Background: The optimal antiplatelet treatment for the secondary prevention of non-cardioembolic stroke or transient ischemic attack (TIA) remains uncertain in Asians. Methods: We searched for eligible randomized control trials in Medline, Embase, and the Cochrane Library. A Bayesian network meta-analysis (NMA) was performed to assess the efficacy and safety of antiplatelet regimens with placebo as the control. Each therapy was compared using relative risk ratios (RR) and 95% credible intervals (CrI), and ranked according to the value of the surface under the cumulative ranking curve. Results: A total of 84,103 patients from 32 studies were included: Patients in used aspirin (n=26,834); cilostazol (n=3,303); clopidogrel (n=12,406); prasugrel (n=1,885); sarpogrelate (n=752); ticagrelor (n=1,933); ticlopidine (n=1,644); triflusal (n=391); aspirin plus cilostazol (n=1,120), aspirin plus clopidogrel (n=4,623); aspirin plus dipyridamole (n=10,853); aspirin plus ticagrelor (n=5,859); aspirin plus ticlopidine (n=132). Patients who used aspirin plus clopidogrel and cilostazol had a lower risk of recurrent stroke than those who used placebo. Patients administered with aspirin plus ticagrelor, aspirin plus clopidogrel, and cilostazol had a lower risk of composite vascular events than those administered placebo. Patients administered aspirin plus ticagrelor had a higher risk of major bleeding than those administered placebo. Clustered three-dimensional rank plots of recurrent stroke, major bleeding, and composite vascular events demonstrated that cilostazol had higher values of the surface under the cumulative ranking curve than other treatments. Conclusions: Of the antiplatelet regimens, cilostazol showed the best net clinical benefits than other antiplatelet regimens in Asians with non-cardioembolic stroke or TIA.
BACKGROUND: The standardization for the clinical use of drug therapy for cerebral infarction (CI) has not yet determined in some aspects. In this paper, we discussed the efficacies of different drug therapies (aspirin, aspirin plus dipyridamole, aspirin plus clopidogrel, aspirin plus warfarin, cilostazol, warfarin, and ticlopidine) for CI.
METHODS: We searched databases of PubMed and Cochrane Library from the inception to April, 2017, randomized controlled trials (RCTs) met the inclusion and exclusion criteria were enrolled in this study. The network meta-analysis integrated evidences of direct and indirect comparisons to assess odd ratios (OR) and surface under the cumulative ranking curves (SUCRA) value.
RESULTS: Thirteen eligible RCTs including 7 drug therapies were included into this network meta-analysis. The network meta-analysis results showed that CI patients who received aspirin plus dipyridamole presented lower mortality when compared with those received aspirin plus clopidogrel (OR = 0.46, 95% CI = 0.18-0.99), indicating aspirin plus dipyridamole therapy had better efficacy for CI. As for intracranial hemorrhage (ICH), stroke recurrence, and adverse event (AE) rate, there were no significant differences of efficacy among 7 drug therapies. Besides, SUCRA values demonstrated that in the 7 drug therapies, aspirin plus dipyridamole therapy was more effective than others (mortality: 80.67%; ICH: 76.6%; AE rate: 90.2%).
CONCLUSIONS: Our findings revealed that aspirin plus dipyridamole therapy might be the optimum one for patients with CI, which could help to improve the survival of CI patients.
背景：目前正在讨论前列腺癌（PC）患者循环微小RNA（miRNA）检测的诊断价值。因此，我们进行了已发表文献的荟萃分析，系统地评估了PC中循环miRNA的诊断潜力。方法：在PubMed，Embase和中国国家知识基础设施数据库中搜索符合条件的研究。使用随机效应模型汇集灵敏度和特异性，并用于绘制汇总接收者操作符特征（SROC）曲线。所有分析使用Stata 13.0软件和Meta-Disc 1.4 for windows进行。结果：根据纳入标准，荟萃分析共纳入10篇。基于所有包括研究的汇总结果显示，循环miRNA具有相对较好的诊断性能，灵敏度为0.74，特异性为0.71，而在不加选择的对照组PC中，SROC曲线下面积（AUC）为0.77。此外，meta回归和亚组分析表明，多个循环miRNAs检测显示出比单一检测更好的诊断性能，AUC从0.75增加到0.81。另外有趣的发现是，与基于非高加索人的PC相比，基于高加索人的循环miRNAs测定可以达到更高的精度，p值为0.0378。结论：我们的结果证实了循环miRNA在PC的早期诊断中的潜在应用，特别是多重循环miRNA的组合。然而，仍然需要进行大规模的前瞻性研究来进一步验证我们的发现。
背景：ACL损伤在运动中很常见，导致风险筛查和损伤预防计划的发展，以针对可修改的神经肌肉风险因素。以前已经分析过单腿切割任务的研究报告说，任务的预期状态（预先计划的和未预期的）对膝关节的力学有显着的影响。假设/目的：本系统综述的目的是评估运动员在竞赛期间经常执行的任务期间预测对矢状，正面和横向平面膝盖力学的影响。研究设计：系统评价。方法：使用相关关键词和搜索限制搜索以下数据库：Pub Med，SPORTDiscus，CINAHL和Web of Science。 Downs和Black清单的修改版本被用来评估由两位独立评审员撰写的文章的方法学质量。结果：在初始数据库搜索期间确定了284篇文章。经筛选后，有34篇文章进一步审查。在这些文章中，13项符合纳入本系统评估的标准。结论：似乎不允许受试者预先计划运动策略的任务可以促进膝关节力学，这可能会增加运动员的受伤风险。临床相关：参与制定和实施ACL损伤风险筛查和预防项目的临床医生可能希望考虑纳入不允许时间进行预先规划的任务。这些意想不到的任务可能更加模仿体育环境的需求，并可能促进增加伤害风险的机制。证据层次：等级1b。
Background: The optimal antiplatelet treatment for the secondary prevention of non-cardioembolic stroke or transient ischemic attack (TIA) remains uncertain in Asians. Methods: We searched for eligible randomized control trials in Medline, Embase, and the Cochrane Library. A Bayesian network meta-analysis (NMA) was performed to assess the efficacy and safety of antiplatelet regimens with placebo as the control. Each therapy was compared using relative risk ratios (RR) and 95% credible intervals (CrI), and ranked according to the value of the surface under the cumulative ranking curve. Results: A total of 84,103 patients from 32 studies were included: Patients in used aspirin (n=26,834); cilostazol (n=3,303); clopidogrel (n=12,406); prasugrel (n=1,885); sarpogrelate (n=752); ticagrelor (n=1,933); ticlopidine (n=1,644); triflusal (n=391); aspirin plus cilostazol (n=1,120), aspirin plus clopidogrel (n=4,623); aspirin plus dipyridamole (n=10,853); aspirin plus ticagrelor (n=5,859); aspirin plus ticlopidine (n=132). Patients who used aspirin plus clopidogrel and cilostazol had a lower risk of recurrent stroke than those who used placebo. Patients administered with aspirin plus ticagrelor, aspirin plus clopidogrel, and cilostazol had a lower risk of composite vascular events than those administered placebo. Patients administered aspirin plus ticagrelor had a higher risk of major bleeding than those administered placebo. Clustered three-dimensional rank plots of recurrent stroke, major bleeding, and composite vascular events demonstrated that cilostazol had higher values of the surface under the cumulative ranking curve than other treatments. Conclusions: Of the antiplatelet regimens, cilostazol showed the best net clinical benefits than other antiplatelet regimens in Asians with non-cardioembolic stroke or TIA.
