ObjectiveThe detailed associations between type 2 diabetes (T2D) and total stroke and magnesium intake as well as the dose–response trend should be updated in a timely manner.DesignSystematic review and meta-analyses.Data sourcesPubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov were rigorously searched from inception to 15 March 2019.Eligibility criteriaProspective cohort studies investigating these two diseases were included.Data synthesisRelative risk (RR) and 95% CI in random effects models as well as absolute risk (AR) were pooled to calculate the risk of T2D and stroke. Methodological quality was assessed by the Newcastle-Ottawa Scale.ResultsForty-one studies involving 53 cohorts were included. The magnitude of the risk was significantly reduced by 22% for T2D (RR 0.78 (95% CI 0.75 to 0.81); p<0.001; AR reduction 0.120%), 11% for total stroke (RR 0.89 (95% CI 0.83 to 0.94); p<0.001; AR reduction 0.281%) and 12% for ischaemic stroke (RR 0.88 (95% CI 0.81 to 0.95); p=0.001; AR reduction 0.246%) when comparing the highest magnesium intake to the lowest. The inverse association still existed when studies on T2D were adjusted for cereal fibre (RR 0.79; p<0.001) and those on total stroke were adjusted for calcium (RR 0.89; p=0.040). Subgroup analyses suggested that the risk for total and ischaemic stroke was significantly decreased in females, participants with ≥25 mg/m2body mass index and those with ≥12-year follow-up; the reduced risk in Asians was not as notable as that in North American and European populations.ConclusionsMagnesium intake has significantly inverse associations with T2D and total stroke in a dose-dependent manner. Feasible magnesium-rich dietary patterns may be highly beneficial for specific populations and could be highlighted in the primary T2D and total stroke prevention strategies disseminated to the public.PROSPERO registration numberCRD42018092690.

Background: Whether video-assisted thoracoscopic surgery (VATS) segmentectomy and VATS lobectomy provide similar perioperative and oncological outcomes in stage I non-small cell lung cancer (NSCLC) is still controversial. Methods: Meta-analysis of 12 studies comparing outcomes after VATS lobectomy and VATS segmentectomy for stage I NSCLC. Data were analyzed by the RevMan 5.3 software. Results: Disease-free survival (HR 1.19, 95% CI 0.89 to 1.33, P = 0.39), overall survival (HR 1.11, 95% CI 0.89 to 1.38, P = 0.36), postoperative complications (OR = 1.10, 95% CI 0.69 to 1.75, P = 0.7), intraoperative blood loss (MD = 3.87, 95% CI − 10.21 to 17.94, P = 0.59), operative time (MD = 10.89, 95% CI − 13.04 to 34.82, P = 0.37), air leak > 5 days (OR = 1.20, 95% CI 0.66 to 2.17, P = 0.55), and in-hospital mortality (OR = 1.67, 95% CI 0.39 to 7.16, P = 0.49) were comparable between the groups. Postoperative hospital stay (MD = − 0.69, 95% CI − 1.19 to − 0.19, P = 0.007) and number of dissected lymph nodes (MD = − 6.44, 95%CI − 9.49 to − 3.40, P < 0.0001) were significantly lower in VATS segmentectomy patients. Conclusions: VATS segmentectomy and VATS lobectomy provide similar oncological and perioperative outcomes for stage I NSCLC patients. This systematic review was registered on PROSPERO and can be accessed at http://www.crd.york.ac.uk/PROSPERO/ display_record.php?ID = CRD42019133398.

Background The efficacy of bevacizumab combined with erlotinib (B + E) for the treatment of advanced hepatocellular carcinoma, especially for sorafenib-refractory patients, has been observed and evaluated in several trials. We conducted this single arm meta-analysis to generally assess the benefit and risk with B + E for advanced hepatocellular carcinoma. Methods The PubMed, Cochrane Library, Embase, ScienceDirect, Web of Science and Scopus databases were searched for related studies. The main outcomes were objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS) and adverse effects (AEs). Results Eight phase II clinical trials including 342 hepatocellular carcinoma patients were analyzed. The pooled ORR was 12.6% (95% CI: 6.3–19.0%), and the pooled DCR was 54.5% (95% CI: 48.9–66.8%). The 16-week PFS rate was 50.2% (95% CI: 38.2–62.2%). The 6- and 12-month OS rates were 77.8% (95% CI: 71.3–84.2%) and 44.9% (95% CI: 36.8–53.0%). The main grade 3–4 AEs were fatigue (11.9%), diarrhea (9.0%), hypertension (6.7%), acne (5.8%) and hemorrhage (5.3%). The only RCT showed that the B + E regimen had a consistent response and equable median OS but fewer toxicities (grade 3–4 AEs: 19% vs. 27%) than sorafenib. Subgroup analysis showed that as a second-line treatment, the B + E regimen had substantial value with a favorable PFS-16w ( P = 0.012), OS-12 m ( P = 0.048) and a favorable tendency of ORR ( P = 0.089), but obvious toxicities in the second-line setting could not be neglected. Conclusion Bevacizumab combined with erlotinib is effective for treating hepatocellular carcinoma patients, especially sorafenib-refractory patients. More well-designed and large-scale RCTs are warranted to prove our findings. Electronic supplementary material The online version of this article (10.1186/s12885-019-5487-6) contains supplementary material, which is available to authorized users.

Background The standard sunitinib schedule to treat metastatic renal cell carcinoma (mRCC) is 4 weeks on/2 weeks off (4/2). However, some studies revealed intolerable adverse events (AEs) in patients on this schedule. An alternative schedule, 2 weeks on/1 week off (2/1), may overcome this issue. This meta-analysis was performed to compare the effectiveness and toxicity between the 2/1 and 4/2 sunitinib dosing schedules. Methods We acquired relevant studies by searching PubMed, ScienceDirect, the Cochrane Library, Scopus, Ovid MEDLINE, Embase, Web of Science, and Google Scholar. Our main endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and AEs. Results We identified 9 medium- and high-quality studies. Both schedules were effective for mRCC, with comparable OS and similar ORR. However, the 2/1 schedule had better PFS (hazard ratio (HR) = 0.81, 95% confidence interval [CI]: 0.66-0.99, P= 0.04), higher DCR (risk rate (RR) = 1.22, 95% CI: 1.01-1.47, P= 0.04) and fewer dosage interruptions (RR= 0.60, 95% CI: 0.43-0.84, P= 0.003). Additionally, the 2/1 schedule elicited fewer specific severe AEs, including thrombocytopenia/platelet disorder, hand-foot syndrome, hypertension and fatigue. In our subanalysis, PFS was better among East Asians using the 2/1 schedule than among other populations (HR= 0.75, 95% CI: 0.58-0.98, P= 0.03), and patients administered an initial dosage of 50 mg/d on the 2/1 schedule had superior PFS (HR= 0.76, 95% CI: 0.59-0.97, P= 0.03) than those others. Conclusions These findings suggest that the 2/1 schedule is more suitable for mRCC than 4/2, due to superior PFS, better DCR and fewer AEs. Nevertheless, more large-scale studies with good quality are needed.

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