rates at very stringent significance levels and can improve power over the traditional meta-analysis methods. We reanalyzed the published type 2 diabetes GWAS meta-analysis (Consortium et al., 2014) and successfully identified one additional SNP that clearly exhibits genetic effect heterogeneity across different ancestry groups. Furthermore, our proposed method provides scalable computing time for genome-wide datasets, in which an analysis of one million SNPs would require less than 3 hours.

  5. On the relative efficiency of using summary statistics versus individual-level data in meta-analysis.

    Science.gov (United States)

    Lin, D Y; Zeng, D

    2010-06-01

    Meta-analysis is widely used to synthesize the results of multiple studies. Although meta-analysis is traditionally carried out by combining the summary statistics of relevant studies, advances in technologies and communications have made it increasingly feasible to access the original data on individual participants. In the present paper, we investigate the relative efficiency of analyzing original data versus combining summary statistics. We show that, for all commonly used parametric and semiparametric models, there is no asymptotic efficiency gain by analyzing original data if the parameter of main interest has a common value across studies, the nuisance parameters have distinct values among studies, and the summary statistics are based on maximum likelihood. We also assess the relative efficiency of the two methods when the parameter of main interest has different values among studies or when there are common nuisance parameters across studies. We conduct simulation studies to confirm the theoretical results and provide empirical comparisons from a genetic association study.

  6. Efficacy of treatments for anxiety disorders: a meta-analysis.

    Science.gov (United States)

    Bandelow, Borwin; Reitt, Markus; Röver, Christian; Michaelis, Sophie; Görlich, Yvonne; Wedekind, Dirk

    2015-07-01

    To our knowledge, no previous meta-analysis has attempted to compare the efficacy of pharmacological, psychological and combined treatments for the three main anxiety disorders (panic disorder, generalized anxiety disorder and social phobia). Pre-post and treated versus control effect sizes (ES) were calculated for all evaluable randomized-controlled studies (n = 234), involving 37,333 patients. Medications were associated with a significantly higher average pre-post ES [Cohen's d = 2.02 (1.90-2.15); 28,051 patients] than psychotherapies [1.22 (1.14-1.30); 6992 patients; P < 0.0001]. ES were 2.25 for serotonin-noradrenaline reuptake inhibitors (n = 23 study arms), 2.15 for benzodiazepines (n = 42), 2.09 for selective serotonin reuptake inhibitors (n = 62) and 1.83 for tricyclic antidepressants (n = 15). ES for psychotherapies were mindfulness therapies, 1.56 (n = 4); relaxation, 1.36 (n = 17); individual cognitive behavioural/exposure therapy (CBT), 1.30 (n = 93); group CBT, 1.22 (n = 18); psychodynamic therapy 1.17 (n = 5); therapies without face-to-face contact (e.g. Internet therapies), 1.11 (n = 34); eye movement desensitization reprocessing, 1.03 (n = 3); and interpersonal therapy 0.78 (n = 4). The ES was 2.12 (n = 16) for CBT/drug combinations. Exercise had an ES of 1.23 (n = 3). For control groups, ES were 1.29 for placebo pills (n = 111), 0.83 for psychological placebos (n = 16) and 0.20 for waitlists (n = 50). In direct comparisons with control groups, all investigated drugs, except for citalopram, opipramol and moclobemide, were significantly more effective than placebo. Individual CBT was more effective than waiting list, psychological placebo and pill placebo. When looking at the average pre-post ES, medications were more effective than psychotherapies. Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects. However, the decision on whether to choose

  7. Meta-analysis of qualitative studies: a tool for reviewing qualitative research findings in psychotherapy.

    Science.gov (United States)

    Timulak, Ladislav

    2009-07-01

    This article focuses on the presentation of qualitative meta-analysis as a method for reviewing qualitative studies. Qualitative meta-analysis is an attempt to conduct a rigorous secondary qualitative analysis of primary qualitative findings. Its purpose*to provide a more comprehensive description of a phenomenon and an assessment of the influence of the method of investigation on findings*is discussed. The distinctive features of conducting meta-analysis approaches are presented. Several considerations important for conducting qualitative meta-analysis are also discussed. The author uses examples of the first experiences attempted with qualitative meta-analysis in the field of psychotherapy research.

  8. 沙美特罗/氟替卡松吸入剂治疗稳定期COPD疗效的Meta分析%Meta-analysis on the Effect of an Inhaled Combination Therapy with Salmeterol and Fluticasone on COPD in Stabilization Period

    Institute of Scientific and Technical Information of China (English)

    张丽娇; 马列; 凌媛; 毛世涛; 刘朔; 王玲玲; 赵明静; 何晓雨; 王笑歌

    2013-01-01

    目的 从循证医学的角度综合分析沙美特罗/氟替卡松吸入剂治疗稳定期COPD的疗效. 方法 采用Meta分析系统评估方法,综合分析我国2005-2011年累计涉及810例的11篇关于沙美特罗/氟替卡松吸入剂治疗稳定期COPD疗效的文献研究. 结果 共纳入11个研究(2005-2011),其中病例组408例,对照组402例.沙美特罗/氟替卡松吸入剂治疗稳定期COPD患者肺功能明显改善:FEV1:合并SMD值并计算95% CI结果为0.53(0.10,0.95),总体效应检验有统计学意义(Z=2.43,P=0.02);FEV1/FVC:合并SMD值并计算95% CI结果为0.47(0.31,0.63),总体效应检验有统计学意义(Z=5.72,P<0.00001);FEV1%:合并SMD值并计算95% CI结果为1.33(0.68,1.98),总体效应检验有统计学意义(Z=4.02,P<0.0001). 结论 和一般治疗相比较,沙美特罗/氟替卡松吸入剂治疗稳定期COPD患者能有效改善患者肺功能.%Objective To comprehensively analyze the effect of an inhaled combination therapy with salmeterol and fluticasone on COPD in stabilization period by the standard of evidence - based medicine. Methods The evaluation method of meta-analysis system was used to comprehensively analyze 11 documents which involved 810 cases about the effect of an inhaled combination therapy with salmeterol and flutucasone on COPD in stabilization period in China during the period of 2005 - 2011. Results There were 408 patients and 402 controls involved in 11 researches. Lung functions of the patients who treated with the therapy with salmeterol and flutucasone were significantly improved. The combined data statistics revealed that FEV1: the calculated result of standardized mean difference (SMD) and the 95% confidence interval (95% CI) was 0. 53 (0. 10, 0.95) and the test for overall effect showed Z = 2.43, P = 0.02; FEVl/FVC: the calculated result of SMD and the 95 % CI was0.47 (0.31, 0.63) and the test for overall effect showed Z = 5. 72, P<0. 00001; FEV1%: the calculated result of

  9. 柴胡疏肝散联合氟西汀治疗中风后抑郁症随机对照试验的 Meta 分析%Treatment of Post - stroke Depression by Chaihu Shugan San in Combina-tion with Fluoxetine:A Meta - analysis of Randomized Controlled Trials

    Institute of Scientific and Technical Information of China (English)

    王凤姣; 王永德; 刘子旺; 李卫红

    2015-01-01

    Objective To evaluate the effectiveness and safety of Chaihu Shugan San in combination with Fluoxetine as an treatment for Post - stroke depression. Methods Data were retrieved through CNKI, VIP,WanfangDatabase,CBM,PubMed to collect randomized controlled trials of Chaihu Shugan San for Post- stroke depression. All trials were assessed according to the Cochrane Reviewer′s Handbook 5. 1 for System-atic Reviews of Intervention and Meta analyses were performed by RevMan5. 3 Software. Results 12 trials were included in total,involving 900 patients. The Meta analysis showed that when compared with the Fluoxe-tine group,Chaihu Shugan San in combination with Fluoxetine group was superior in improving patients with a Post - stroke depression. And Chaihu Shugan San in combination with Fluoxetine compared with Fluoxetine group showed superior effect over reducing adverse drug events. Funnel figure seemed that there was publica-tion bias. Conclusion According to present evidence,we consider that Chaihu Shugan San in combination with Fluoxetine may be effective in treating Post - stroke depression. However,given the quality of current re-search is low,it needs more high quality studies to confirm the results of this study to enhance the strength of the evidence.%目的:评价柴胡疏肝散联合氟西汀治疗中风后抑郁症的有效性及安全性。方法计算机检索中国期刊全文数据库、中文科技期刊数据库、万方数据库、中国生物医学数据库、PubMed,筛选出柴胡疏肝散治疗中风后抑郁症的随机对照试验;根据 Cochrane Reviewer′s Handbook 5.1评价标准和工具对纳入研究进行质量评价,用 RevMan5.3软件进行 Meta 分析。结果本研究共纳入12个随机对照试验,共900例。Meta 分析结果显示柴胡疏肝散联合氟西汀组治疗脑卒中后抑郁症在汉密尔顿抑郁量表(HAMD)评分、临床疗效、神经功能缺损程度评分方面优于氟西汀组;胃肠道及自主

  10. Meta analysis of chemotherapy combination with radiotherapy versus radiotherapy alone in the treatment of locally advanced cervical carcinoma%同步放化疗与单纯放疗治疗局部晚期宫颈癌的Meta分析

    Institute of Scientific and Technical Information of China (English)

    张蕾; 唐杰; 张娟娟

    2014-01-01

    Objective To systematically assess the efficacy of chemotherapy combination with radiotherapy versus radiotherapy alone in the treatment of locally advanced cervical carcinoma. Methods We searched Embase, Pubmed, the Cochrane Library, VIP, CNKI, Chinese biomedicine literature database for randomized controlled trials comparing chemotherapy combination with radiotherapy versus radiotherapy alone in the treatment of locally advanced cervical carcinoma. Two reviewers independently assessed the quality of included studies and extracted data. We analyzed the data using Review Manager (version 5.1). Results Ten randomized controlled trials totaling were included. Meta analysis showed that there was statistical difference between the radiotherapy alone group and chemotherapy combination with radiotherapy group in overall survival rate (RR=1.17, 95% CI: 1.10-1.24) and overall response rate (RR=1.24, 95%CI:1.16-1.33). Conclusion Current evidence indicated that compared with radiotherapy alone, chemotherapy combination with radiotherapy could improve overall survival rate (RR=1.17, 95%CI:1.10-1.24) and overall response rate for patient with locally advanced cervical carcinoma.%目的:系统评价同步放化疗和单纯放疗治疗宫颈癌的有效性。方法计算机检索Cochrane Library、PubMed、Embase、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库。全面查找有关同步放化疗和单纯放疗治疗宫颈癌的随机对照试验,两名评价者单独评价纳入研究的方法学质量并提取资料,用RevMan 5.1软件进行Meta分析。结果共纳入文献10篇, Meta分析结果显示:同步放化疗组和单纯放疗组比较,两组在总生存率方面差异有统计学意义(RR=1.17,95%CI:1.10~1.24),两组在总有效率方面差异有统计学意义(RR=1.24,95%CI:1.16~1.33)。结论当前临床证据表明与单纯放疗相比,同步放化疗可提高局部晚

  11. Therapeutic Hypothermia for Neonatal Encephalopathy in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

    OpenAIRE

    2013-01-01

    UNLABELLED: Although selective or whole body cooling combined with optimal intensive care improves outcomes following neonatal encephalopathy in high-income countries, the safety and efficacy of cooling in low-and middle-income countries is not known. OBJECTIVE: We performed a systematic review and meta-analysis of all published randomised or quasi-randomised controlled trials of cooling therapy for neonatal encephalopathy in low-and middle-income countries. RESULTS: Seven trials, comprising ...

  12. Prevalence of nontuberculous mycobacteria isolated from environmental samples in Iran: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Azad Khaledi

    2016-01-01

    Full Text Available Background: While the most nontuberculous mycobacteria (NTMs species are considered as opportunistic pathogens, some of them are related to several human infections. It is believed that environment is the main source for these infections. Distribution and scattering pattern of NTMs has not been well studied in Iran and a few studies about this subject have been done, so the aim of this study was to determine prevalence of NTMs in environmental samples from Iran. Materials and Methods: Data about prevalence of NTMs in environmental samples from Iran were obtained by searching databases. The studies presenting cross-sectional or cohort and the papers with sample size ≥30 were included. Then, the meta-analysis was performed using Comprehensive Meta-Analysis software and Cochran′s Q and I2 tests. The strategy search was based PRISMA protocol is available online (PRISMA, http://www.prisma-statement.org. Results : The results of this meta-analysis showed that overall combined prevalence of NTMs in environmental samples from Iran was 38.3%. The frequency of NTM was higher in the north of Iran (73.2%. The most prevalent rapid-growing mycobacterium was Mycobacterium fortuitum (19.8%, and the most dominant slow-growing mycobacterium was Mycobacterium flavescens (16.8%. Conclusion: In regard to increasing incidence of disease in immunocompromised patients and existence of different types of mycobacteria species in environmental samples, efforts should be focused on measures that will specifically remove NTMs from habitats where susceptible individuals are exposed.

  13. Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies.

    Science.gov (United States)

    Yang, Ping; Zhou, Yong; Chen, Bo; Wan, Hong-Wei; Jia, Gui-Qing; Bai, Hai-Long; Wu, Xiao-Ting

    2009-11-01

    The relationship between excess body weight and gastric cancer risk has not been well studied to date. We therefore carried out a systematic review and meta-analysis of published cohort studies to evaluate the association between excess body weight and gastric cancer risk. An electronic search of the MEDLINE, PubMed, EMBASE and Academic Search Premier (EBSCO) databases, which contain articles published from 1950 onwards, was conducted in order to select studies for this meta-analysis. Ten studies with a total number of 9492 gastric cancer cases and a studied population of 3,097,794 were identified. Overall, excess body weight [body mass index (BMI)25] was associated with an increased risk of gastric cancer [odds ratio (OR)=1.22; 95% confidence intervals (CIs)=1.06-1.41]. Specifically, a stratified analysis showed that excess body weight was associated with an increased risk of cardia gastric cancer [overweight and obese (BMI 25), OR=1.55, 95% CIs=1.31-1.84] and gastric cancer among non-Asians (overweight and obese, OR=1.24, 95% CIs=1.14-1.36); however, the stratified analysis also showed that there was no statistically significant link between excess body weight and gastric cancer in the following subgroups: males (overweight and obese, OR=1.22, 95% CIs=0.96-1.55), females (overweight and obese, OR=1.13, 95% CIs=0.65-1.94), non-cardia gastric cancer (overweight and obese, OR=1.18, 95% CIs=0.96-1.45) and Asians (overweight and obese, OR=1.17, 95% CIs=0.88-1.56). The combined results of this meta-analysis, however, do indicate that overweight and obesity are associated with an increased risk of gastric cancer. The strength of the association also increases with increasing BMI.

  14. Interleukin-8 for diagnosis of neonatal sepsis: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Min Zhou

    Full Text Available Neonatal sepsis (NS is a life-threatening disorder and an important cause of morbidity and mortality in neonates. Previous studies showed that interleukin 8 (IL-8 may effectively and rapidly diagnose NS.We conducted the systematic review and meta-analysis to investigate the diagnostic value of the IL-8 in NS.The literature was searched in PUBMED, EMBASE, Cochrane Library, CNKI, VIP and other Chinese Medical Databases during October 1998 to January 2014 using set search criteria. Each included study was evaluated by quality assessment of diagnostic accuracy studies tool. Two investigators independently extracted the data and study characteristics, and disagreements, if any, were resolved by consensus. Meta-disc software was used to calculate the pooled sensitivity, specificity and summary diagnostic odds ratio (SDOR, I² or Cochrane Q to test heterogeneity, and meta-regression to investigate the source of heterogeneity. Funnel plots were used to test the potential presence of publication bias. False-positive report probability (FPRP was calculated to confirm the significance of the results.Eight studies (548 neonates were included in this meta-analysis. The pooled sensitivity and specificity of IL-8 were 0.78 and 0.84, respectively, which had moderate accuracy in the diagnosis of NS. The pooled diagnostic odds ratio (DOR and area under curve (AUC was 21.64 and 0.8908 (Q*=0.8215, respectively. The diagnostic threshold analysis showed that there was no threshold effect. The meta-regression analysis showed the cut-off, QUADAS and onset time have no effect on the heterogeneity. The funnel plots showed the existence of publication bias.Meta-analysis showed IL-8 had a moderate accuracy (AUC=0.8908 for the diagnosis of NS. IL-8 is a helpful biomarker for early diagnosis of NS. However, we should combine the results with clinical symptoms and signs, laboratory and microbial results.

  15. A Healthy Dietary Pattern Reduces Lung Cancer Risk: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yanlai Sun

    2016-03-01

    Full Text Available Background: Diet and nutrients play an important role in cancer development and progress; a healthy dietary pattern has been found to be associated with several types of cancer. However, the association between a healthy eating pattern and lung cancer risk is still unclear. Objective: Therefore, we conducted a systematic review with meta-analysis to evaluate whether a healthy eating pattern might reduce lung cancer risk. Methods: We identified relevant studies from the PubMed and Embase databases up to October 2015, and the relative risks were extracted and combined by the fixed-effects model when no substantial heterogeneity was observed; otherwise, the random-effects model was employed. Subgroup and publication bias analyses were also performed. Results: Finally, eight observational studies were included in the meta-analysis. The pooled relative risk of lung cancer for the highest vs. lowest category of healthy dietary pattern was 0.81 (95% confidence interval, CI: 0.75–0.86, and no significant heterogeneity was detected. The relative risks (RRs for non-smokers, former smokers and current smokers were 0.89 (95% CI: 0.63–1.27, 0.74 (95% CI: 0.62–0.89 and 0.86 (95% CI: 0.79–0.93, respectively. The results remained stable in subgroup analyses by other confounders and sensitivity analysis. Conclusions: The results of our meta-analysis suggest that a healthy dietary pattern is associated with a lower lung cancer risk, and they provide more beneficial evidence for changing the diet pattern in the general population.

  16. Tooth erosion and eating disorders: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Ana Paula Hermont

    Full Text Available BACKGROUND: Eating disorders are associated with the highest rates of morbidity and mortality of any mental disorders among adolescents. The failure to recognize their early signs can compromise a patient's recovery and long-term prognosis. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders. OBJECTIVES: The aim of this systematic review and meta-analysis was to search for scientific evidence regarding the following clinical question: Do eating disorders increase the risk of tooth erosion? METHODS: An electronic search addressing eating disorders and tooth erosion was conducted in eight databases. Two independent reviewers selected studies, abstracted information and assessed its quality. Data were abstracted for meta-analysis comparing tooth erosion in control patients (without eating disorders vs. patients with eating disorders; and patients with eating disorder risk behavior vs. patients without such risk behavior. Combined odds ratios (ORs and a 95% confidence interval (CI were obtained. RESULTS: Twenty-three papers were included in the qualitative synthesis and assessed by a modified version of the Newcastle-Ottawa Scale. Fourteen papers were included in the meta-analysis. Patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1-37.5. Patients with eating disorders who self-induced vomiting had more risk of tooth erosion than those patients who did not self-induce vomiting (OR = 19.6, 95%CI = 5.6-68.8. Patients with risk behavior of eating disorder had more risk of tooth erosion than patients without such risk behavior (Summary OR = 11.6, 95%CI = 3.2-41.7. CONCLUSION: The scientific evidence suggests a causal relationship between tooth erosion and eating disorders and purging practices. Nevertheless, there is a lack of scientific evidence to fulfill the basic criteria of causation between the risk behavior for eating disorders and tooth erosion.

  17. Multivariate meta-analysis of proteomics data from human prostate and colon tumours

    Directory of Open Access Journals (Sweden)

    Lehtiö Janne

    2010-09-01

    Full Text Available Abstract Background There is a vast need to find clinically applicable protein biomarkers as support in cancer diagnosis and tumour classification. In proteomics research, a number of methods can be used to obtain systemic information on protein and pathway level on cells and tissues. One fundamental tool in analysing protein expression has been two-dimensional gel electrophoresis (2DE. Several cancer 2DE studies have reported partially redundant lists of differently expressed proteins. To be able to further extract valuable information from existing 2DE data, the power of a multivariate meta-analysis will be evaluated in this work. Results We here demonstrate a multivariate meta-analysis of 2DE proteomics data from human prostate and colon tumours. We developed a bioinformatic workflow for identifying common patterns over two tumour types. This included dealing with pre-processing of data and handling of missing values followed by the development of a multivariate Partial Least Squares (PLS model for prediction and variable selection. The variable selection was based on the variables performance in the PLS model in combination with stability in the validation. The PLS model development and variable selection was rigorously evaluated using a double cross-validation scheme. The most stable variables from a bootstrap validation gave a mean prediction success of 93% when predicting left out test sets on models discriminating between normal and tumour tissue, common for the two tumour types. The analysis conducted in this study identified 14 proteins with a common trend between the tumour types prostate and colon, i.e. the same expression profile between normal and tumour samples. Conclusions The workflow for meta-analysis developed in this study enabled the finding of a common protein profile for two malign tumour types, which was not possible to identify when analysing the data sets separately.

  18. Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula.

    Science.gov (United States)

    Xu, Yansong; Liang, Siyuang; Tang, Weizhong

    2016-01-01

    We evaluated the efficacy of fistulectomy compared to fistulotomy, and which procedure was the best procedure for patients with low anal fistula. The literature search included PubMed, EMBASE, Cochrane library, Google original studies and a manual search of reference on the topic of fistulectomy compared to fistulotomy for anal fistula that had a deadline for publication by June 2016. Randomized controlled trials studies were included in the review. The outcome variables were analyzed which including operative time, healing time, postoperative complications, recurrence and incontinence. Six randomized controlled trials (fistulectomy = 280, fistulotomy = 285) were considered suitable for the meta-analysis, with a total of 565 patients. The result of meta-analysis indicated no statistically significant difference in operative time [OR 4.74, 95 % CI -2.74, 12.23, p = 0.21] and healing time [OR -3.32, 95 % CI -19.86, 13.23, p = 0.69] between the fistulectomy and fistulotomy procedures. Three main postoperative complications were included, and the combined result indicated no statistically significant difference in overall complications [OR 1.39, 95 % CI 0.51, 3.78, p = 0.52] and subgroup complication. At the end of follow up, two kinds of surgical methods have the same low recurrence rate and faecal incontinence. The result revealed that there was no significant difference in rate of fistula recurrence between the fistulectomy and the fistulotomy [OR 1.39, 95 % CI 0.70, 2.73, p = 0.34]. The meta-analysis indicates that there is no conclusive evidence if fistulectomy or fistulotomy procedure is better in the treatment of low anal fistula.

  19. The results of transperineal versus transrectal prostate biopsy: a systematic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Peng-Fei Shen; Yu-Chun Zhu; Wu-Ran Wei; Yong-Zhong Li; Jie Yang; Yu-Tao Li; Ding-Ming Li; Jia Wang; Hao Zeng

    2012-01-01

    This systematic review was performed to compare the efficacy and complications of transperineal (TP) vs.transrectal (TR) prostate biopsy.A systematic research of PUBMED,EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer (PCa) detection rate and complications achieved by TP and TR biopsies.Prostate biopsies included sextant,extensive and saturation biopsy procedures.All patients were assigned to a TR group and a TP group.Subgroup analysis was performed according to prostate-specific antigen (PSA) levels and digital rectal examination (DRE) findings.The Cochrane Collaboration's RevMan 5.1 software was used for the meta-analysis.A total of seven trials,including three randomized controlled trials (RCTs) and four case- control studies (CCS),met our inclusion criteria.There was no significant difference in the cancer detection rate between the sextant TR and TP groups (risk difference (RD),-0.02; 95% confidence interval (Cl),-0.08-0.03; P=0.34).Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group (RD,-0.01; 95% CI,-0.05-0.04; P=0.81).There was no significant difference in PCa detection rate between the saturation TR and TP approaches (31.4% vs.25.7%,respectively; P=0.3).There were also no significant differences in cancer detection between the TR and TP groups in each subgroup.Although the data on complications were not pooled for the meta-analysis,no significant difference was found when comparing TR and TP studies.TR and TP biopsies were equivalent in terms of efficiency and related complications.TP prostate biopsy should be an available and alternative procedure for use by urologists.

  20. Occupational exposures and genetic susceptibility to urinary tract cancers: a systematic review and meta-analysis.

    Science.gov (United States)

    Stojanovic, Jovana; Milovanovic, Sonja; Pastorino, Roberta; Iavicoli, Ivo; Boccia, Stefania

    2017-04-11

    This study aims to summarize the current knowledge on the relationship between genetic polymorphisms, occupational exposures, and urinary tract cancers. We searched MEDLINE, ISI Web of science, and SCOPUS online databases for all articles published in English language up to September 2016. A meta-analysis was performed to provide summary estimates for the association between a certain genetic polymorphism, occupational exposure and bladder cancer (BC) or kidney cancer (KC), when appropriate. Fifteen studies on BC and six on KC were deemed eligible for the review. With regard to BC, an overall odds ratio (OR) of 2.07 [95% confidence interval (CI): 1.38-3.09] for those with GSTM1 and an OR of 2.07 (95% CI: 1.38-3.09) for those with GSTT1 null genotype were reported when exposed to polycyclic aromatic hydrocarbons (PAHs). NAT2 slow genotype carriers had an OR of 3.59 (95% CI: 2.62-4.93) for BC when exposed to aromatic amines and an OR of 2.07 (95% CI: 1.36-3.15) when exposed to PAHs. With regard to KC and pesticide exposure, the meta-analysis reported an OR of 4.38 (95% CI: 2.28-8.41) for GSTM1 present genotype, an OR of 2.59 (95% CI: 1.62-4.15) for GSTT1-present genotype and an OR of 6.51 (95% CI: 2.85-14.89) for combined effects of GSTM1 and GSTT1 active genotypes. This meta-analysis indicates a possible association between the variant genotypes of GSTM1, GSTT1, NAT2 and SULT1A1, occupational exposure to aromatic amines or PAHs, and development of BC. Our results suggest that polymorphisms in GSTM1 and GSTT1 genes could influence the risk for developing KC in individuals occupationally exposed to pesticides.

  1. Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis

    Science.gov (United States)

    Amgad, Mohamed; Man Kin Tsui, Marco; Liptrott, Sarah J.; Shash, Emad

    2015-01-01

    Importance Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research. Objective To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue. Evidence Review We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed. Findings and Conclusions Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD) before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may

  2. Subglottic Secretion Drainage for Preventing Venti-lator Associated Pneumonia: A Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Rong Wang; Xiang Zhen; Bao-Yi Yang; Xue-Zhen Guo; Xue Zeng; Chun-Yan Deng

    2015-01-01

    Objective: Ventilator associated pneumonia ( VAP) has been shown to be associated with signifi-cant morbidity and mortality( Chastre and Fagon, 2002;klompas, 2007) among mechanically venti-lated patients in the intensive care unit ( ICU ) , with the incidence ranging from 9% to 27%;crude mortality ranges from 25% to 50%. 1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage ( SSD ) on the inci-dence of ventilated associated pneumonia in adult ICU patients. Methods: Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases ( December 30, 2010) . Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results: Ten RCTs with 2, 314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk ( RR)=0. 52, 95% confidence interval ( CI): 0. 42-0. 64, P<0. 000 01] . When SSD was compared with the control groups, the overall RR for ICU mortality was 1. 00 ( 95% CI, 0. 84-1. 19) and for hospital mortality was 0. 95 ( 95% CI, 0. 80-1. 13) . Overall, the subglottic drainage effect on the days of mechanical ventilation was -1. 52 days ( 95% CI, -2. 94 to -0. 11) and on the ICU length of stay ( LOS) was -0. 81days ( 95% CI, -2. 33 to -0. 7) . Conclusions: In this meta-analysis, when an endotracheal tube ( ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi-mately 50%. Time on mechanical ventilation ( MV) and the ICU LOS may be reduced, but no re-duction in ICU or hospital mortality has been observed in published trials.

  3. Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol

    Science.gov (United States)

    Greene, Richard A; Corcoran, Paul; O'Neill, Sinéad M

    2017-01-01

    Introduction Caesarean section (CS) rates have increased globally during the past three decades. Surgical site infection (SSI) following CS is a common cause of morbidity with reported rates of 3–15%. SSI represents a substantial burden to the health system including increased length of hospitalisation and costs of postdischarge care. The definition of SSI varies with the postoperative follow-up period among different health systems, resulting in differences in the reporting of SSI incidence. We propose to conduct the first systematic review and meta-analysis to determine the pooled estimate for the overall incidence of SSI following CS. Methods and analysis We will perform a comprehensive search to identify all potentially relevant published studies on the incidence of SSI following CS reported from 1992 in the English language. Electronic databases including PubMed, CINAHL, EMBASE and Scopus will be searched using a detailed search strategy. Following study selection, full-text paper retrieval, data extraction and synthesis, we will appraise study quality and risk of bias and assess heterogeneity. Incidence data will be combined where feasible in a meta-analysis using Stata software and fixed-effects or random-effects models as appropriate. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ethics and dissemination Ethical approval is not required as this review will use published data. The review will evaluate the overall incidence of SSI following CS and will provide the first quantitative estimate of the magnitude of SSI. It will serve as a benchmark for future studies, identify research gaps and remaining challenges, and emphasise the need for appropriate prevention and control measures for SSI post-CS. A manuscript reporting the results of the systematic review and meta-analysis will be submitted to a peer-reviewed journal and presented at scientific conferences

  4. Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Mohamed Amgad

    Full Text Available Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research.To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue.We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed.Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during

  5. The incidence rate of cancer in patients with schizophrenia: A meta-analysis of cohort studies.

    Science.gov (United States)

    Li, Hailong; Li, Jiasi; Yu, Xiya; Zheng, Huiwen; Sun, Xu; Lu, Yue; Zhang, Yanbo; Li, Chunbo; Bi, Xiaoying

    2017-09-21

    Numerous studies report that cancer prevalence in patients with schizophrenia might be different from the general population, but findings remain controversial. Our updated meta-analysis of cohort studies aims to analyze the data from cohort studies concerning the incidence risk of overall cancer and some site-specific cancers in patients with schizophrenia. We performed a systemic search through electronic databases. Cohort studies evaluating and describing the cancer incidence among patients with schizophrenia were included. Pooled risk ratios (RRs) were calculated for assessing the incidence risk of cancer. There were 16 cohort studies included in this meta-analysis, which combined a total of 480,356 participants with schizophrenia and 41,999 cases of cancer. Results showed that there was a slight significant decreased overall risk ratio of cancer incidence among patients with schizophrenia (RR=0.90, 95% CI 0.81-0.99). When stratified by cancer site and gender, there were significant decreased incidence risk rates of colorectal cancer (RR=0.82, 95% CI 0.69-0.98) and prostate cancer (RR=0.55, 95% CI 0.42-0.71) in those patients, moreover, the incidence rate of colorectal cancer decreased significantly in male patients (RR=0.89, 95% CI 0.81-0.98), and the incidence rate of lung cancer increased significantly in female patients (RR=1.12, 95% CI 1.01-1.25). The incidence risk of some cancers was reduced in patients with schizophrenia. Gender and type of cancer were two important confounding factors contributed to the heterogeneity that required adjustment in our cancer incidence meta-analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Systematic review and meta-analysis of Meniett therapy for Meniere's disease.

    Science.gov (United States)

    Ahsan, Syed F; Standring, Robert; Wang, Yun

    2015-01-01

    To perform a systematic review and meta-analysis of micropressure treatment for Meniere's disease (MD). Medline, Ovid, Web of Science, and Cochrane Library search of the literature from January 1996 to December 2012. Systematic literature review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria required definitive diagnosis of unilateral MD, treatment with Meniett device, vertigo control results, and hearing results before and after treatment. Randomized controlled trials and other types of case-control studies were included. Improvements in vertigo, American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) functional score, and pure tone average (PTA) were assessed. Funnel plots were used to detect bias and Q test was used to assess for heterogeneity. Random effects model was used for meta-analysis. T test was used to assess for significance. Of 113 abstracts screened, 18 studies met criteria for review and 12 were used for meta-analysis. Eight studies reported hearing evaluation and the improvement in PTA after Meniett treatment was significant (P = 0.0085). Data could not be combined for AAO-HNS functional score due to heterogeneity. However, there was a trend toward improvement. Of six studies reporting frequency of vertigo, Meniett treatment significantly reduced frequency of vertigo (P = < .0001). Much of the data used in the analysis was derived from retrospective or level 4 studies. The average follow-up was only 5 months, and there were low number of patients in the treatment and control groups. The Meniett device is a safe, nondestructive treatment for patients' refractory to medical therapy for MD. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers: a meta-analysis.

    Science.gov (United States)

    García-Fernández, Francisco Pedro; Pancorbo-Hidalgo, Pedro L; Agreda, J Javier Soldevilla

    2014-01-01

    A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale.

  8. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight.

    Science.gov (United States)

    Romero, R; Oyarzun, E; Mazor, M; Sirtori, M; Hobbins, J C; Bracken, M

    1989-04-01

    The relationship between asymptomatic bacteriuria and prematurity/low birth weight (LBW) is still a controversial issue, despite many studies. Meta-analysis, a research tool designed to analyze and combine the results of previous studies, may resolve this discrepancy among contradictory results of clinical trials. The purpose of this study was to examine the relationship between asymptomatic bacteriuria and preterm delivery/LBW using meta-analysis. Reports from the literature were classified according to study design into cohort or randomized-treatment control trials. Meta-analysis of cohort studies showed that untreated asymptomatic bacteriuria during pregnancy significantly increased rates of LBW and preterm delivery. Nonbacteriuric patients had only about two-thirds the risk (typical relative risk = 0.65; 95% confidence interval 0.57, 0.74) of LBW and half the risk (typical relative risk = 0.50; 95% confidence interval 0.36, 0.70) of preterm delivery of those with untreated asymptomatic bacteriuria. These reduced risks correspond to a 3.4 (confidence interval 1.8, 5.0) percentage-point difference in LBW and a 3.8 (1.1, 6.4) percentage-point difference in preterm delivery. The analysis of randomized clinical trials showed that antibiotic treatment significantly reduced the risk of LBW (typical relative risk = 0.56; 95% confidence interval 0.43, 0.73), with a substantial reduction of 6.4 (confidence interval 3.3, 9.5) percentage points in the rate of LBW. We conclude that clinical and epidemiologic evidence indicates a strong association between untreated asymptomatic bacteriuria and LBW/preterm delivery and that antibiotic treatment is effective in reducing the occurrence of LBW.

  9. The Effect of Hypnosis on Anxiety in Patients With Cancer: A Meta-Analysis.

    Science.gov (United States)

    Chen, Pei-Ying; Liu, Ying-Mei; Chen, Mei-Ling

    2017-06-01

    Anxiety is a common form of psychological distress in patients with cancer. One recognized nonpharmacological intervention to reduce anxiety for various populations is hypnotherapy or hypnosis. However, its effect in reducing anxiety in cancer patients has not been systematically evaluated. This meta-analysis was designed to synthesize the immediate and sustained effects of hypnosis on anxiety of cancer patients and to identify moderators for these hypnosis effects. Qualified studies including randomized controlled trials (RCT) and pre-post design studies were identified by searching seven electronic databases: Scopus, Medline Ovidsp, PubMed, PsycInfo-Ovid, Academic Search Premier, CINAHL Plus with FT-EBSCO, and SDOL. Effect size (Hedges' g) was computed for each study. Random-effect modeling was used to combine effect sizes across studies. All statistical analyses were conducted with Comprehensive Meta-Analysis, version 2 (Biostat, Inc., Englewood, NJ, USA). Our meta-analysis of 20 studies found that hypnosis had a significant immediate effect on anxiety in cancer patients (Hedges' g: 0.70-1.41, p < .01) and the effect was sustained (Hedges' g: 0.61-2.77, p < .01). The adjusted mean effect size (determined by Duvan and Tweedie's trim-and-fill method) was 0.46. RCTs had a significantly higher effect size than non-RCT studies. Higher mean effect sizes were also found with pediatric study samples, hematological malignancy, studies on procedure-related stressors, and with mixed-gender samples. Hypnosis delivered by a therapist was significantly more effective than self-hypnosis. Hypnosis can reduce anxiety of cancer patients, especially for pediatric cancer patients who experience procedure-related stress. We recommend therapist-delivered hypnosis should be preferred until more effective self-hypnosis strategies are developed. © 2017 Sigma Theta Tau International.

  10. Poor Gait Performance and Prediction of Dementia: Results From a Meta-Analysis

    Science.gov (United States)

    Beauchet, Olivier; Annweiler, Cédric; Callisaya, Michele L.; De Cock, Anne-Marie; Helbostad, Jorunn L.; Kressig, Reto W.; Srikanth, Velandai; Steinmetz, Jean-Paul; Blumen, Helena M.; Verghese, Joe; Allali, Gilles

    2017-01-01

    Background Poor gait performance predicts risk of developing dementia. No structured critical evaluation has been conducted to study this association yet. The aim of this meta-analysis was to systematically examine the association of poor gait performance with incidence of dementia. Methods An English and French Medline search was conducted in June 2015, with no limit of date, using the medical subject headings terms “Gait” OR “Gait Disorders, Neurologic” OR “Gait Apraxia” OR “Gait Ataxia” AND “Dementia” OR “Frontotemporal Dementia” OR “Dementia, Multi-Infarct” OR “Dementia, Vascular” OR “Alzheimer Disease” OR “Lewy Body Disease” OR “Frontotemporal Dementia With Motor Neuron Disease” (Supplementary Concept). Poor gait performance was defined by standardized tests of walking, and dementia was diagnosed according to international consensus criteria. Four etiologies of dementia were identified: any dementia, Alzheimer disease (AD), vascular dementia (VaD), and non-AD (ie, pooling VaD, mixed dementias, and other dementias). Fixed effects meta-analyses were performed on the estimates in order to generate summary values. Results Of the 796 identified abstracts, 12 (1.5%) were included in this systematic review and meta-analysis. Poor gait performance predicted dementia [pooled hazard ratio (HR) combined with relative risk and odds ratio = 1.53 with P < .001 for any dementia, pooled HR = 1.79 with P < .001 for VaD, HR = 1.89 with P value < .001 for non-AD]. Findings were weaker for predicting AD (HR = 1.03 with P value = .004). Conclusions This meta-analysis provides evidence that poor gait performance predicts dementia. This association depends on the type of dementia; poor gait performance is a stronger predictor of non-AD dementias than AD. PMID:26852960

  11. Dietary magnesium intake and risk of metabolic syndrome: a meta-analysis

    Science.gov (United States)

    Dibaba, D. T.; Xun, P.; Fly, A. D.; Yokota, K.; He, K.

    2014-01-01

    Aims To estimate quantitatively the association between dietary magnesium intake and risk of metabolic syndrome by combining the relevant published articles using meta-analysis. Methods We reviewed the relevant literature in PubMed and EMBASE published up until August 2013 and obtained additional information through Google or a hand search of the references in relevant articles. A random-effects or fixed-effects model, as appropriate, was used to pool the effect sizes on metabolic syndrome comparing individuals with the highest dietary magnesium intake with those having the lowest intake. The dose–response relationship was assessed for every 100-mg/day increment in magnesium intake and risk of metabolic syndrome. Result Six cross-sectional studies, including a total of 24 473 individuals and 6311 cases of metabolic syndrome, were identified as eligible for the meta-analysis. A weighted inverse association was found between dietary magnesium intake and the risk of metabolic syndrome (odds ratio 0.69, 95% CI 0.59, 0.81) comparing the highest with the lowest group. For every 100-mg/day increment in magnesium intake, the overall risk of having metabolic syndrome was lowered by 17% (odds ratio 0.83, 95% CI 0. 77, 0.89). Conclusion Findings from the present meta-analysis suggest that dietary magnesium intake is inversely associated with the prevalence of metabolic syndrome. Further studies, in particular well-designed longitudinal cohort studies and randomized placebo-controlled clinical trials, are warranted to provide solid evidence and to establish causal inference. PMID:24975384

  12. Association between PPAR-γ2 Pro12Ala polymorphism and obesity: a meta-analysis.

    Science.gov (United States)

    Yao, Ying-Shui; Li, Jie; Jin, Yue-Long; Chen, Yan; He, Lian-Ping

    2015-06-01

    The peroxisome proliferator-activated receptor-γ2 (PPAR-γ2) gene has been reported in the pathogeny of obesity. However, the results have been inconsistent. The purpose of this meta-analysis was to acquire a more accurate assessment of the association between PPAR-γ2 Pro12Ala polymorphism and obesity. PubMed, Wan Fang (Chinese) databases, Chinese Biomedical Medical databases, and Chinese National Knowledge Infrastructure were searched to identify eligible studies. Finally, 25 studies (6491 cases and 8242 controls) were enrolled in this meta-analysis. The effect summary odds ratio (OR) with 95 % confidence interval (CI) was applied. Random-effects or fixed-effects model was performed based on the heterogeneity. STATA 12.0 was applied for this meta-analysis. The combined results showed that PPAR-γ Pro12Ala polymorphism was associated with the obesity risk (Ala vs. Pro: OR = 1.55, 95 % CI 1.34-1.80; Pro/Ala vs. Pro/Pro: OR = 1.54, 95 % CI 1.31-1.82; Ala/Ala + Pro/Ala vs. Pro/Pro: OR = 1.61, 95 % CI 1.36-1.90). Subgroup analysis by ethnicity showed that there were significant associations between PPAR-γ Pro12Ala polymorphism and obesity risk in Caucasians, Asians, and Mixed population. Subgroup analysis by obesity's cutoff points showed that the associations were found among the patients with the cutoff point of BMI ≥24 and BMI ≥30 but not among the patients with the cutoff point of BMI ≥95th percentile. These results suggested that PPAR-γ Pro12Ala polymorphism might be a risk factor for obesity susceptibility.

  13. HYPOTHESIS SETTING AND ORDER STATISTIC FOR ROBUST GENOMIC META-ANALYSIS.

    Science.gov (United States)

    Song, Chi; Tseng, George C

    2014-01-01

    Meta-analysis techniques have been widely developed and applied in genomic applications, especially for combining multiple transcriptomic studies. In this paper, we propose an order statistic of p-values (rth ordered p-value, rOP) across combined studies as the test statistic. We illustrate different hypothesis settings that detect gene markers differentially expressed (DE) "in all studies", "in the majority of studies", or "in one or more studies", and specify rOP as a suitable method for detecting DE genes "in the majority of studies". We develop methods to estimate the parameter r in rOP for real applications. Statistical properties such as its asymptotic behavior and a one-sided testing correction for detecting markers of concordant expression changes are explored. Power calculation and simulation show better performance of rOP compared to classical Fisher's method, Stouffer's method, minimum p-value method and maximum p-value method under the focused hypothesis setting. Theoretically, rOP is found connected to the naïve vote counting method and can be viewed as a generalized form of vote counting with better statistical properties. The method is applied to three microarray meta-analysis examples including major depressive disorder, brain cancer and diabetes. The results demonstrate rOP as a more generalizable, robust and sensitive statistical framework to detect disease-related markers.

  14. Comparison of multiplex meta analysis techniques for understanding the acute rejection of solid organ transplants

    Directory of Open Access Journals (Sweden)

    Khatri Purvesh

    2010-10-01

    Full Text Available Abstract Background Combining the results of studies using highly parallelized measurements of gene expression such as microarrays and RNAseq offer unique challenges in meta analysis. Motivated by a need for a deeper understanding of organ transplant rejection, we combine the data from five separate studies to compare acute rejection versus stability after solid organ transplantation, and use this data to examine approaches to multiplex meta analysis. Results We demonstrate that a commonly used parametric effect size estimate approach and a commonly used non-parametric method give very different results in prioritizing genes. The parametric method providing a meta effect estimate was superior at ranking genes based on our gold-standard of identifying immune response genes in the transplant rejection datasets. Conclusion Different methods of multiplex analysis can give substantially different results. The method which is best for any given application will likely depend on the particular domain, and it remains for future work to see if any one method is consistently better at identifying important biological signal across gene expression experiments.

  15. The relationship between job satisfaction and health: a meta-analysis.

    Science.gov (United States)

    Faragher, E B; Cass, M; Cooper, C L

    2005-02-01

    A vast number of published studies have suggested a link between job satisfaction levels and health. The sizes of the relationships reported vary widely. Narrative overviews of this relationship have been published, but no systematic meta-analysis review has been conducted. A systematic review and meta-analysis of 485 studies with a combined sample size of 267 995 individuals was conducted, evaluating the research evidence linking self-report measures of job satisfaction to measures of physical and mental wellbeing. The overall correlation combined across all health measures was r = 0.312 (0.370 after Schmidt-Hunter adjustment). Job satisfaction was most strongly associated with mental/psychological problems; strongest relationships were found for burnout (corrected r = 0.478), self-esteem(r = 0.429), depression (r = 0.428), and anxiety(r = 0.420). The correlation with subjective physical illness was more modest (r = 0.287). Correlations in excess of 0.3 are rare in this context. The relationships found suggest that job satisfaction level is an important factor influencing the health of workers. Organisations should include the development of stress management policies to identify and eradicate work practices that cause most job dissatisfaction as part of any exercise aimed at improving employee health. Occupational health clinicians should consider counselling employees diagnosed as having psychological problems to critically evaluate their work-and help them to explore ways of gaining greater satisfaction from this important aspect of their life.

  16. Effect of preoperative biliary drainage on malignantobstructive jaundice: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Yu-Dong Qiu; Jian-Ling Bai; Fang-Gui Xu; Yi-Tao Ding

    2011-01-01

    AIM: To evaluate the effect of preoperative biliary drainage(PBD) on obstructive jaundice resulting from malignant tumors.METHODS: According to the requirements of Cochrane systematic review, studies in the English language were retrieved from MEDLINE and Embase databases from 1995 to 2009 with the key word "preoperative biliary drainage". Two reviewers independently screened the eligible studies, evaluated their academic level and extracted the data from the eligible studies confirmed by cross-checking. Data about patients with and without PBD after resection of malignant tumors were processed for meta-analysis using the Stata 9.2 software, including postoperative mortality, incidence of postoperative pancreatic and bile leakage, abdominal abscess, delayed gastric emptying and incision infection.RESULTS: Fourteen retrospective cohort studies involving 1826 patients with malignant obstructive jaundice accorded with our inclusion criteria, and were included in meta-analysis. Their baseline characteristics were comparable in all the studies. No significant difference was found in combined risk ratio (RR) of postoperative mortality and incidence of pancreatic and bile leakage, abdominal abscess, delayed gastric emptying between patients with and without PBD. However, the combined RR for the incidence of postoperative incision infectionwas improved better in patients with PBD than in those without PBD (P<0.05).CONCLUSION: PBD cannot significantly reduce the postoperative mortality and complications of malignant obstructive jaundice, and therefore should not be used as a preoperative routine procedure for malignant obstructive jaundice.

  17. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Gonzalo Labarca

    2016-01-01

    Full Text Available Introduction. Endobronchial ultrasound (EBUS is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients were included; two were randomized controlled trials (RCTs and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84–89% and the specificity was 99% (CI 98–100%. For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1–91.4% and specificity improved to 100% (CI 99-100%. Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.

  18. Catheter-directed thrombolysis in the treatment of acute deep venous thrombosis: a meta-analysis.

    Science.gov (United States)

    Zheng, J J; Zhang, Z H; Shan, Z; Wang, W J; Li, X X; Wang, S M; Li, Y-X; Cheng, G-S

    2014-07-24

    We performed a meta-analysis for systematic evaluation of the status quo of catheter thrombolysis for the treatment of acute lower limb deep vein thrombosis in China. We searched the China Biomedical bibliographic database (CBM), China National Knowledge Infrastructure (CNKI), Weipu full-text electronic journals, Wanfang full-text database, and Medline (1990 through June 2011) for clinical randomized controlled trials of catheter-directed thrombolysis and superficial venous thrombolysis to compare their efficacies for the treatment of acute deep vein thrombosis. The results were analyzed by using the Cochrane-recommended RevMan 4.2 software package, and the odds ratio (OR) was used as the combined measure of efficacy. The search retrieved 8 randomized controlled trials, and meta-analysis using the total rate of effective treatment as the clinical observation index found that the combined OR for the catheter thrombolysis group versus the superficial venous thrombolysis group was significant (P venous thrombolysis for the treatment of acute deep vein thrombosis in the lower limb in Chinese individuals. However, the included trials were only of medium quality, so more rational and scientific clinical trials are needed to validate this conclusion.

  19. Network Meta-analysis of 10 Chinese Herb Injections Combined with Vinorelbine and Cisplatin for Non Small Cell Lung Cancer%10种中药注射剂联合长春瑞滨+顺铂化疗方案治疗非小细胞肺癌的网状Meta分析

    Institute of Scientific and Technical Information of China (English)

    田金徽; 赵晔; 李金龙; 葛龙; 杨克虎

    2015-01-01

    safety of Chinese herb injection(CHI) combined vinorelbine and cisplatin ( NP) for non small cell lung cancer ( NSCLC ) based on the same comparison.Methods: The relative randomized controlled trials ( RCTs) of CHIs were searched from Science Citation Index Expanded ( SCI-EXPANDED) , EMBASE, PubMed,Cochrane Library, Can-cerLit, Chinese Knowledge Infrastructure,Chinese Scientific Journals Fulltext Database( VIP-CSJFD) ,Chinese Biomedical Literature Da-tabase( CBM) ,Wan-Fang Database( WANFANG) ,Chinese Science Citation Database( CSCD) and Traditional Chinese Medical Database System.The related references and website were also traced.The RCTs were screened according to the predefined inclusion and exclusion criteria,the related items were used to assess the quality of RCTs, data were analyzed by WinBugs software.Results:167 RCTs and 10 CHIs were finally included.The results of network Meta-analysis showed that, based on the NP intervention, there were significant differ-ence between only huachansu injection or yadanzyouru injection or aidi injection respectively and delisheng injection in quality of life. There were significant difference between only delisheng injection and yadanziyouru injection, huachansu injection or yadanziyouru injec-tion respectively and compound matrine injection or kanglaite injection or aidi injection, kang′ai injection and compound matrine injection or kanglaite injection or aidi injection in nausea and vomiting.There was no difference between 10 CHIs in efficacy.Conclusion:Based on the results of network Meta-analysis,delisheng injection,shengqifuzhe injection and yadanziyouru injection were more than other 7 CHIs based on the common intervention.

  20. Family-Based Interventions in Preventing Children and Adolescents from Using Tobacco: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Thomas, Roger E; Baker, Philip R A; Thomas, Bennett C

    2016-07-01

    Tobacco is the main preventable cause of death and disease worldwide. Adolescent smoking is increasing in many countries with poorer countries following the earlier experiences of affluent countries. Preventing adolescents from starting smoking is crucial to decreasing tobacco-related illness. To assess effectiveness of family-based interventions alone and combined with school-based interventions to prevent children and adolescents from initiating tobacco use. Fourteen bibliographic databases and the Internet, journals hand-searched, and experts consulted. Randomized controlled trials (RCTs) with children or adolescents and families, interventions to prevent starting tobacco use, and follow-up ≥6 months. Abstracts/titles independently assessed and data independently entered by 2 authors. Risk of bias was assessed with the Cochrane Risk-of-Bias tool. Twenty-seven RCTs were included. Nine trials of never-smokers compared with a control provided data for meta-analysis. Family intervention trials had significantly fewer students who started smoking. Meta-analysis of 2 RCTs of combined family and school interventions compared with school only, showed additional significant benefit. The common feature of effective high-intensity interventions was encouraging authoritative parenting. Only 14 RCTs provided data for meta-analysis (approximately a third of participants). Of the 13 RCTs that did not provide data for meta-analysis 8 compared a family intervention with no intervention and 1 reported significant effects, and 5 compared a family combined with school intervention with a school intervention only and none reported additional significant effects. There is moderate-quality evidence that family-based interventions prevent children and adolescents from starting to smoke. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  1. Comparing the effectiveness of competing tests for reducing colorectal cancer mortality: a network meta-analysis.

    Science.gov (United States)

    Elmunzer, B Joseph; Singal, Amit G; Sussman, Jeremy B; Deshpande, Amar R; Sussman, Daniel A; Conte, Marisa L; Dwamena, Ben A; Rogers, Mary A M; Schoenfeld, Philip S; Inadomi, John M; Saini, Sameer D; Waljee, Akbar K

    2015-03-01

    Comparative effectiveness data pertaining to competing colorectal cancer (CRC) screening tests do not exist but are necessary to guide clinical decision making and policy. To perform a comparative synthesis of clinical outcomes studies evaluating the effects of competing tests on CRC-related mortality. Traditional and network meta-analyses. Two reviewers identified studies evaluating the effect of guaiac-based fecal occult blood testing (gFOBT), flexible sigmoidoscopy (FS), or colonoscopy on CRC-related mortality. gFOBT, FS, colonoscopy. Traditional meta-analysis was performed to produce pooled estimates of the effect of each modality on CRC mortality. Bayesian network meta-analysis (NMA) was performed to indirectly compare the effectiveness of screening modalities. Multiple sensitivity analyses were performed. Traditional meta-analysis revealed that, compared with no intervention, colonoscopy reduced CRC-related mortality by 57% (relative risk [RR] 0.43; 95% confidence interval [CI], 0.33-0.58), whereas FS reduced CRC-related mortality by 40% (RR 0.60; 95% CI, 0.45-0.78), and gFOBT reduced CRC-related mortality by 18% (RR 0.82; 95% CI, 0.76-0.88). NMA demonstrated nonsignificant trends favoring colonoscopy over FS (RR 0.71; 95% CI, 0.45-1.11) and FS over gFOBT (RR 0.74; 95% CI, 0.51-1.09) for reducing CRC-related deaths. NMA-based simulations, however, revealed that colonoscopy has a 94% probability of being the most effective test for reducing CRC mortality and a 99% probability of being most effective when the analysis is restricted to screening studies. Randomized trials and observational studies were combined within the same analysis. Clinical outcomes studies demonstrate that gFOBT, FS, and colonoscopy are all effective in reducing CRC-related mortality. Network meta-analysis suggests that colonoscopy is the most effective test. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  2. Meta-analysis of aspirin-heparin therapy for un-explained recurrent miscarriage.

    Science.gov (United States)

    Ling, Tong; Xian-Jiang, Wei

    2016-11-20

    Objective This study was designed to evaluate the efficacy and safety of aspirin-heparin treatment for un-explained recurrent spontaneous abortion (URSA). Methods Literatures reporting the studies on the aspirin-heparin treatment of un-explained recurrent miscarriage with randomized controlled trials (RCTs) were collected from the major publication databases. The live birth rate was used as primary indicator, preterm delivery, preeclampsia, intrauterine growth restriction, and adverse reactions (thrombocytopenia ) were used as the secondary indicators. The quality of the included studies was evaluated using RCT bias risk assessment tool in the Cochrane Handbook (v5.1.0). Meta-analysis was conducted using RevMan (v5.3) software. Subgroup analyses were conducted with an appropriately combined model according to the type of the treatments if heterogeneity among the selected studies was detected. Results Six publications of RCTs were included in this study. There were a total of 907 pregnant women with diagnosis of URSA, 367 of them were pooled in the study group with aspirin-heparin therapy and 540 women in the control group with placebo, aspirin or progesterone therapy. Meta-analysis showed that the live birth rate in the study group was significantly different from that in the control group [RR = 1.18, 95% CI (1.00-1.39), P=0.04]. Considering the clinical heterogeneity among the six studies, subgroup analysis were performed. Live birth rates in the aspirin-heparin treated groups and placebo groups were compared and no significant difference was found. There were no significant differences found between the two groups in the incidence of preterm delivery [RR=1.22, 95% CI (0.54-2.76), P=0.64], preeclampsia [RR=0.52, 95% CI (0.25-1.07), P=0.08], intrauterine growth restriction [RR=1.19, 95% CI (0.56-2.52), P=0.45] and thrombocytopenia [RR=1.17, 95% CI (0.09-14.42), P=0.90]. Conclusion This meta-analysis did not provide evidence that aspirin-heparin therapy had

  3. Risk of aspirin continuation in spinal surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Goes, R; Muskens, I S; Smith, T R; Mekary, R A; Broekman, M L D; Moojen, W A

    2017-08-17

    Aspirin is typically discontinued in spinal surgery because of increased risk of haemorrhagic complications. The risk of peri-operative continuation of aspirin in neurosurgery needed to be evaluated. To evaluate all available evidence about continuation of aspirin and to compare peri- and post-operative blood loss and complication rates between patients that continued aspirin and those who discontinued aspirin peri-operatively in spinal surgery. Systematic review and meta-analysis. A meta-analysis was conducted according to the PRISMA guidelines. Studies comparing aspirin continuation with discontinuation were included. Studies using a combination of anticlotting agents or non-spinal procedures were excluded. Operative outcomes (blood loss and operative length) and different complications (surgical site infection (SSI), stroke, myocardial infarction within 30 days post-operatively) were extracted. Overall prevalence and means were calculated for the reported outcomes in fixed-effects models with heterogeneity (I(2)) and effect modification (P-interaction) assessment. Out of 1339 studies, 3 case series were included in the meta-analysis. No significant differences in mean operating time were seen between the aspirin-continuing group (mean=201.8 minutes, 95%CI=193.3; 210.3; I(2)=95.4%; 170 patients) and the aspirin-discontinuing group (mean=178.4 minutes, 95%CI=119.1; 237.6; I(2)=93.5%; 200 patients); (P-interaction=0.78). No significant differences in mean peri-operative blood loss were seen between the aspirin-continuing group (mean=553.9 millilitres, 95%CI=468.0; 639.9; I(2)=83.4%; 170 patients) and the aspirin-discontinuing group (mean=538.7 millilitres, 95%CI=427.6; 649.8; I(2)=985.5%; 200 patients); (P-interaction=0.96). Similar non-significant differences between the 2 groups were found for cardiac events, stroke, and surgical site infections. This meta-analysis showed an absence of significant differences in peri-operative complications between aspirin

  4. Quick, “Imputation-free” meta-analysis with proxy-SNPs

    Directory of Open Access Journals (Sweden)

    Meesters Christian

    2012-09-01

    Full Text Available Abstract Background Meta-analysis (MA is widely used to pool genome-wide association studies (GWASes in order to a increase the power to detect strong or weak genotype effects or b as a result verification method. As a consequence of differing SNP panels among genotyping chips, imputation is the method of choice within GWAS consortia to avoid losing too many SNPs in a MA. YAMAS (Yet Another Meta Analysis Software, however, enables cross-GWAS conclusions prior to finished and polished imputation runs, which eventually are time-consuming. Results Here we present a fast method to avoid forfeiting SNPs present in only a subset of studies, without relying on imputation. This is accomplished by using reference linkage disequilibrium data from 1,000 Genomes/HapMap projects to find proxy-SNPs together with in-phase alleles for SNPs missing in at least one study. MA is conducted by combining association effect estimates of a SNP and those of its proxy-SNPs. Our algorithm is implemented in the MA software YAMAS. Association results from GWAS analysis applications can be used as input files for MA, tremendously speeding up MA compared to the conventional imputation approach. We show that our proxy algorithm is well-powered and yields valuable ad hoc results, possibly providing an incentive for follow-up studies. We propose our method as a quick screening step prior to imputation-based MA, as well as an additional main approach for studies without available reference data matching the ethnicities of study participants. As a proof of principle, we analyzed six dbGaP Type II Diabetes GWAS and found that the proxy algorithm clearly outperforms naïve MA on the p-value level: for 17 out of 23 we observe an improvement on the p-value level by a factor of more than two, and a maximum improvement by a factor of 2127. Conclusions YAMAS is an efficient and fast meta-analysis program which offers various methods, including conventional MA as well as inserting proxy

  5. A Meta Analysis of Fructose Diphosphate Sodium Combined with Astragalus Membranaceus in Treatment of Vital Myocarditis%1-6二磷酸果糖联合黄芪注射液治疗病毒性心肌炎Meta分析

    Institute of Scientific and Technical Information of China (English)

    李虎; 李晓艳; 蒋学俊; 权力; 郑晓新; 冯高科

    2013-01-01

    Objective To evaluate the effectiveness of fructose diphosphate sodium (FDP) combined with astragalus membranaceus in treatment of vital myocarditis (VMC). Methods The related literature of fructose diphosphate sodium (FDP) com-hined with astragalus membranaceus in treatment of viral myocarditis were searched by computer from electronic database of Co-chrane controlled clinical trials data bank, MEDUNE, EMbase, Wanfang Data, CQVIP database, China know nets (CNKI) and China biological medical literature database (CRM) . and were searched by hand during March 1995 and December 2011. All the data were processed by meta analysis using Review manager 5.0. Results There were significant differences in patients'symptomatic relief between iht-rap; group and control group [Z=5.66 (P<0.001) . OR =5.65. 95% CI (3. 10,10. 30)] ; the total effective rate of electrocardiogram curative elfect in therapy group was significantly higher than that ol control group [ Z = 3. 31 ( P =0.0009), OR=3.81, 95% CI (1.73,8.43)]; the decrease of CK-MB isoenzyme in therapy group was more obvious than that of control group [WMD= -9.27,95% CI ( -78. 17, -4.47), P =0. 000 2]. The funnel schema was nearly symmetry with little bias. Conclusion The method of FDP combined with astragalus membranaceus in treatment of viral myocarditis may be effective in clinical symptoms improvement, electrocardiogram improvement and the myocardial CK-MB isoenzyme reduction.%目的 评价1-6二磷酸果糖联合黄芪注射液治疗病毒性心肌炎的疗效.方法 计算机检索Cochrane图书馆临床对照试验资料库、MEDLINE、EMbase、万方、维普、CNKI、CBM,手工检索1-6二磷酸果糖联合黄芪注射液治疗病毒性心肌炎1995年3月-2011年12月发表的相关文献,应用Rev Man 5.0软件对数据进行Meta分析.结果 试验组患者症状缓解与对照组相比差异有统计学意义[Z=5.66(P<0.001),比值比(OR) =5.65,95%CI (3.10,10.30)];心电图改善总有效率试验组均

  6. Efficacy of escitalopram compared to citalopram: a meta-analysis.

    Science.gov (United States)

    Montgomery, Stuart; Hansen, Thomas; Kasper, Siegfried

    2011-03-01

    The aim of this review was to assess the clinical relevance of the relative antidepressant efficacy of escitalopram and citalopram by meta-analysis. Studies in major depressive disorder (MDD) with both escitalopram and citalopram treatment arms were identified. Adult patients had to meet DSM-IV criteria for MDD. The primary outcome measure was the treatment difference in Montgomery-Asberg Depression Rating Scale (MADRS) total score at week 8 (or last assessment if escitalopram, n=995; citalopram, n=1014). Escitalopram was significantly more effective than citalopram in overall treatment effect, with an estimated mean treatment difference of 1.7 points at week 8 (or last assessment if escitalopram. In this meta-analysis, the statistically significant superior efficacy of escitalopram compared to citalopram was shown to be clinically relevant.

  7. Meta analysis of risk factors for colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    Kun Chen; Jiong-Liang Qiu; Yang Zhang; Yu-Wan Zhao

    2003-01-01

    AIM: To study the risk factors for colorectal cancer in China.METHODS: A meta-analysis of the risk factors of colorectal cancer was conducted for 14 case-control studies, and reviewed 14 reports within 13 years which included 5034cases and 5205 controls. Dersimonian and Laird random effective models were used to process the results.RESULTS: Meta analysis of the 14 studies demonstrated that proper physical activites and dietary fibers were protective factors (pooled OR<0.8), while fecal mucohemorrhage,chronic diarrhea and polyposis were highly associated with colorectal cancer (all pooled OR>4). The stratified results showed that different OR values of some factors were due to geographic factors or different resourses.CONCLUSION: Risks of colorectal cancer are significantly associated with the histories of intestinal diseases or relative symptoms, high lipid diet, emotional trauma and family history of cancers. The suitable physical activities and dietary fibers are protective factors.

  8. Automated drawing of network plots in network meta-analysis.

    Science.gov (United States)

    Rücker, Gerta; Schwarzer, Guido

    2016-03-01

    In systematic reviews based on network meta-analysis, the network structure should be visualized. Network plots often have been drawn by hand using generic graphical software. A typical way of drawing networks, also implemented in statistical software for network meta-analysis<