Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of different malignancies. However, their efficacy in advanced adrenocortical carcinoma (ACC) remains uncertain. Thus, we conducted a systematic review and meta-analysis to summarize the efficacy and tolerability of ICIs in patients with advanced ACC. We searched PubMed, Scopus, and CENTRAL for studies that used ICIs in ACC. Studies with more than five patients were included in the meta-analysis of the objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and grade 3/4 adverse events. Twenty studies with 23 treatment arms and 250 patients were included. Single-agent anti-PD1 or anti-PD-L1 treatment was utilized in 13 treatment arms, whereas an anti-PD1 or anti-PD-L1 and anti-CTLA4 combination was used in 4 treatment arms. Other anti-PD1- or anti-PD-L1-based combinations were used in five treatment arms. The ORR was 14% (95% CI = 10–19%, I² = 0%), and the DCR was 43% (95% CI = 37–50%, I² = 13%). The combination anti-PD1- or anti-PD-L1-based treatment strategies did not correlate with higher responses compared with monotherapy. The median OS was 13.9 months (95% CI = 7.85–23.05), and the median PFS was 2.8 months (95% CI = 1.8–5.4). ICIs have a modest efficacy in advanced ACC but a good OS. Further studies are needed to investigate predictive biomarkers for ICI response and to compare ICI-based strategies with the current standard of care.

Although free-floating thrombus (FFT) poses a significant risk of stroke or transient ischemic attack (TIA), optimal management strategies are uncertain. To determine the state-of-the-art of medical interventions for FFT, we conducted a systematic review of the efficacy of various medical interventions and factors influencing FFT resolution and recurrence. A comprehensive search of Embase, PubMed, and ScienceDirect identified 61 studies encompassing 179 patients with FFT-related stroke or TIA treated with anticoagulants, antiplatelets, or their combinations. Primary outcomes assessed were stroke recurrence and thrombus resolution. Statistical analyses (Fisher’s exact test, chi-square test, Mann–Whitney test, and Kruskal–Wallis test) utilized significance set at p < 0.05. Over a median follow-up of 7 months, thrombus resolution occurred in 65% of patients, while 11.2% experienced recurrence, primarily as TIAs. Cardioembolism was significantly less common in resolved cases (p = 0.025). Combination therapy (antiplatelets, anticoagulants, and statins) significantly enhanced clot resolution (OR 11.4; 95% CI 1.436–91.91; p = 0.021) compared to monotherapies. Ulcerated plaque was a significant predictor of recurrence (OR 8.2; 95% CI 1.02–66.07; p = 0.048). These findings underscore the superiority of combination therapy in FFT management and highlight the need for targeted interventions in patients with ulcerated plaques to mitigate recurrence risk.

BackgroundTrans-radial coronary angiogram (TR-CAG) has gained popularity due to lower complication rates compared to transfemoral access. Operators can use either conventional catheters, such as Judkins, or single dedicated catheters, such as Tiger-II. This meta-analysis compared the safety and efficacy of Tiger-II versus Judkins catheters in TR-CAG. MethodsWe searched PubMed, Web of Science, Scopus, and Cochrane Library through February 2024 for studies comparing Tiger-II and Judkins catheters in TR-CAG. Fixed- and random-effect models pooled estimates of odds ratios (ORs) and standardised mean differences (SMDs). Primary outcomes included fluoroscopy time and contrast volume. Secondary outcomes included procedural time, radiation exposure, procedural success, radial artery vasospasm, and crossover rate. ResultsSeven studies with 2879 patients (1799 in Tiger-II and 1080 in Judkins) were included. Tiger-II use significantly reduced fluoroscopy time (SMD = -0.50 min, 95% CI [-0.80, -0.19], p < 0.01), procedural time (MD = -2.00 min, 95% CI [-2.35, -1.66], p < 0.01), and contrast volume (MD = -7.48 ml, 95% CI [-12.66, -2.29], p < 0.01). Radial artery spasm incidence was also lower (OR = 0.30, 95% CI [0.12, 0.75], p = 0.01). There were no significant differences in radiation exposure, procedural success, or crossover rate. ConclusionTiger-II catheters offer reduced fluoroscopy time, procedural time, contrast volume, and radial artery spasm rates in TR-CAG.