We aimed to evaluate the response rate of migraines by using anti-calcitonin gene-related peptide (anti-CGRP) for patients with migraines. We searched three main medical databases up to 29 March 2019. No restriction on language and publication time were applied. Eligible trials included randomized clinical trials investigating a 50%, 75%, and 100% response rate of migraine patients after anti-CGRP intervention. The collected data were dichotomous, and risk ratios (RRs) with a 95% confidence interval (CI) were used to present the quantitative synthesis results. The systematic review identified 16 eligible randomized clinical trials (RCTs) with 9439 patients. Eight of the 16 trials with 2516 patients reported a 50% response rate, and the pooled results showed a significant benefit from anti-CGRP. However, the effects seem to gradually reduce from the first month (RR 1.99, 95% CI 1.59 to 2.49) to the third month (RR 1.48, 95% CI 1.26 to 1.75) of treatment. The magnitude of effect was influenced by the type of anti-CGRP, according to the test for differences between subgroups (I-square = 53%). The funnel plots and Egger’s tests did not show serious small study effects in the results. In conclusion, the current evidences confirmed that anti-CGRP treatment can reduce migraine pain in the short term (within three months), but the long-term effect should be investigated in the future. Moreover, its effects may be influenced by the type and dose of anti-CGRP. Therefore, future studies should make direct comparisons among anti-CGRP medications.

Background/Aims: To evaluate the effects of topical cyclosporin A (CsA) and artificial tears (ATs) for treating patients with dry-eye disease (DED). Methods: On January 25, 2019, five electronic databases and reference lists were searched for randomized clinical trials (RCTs) comparing CsA with ATs among patients with DED. The search strategy had no restriction on language or time. Two authors extracted surgery, mean age, anesthesia for Schirmer's test, tear-breakup time, Schirmer's test score, fluorescein-staining score, ocular surface-disease index, and adverse events. Mean differences (MDs) were calculated for continuous outcomes and Peto ORs for dichotomous data with zero cells. Results were analyzed with 95% CIs in a random-effect model. Results: Eleven RCTs recruiting 1,085 cases with DED were included. Pooled results showed that CsA had better tear-breakup time (MD 0.94, 95% CI 0.08-1.80), fluoresceinstaining score (standardized MD −0.72, 95% CI −1.28 to −0.16), and ocular surface-disease index (MD −4.75, 95% CI −6.31 to −3.18) when compared to ATs. Although CsA had more adverse events than ATs (Peto OR 7.70, 95% CI 3.17-18.68), no serious adverse events were reported. Conclusion: Overall, CsA is an effective option for treating patients with DED, yet our evidence indicated decreasing effects when CsA was combined with ATs. CsA may be worth suggesting to relatively older patients with DED. We anticipate further RCTs to explore the effects of treatment duration, optimal dosage, and efficacy of CsA in different DED etiology.

Background and objectivesPatients with kidney failure have a high risk of cardiovascular disease due to cardiac remodeling, left ventricular fibrosis, and hyperaldosteronism, all of which can be potentially mitigated by mineralocorticoid receptor antagonists. However, because of the fear of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with kidney failure is limited in current clinical practice, and few studies have investigated the efficacy and safety. Thus, we aimed to determine the benefits and side effects of mineralocorticoid receptor antagonists in patients with kidney failure treated with dialysis.Design, setting, participants, & measurementsThis is a systematic review and meta-analysis of randomized controlled trials published from 2005 to 2020 that compared the effect of mineralocorticoid receptor antagonists with either placebo or no treatment in patients with kidney failure. Two reviewers independently searched the PubMed, EMBASE, and Cochrane databases for all published studies, extracted data, assessed the risk of bias, and rated the quality of evidence. A meta-analysis was conducted on 14 eligible randomized controlled trials, and a total of 1309 patients were included.ResultsHigh-quality evidence suggested that mineralocorticoid receptor antagonists are associated with lower cardiovascular mortality (relative risk, 0.41; 95% confidence interval, 0.24 to 0.70; P=0.001) and all-cause mortality (relative risk, 0.44; 95% confidence interval, 0.30 to 0.66; P<0.001), and the risk of hyperkalemia was comparable with that of control group (relative risk, 1.12; 95% confidence interval, 0.91 to 1.36; P=0.29). However, no significant decrease in nonfatal cardiovascular events and stroke was observed, and there was no significant improvement in BP or cardiac performance parameters, including left ventricular ejection fraction and left ventricular mass index.ConclusionsOur meta-analysis suggests that mineralocorticoid receptor antagonists might improve clinical outcomes of patients with kidney failure without significant increase in the risk of hyperkalemia.

Background As ultrasound has become increasingly prominent in medicine, portable ultrasound is perceived as the visual stethoscope of the twenty-first century. Many studies have shown that exposing preclinical students to ultrasound training can increase their motivation and ultrasound competency. However, few studies have discussed the effect of ultrasound training on anatomy learning. Method The Parallel Ultrasound Hands-on (PUSH) course was designed to investigate whether or not ultrasonography training affects anatomy knowledge acquisition. The PUSH course included anatomical structures located in the chest and abdomen (target anatomy) and was conducted in parallel to the compulsory gross anatomy course. Learners (n = 140) voluntarily participated in this elective course (learners in the course before the midterm examination (Group 1, n = 69), or after the midterm examination (Group 2, n = 71)). Anatomy examination scores (written and laboratory tests) were utilized to compare the effects of the PUSH course. Result Group 1 obtained significantly higher written test scores on the midterm examination (mean difference [MD] = 1.5(7.6%), P = 0.014, Cohen’s d = 0.43). There was no significant difference in the final examination scores between the two groups (Written Test: MD = 0.3(1.6%), P = 0.472). In Laboratory test, both mid-term (MD:0.7(2.8%), P = 0.308) and final examination (MD:0.3(1.5%), P = 0.592) showed no significant difference between two groups. Students provided positive feedback in overall learning self-efficacy after the PUSH course (Mean = 3.68, SD = ±0.56 on a 5-point Likert scale). Learning self-efficacy in the cognitive domain was significantly higher than that in the affective domain (MD = 0.58; P < 0.001) and psychomotor domain (MD = 0.12; P = 0.011). Conclusion The PUSH course featured a hands-on learning design that empowered medical students to improve their anatomy learning.

Study Design: A network meta-analysis. Objectives: Lumbar degenerative disc disease (LDDD) is an important issue in aging population, for which lumbar interbody fusion (LIF) is a feasible management in cases refractory to conservative therapy. There are various techniques available to perform LIF, including posterior (PLIF), transforaminal (TLIF), and anterior (ALIF) approaches. However, the comparative safety profile of these procedures remains controversial. Our study aimed to evaluate comparative adverse events of the LIF procedures in patients with LDDD. Methods: We searched 5 databases for relevant prospective cohort studies and randomized clinical trials. After quality assessments, we extracted neural, spinal, vascular, and wound events for conducting contrast-based network meta-analysis. Results were reported in risk ratio (RR), 95% confidence interval (CI), and surface under the cumulative ranking (SUCRA). Results: We identified 14 studies involving 921 participants with LDDD. Pooled result showed that open PLIF (OPLIF) leads to significantly higher overall adverse event rate than does open TLIF (OTLIF; RR = 3.43, 95% CI = 1.21-9.73). OTLIF confers the highest SUCRA in neural (78.7) and spinal (80.8) event rates. Minimally invasive TLIF has the highest SUCRA in vascular event (84.2), and minimally invasive PLIF has the highest SUCRA in wound event (88.1). No inconsistency or publication bias was detected in the results. Conclusions: Based on our results, perhaps OPLIF should be avoided in the management of LDDD due to the inferiority of overall complications. Specifically, TLIF seems to have the safest profile in terms of neural, spinal, and vascular events. Nevertheless, shared decision making is still mandatory when choosing the proper LIF procedure for patients with LDDD in clinical practice.

Background Endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal lesions. A traction-assisted (TA) strategy has been recently developed for ESD. In this study, we evaluated the safety and efficacy of TA-ESD compared with conventional ESD (C-ESD). Methods We searched PubMed, Embase, Web of Science, and the China National Knowledge Infrastructure to identify randomized clinical trials that compared TA-ESD and C-ESD. No filters for language or date of publication were used. Outcomes included complete resection rate, resected specimen size, procedure time, hemostasis usage (frequency), overall complication rate, perforation rate, and delayed bleeding rate. We used the mean difference (MD) for continuous outcomes in a random-effects model and Peto odds ratio (POR) for binary outcomes where any zero cell existed. Effect sizes and their 95 % confidence intervals (CIs) were determined. Results 12 out of 929 identified articles, including 1499 patients, were analyzed. According to pooled results, TA-ESD produced similar R0 resections to C-ESD, but its procedure time (minutes) was shorter than that of C-ESD (MD – 16.02, 95 %CI – 22.71 to – 9.33). Moreover, TA-ESD had a lower complication rate (POR 0.47, 95 %CI 0.29 to 0.76) and perforation rate (POR 0.24, 95 %CI 0.10 to 0.56) than C-ESD. A nonsignificant difference in delayed bleeding rate was observed, although there was a trend toward this being lower in TA-ESD than C-ESD (POR 0.90, 95 %CI 0.46 to 1.75, I 2 = 12 %). Conclusions The traction-assisted strategy improves safety and efficacy in the treatment of patients with ESD. However, we observed different effect sizes in the esophagus, stomach, and colorectum.

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To better understand the efficacy of intravitreal dexamethasone implant (Ozurdex) versus antivascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular edema (DME). A systematic review and meta-analysis. The study included randomized control trials (RCTs) and non-randomized control trials (Non-RCTs) before December 2021 that compare the efficacy of Ozurdex-related therapyand anti-VEGF therapy. We searched PubMed, Cochrane Library, and EMBASE. The quality of the included studies was assessed carefully. 30 studies were included. Regarding BCVA change, the overall result revealed no significant differences between Ozurdex and anti-VEGF therapies in patients with nonresistant DME, but Ozurdex group had significantly more VA improvement than anti-VEGF therapies in patients with resistant DME (MD 0.12, 95% CI 0.02–0.21). In terms of central retinal thickness (CRT) decrease, there was a significant difference between Ozurdex therapy and anti-VEGF therapy in patients with nonresistant DME (MD 48.10, 95% CI 19.06–77.13) and resistant DME (MD 65.37, 95% CI 3.62–127.13). Overall, Ozurdex therapy resulted in significantly greater VA improvement and CRT decrease than anti-VEGF therapy in resistant DME patients. Ozurdex therapy was not inferior to anti-VEGF therapy in patients with nonresistant DME.