Background Conflicting evidence exists regarding the effect of hypertension on the prognosis of metastatic renal cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors (TKIs). This study aimed to assess the predictive value of TKIs-induced hypertension in patients with mRCC. Methods This study was registered in PROSPERO (CRD42019129593). PubMed, Embase, Web of Science and the Cochrane Library database were searched with terms: “renal cell carcinoma”, “hypertension”, “blood pressure”, “tyrosine kinase inhibitor”, “sunitinib”, “axitinib”, “sorafenib” and “pazopanib” until March 21, 2019. Hazard Ratios (HR) and 95% confidence intervals (CI) for progression-free survival (PFS) or overall survival (OS) were extracted and analyzed with Stata 15.0 software. Heterogeneity was assessed using the I 2 value. Meta-regression, subgroup analysis and sensitivity analysis were also performed to explore heterogeneity. Publication bias was assessed with funnel plots and precisely assessed by Egger’s and Begg’s tests. The quality of evidence of outcomes was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results A total of 4661 patients from 22 studies were included in the study. The results showed that the increase of blood pressure was an effective predictor for longer PFS (HR = 0.59, 95% CI: 0.48–0.71, p < 0.001; I 2 = 77.3%) and OS (HR = 0.57, 95% CI: 0.45–0.70, p < 0.001; I 2 = 77.4%) of patients with mRCC. Subgroup analysis revealed that patients receiving sunitinib and pazopanib could have longer PFS and OS. Conclusions This study indicated that TKIs-induced hypertension may be a good predictor for better prognosis of patients with mRCC receiving TKIs treatment, especially using sunitinib or pazopanib. Electronic supplementary material The online version of this article (10.1186/s12894-019-0481-5) contains supplementary material, which is available to authorized users.

Introduction The role of sexual activity (SA) on prostate cancer (PCa) risk is still controversial. Aim To determine the associations among number of female sexual partners, age at first intercourse, ejaculation frequency (EF), and the risk of PCa. Methods A systematic literature search on MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify the relevant studies published before April 2018. We calculated the summary odds ratio (OR) and 95% CI to determine the association between SA and PCa risk. A 2-stage dose-response meta-analysis was performed to explore the trend from the correlated log OR estimates. Main Outcome Measures Outcome measures included characteristics of included studies, associations among number of female sexual partners, age at first intercourse, as well as EF and PCa risk. Results A total of 21 case-control studies and 1 cohort study with 55,490 participants (14,976 patients and 40,514 controls) were included in this meta-analysis. Linear and significant dose–response associations were found among number of female sexual partner as well as age at first intercourse and PCa risk, an increment of 10 female sexual partners associated with a 1.10-fold increase of PCa risk (OR 1.10, 95% CI 1.01–1.21), and the risk of PCa was decreased by 4% for every 5-year delay in age at first intercourse (OR 0.96, 95% CI 0.92–0.99). Although no linear association was observed between EF and the risk of PCa, moderate EF (2–4 times per week) was significantly associated with a lower risk of PCa (OR 0.91, 95% CI 0.87–0.96). Clinical Implications Modification of SA factors would appear to be a useful low-risk approach to decreasing the risk of PCa. Strengths & Limitations This is the first dose–response meta-analysis performed to describe the association between SA and PCa risk. However, the direction of causality between SA and risk of PCa should be interpreted with caution because most included studies used case-control design. Conclusion Meta-analysis of the included studies indicated that men with fewer sexual partner numbers, older age at first intercourse, and moderate frequent ejaculation were associated with a significantly decreased risk of PCa.

We recommend the initial use of dapoxetine 30 mg OD for PE because it has been tested in largest and better designed clinical trials rather than it is more effective than the other drugs studied. TAs and tramadol 50 mg OD can be used as a viable alternative to oral treatment with SSRIs. PDE5is combined with SSRIs are more effective than SSRIs monotherapy but are also associated with more side effects. PDE5is OD can be recommended to PE patients with ED.

The protocol of this systematic review and network meta-analysis was submitted to the PROSPERO register and the registration number is CRD42019122324. The original data are available in the supplementary information. Because no human beings or animals were part of this study, ethics committee approval was not required. Search strategies. Two investigators (TJX and DLQ) independently performed a systematic literature retrieval. Commonly used databases, including Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and EMBASE, were searched on December 30, 2018, and the last searched date was April 1, 2019. The text-word terms and subject headings we used in this study were "Immunoglobulin A nephropathy", "cyclophosphamide", "azathioprine", "tacrolimus", "mycophenolic acid", "mycophenolate mofetil", "steroids", and "glucocorticoid". The syntax used in each database is shown in Supplementary Table 1 (Table S1). To avoid omitting important articles, we also hand-searched the references of each retrieved study, relevant reviews, editorials and commentary.