ABSTRACT
Neonatal encephalopathy (NE) is one of the major causes of neonatal death and severe disability in childhood.The etiology of NE is complex, which can occur in prenatal or delivery, and some neonates may even have high risk factors in both prenatal and delivery.Prenatal maternal diseases, hereditary diseases and genetic predisposition, hypoxic-ischemic encephalopathy, infections, placental abnormalities, thrombosis, abnormal blood coagulation, and metabolic diseases can all directly cause NE.Some patients of NE have comorbidities such as neuromuscular diseases, congenital heart disease, severe anemia, and severe pulmonary diseases, which lead to the disturbance of extrauterine adjustment during delivery, and the occurrence of hypoxic-ischemia leading to NE.NE is a heterogeneous disease, and the selection of appropriate assessment based on the medical history and examination, identification of the etiology of NE and treatment for the etiology can improve the prognosis.
ABSTRACT
Objective To evaluate the efficacy and adverse events of adjuvant targeted therapy for non-distant metastatic renal cell carcinoma (ndmRCC).Methods A comprehensive literature search was conducted in PubMed,SpringerLink,Web of Science,and the Cochrane Library.All clinical randomized controlled trials on adjuvant targeting therapy for ndmRCC were retrieved.Literature screening,data extraction and literature quality evaluation were conducted by three researchers independently,and metaanalysis was performed using Review Manager Version 5.3.Outcomes we were interested in included progression-free survival (PFS),overall survival (OS),and adverse events.Results A total of 4 RCTs with 5 studies and 4 944 ndmRCC patients were selected for meta-analysis.Targeted adjuvant therapy improved the PFS of ndmRCC patients.The hazard ratio (HR) was 0.92(95％ CI0.85-1.00,P =0.05) between the targeted therapy group and the placebo group.With the extension of follow-up,this effect was more significant,and the HR was 0.89 (95％ CI0.81-0.97,P =0.01).However,targeted adjuvant therapy did not extend the OS of ndmRCC patients,and the HR was 0.92(95％ CI0.81-1.05,P =0.22).Compared with the placebo,targeted adjuvant therapy increased the incidence of adverse events and the number of patients who had to discontinue because of adverse events was also increased.The odds ratios were 6.03 (95％ CI5.30-6.86,P ＜ 0.001) and 7.65 (95 ％ CI6.31-9.26,P ＜ 0.001),respectively.Conclusions Targeted adjuvant therapy can improve the PFS of ndmRCC patients after surgery,but it cannot improve the OS.At the same time,it increases the incidence of adverse events.
