Objective: Procedural characteristics, including stent design, may influence the outcome of carotid artery stenting (CAS). A thorough comparison of the effect of stent design on outcome of CAS is thus warranted to allow for optimal evidence-based clinical decision making. This study sought to evaluate the effect of stent design on clinical and radiological outcomes of CAS.Methods: A systematic search was conducted in MEDLINE, Embase, and Cochrane databases in May 2018. Included were articles reporting on the occurrence of clinical short-and long-term major adverse events (MAE, any stroke or death) or radiological adverse events (new ischemic lesions on postprocedural magnetic resonance diffusion-weighted imaging (MR-DWI), restenosis or stent fracture) in different stent designs used to treat carotid artery stenosis.Random effects models were used to calculate combined overall effect sizes. Meta-regression was performed to identify the effect of specific stents on MAE rates. Results: From 2,654 unique identified articles, two randomized controlled trials and 66 cohort studies were eligible for analysis (including 46,728 procedures). Short-term clinical MAE rates were similar for patients treated with open cell versus closed cell or hybrid stents. Use of Acculink stent was associated with a higher risk of MAE compared to Wallstent (RR: 1.51, p=0.03), as was true for use of Precise stent versus Xact stent (RR: 1.55, p<0.001). Long-term clinical MAE rates were similar for open versus closed cell stents. Use of open cell stents predisposed to a 25% higher chance (RR: 1.25; p=0.03) of developing postprocedural new ischemic lesions on MR-DWI. No differences were observed in incidence of restenosis, stent fracture, or intraprocedural hemodynamic depression with respect to different stent design. [Type here] Conclusions: Stent design does not affect short-or long-term clinical MAE rates in patients undergoing CAS. Furthermore, the division in open and closed cell stent design might conceal true differences in single stent efficacy. Nevertheless, open cell stenting resulted in a significantly higher number of MR-DWI-detected subclinical postprocedural new ischemic lesions compared with closed cell stenting. An individualized patient data meta-analysis,including future studies with prospective homogenous study design, is required to adequately correct for known risk factors and provide definite conclusions with respect to carotid stent design for specific subgroups.
Background: The pathophysiologic of vascular malformations is still unclear, and the treatment of vascular malformations is a challenge. With improvement in the understanding of pathogenesis of vascular malformations, sirolimus has been a promising and effective treatment. As so far, there is absent convincing evidence to confirm the efficacy of sirolimus for vascular malformations. The purpose of this study was to evaluate the effectiveness and safety of sirolimus in the treatment of vascular malformations. Methods: The literatures about the management of vascular malformations with sirolimus would be searched from databases of MEDLINE, EMBASE, PubMed, Web of Science, Clinicaltrials.org., Cochrane Library, China Biology Medicine Database (CBM), Wan Fang Database, China National Knowledge Infrastructure Database (CNKI), and VIP Science Technology Periodical Database. We will search each database from inception or 1995 to August 20, 2020. Two researchers worked independently on literature selection, data extraction and quality assessment. The efficacy and safety of sirolimus in the treatment of vascular malformations were the main outcomes. Adverse events after sirolimus were evaluated as the secondary outcomes. The included studies will be analyzed by Review Manager 5.3. If the results are applicable, meta-analysis would also be performed. Results: The study will evaluate the efficacy and safety of sirolimus in the treatment of vascular malformations based on current evidence. Conclusion: The conclusion of this study will provide more reliable, evidence-based data for the use of sirolimus in the treatment of vascular malformations. PROSPERO registration number: CRD42020167881.
Background: The advent of PD-1/L1 inhibitors has changed the landscape for patients with non-small-cell lung cancer (NSCLC). Meanwhile, the adverse events of PD-1/L1 inhibitors have been focused. Methods: The Cochrane Central Register of Controlled Trials, PubMed and Embase databases and ClinicalTrials.gov were searched from inception to February 2021. Results: 18 studies involving 11,394 patients with NSCLC were included. PD-1/L1 inhibitor monotherapy was associated (relative risk, 95% confidence interval) with an increased risk of pericardial effusion (2.72 [1.45–5.12]; p = 0.002) and cardiac tamponade (2.76 [1.15–6.62]; p = 0.023), whereas PD-1/L1 inhibitors combined with chemotherapy did not increase the risk of pericardial effusion and cardiac tamponade (3.08 [0.93–10.21]; p = 0.066 and 3.27 [0.37–28.94]; p = 0.288, respectively). Conclusion: For patients with NSCLC, treatment with PD-1/L1 inhibitor monotherapy increases the risk of pericardial effusion and cardiac tamponade, but PD-1/L1 inhibitors combined with chemotherapy do not.
Introduction: Programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors have been increasingly used in the treatment of cancer. Immunosuppressive therapy can control the cancer well and is suitable for the moderate to severe diseases. However, according to clinical observation, immune-related cardiac adverse events against PD-1or/and PD-L1 are inevitable, but generally reversible. Understanding the cardiac adverse events of PD-1 or/and PD-L1 inhibitors is crucial to improve the anti-cancer efficacy and ensure the life safety of patients. The variability of cardiac adverse events between different immunosuppressants and different cancers is not clear. Methods and analysis: This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will search the following electronic bibliographic databases: PubMed, Cochrane Library, EMBASE databases and ClinicalTrials.gov from their inception to December 2019. We will use a combination of Medical Subject Heading, and free-text terms with various synonyms to search based on the Eligibility criteria. We will include RCTs on PD-1 or/and PD-L1 inhibitors therapy to analyze. In addition, our study will include some clinical trials. All relevant RCTs will be included, such as early phase I/II, phase III experimental trials, prospective and retrospective observational studies. According to the inclusion and exclusion criteria outlined above, the full texts of each eligible study will be retrieved for further identification by one reviewer. Two authors will screen the titles and abstracts of all records retrieved in above electronic databases independently to find potentially eligible reviews. Data will be extracted by 2 reviewers independently using a pre-designed data extraction form. The other reviewer will validate data. I-square (I2) test, substantial heterogeneity, sensitivity analysis and publication bias assessment will be performed accordingly. For our network meta-analysis, we will use Stata 15.0 and WinBUGS 1.4.3. Ethics and dissemination: Ethics approval and patient consent would be not required because the data of this network meta-analysis mainly are obtained from existing resources. This network meta-analysis will be published in a peer-reviewed journal. PROSPERO number: CRD42019142865
Objective To investigate the inhibitory effect of Brazilin (BN) on the inflammatory response of THP-1-derived macrophages induced by LPS. Methods THP-1 cells were induced with PMA to extend pseudopodia and form macrophages, and the inflammatory model was induced by LPS. The cell survival rate intervented by Brazilin was determined by the CCK-8 method, and the expression of PD-1 was detected by Flow cytometry, and contents of the cytokines IL-10 and TNF-α in the extracted supernatant of THP-1 cells were detected by ELISA, and the mRNA level was detected by RT‒PCR, while the protein level were detected by Western blot. Results The results showed that the best concentration of Brazilin was 12 µg/mL. The best concentration of simvastatin was 15 µg/mL, and the growth was concentration dependent. The expression of PD-1 on the cell surface in the two groups was significantly decreased compared with the control group, and the differences in the Brazilin group and the simvastatin group were significant (P < 0.01; P < 0.001; P < 0.001). The concentrations of TNF-α in the drug groups were significantly decreased while the IL-10 concentration was increased, and compared with the model group, the two drug groups were highly statistically significant (P < 0.001). The mRNA and the protein expression levels of PD-1, NF-κB, TLR4 and MMP-9 in the test groups had extremely significant difference compared with the model group (P < 0.001). Conclusion Brazilin can inhibit the abnormal activation of PD-1, TLR4, NF-κB and MMP-9 and is a good anti-AS drug that can not only reduce blood lipids but also have immunoregulatory and anti-inflammatory activity, laying a solid theoretical foundation for future screening and development of anti-AS drugs.
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