scholarly journals Blumgart Anastomosis After Pancreaticoduodenectomy. A Comprehensive Systematic Review, Meta-Analysis, and Meta-Regression

2021 ◽  
Author(s):  
Claudio Ricci ◽  
Carlo Ingaldi ◽  
Laura Alberici ◽  
Nico Pagano ◽  
Cristina Mosconi ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Postoperative Morbidity ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Reoperation Rate ◽  
Protective Role ◽  
Risk Difference ◽  
Number Needed To Treat ◽  
Secondary Endpoints

Abstract Background The superiority of Blumgart anastomosis (BA) over non-BA duct to mucosa (non-BA DtoM) still remains under debate. Methods We performed a systematic search of studies comparing BA to non-BA DtoM. The primary endpoint was CR-POPF. Postoperative morbidity and mortality, post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), reoperation rate, and length of stay (LOS) were evaluated as secondary endpoints. The meta-analysis was carried out using random effect. The results were reported as odds ratio (OR), risk difference (RD), weighted mean difference (WMD), and number needed to treat (NNT). Results Twelve papers involving 2368 patients: 1075 BA and 1193 non-BA DtoM were included. Regarding the primary endpoint, BA was superior to non-BA DtoM (RD = 0.10; 95% CI: −0.16 to −0.04; NNT = 9). The multivariate ORs' meta-analysis confirmed BA's protective role (OR 0.26; 95% CI: 0.09 to 0.79). BA was superior to DtoM regarding overall morbidity (RD = −0.10; 95% CI: −0.18 to −0.02; NNT = 25), PPH (RD = −0.03; 95% CI −0.06 to −0.01; NNT = 33), and LOS (− 4.2 days; −7.1 to −1.2 95% CI). Conclusion BA seems to be superior to non-BA DtoM in avoiding CR-POPF.

Bridging versus Direct Mechanical Thrombectomy in Acute Ischemic Stroke: A Subgroup Pooled Meta-Analysis for Time of Intervention, Eligibility, and Study Design

2020 ◽  
Vol 49 (2) ◽  
pp. 223-232 ◽  
Author(s):  
Simone Vidale ◽  
Michele Romoli ◽  
Domenico Consoli ◽  
Elio Clemente Agostoni
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Primary Endpoint ◽  
Meta Analysis ◽  
Functional Independence ◽  
Clinical Severity ◽  
Number Needed To Treat ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
The Impact

Background and Aim: The risk/benefit profile of intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) in acute ischemic stroke is still unclear. We provide a systematic review and meta-analysis including studies comparing direct EVT (dEVT) vs. bridging treatment (IVT + EVT), defining the impact of treatment timing and eligibility to IVT on functional status and mortality. Methods: Protocol was registered with PROSPERO (CRD42019135915) and followed PRISMA guidelines. PubMed, EMBASE, and Cochrane Central were searched for randomized controlled trials (RCTs), retrospective, and prospective studies comparing IVT + EVT vs. dEVT in adults (≥18) with acute ischemic stroke. Primary endpoint was functional independence at 90 days (modified Rankin Scale <3); secondary endpoints were (i) good recanalization (thrombolysis in cerebral infarction >2a), (ii) mortality, and (iii) symptomatic intracranial hemorrhage (sICH). Subgroup analysis was performed according to study type, eligibility to IVT, and onset-to-groin timing (OGT), stratifying studies for similar OGT. ORs for endpoints were pooled with meta-analysis and compared between reperfusion strategies. Results: Overall, 35 studies were included (n = 9,117). No significant differences emerged comparing patients undergoing dEVT and bridging treatment for gender, hypertension, diabetes, National Institute of Health Stroke Scale score at admission. Regarding primary endpoint, IVT + EVT was superior to dEVT (OR 1.44, 95% CI 1.22–1.69, p < 0.001, pheterogeneity<0.001), with number needed to treat being 18 in favor of IVT + EVT. Results were confirmed in studies with similar OGT (OR 1.66; 95% CI 1.21–2.28), shorter OGT for IVT + EVT (OR 1.53, 95% CI 1.27–1.85), and independently from IVT eligibility (OR 1.53, 95% CI 1.29–1.82). Mortality at 90 days was higher in dEVT (OR 1.38; 95% CI 1.09–1.75), but no significant difference was noted for sICH. However, considering data from RCT only, reperfusion strategies had similar primary (OR 0.91, 95% CI 0.6–1.39) and secondary endpoints. Differences in age and clinical severity across groups were unrelated to the primary endpoint. Conclusions: Compared to dEVT, IVT + EVT associates with better functional outcome and lower mortality. Post hoc data from RCTs point to substantial equivalence of reperfusion strategies. Therefore, an adequately powered RCTs comparing dEVT versus IVT + EVT are warranted.

scholarly journals The efficacy of antidepressants for generalized anxiety disorder: a systematic review and meta-analysis

2005 ◽  
Vol 27 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Ricardo Schmitt ◽  
Fernando Kratz Gazalle ◽  
Maurício Silva de Lima ◽  
Ângelo Cunha ◽  
Juliano Souza ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Generalized Anxiety ◽  
Number Needed To Treat ◽  
Relative Risks ◽  
Co Morbidity ◽  
Axis I ◽  
Calculated Number

OBJECTIVE: To investigate the efficacy and acceptability of antidepressants in the treatment of generalized anxiety disorder. METHODS: All randomized controlled trials assessing the use of antidepressants in generalized anxiety disorder up to may 2002 were included. Non randomized trials and those that included patients with both generalized anxiety disorder and another Axis I co-morbidity were excluded. Relative risks, weighted mean difference and number needed to treat were estimated. People who died or dropped out were regarded as having had no improvement. RESULTS: Antidepressants (imipramine, venlafaxine and paroxetine) were found to be superior to placebo in treating generalized anxiety disorder. The calculated number needed to treat for antidepressants in generalized anxiety disorder was 5.15. Dropout rates did not differ between antidepressants and placebo. CONCLUSION: The available evidence suggests that antidepressants would probably be a reasonable treatment for generalized anxiety disorder patients in the clinical context.

scholarly journals Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marta Berta ◽  
Helena Lindgren ◽  
Kyllike Christensson ◽  
Sollomon Mekonnen ◽  
Mulat Adefris
Keyword(s):  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Birth Position ◽  
Study Designs ◽  
The Impact

Abstract Background It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2–34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839–30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%, p < 000). Conclusion The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

Hydrocortisone for Preventing Mortality and Bronchopulmonary Dysplasia in Preterm Infants with or without Chorioamnionitis Exposure: A Meta-Analysis of Randomized Trials

2020 ◽  
Author(s):  
Jianguo Zhou ◽  
Zhuowen Yu ◽  
Chao Chen
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Low Dose ◽  
Meta Analysis ◽  
Secondary Analysis ◽  
Risk Difference ◽  
Number Needed To Treat ◽  
Early Application ◽  
Infant Exposure ◽  
Significant Difference

Abstract Objective This study sought to assess whether infants exposed to chorioamnionitis are the optimal population to benefit the most from early postnatal hydrocortisone delivery in preventing bronchopulmonary dysplasia (BPD). This meta-analysis was conducted to discover the efficacy of hydrocortisone in preterm infants with and without chorioamnionitis. Study Design From the earliest available date until March 2018, studies, review articles, and papers published in PubMed, Ovid, and Web of Science were reviewed. Randomized controlled trials comparing hydrocortisone with placebo/no intervention in preterm infants with a known status of chorioamnionitis exposure were included. Result Early postpartum low-dose hydrocortisone prevents the combined outcome of neonatal BPD or death in infants weighing less than 1,000 g with chorioamnionitis exposure (odds ratio [95% confidence interval]: 0.52 [0.32–0.79]; risk difference: –0.15 [–0.24 to –0.06]; number needed to treat: 6 [4–16]) but not in infants without chorioamnionitis exposure. Further secondary analysis showed no significant difference between the hydrocortisone group and the placebo group in individual outcomes of BPD or death, regardless of infant exposure to chorioamnionitis. Conclusion Early application of low-dose hydrocortisone could potentially prevent BPD or death in infants weighing less than 1,000 g with exposure to chorioamnionitis. This finding provides the basis for further study in this target group.

scholarly journals Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies

2020 ◽  
Author(s):  
Jishnu Malgie ◽  
Jan W Schoones ◽  
Bart G Pijls
Keyword(s):  
Side Effects ◽  
Meta Analysis ◽  
Risk Difference ◽  
World Health ◽  
Cochrane Library ◽  
Control Group ◽  
Number Needed To Treat ◽  
Receptor Antagonists ◽  
Increased Risk ◽  
Health Organization

Abstract Background We systematically reviewed the literature to answer the following research questions: (1) Does interleukin 6 (IL-6) (receptor) antagonist therapy reduce mortality in coronavirus disease 2019 (COVID-19) patients compared to patients not treated with IL-6 (receptor) antagonists; and (2) is there an increased risk of side effects in COVID-19 patients treated with IL-6 (receptor) antagonists compared to patients not treated with IL-6 (receptor) antagonists? Methods We systematically searched PubMed, PMC PubMed Central, Medline, World Health Organization COVID-19 Database, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier (through 30 June 2020). Random effects meta-analysis was used to pool the risk ratios and risk differences of individual studies. Risk of bias was appraised using the Methodological Index for Non-randomized Studies (MINORS) checklist. Results The search strategy retrieved 743 unique titles, of which 10 studies (all on tocilizumab [TCZ]) comprising 1358 patients were included. Nine of 10 studies were considered to be of high quality. Meta-analysis showed that the TCZ group had lower mortality than the control group. The risk ratio was 0.27 (95% confidence interval [CI], .12–.59) and the risk difference was 12% (95% CI, 4.6%–20%) in favor of the TCZ group. With only a few studies available, there were no differences observed regarding side effects. Conclusions Our results showed that mortality was 12% lower for COVID-19 patients treated with TCZ compared with those not treated with TCZ. The number needed to treat was 11, suggesting that for every 11 (severe) COVID-19 patients treated with TCZ, 1 death is prevented. These results require confirmation by randomized controlled trials.

scholarly journals Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials

2020 ◽  
Vol 109 (11) ◽  
pp. 1381-1391 ◽  
Author(s):  
Hans-Josef Feistritzer ◽  
Alexander Jobs ◽  
Suzanne de Waha-Thiele ◽  
Ingo Eitel ◽  
Anne Freund ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Randomized Controlled Trials ◽  
Primary Endpoint ◽  
Meta Analysis ◽  
Random Effect ◽  
Final Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Risk Of Death ◽  
Randomized Controlled

Abstract Aims To perform a pairwise meta-analysis of randomized controlled trials (RCTs) comparing multivessel percutaneous coronary intervention (PCI) and culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) patients without cardiogenic shock. Methods We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for RCTs comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models. Results Nine RCTs were included in the final analysis. In total, 523 (8.3%) of 6314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43–0.93; p = 0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52–0.79; p = 0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44–1.35; p = 0.28) or cardiovascular death (HR 0.64, 95% CI 0.37–1.11; p = 0.09) was observed. Conclusions In STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI.

The efficacy of drug treatments for dysthymia: a systematic review and meta-analysis

1999 ◽  
Vol 29 (6) ◽  
pp. 1273-1289 ◽  
Author(s):  
M. S. DE LIMA ◽  
M. HOTOPH ◽  
S. WESSELY
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Common Mental Disorder ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Dysthymic Disorder ◽  
Number Needed To Treat ◽  
Relative Risks ◽  
Co Morbidity ◽  
Drug Treatments

Background. Dysthymia is a common mental disorder, associated with considerable disability and high co-morbidity. This review assessed the role of pharmacological treatment.Methods. All randomized-controlled trials that compared active drug versus placebo for dysthymic patients were included. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated with the Random Effect Model method. Where possible, number needed to treat and number needed to harm were estimated.Results. Fifteen trials were included for the main comparisons. Similar results were obtained in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and ritanserin). The pooled RR treatment response was 0·68 (95% CI 0·59–0·78) for TCA, 0·64 (95% CI 0·55–0·74) for SSRIs, 0·59 (95% CI 0·48–0·71) for MAOIs. Other drugs (amisulpride, amineptine and ritanserin) showed similar results. Patients treated on TCA were more likely to report adverse events, compared with placebo. There were no differences in response to active treatment when dysthymia was compared to either dysthymia plus major depression or briefer non-major depressive states.Conclusions. Drug treatment appears to be effective in the short-term management of dysthymic disorder. The choice of drug should take into account specific side-effects profile of each drug.

scholarly journals Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis

2019 ◽  
Author(s):  
Marta Berta Badi ◽  
Helena Lindgren ◽  
Kyllike Christensson ◽  
Sollomon Mekonnen ◽  
Mulat Adefris
Keyword(s):  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Birth Position ◽  
Study Designs ◽  
The Impact

Abstract Background: it is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Objective: The aim of this review was to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method: The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1,985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results: We identified 1,680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I2=96.8%, p<000). Conclusion: The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

Excision repair cross-complementary group 1 (ERCC1) as a prognostic biomarker in patients (pts) with solid tumors: A meta-analysis on detection methods.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21040-e21040
Author(s):  
Milena Perez Mak ◽  
Tiago Kenji Takahashi ◽  
Paulo Marcelo Hoff ◽  
Gilberto Castro ◽  
Igor M. L. Snitcovsky
Keyword(s):  
Primary Endpoint ◽  
Excision Repair ◽  
Meta Analysis ◽  
Random Effect ◽  
Secondary Endpoint ◽  
Detection Methods ◽  
Retrospective Nature ◽  
Ercc1 Expression ◽  
Effect Heterogeneity ◽  
Platinum Chemotherapy

e21040 Background: ERCC1 overexpression is associated with better outcomes in some cancers. The best method to assess its expression, immunohistochemistry (IHC) or polymerase chain reaction (PCR), is not established. To clarify such question, this meta-analysis was conducted. Methods: PUBMED, EMBASE and Cochrane databases were searched with terms: “ERCC1” and “IHC” and/or “PCR” and/or “mRNA”. Inclusion criteria: full papers in English, solid tumor pts, ERCC1 evaluated by IHC and PCR on the same samples, reported correlation between ERCC1 expression and overall survival (OS) – the primary endpoint. As secondary endpoint, correlation between IHC and PCR expression was assessed. Exclusion criteria: review articles and no reported endpoint. Two authors reviewed and classified all papers. Pooled HR and variance were calculated by standard methods, using CMA v2.2.064 (Englewood, USA). Results: 25 articles were retrieved, with 4 included for the primary endpoint (224 pts) and 4 (191) for the secondary endpoint. All were retrospective, with diverse primary sites. Except for one, platinum chemotherapy was employed. All studies used 8F1 clone, and in 2, FL297 clone was also evaluated. ERCC1 positivity was determined by H-score in 2 studies and by AQUA in 2. mRNA ERCC1 positivity was variably defined. In general, ERCC1 overexpression was correlated with longer OS (HR 0.569, 95% CI 0.436 - 0.743, p <0.001). Similar results were found in terms of OS either by IHC or PCR (HR 0.626, 95% CI 0.46 – 0.853, p 0.003 and HR 0.434, 95% CI 0.257 – 0.730, p 0.002; respectively). No correlation between IHC and PCR overexpression was found (coefficient 0.098 p 0.444, random effect). Heterogeneity was detected only in IHC analysis, when expression was detected by both FL297 and 8F1 antibodies (p 0.001, fixed effect). Conclusions: ERCC1 overexpression is associated with better OS, regardless of employed methodology. However, protein and mRNA expression are not correlated. Major limitations to our analysis include the variety of employed ERCC1 detection methods and retrospective nature of data. Definitive conclusions on the prognostic role of ERCC1 and best methodology remain to be answered.

Effect of Mediterranean diet on liver enzymes: A systematic review and meta-analysis of randomized controlled trials

2021 ◽  
pp. 1-25
Author(s):  
Abbas Ali Sangouni ◽  
Shirin Hassani Zadeh ◽  
Hassan Mozaffari-Khosravi ◽  
Mahdieh Hosseinzadeh
Keyword(s):  
Mediterranean Diet ◽  
Randomized Clinical Trials ◽  
Liver Enzymes ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Alcoholic Fatty Liver ◽  
Effect Model ◽  
Alcoholic Fatty Liver Disease

Abstract Elevated levels of liver enzymes are the main markers of liver dysfunction. Liver enzymes are the important indicators of non-alcoholic fatty liver disease (NAFLD) in the general population. Previous randomized clinical trials (RCTs) investigated the effects of Mediterranean diet (MedDiet) as a plant-based diet on features of NAFLD like liver enzymes, but their results are contradictory. This study aimed to systematically review and meta-analyze RCTs investigating the effect of MedDiet on liver enzymes. PubMed, Web of Science, Scopus, and Google Scholar were searched until December 2020. A total of 10 RCTs (n=705 participants) evaluating the effect of MedDiet on liver enzymes including aspartate aminotransferase (AST), alanine transaminase (ALT) and γ-glutamyltransferase (GGT) were included. A random-effect model was used to estimates the pooled effect size. To evaluate the heterogeneity among the included studies, the Cochran’s Q-test and I-squared test were used. The MedDiet significantly reduced AST (weighted mean difference (WMD)= −0.38 IU/L; 95 % CI −0.73, −0.03 IU/L; P=0.03) and GGT (WMD= −0.16 IU/L; 95 % CI −0.32, −0.006 IU/L; P=0.04), but had no significant effect on ALT (WMD = −0.55 IU/L; 95 % CI −1.25, 0.13 IU/L; P=0.11). However, sensitivity analysis revealed that the overall effects of MedDiet on AST, GGT and ALT were significantly influenced by removing some studies. There was no publication bias based on Begg’s and Egger’s tests. Generally, MedDiet can improve liver enzymes. To better conclusion, further RCTs investigating the effect of MedDiet on liver enzymes, especially in patients with NAFLD are still required.

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