scholarly journals Anterior Cervical Spondylosis Surgical Interventions are Associated with Improved Lordosis and Neurological Outcomes at Latest Follow up: A Meta-analysis

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Zengdong Meng ◽  
Jing Yu ◽  
Chong Luo ◽  
Xia Liu ◽  
Wei Jiang ◽  
...  
Keyword(s):  
Cervical Spondylosis ◽  
Meta Analysis ◽  
Surgical Interventions ◽  
Neurological Outcomes

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

scholarly journals 413 Posterior Stabilisation Without Formal Debridement for The Treatment of Non-Tuberculous Pyogenic Spinal Infection in A Frail and Debilitated Population – A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Elmajee ◽  
C Munasinghe ◽  
A Aljawadi ◽  
K Elawady ◽  
F Shuweihde ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Meta Analysis ◽  
Spinal Infection ◽  
Spinal Instability ◽  
Surgical Interventions ◽  
Spine Tango ◽  
Neurological Outcomes ◽  
Neurological Improvement ◽  
Posterior Stabilisation ◽  
Successful Infection

Abstract Background Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where there is evidence of spinal instability or neurological compromise. The primary surgical procedure focuses on the anterior approach with aggressive debridement of the infected tissue regions. We aim to evaluate the effectiveness of the posterior approach without debridement. Method Several databases including MEDLINE, NHS evidence and the Cochrane database were searched. The main clinical outcomes evaluated include pain, neurological recovery (Frankel Grading System, FGS) post-operative complications and functional outcomes (Kirkaldy-Willis Criteria and Spine Tango Combined Outcome Measure Index, COMI). Results From the four papers included in the meta-analysis, post-operative pain levels were found to be lower at a statistically significant level when a random effects model was applied, with the effect size found to be at 0.872 (p &lt; 0.001, 95% CI: 0.7137 to 1.0308). Post-surgical neurological improvement was also demonstrated with a mean FGS improvement of 1.12 in 64 patients over the included articles. Conclusions Posterior approach with posterior stabilisation without formal debridement can results in successful infection resolution, improved pain scores and neurological outcomes. However, Larger series with longer follow-up duration are strongly recommended.

scholarly journals Surgical management of focal chondral defects of the knee: a Bayesian network meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Filippo Migliorini ◽  
Jörg Eschweiler ◽  
Hanno Schenker ◽  
Alice Baroncini ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Bayesian Network ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Continuous Variables ◽  
Surgical Interventions ◽  
Bayesian Hierarchical ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
Meta Analyses

Abstract Background Focal chondral defects of the knee are common. Several surgical techniques have been proposed for the management of chondral defects: microfractures (MFX), osteochondral autograft transplantation (OAT), autologous matrix-induced chondrogenesis (AMIC) and autologous chondrocyte implantation (ACI)—first generation (pACI), second generation (cACI) and third generation (mACI). A Bayesian network meta-analysis was conducted to compare these surgical strategies for chondral defects in knee at midterm follow-up. Methods This Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Google Scholar, Embase and Scopus databases were accessed in July 2021. All the prospective comparative clinical trials investigating two or more surgical interventions for chondral defects of the knee were accessed. The network meta-analyses were performed through a Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measures were used for dichotomic variables, while the standardized mean difference (SMD) for the continuous variables. Results Data from 2220 procedures (36 articles) were retrieved. The median follow-up was 36 (24 to 60) months. The ANOVA test found good baseline comparability between symptoms duration, age, sex and body mass index. AMIC resulted in higher Lysholm score (SMD 3.97) and Tegner score (SMD 2.10). AMIC demonstrated the lowest rate of failures (LOR −0.22) and the lowest rate of revisions (LOR 0.89). As expected, MFX reported the lower rate of hypertrophy (LOR −0.17) followed by AMIC (LOR 0.21). No statistically significant inconsistency was found in the comparisons. Conclusion AMIC procedure for focal chondral defects of the knee performed better overall at approximately 3 years’ follow-up.

scholarly journals Acute surgical vs non-surgical management for ocular and peri-ocular burns: a systematic review and meta-analysis

2019 ◽  
Vol 7 ◽  
Author(s):  
Kevin M. Klifto ◽  
Ala Elhelali ◽  
Caresse F. Gurno ◽  
Stella M. Seal ◽  
Mohammed Asif ◽  
...  
Keyword(s):  
Systematic Review ◽  
Visual Acuity ◽  
Meta Analysis ◽  
Baseline Risk ◽  
Cochrane Library ◽  
Epithelial Defect ◽  
Reconstructive Procedures ◽  
Surgical Interventions ◽  
Ocular Burns

Abstract Background Burn-related injury to the face involving the structures of the eyes, eyelids, eyelashes, and/or eyebrows could result in multiple reconstructive procedures to improve functional and cosmetic outcomes, and correct complications following poor acute phase management. The objective of this article was to evaluate if non-surgical or surgical interventions are best for acute management of ocular and/or peri-ocular burns. Methods This systematic review and meta-analysis compared 272 surgical to 535 non-surgical interventions within 1 month of patients suffering burn-related injuries to 465 eyes, 253 eyelids, 90 eyelashes, and 0 eyebrows and evaluated associated outcomes and complications. The PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical and medical interventions, outcomes, and complications were recorded. Results Eight of the 14,927 studies queried for this study were eligible for the systematic review and meta-analysis, with results from 33 of the possible 58 outcomes and complications using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines. Surgery was associated with standard mean differences (SMD) 0.44 greater visual acuity on follow-up, SMD 1.63 mm shorter epithelial defect diameters on follow-up, SMD 1.55 mm greater changes in epithelial diameters from baseline, SMD 1.17 mm2 smaller epithelial defect areas on follow-up, SMD 1.37 mm2 greater changes in epithelial defect areas from baseline, risk ratios (RR) 1.22 greater numbers of healed epithelial defects, RR 11.17 more keratitis infections, and a 2.2 greater reduction in limbal ischemia compared to no surgical intervention. Conclusions This systematic review and meta-analysis found that compared to non-surgical interventions, acute surgical interventions for ocular, eyelid, and/or eyelash burns were found to have greater visual acuity on follow-up, shorter epithelial defect diameters on follow-up, greater changes in epithelial diameters from baseline, smaller epithelial defect areas on follow-up, greater changes in epithelial defect areas from baseline, greater numbers of healed epithelial defects, more keratitis infections, and a greater reduction in limbal ischemia, possibility preventing the need of a future limbal stem cell transplantation.

scholarly journals 012 Mechanical thrombectomy in pediatric stroke: systematic review, individual patient-data meta-analysis, and case series

2019 ◽  
Vol 90 (e7) ◽  
pp. A5.1-A5
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Chris Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scale Score ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Individual Participant Data ◽  
Neurological Outcomes ◽  
Paediatric Patients ◽  
Individual Participant

IntroductionIn adults, there is strong evidence demonstrating the superiority of mechanical thrombectomy (MT) plus intravenous thrombolysis over thrombolysis alone for the treatment of acute ischemic stroke due to large vessel occlusion (LVO). The role of MT in the paediatric stroke population is less clear. Here we present an updated systematic review addressing the use of MT in paediatric patients, including three cases from our centre in Sydney, Australia. We have also completed an individual participant data (IPD) meta-analysis of clinical and angiographic outcomes based on these results.MethodOur systematic review and IPD meta-analysis was performed according to PRISMA-IPD (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Individual Participant Data) guidelines. Primary outcomes measures were change in NIHSS (National Institute of Health Stroke Scale) score following MT, and mRS (modified Rankin Scale) score at final reported follow-up. The secondary outcome measure was final angiographic result using the mTICI (modified Treatment in Cerebral Ischemia) scale.ResultsMT resulted in good long-term neurological outcomes (mRS 0–2) in 60/67 cases (89.6%;follow-up timing µ=4.1 months: 95%CI 2.9–5.3), good short-term neurological outcomes (reduction in NIHSS by 8 or more points or post-MT NIHSS of 0–1) in 37/52 cases (71.2%), and successful recanalization (mTICI 2b/3) in 57/67 cases (85.1%).ConclusionsIn paediatric patients, MT is an effective treatment for ischaemic stroke due to LVO. In the absence of a dedicated prospective registry and with randomized control trails unfeasible, this report represents the best available evidence for the use of MT in the paediatric setting.

scholarly journals Quality of Life After Bariatric Surgery—a Systematic Review with Bayesian Network Meta-analysis

2021 ◽  
Author(s):  
Piotr Małczak ◽  
Magdalena Mizera ◽  
Yung Lee ◽  
Magdalena Pisarska-Adamczyk ◽  
Michał Wysocki ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Gastric Bypass ◽  
Meta Analysis ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Related Quality ◽  
Health Related

Abstract Objective Comprehensive analysis and comparison of HRQoL following different bariatric interventions through systematic review with network meta-analysis. Background Different types of bariatric surgeries have been developed throughout the years. Apart from weight loss and comorbidities remission, improvement of health-related quality of life (HRQoL) is an important outcome of metabolic surgery. Methods MEDLINE, EMBASE, and Scopus databases have been searched up to April 2020. Inclusion criteria to the analysis were (1) study with at least 2 arms comparing bariatric surgeries; (2) reporting of HRQoL with a validated tool; (3) follow-up period of 1, 2, 3, or 5 years. Network meta-analysis was conducted using Bayesian statistics. The primary outcome was HRQoL. Results Forty-seven studies were included in the analysis involving 26,629 patients and 11 different surgeries such as sleeve gastrectomy (LSG), gastric bypass (LRYGB), one anastomosis gastric bypass (OAGB), and other. At 1 year, there was significant difference in HRQoL in favor of LSG, LRYGB, and OAG compared with lifestyle intervention (SMD: 0.44; 95% CrI 0.2 to 0.68 for LSG, SMD: 0.56; 95% CrI 0.31 to 0.8 for LRYGB; and SMD: 0.43; 95% CrI 0.06 to 0.8 for OAGB). At 5 years, LSG, LRYGB, and OAGB showed better HRQoL compared to control (SMD: 0.92; 95% CrI 0.58 to 1.26, SMD: 1.27; 95% CrI 0.94 to 1.61, and SMD: 1.01; 95% CrI 0.63 to 1.4, respectively). Conclusions LSG and LRYGB may lead to better HRQoL across most follow-up time points. Long-term analysis shows that bariatric intervention results in better HRQoL than non-surgical interventions. Graphical abstract

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

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