Difference between revisions of "Shao"

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==<span style="font-family: Arial,Helvetica,sans-serif;">Intravesical instillation of hyaluronic acid as effective as hyperbaric oxygen for radiation-induced haemorrhagic cystitis </span>==  
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== '''<span style="font-size:x-large;"><span style="font-family: Arial,Helvetica,sans-serif;">Intravesical instillation of hyaluronic acid as effective as hyperbaric oxygen for radiation-induced haemorrhagic cystitis</span></span>''' ==
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| '''<span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Both treatments were equally effective in improving symptoms of haematuria, dysuria and pelvic pain in patients with radiation-induced hemorrhagic cystitis.</span>'''<br>**<span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. No improvements in frequency was noted in patients of either group at 18 months </span>'''<br>**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">post-treatment</span>'''
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<span style="font-size:large;">'''<span style="font-family: Arial,Helvetica,sans-serif;">Clinical Bottom Line:</span>'''</span>
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| <span style="font-size:large;">1. Both treatments were equally effective in improving symptoms of haematuria, dysuria and pelvic pain in patients with radiation-induced hemorrhagic cystitis.<br/> 2. No improvements in frequency was noted in patients of either group at 18 months after t<span style="font-family: Arial, Helvetica, sans-serif;">reatment</span></span>
 
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation:''' </span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation:'''</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1.Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int. 2012 Mar; 109(5):691-4. doi: 10.1111/j.1464-410X.2011.10550.x. Epub 2011 Sep 2.</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1.Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int. 2012 Mar; 109(5):691-4. doi: 10.1111/j.1464-410X.2011.10550.x. Epub 2011 Sep 2.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2.</span><span style="color: #222222; font-size: 120%;">Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation‐induced hemorrhagic cystitis. BJU international. 2012 Mar 1;109(5):691-4.</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2.</span><span style="color: #222222; font-size: 120%;">Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation‐induced hemorrhagic cystitis. BJU international. 2012 Mar 1;109(5):691-4.</span>
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' Non-blinded randomised controlled trial without intention-to-treat.The Study Patients: Patients who developed HC after radiotherapy for pelvic malignancies</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' Non-blinded randomised controlled trial without intention-to-treat.The Study Patients: Patients who developed HC after radiotherapy for pelvic malignancies</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 20; 20 analysed): 30 daily sessions at 2.5ATA breathing 100% oxygen for 60 minutes</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 20; 20 analysed): 30 daily sessions at 2.5ATA breathing 100% oxygen for 60 minutes</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 16; 16 analysed): Intravesicular instillation of 40mg of HA weekly in the first month and subsequently monthly in the following 2 months.</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 16; 16 analysed): Intravesicular instillation of 40mg of HA weekly in the first month and subsequently monthly in the following 2 months.</span>
  
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**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The Evidence:</span>'''
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<span style="font-size:large;">'''<span style="font-family: Arial, Helvetica, sans-serif;">The Evidence:</span>'''</span>
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Outcome'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Time to Outcome'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Control group'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''HA group'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Relative risk reduction'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Absolute risk reduction'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''NNT'''</span></span>
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{| class="Table" style="border:solid windowtext 1.0pt"
 
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| '''Complete response''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">18 months</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.45</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.5</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">11%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.05</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">20</span></span>  
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| style="width:75.4pt; border:solid windowtext 1.0pt" width="104" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span>
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| style="width:55.1pt; border:solid windowtext 1.0pt" width="75" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Time to Outcome</span></span>'''</span></p>
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| style="width:42.5pt; border:solid windowtext 1.0pt" width="59" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control group</span></span>'''</span></p>
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| style="width:46.8pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HA group</span></span>'''</span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Relative risk reduction</span></span>'''</span></p>
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| style="width:69.9pt; border:solid windowtext 1.0pt" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Absolute risk reduction</span></span>'''</span></p>
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| style="width:72.6pt; border:solid windowtext 1.0pt" width="100" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT</span></span>'''</span></p>  
 
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; text-align: right;">95% CI:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-62% to 84%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-0.28 to 0.38</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">NNT ''' 3 to INF; NNH ''' 4 to INF</span></span>  
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| style="width:75.4pt; border:solid windowtext 1.0pt" width="104" |  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Complete response</span></span>'''</span>
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| style="width:55.1pt; border:solid windowtext 1.0pt" width="75" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">18 months</span></span></span></p>
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| style="width:42.5pt; border:solid windowtext 1.0pt" width="59" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.45</span></span></span></p>
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| style="width:46.8pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.5</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">11%</span></span></span></p>
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| style="width:69.9pt; border:solid windowtext 1.0pt" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.05</span></span></span></p>
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| style="width:72.6pt; border:solid windowtext 1.0pt" width="100" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">20</span></span></span></p>  
 
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| '''No clots, but macroscopic haematuria persisting''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">18 months</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.30</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.25</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">17%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.05</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">20</span></span>  
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| style="width:75.4pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="104" | &nbsp;
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| style="width:55.1pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="75" | &nbsp;
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| style="width:42.5pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="59" | &nbsp;
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| style="width:46.8pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-62% to 84%</span></span></span></p>
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| style="width:69.9pt; border:solid windowtext 1.0pt" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.28 to 0.38</span></span></span></p>
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| style="width:72.6pt; border:solid windowtext 1.0pt" width="100" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT 3 to INF NNH 4 to INF</span></span></span></p>  
 
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; text-align: right;">95% CI:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-81% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-0.24 to 0.34</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">NNT ''' 3 to INF; NNH ''' 4 to INF</span></span>  
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| style="width:75.4pt; border:solid windowtext 1.0pt" width="104" |  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">No clots, but macroscopic haematuria persisting</span></span>'''</span>
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| style="width:55.1pt; border:solid windowtext 1.0pt" width="75" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">18 months</span></span></span></p>
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| style="width:42.5pt; border:solid windowtext 1.0pt" width="59" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.30</span></span></span></p>
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| style="width:46.8pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.25</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">17%</span></span></span></p>
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| style="width:69.9pt; border:solid windowtext 1.0pt" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.05</span></span></span></p>
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| style="width:72.6pt; border:solid windowtext 1.0pt" width="100" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">20</span></span></span></p>  
 
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| style="width:75.4pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="104" | &nbsp;
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| style="width:55.1pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="75" | &nbsp;
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| style="width:42.5pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="59" | &nbsp;
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| style="width:46.8pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-81% to 100%</span></span></span></p>
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| style="width:69.9pt; border:solid windowtext 1.0pt" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.24 to 0.34</span></span></span></p>
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| style="width:72.6pt; border:solid windowtext 1.0pt" width="100" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT 3 to INF NNH 4 to INF</span></span></span></p>
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Outcome'''</span></span> |||| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''HBOT Group'''</span></span> |||| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''HA Group'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Difference'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''95% CI'''</span></span>
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{| class="Table" style="border:solid windowtext 1.0pt"
 
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|^  || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^  ||^ 
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| style="width:153.45pt; border:solid windowtext 1.0pt" width="208" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span></p>
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| colspan="2" style="width:90.65pt; border:solid windowtext 1.0pt" width="123" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBOT Group</span></span>'''</span></p>
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| colspan="2" style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HA Group</span></span>'''</span></p>
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| style="width:55.2pt; border:solid windowtext 1.0pt" width="77" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Difference</span></span>'''</span></p>
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| style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI</span></span>'''</span></p>
 
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| '''Visual analogue scale (pelvic pain) at 18 months'''<br>**(0 to 10)''' || 1.35 || 1.69 || 1.25 || 1.53 || 0.10 || -1.01 to 1.21
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| style="width:153.45pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="208" | &nbsp;
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| style="width:41.0pt; border:solid windowtext 1.0pt" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mean</span></span>'''</span></p>
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| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">SD</span></span>'''</span></p>
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| style="width:33.9pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mean</span></span>'''</span></p>
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| style="width:33.95pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">SD</span></span>'''</span></p>
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| style="width:55.2pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="77" | &nbsp;
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| style="width:73.15pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="101" | &nbsp;
 
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| '''Urinary Frequency at 18 months (Voids per day)''' || 10.0 || 1.97 || 10.3 || 1.5 || -0.30 || -1.51 to 0.91
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| style="width:153.45pt; border:solid windowtext 1.0pt" width="208" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Visual analogue scale (pelvic pain) at 18 months</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">(0 to 10)</span></span></span>
 +
 
 +
| style="width:41.0pt; border:solid windowtext 1.0pt" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.35</span></span></span></p>
 +
| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.69</span></span></span></p>
 +
| style="width:33.9pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.25</span></span></span></p>
 +
| style="width:33.95pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.53</span></span></span></p>
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="77" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.10</span></span></span></p>
 +
| style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-1.01 to 1.21</span></span></span></p>
 
|-
 
|-
 +
| style="width:153.45pt; border:solid windowtext 1.0pt" width="208" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Urinary Frequency at 18 months (Voids per day)</span></span>'''</span>
 +
 +
| style="width:41.0pt; border:solid windowtext 1.0pt" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">10.0</span></span></span></p>
 +
| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.97</span></span></span></p>
 +
| style="width:33.9pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">10.3</span></span></span></p>
 +
| style="width:33.95pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.5</span></span></span></p>
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="77" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.30</span></span></span></p>
 +
| style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-1.51 to 0.</span></span></span></p>
 
|}
 
|}
  
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**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Comments:</span>'''
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&nbsp;
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'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Comments:</span>'''
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. The exclusion criteria of this study (if any) were not mentioned in the report</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. The exclusion criteria of this study (if any) were not mentioned in the report</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. 25% of patients did not benefit in either group with respect to haematuria symptoms </span>
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 +
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. 25% of patients did not benefit in either group with respect to haematuria symptoms</span>
 +
 
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. Decrease in frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. Decrease in frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy</span>
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Bryan Hui; Tuesday, 30 April 2013</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Bryan Hui; Tuesday, 30 April 2013</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Email:''' bryan.hui@student.unsw.edu.au</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Email:''' bryan.hui@student.unsw.edu.au</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Kill or Update By:''' December 2019</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Kill or Update By:''' December 2019</span>
  
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[[File:sumhorsa.gif|center]]
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[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
  
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Radiation tissue injury  | BACK]]'''</span>
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Radiation_tissue_injury|BACK]]'''</span>

Latest revision as of 02:55, 9 July 2019

Intravesical instillation of hyaluronic acid as effective as hyperbaric oxygen for radiation-induced haemorrhagic cystitis

Clinical Bottom Line:

1. Both treatments were equally effective in improving symptoms of haematuria, dysuria and pelvic pain in patients with radiation-induced hemorrhagic cystitis.
2. No improvements in frequency was noted in patients of either group at 18 months after treatment

Citation:

1.Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int. 2012 Mar; 109(5):691-4. doi: 10.1111/j.1464-410X.2011.10550.x. Epub 2011 Sep 2.

2.Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation‐induced hemorrhagic cystitis. BJU international. 2012 Mar 1;109(5):691-4.

Lead author's name and fax: Yuan Shao: shenzhoujun@hotmail.com

Three-part Clinical Question: For patients with radiation-induced haemorrhagic cystitis (HC), does treatment with intravesicular hyaluronic acid (HA), compared with HBOT, reduce the symptoms of HC?Search Terms: Intravesical hyaluronic acid instillation, hematuria, radiation-induced hemorrhagic cystitis

The Study: Non-blinded randomised controlled trial without intention-to-treat.The Study Patients: Patients who developed HC after radiotherapy for pelvic malignancies

Control group (N = 20; 20 analysed): 30 daily sessions at 2.5ATA breathing 100% oxygen for 60 minutes

Experimental group (N = 16; 16 analysed): Intravesicular instillation of 40mg of HA weekly in the first month and subsequently monthly in the following 2 months.

The Evidence:

 

Outcome

Time to Outcome

Control group

HA group

Relative risk reduction

Absolute risk reduction

NNT

Complete response

18 months

0.45

0.5

11%

0.05

20

     

95% CI:

-62% to 84%

-0.28 to 0.38

NNT 3 to INF NNH 4 to INF

No clots, but macroscopic haematuria persisting

18 months

0.30

0.25

17%

0.05

20

     

95% CI:

-81% to 100%

-0.24 to 0.34

NNT 3 to INF NNH 4 to INF

 

Outcome

HBOT Group

HA Group

Difference

95% CI

 

Mean

SD

Mean

SD

    

Visual analogue scale (pelvic pain) at 18 months(0 to 10)

1.35

1.69

1.25

1.53

0.10

-1.01 to 1.21

Urinary Frequency at 18 months (Voids per day)

10.0

1.97

10.3

1.5

-0.30

-1.51 to 0.

 

Comments:

1. The exclusion criteria of this study (if any) were not mentioned in the report

2. 25% of patients did not benefit in either group with respect to haematuria symptoms

3. Decrease in frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy

Appraised by: Bryan Hui; Tuesday, 30 April 2013 Email: bryan.hui@student.unsw.edu.au

Kill or Update By: December 2019

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