• MeSH
• lékařství MeSH
• metaanalýza jako téma MeSH
• náklady a analýza nákladů MeSH
• Publikační typ
• metaanalýza MeSH

• Konspekt
• Lékařské vědy. Lékařství
• NLK Obory
• lékařství
• management, organizace a řízení zdravotnictví

Systematické přehledy se široce využívají jako prostředek medicíny založené na důkazech. Systematický přehled je metoda hledání, hodnocení a syntéza evidence. Meta-analýza znamená kvantitativní syntézu výsledků klinických pokusů nebo jiných primárních studií. Podáváme jednoduchý úvod do této metody, popisujeme dva příklady aplikace v medicíně, její přednosti a slabostí.

Systematic reviews are widely used in medicine as a method of decision making based on evidences. The systematic review is a method of locating and evaluation of a synthesising evidence. Meta-analysis refers to quantitative synthesis of the results of clinical trials or other primary studdis. Simple introductory account about meta-analysis is given. We describe two examples of meta-analysis application and strengths and weaknesses of this research method.

• MeSH
• finanční podpora výzkumu jako téma MeSH
• homeopatie MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• statistika jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• klinické zkoušky MeSH
• metaanalýza MeSH
• přehledy MeSH

• Konspekt
• Veřejné zdraví a hygiena
• NLK Obory
• management, organizace a řízení zdravotnictví
• veřejné zdravotnictví

• MeSH
• klinické zkoušky jako téma MeSH
• metaanalýza jako téma MeSH
• Publikační typ
• klinické zkoušky MeSH

• Konspekt
• Statistika
• NLK Obory
• statistika, zdravotnická statistika
• diagnostika

Recently, concerns regarding the safety of red yeast rice (RYR) have been raised after the publication of some case reports claiming toxicity. Since the previous meta-analyses on the effects of RYR were mainly focused on its efficacy to improve lipid profile and other cardiovascular parameters, we carried out a meta-analysis on safety data derived from the available randomized controlled clinical trials (RCTs). Primary outcomes were musculoskeletal disorders (MuD). Secondary outcomes were non-musculoskeletal adverse events (Non-MuD) and serious adverse events (SAE). Subgroups analyses were carried out considering the intervention (RYR alone or in association with other nutraceutical compounds), monacolin K administered daily dose (≤3, 3.1-5 or >5 mg/day), follow-up (>12 or ≤12 weeks), with statin therapy or statin-intolerance and type of control treatment (placebo or statin treatment). Data were pooled from 53 RCTs comprising 112 treatment arms, which included 8535 subjects, with 4437 in the RYR arm and 4303 in the control one. Monacolin K administration was not associated with increased risk of MuD (odds ratio (OR) = 0.94, 95% confidence interval (CI) 0.53,1.65). Moreover, we showed reduced risk of Non-MuD (OR = 0.59, 95%CI 0.50, 0.69) and SAE (OR = 0.54, 95%CI 0.46, 0.64) vs. control. Subgroups analyses confirmed the high tolerability profile of RYR. Furthermore, increasing daily doses of monacolin K were negatively associated with increasing risk of Non-MuD (slope: -0.10; 95%CI: -0.17, -0.03; two-tailed p < 0.01). Based on our data, RYR use as lipid-lowering dietary supplement seems to be overall tolerable and safe in a large kind of moderately hypercolesterolaemic subjects.

• MeSH
• biologické přípravky škodlivé účinky   MeSH
• lidé MeSH
• muskuloskeletální nemoci MeSH
• potravní doplňky škodlivé účinky   MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

• MeSH
• metaanalýza jako téma * MeSH
• statistika jako téma MeSH
• Publikační typ
• metaanalýza MeSH
• příručky MeSH

• Konspekt
• Statistika
• NLK Obory
• statistika, zdravotnická statistika

• MeSH
• metaanalýza jako téma MeSH
• zdravotní politika MeSH
• Publikační typ
• metaanalýza MeSH

• Konspekt
• Veřejné zdraví a hygiena
• NLK Obory
• management, organizace a řízení zdravotnictví

• MeSH
• lidé MeSH
• příroda MeSH
• psychologické jevy a procesy MeSH
• sebepojetí MeSH
• sporty MeSH
• tělesná výchova MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• metaanalýza MeSH

CONTEXT: Adjuvant immune checkpoint inhibitors (ICIs) have recently emerged as guideline-recommended treatments of high-risk muscle-invasive urothelial carcinoma (MIUC). However, there is limited evidence regarding the optimal candidates and the differential efficacy of adjuvant ICI regimens. OBJECTIVE: To synthesize and compare the efficacy and safety of adjuvant ICIs for high-risk MIUC using updated data from phase III randomized controlled trials. EVIDENCE ACQUISITION: In April 2024, three databases were searched for eligible randomized controlled trials that evaluated oncologic outcomes in patients with MIUC treated with adjuvant ICIs. Pairwise meta-analysis (MA) and network meta-analyses were performed to compare the hazard ratios of oncological outcomes, including disease-free survival (DFS), overall survival (OS), and adverse events. Subgroup analyses were conducted on the basis of predefined clinicopathological features. EVIDENCE SYNTHESIS: Three randomized controlled trials that assessed the efficacy of adjuvant nivolumab, pembrolizumab, and atezolizumab were included in the MAs and network meta-analyses groups. Pairwise MAs showed that treatment with adjuvant ICIs significantly improved DFS [hazards ratio: 0.77, 95% confidence interval (CI): 0.66-0.90] as well as OS (hazards ratio: 0.87, 95% CI 0.76-1.00) in patients with MIUC compared with in the placebo/observation group. The DFS benefit was prominent in patients who underwent neoadjuvant chemotherapy (P = 0.041) and in those with bladder cancer (P = 0.013) but did not differ across programmed death-ligand 1 and lymph node status. Adjuvant ICI therapy was associated with increased risk of any (OR: 2.98, 95% CI 2.06-4.33) and severe adverse events (OR: 1.78, 95% CI 1.49-2.13). The treatment rankings revealed that pembrolizumab for DFS (84%) and nivolumab for OS (93%) had the highest likelihood of improving survival. CONCLUSIONS: Our analyses demonstrated the DFS and OS benefits of adjuvant ICIs for high-risk MIUC. Furthermore, patients with bladder cancer who underwent neoadjuvant chemotherapy appeared to be the optimal candidates for adjuvant ICIs regarding prolonged DFS. Adjuvant ICIs are the standard of care for high-risk MIUC, and differential clinical behaviors and efficacy will enrich clinical decision-making.

• MeSH
• adjuvantní chemoterapie metody   MeSH
• inhibitory kontrolních bodů * terapeutické užití   farmakologie   MeSH
• invazivní růst nádoru MeSH
• karcinom z přechodných buněk farmakoterapie   patologie   MeSH
• lidé MeSH
• nádory močového měchýře farmakoterapie   patologie   MeSH
• síťová metaanalýza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

BACKGROUND: Laser therapy has emerged as a promising treatment modality for improving the appearance and symptoms associated with hypertrophic and keloid scars. In this network meta-analysis, we aimed to evaluate the efficacy of different laser types in treating hypertrophic and keloid scars. METHODS: A comprehensive search of four databases was conducted to identify relevant studies published up until July 2023. Data were extracted from eligible studies and pooled as mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous data in a network meta-analysis (NMA) model, using R software. RESULTS: A total of 18 studies, comprising 550 patients, were included in the analysis. Pooling our data showed that fractional carbon dioxide (FCO2) plus 5-fluorouracil (5-FU) was superior to control in terms of Vancouver Scar Scale (VSS), pliability score, and thickness; [MD = - 5.97; 95% CI (- 7.30; - 4.65)], [MD = - 2.68; 95% CI (- 4.03; - 1.33)], [MD = - 2.22; 95% CI (- 3.13; - 1.31)], respectively. However, insignificant difference was observed among FCO2 plus 5-FU compared to control group in terms of erythema, vascularity, redness and perfusion, and pigmentation [MD = - 0.71; 95% CI (- 2.72; 1.30)], [MD = - 0.44; 95% CI (- 1.26; 0.38)], respectively. CONCLUSION: Our NMA found that the FCO2 plus 5-FU was the most effective intervention in decreasing the VSS and thickness, while FCO2 plus CO2 was the most effective intervention in decreasing the pliability score. Further research is needed to determine the optimal laser parameters and long-term efficacy of laser therapy in hypertrophic and keloid scars. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

• MeSH
• jizva hypertrofická * diagnóza   terapie   MeSH
• keloid * diagnóza   terapie   MeSH
• laserová terapie škodlivé účinky   přístrojové vybavení   metody   MeSH
• lidé MeSH
• síťová metaanalýza MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH