Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis

Summary Limited uptake of minimally invasive surgery (MIS) of the aorta hinders assessment of its efficacy compared to median sternotomy (MS). The objective of this systematic review is to compare operative and perioperative outcomes for MIS versus MS. Online databases Medline, EMBASE, Cochrane Library and Web of Science were searched from inception until July 2018. Both randomized and observational studies of patients undergoing aortic root, ascending aorta or aortic arch surgery by MIS versus MS were eligible for inclusion. Primary outcomes were 30-day mortality, reoperation for bleeding, perioperative renal impairment and neurological events. Intraoperative and postoperative timing measures were also evaluated. Thirteen observational studies were included comparing 1101 MIS and 1405 MS patients. The overall quality of evidence was very low for all outcomes. Mortality and the incidence of stroke were similar between the 2 cohorts. Meta-analysis demonstrated increased length of cardiopulmonary bypass (CPB) time for patients undergoing MS [standardized mean difference 0.36, 95% confidence interval (CI) 0.15–0.58; P = 0.001]. Patients receiving MS spent more time in hospital (standardized mean difference 0.30, 95% CI 0.17–0.43; P < 0.001) and intensive care (standardized mean difference 0.17, 95% CI 0.06–0.27; P < 0.001). Reoperation for bleeding (risk ratio 1.51, 95% CI 1.06–2.17; P = 0.024) and renal impairment (risk ratio 1.97, 95% CI 1.12–3.46; P = 0.019) were also greater for MS patients. There was substantial heterogeneity in meta-analyses for CPB and aortic cross-clamp timing outcomes. MIS may be associated with improved early clinical outcomes compared to MS, but the quality of the evidence is very low. Randomized evidence is needed to confirm these findings.

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Repetitive transcranial magnetic stimulation for fibromyalgia patients: A Systematic Review with Meta-Analysis

Pain Medicine ◽

10.1093/pm/pnab276 ◽

2021 ◽

Cited By ~ 1

Author(s):

Pingping Sun ◽

Lei Fang ◽

Jianzhong Zhang ◽

Yang Liu ◽

Guodong Wang ◽

...

Keyword(s):

Systematic Review ◽

Transcranial Magnetic Stimulation ◽

Confidence Interval ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Mean Difference ◽

Significant Difference ◽

Standardized Mean Difference

Abstract Objective Fibromyalgia is a poorly understood pain syndrome. Repetitive transcranial magnetic stimulation is a noninvasive brain stimulation therapy and is commonly applied for the management of fibromyalgia. However, controversy regarding its efficacy remains. Therefore, a meta-analysis was conducted to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for fibromyalgia syndrome. Method Four medical databases and one physiotherapy database were screened for randomized controlled trials. A systematic review and meta-analysis was performed. Numerical Pain Rating Scale (NPRS), Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS) anxiety score, Pain Catastrophizing Scale (PCS), Fatigue Severity Scale (FSS), Short Form-36 general health survey mental score, and Fibromyalgia Impact Questionnaire (FIQ) were set as outcome measures. Results Analysis of 14 studies and 433 participants indicated that rTMS exerted more favorable effects on the NPRS than sham rTMS after treatment (standardized mean difference = −0.49, 95% confidence interval = −0.86 to − 0.13, P = 0.008, I2 = 68%) and FIQ (standardized mean difference = −0.50, 95% confidence interval = −0.75 to − 0.25, P = 0.0001, I2 = 28%). However, the BDI, FSS, PCS, mood index, and HADS scores showed no significant difference compared with sham rTMS after treatment. The mean methodological quality of included studies was an acceptable score of 8.5 based on the PEDro scale, suggesting the validity of our conclusions. Conclusion This study demonstrated that rTMS relieved pain and enhanced quality of life of patients with fibromyalgia; however, it did not improve anxiety, depression, and other symptoms based on current reports.

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Intralymphatic immunotherapy for allergic rhinitis: A systematic review and meta-analysis

Allergy and Asthma Proceedings ◽

10.2500/aap.2021.42.210028 ◽

2021 ◽

Vol 42 (4) ◽

pp. 283-292 ◽

Cited By ~ 1

Author(s):

Michael T. Werner ◽

John V. Bosso

Keyword(s):

Systematic Review ◽

Allergic Rhinitis ◽

Adverse Event ◽

Skin Prick Testing ◽

Meta Analysis ◽

Mean Difference ◽

Random Effects Model ◽

Nasal Provocation ◽

Intralymphatic Immunotherapy ◽

Standardized Mean Difference

Background: Only a fraction of patients with allergic rhinitis receive allergen-specific immunotherapy (AIT). AIT is most commonly delivered subcutaneously in a series of injections over 3‐5 years. Common obstacles to completing this therapy include cost and inconvenience. Intralymphatic immunotherapy (ILIT) has been proposed as a faster alternative, which requires as few as three injections spaced 4 weeks apart. Objective: This systematic review and meta-analysis evaluated the current evidence that supports the use of ILIT for allergic rhinitis. Methods: Clinical trials were identified in the published literature by using an electronic search strategy and were evaluated by using a risk of bias tool. Treatment outcome (symptom scores, medication scores, and combined symptom and medication scores) and provocation testing results (nasal provocation and skin-prick testing) were included in a meta-analysis of standardized mean difference with subgrouping by using a random-effects model. Overall adverse event rates were tabulated, and overall risk ratios were calculated by using a random-effects model. Results: We identified 17 clinical trials that met eligibility criteria. The standardized mean difference of ILIT on the symptom and medication score was ‐0.72 (95% confidence interval [CI], ‐0.98 to ‐0.46; p < 0.0001) (n = 10). The standardized mean difference of ILIT on nasal provocation and skin-prick testing was ‐1.00 (95% CI, ‐1.38 to ‐0.61; p < 0.0001) (n = 7) and ‐0.73 (95% CI, ‐0.99 to ‐0.47; p < 0.0001) (n = 7), respectively. No statistically significant heterogeneity was detected. The overall adverse event rate was 39.5% for ILIT and 23.5% for placebo. Also, 98.4% of adverse events were mild. Conclusion: Our meta-analysis demonstrated that ILIT was safe, conferred desensitization to seasonal and nonseasonal allergens, alleviated allergic rhinitis symptoms, and reduced medication use. A larger randomized, double-blind, placebo controlled trial will be necessary for wider adaptation of this form of AIT.

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The effect of unilateral and bilateral laparoscopic surgery for endometriosis on Anti-Mullerian Hormone (AMH) level after 3 and 6 months: a systematic review and meta-analysis

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01561-3 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Anisodowleh Nankali ◽

Mohsen Kazeminia ◽

Parnian Kord Jamshidi ◽

Shamarina Shohaimi ◽

Nader Salari ◽

...

Keyword(s):

Systematic Review ◽

Laparoscopic Surgery ◽

Growth Factors ◽

Web Of Science ◽

Meta Analysis ◽

Research Work ◽

Mean Difference ◽

Transient Growth ◽

Common Causes ◽

Standardized Mean Difference

Abstract Background Endometriosis is one of the most common causes of infertility. The causes of the disease and its definitive treatments are still unclear. Moreover, Anti-Mullerian Hormone (AMH) is a glycoprotein dimer that is a member of the transient growth factors family. This research work aimed to identify the effect of unilateral and bilateral laparoscopic surgery for endometriosis on AMH levels after 3 months, and 6 months, using meta-analysis. Methods In this study, the articles published in national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were searched to find electronically published studies between 2010 and 2019. The heterogeneous index between studies was determined using the I2 index. Results In this meta-analysis and systematic review, 19 articles were eligible for inclusion in the study. The standardized mean difference was obtained in examining of unilateral laparoscopic surgery for endometriosis (before intervention 2.8 ± 0.11, and after 3 months 2.05 ± 0.13; and before intervention 3.1 ± 0.46 and after 6 months 2.08 ± 0.31), and in examining bilateral laparoscopic surgery for endometriosis examination (before intervention 2.0 ± 08.08, and after 3 months 1.1 ± 0.1; and before intervention 2.9 ± 0.23 and after 6 months 1.4 ± 0.19). Conclusion The results of this study demonstrate that unilateral and bilateral laparoscopic surgery for endometriosis is effective on AMH levels, and the level decreases in both comparisons.

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The Comparison of Short-Term Postoperative Pain in Single- versus Multiple-Visit Root Canal Treatment: A Systematic Review and Meta-Analysis Study

Pain Research and Management ◽

10.1155/2021/5574995 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Armin Izadpanah ◽

Ailar Javaheripour ◽

Azam Maleki ◽

Mahdieh Alipour ◽

Hossein Hosseinifard ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Root Canal ◽

Meta Analysis ◽

Mean Difference ◽

Single Visit ◽

Multiple Visit ◽

Statistical Heterogeneity ◽

The Times

Postoperative pain after root canal therapy (RoCT) is an unpleasant experience for patients, and it could be affected by different factors. The times of visits could be one of these factors that were evaluated in various studies. However, there is inconsistent evidence on the relation between postoperative pain and the times of visits. Therefore, the current systematic review aimed to summarize the results of these studies and meta-analyze them. For this purpose, a comprehensive search was conducted in four main databases (Cochrane Database of Systematic Reviews, Web of Science, PubMed, and Scopus databases) for related English articles from 1978 to August 2020. The quality of studies was evaluated using the Delphi checklist. The heterogeneity of studies was determined by I2 statistic, and publication bias was assessed using the funnel plot and the Begg test. The results were presented by using relative ratio (RR) estimates and standard mean difference (SMD) with its 95% confidence intervals (CI) using a random-effects model. Initial searches from mentioned databases identified 1480 papers; of which only 27 of them met the inclusion criteria. In quality assessment, thirteen studies had quality scores of more than 7, two studies had 4 scores, and the rest had 5 scores. Overall, based on the available evidence, the meta-analysis showed that the risk of postoperative pain in single-visit was 1.02 times (CI 95% (0.99, 1.19), I2 = 60.7%, p = 0.001 ) higher than that of the multiple-visit treatment. The mean difference of postoperative pain in single-visit was −0.30 (CI 95% (−0.36, −0.25), I2 = 0.94.4, p = 0.001 ) compared with the multiple-visit treatment. Based on the results of this meta-analysis, the risk of postoperative pain in single-visit RoCT was higher than that in multiple-visit RoCT with acceptable statistical heterogeneity and moderate quality of the studies.

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Non-intubated thoracoscopic lobectomies for lung cancer: an exploratory systematic review and meta-analysis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa141 ◽

2020 ◽

Vol 31 (4) ◽

pp. 499-506 ◽

Cited By ~ 1

Author(s):

Elena Prisciandaro ◽

Luca Bertolaccini ◽

Giulia Sedda ◽

Lorenzo Spaggiari

Keyword(s):

Lung Cancer ◽

Systematic Review ◽

Risk Ratio ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Complication Rates ◽

Thoracoscopic Lobectomy ◽

Retrospective Cohort Studies ◽

The Individual

Abstract Our goal was to assess the safety, feasibility and oncological outcomes of non-intubated thoracoscopic lobectomies for non-small-cell lung cancer (NSCLC). A comprehensive search was performed in EMBASE (via Ovid), MEDLINE (via PubMed) and Cochrane CENTRAL from January 2004 to March 2020. Studies comparing non-intubated anaesthesia with intubated anaesthesia for thoracoscopic lobectomy for NSCLC were included. An exploratory systematic review and a meta-analysis were performed by combining the reported outcomes of the individual studies using a random effects model. For dichotomous outcomes, risk ratios were calculated and for continuous outcomes, the mean difference was used. Three retrospective cohort studies were included, with a total of 204 patients. The comparison between non-intubated and intubated patients undergoing thoracoscopic lobectomy showed no statistically significant differences in postoperative complication rates [risk ratio 0.65, 95% confidence interval (CI) 0.36–1.16; P = 0.30; I2 = 17%], operating times (mean difference −12.40, 95% CI −28.57 to 3.77; P = 0.15; I2 = 48%), length of hospital stay (mean difference −1.13, 95% CI −2.32 to 0.05; P = 0.90; I2 = 0%) and number of dissected lymph nodes (risk ratio 0.92, 95% CI 0.78–1.25; P = 0.46; I2 = 0%). Despite the limitation of only 3 papers included, awake and intubated thoracoscopic lobectomies for resectable NSCLC seem to have comparable perioperative and postoperative outcomes. Nevertheless, the oncological implications of the non-intubated approach should be considered. The long-term benefits for patients with lung cancer need to be carefully assessed.

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Dietary factors and diabetes-related health outcomes in patients with type 2 diabetes: protocol for a systematic review and meta-analysis of prospective observational studies

BMJ Open ◽

10.1136/bmjopen-2018-027298 ◽

2019 ◽

Vol 9 (7) ◽

pp. e027298

Author(s):

Janett Barbaresko ◽

Manuela Neuenschwander ◽

Lukas Schwingshackl ◽

Sabrina Schlesinger

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Observational Studies ◽

Meta Analysis ◽

Risk Of Bias ◽

Dietary Factors ◽

Dietary Behaviour ◽

Health Concern

IntroductionType 2 diabetes (T2D) is a major health concern associated with several comorbidities such as diabetic chronic kidney disease, neuropathy and cardiovascular diseases. Many of these complications may be preventable by an adequate lifestyle, including a favourable dietary behaviour, additionally to pharmacological management. In general, dietary guidelines for patients with diabetes recommend a hypocaloric diet to achieve a normal weight, but there is a lack of detailed instructions on specific nutrients and foods to prevent diabetes-related outcomes. Therefore, the aim of this systematic review and meta-analysis is to summarise the available evidence on the association between dietary factors and health-related outcomes in patients with T2D.Methods and analysisA systematic literature search will be conducted in PubMed and Web of Science in May 2019 to identify prospective observational studies investigating dietary factors in association with major complications in patients with T2D. We will include studies investigating dietary patterns, food groups, foods, macronutrients and micronutrients as well as secondary plant compounds. As diabetes-related outcomes, we will include macrovascular (cardiovascular and cerebrovascular diseases) and microvascular outcomes (nephropathy, neuropathy and retinopathy), as well as cancer, quality of life, depression, cognitive disorders and mortality. We will conduct dose-response meta-analyses using random effects models. We will investigate heterogeneity across studies and publication bias. To assess the risk of bias and quality of the included studies, we will use the Cochrane risk of bias tool ROBINS-I and the quality of evidence will be assessed using Grades of Recommendation, Assessment, Development, and Evaluation.Ethics and disseminationAs the systematic review is based on published studies, ethical considerations are not required. The systematic review and meta-analysis will be published in a peer-reviewed Journal.PROSPERO registration numberCRD42018110669

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Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/6295737 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 6

Author(s):

Chen X. Chen ◽

Bruce Barrett ◽

Kristine L. Kwekkeboom

Keyword(s):

Systematic Review ◽

Methodological Quality ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Grey Literature ◽

Zingiber Officinale ◽

Mean Difference ◽

Significant Difference ◽

Meta Analyses

This systematic review examines the efficacy of oral ginger for dysmenorrhea. Key biomedical databases and grey literature were searched. We included randomized controlled trials comparing oral ginger against placebo or active treatment in women with dysmenorrhea. Six trials were identified. Two authors independently reviewed the articles, extracted data, and assessed risk of bias. Discrepancies were resolved by consensus with a third reviewer. We completed a narrative synthesis of all six studies and exploratory meta-analyses of three studies comparing ginger with placebo and two studies comparing ginger with a nonsteroidal anti-inflammatory drug (NSAID). Ginger appeared more effective for reducing pain severity than placebo. The weighted mean difference on a 10 cm visual analogue scale was 1.55 cm (favoring ginger) (95% CI 0.68 to 2.43). No significant difference was found between ginger and mefenamic acid (an NSAID). The standardized mean difference was 0 (95% CI −0.40 to 0.41). Available data suggest that oral ginger could be an effective treatment for menstrual pain in dysmenorrhea. Findings, however, need to be interpreted with caution because of the small number of studies, poor methodological quality of the studies, and high heterogeneity across trials. The review highlights the need for future trials with high methodological quality.

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A Systematic Review and Meta-Analysis of Seasonal Influenza Vaccination of Health Workers

Vaccines ◽

10.3390/vaccines9101104 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1104

Author(s):

Tingting Li ◽

Xiaoling Qi ◽

Qin Li ◽

Wenge Tang ◽

Kun Su ◽

...

Keyword(s):

Systematic Review ◽

Influenza Vaccination ◽

Randomized Clinical Trials ◽

Health Workers ◽

Meta Analysis ◽

Random Effect ◽

Mean Difference ◽

Sensitivity Analyses ◽

Standardized Mean Difference ◽

Influenza Vaccinations

A systematic review and meta-analysis was conducted to estimate the pooled effect of influenza vaccinations for health workers (HWs). Nine databases were screened to identify randomized clinical trials and comparative observational studies that reported the effect of influenza vaccination among HWs. The risk ratio (RR), standardized mean difference, and 95% confidence interval (CI) were employed to study the effect size using fixed/random-effect models. Subgroup analyses and sensitivity analyses were conducted accordingly. Publication bias was examined. Sixteen studies (involving 7971 HWs from nine countries) were included after a comprehensive literature search. The combined RR regarding the incidence of laboratory-confirmed influenza was 0.36 (95% CI: 0.25 to 0.54), the incidence of influenza-like illness (ILI) was 0.69 (95% CI: 0.45 to 1.06), the absenteeism rate was 0.63 (95% CI: 0.46 to 0.86), and the integrated standardized mean difference of workdays lost was −0.18 (95% CI: −0.28 to −0.07) days/person. The subgroup analysis indicated that vaccination significantly decreases the incidence of laboratory-confirmed influenza in different countries, study populations, and average-age vaccinated groups. Influenza vaccinations could effectively reduce the incidence of laboratory-confirmed influenza, absenteeism rates, and workdays lost among HWs. It is advisable, therefore, to improve the coverage and increase the influenza vaccination count among HWs, which may benefit both workers and medical institutions.

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Oxygen Cost of Walking in People with Multiple Sclerosis and Its Association with Fatigue: A Systematic Review and Meta-analysis

International Journal of MS Care ◽

10.7224/1537-2073.2020-128 ◽

2021 ◽

Author(s):

Scott Rooney ◽

Gavin McWilliam ◽

Leslie Wood ◽

Fiona Moffat ◽

Lorna Paul

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Energy Expenditure ◽

Meta Analysis ◽

Positive Association ◽

Mean Difference ◽

Oxygen Cost ◽

Future Studies ◽

Standardized Mean Difference ◽

The Relationship

Abstract Background: This systematic review and meta-analysis aimed to compare the oxygen cost of walking in people with multiple sclerosis (MS) and controls and to assess the relationship between oxygen cost of walking and fatigue in people with MS. Methods: Four databases (CINAHL, MEDLINE, ProQuest, Web of Science) were searched up to September 2020. Studies were included if they recruited adults with MS and either compared oxygen cost of walking in those with MS and a control population or determined the relationship between oxygen cost of walking and fatigue. Meta-analysis of the standardized mean difference in oxygen cost of walking between people with MS and controls was performed. Results: Nine studies were included in this review, of which seven compared oxygen cost of walking in people with MS (n = 176) and controls (n = 142) and four investigated the relationship between oxygen cost of walking and fatigue. Meta-analysis revealed that people with MS (with predominantly mild-to-moderate disability) had a significantly higher oxygen cost of walking compared with controls (standardized mean difference = 2.21, 95% CI = 0.88 to 3.54, P = .001). In addition, three studies found a significant yet weak positive association between oxygen cost of walking and fatigue. Conclusions: People with MS expend more energy when walking compared with controls. This increase in energy expenditure may contribute to the development of fatigue, as some studies found that higher oxygen costs of walking were associated with greater fatigue. Future studies should investigate whether reducing energy expenditure during movement improves fatigue.

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Timing of cholecystectomy after percutaneous cholecystectomy for acute cholecystitis- A systematic review and meta-analysis

10.1101/2021.06.06.21258426 ◽

2021 ◽

Author(s):

BHAVIN VASAVADA ◽

Hardik Patel

Keyword(s):

Systematic Review ◽

Hospital Stay ◽

Biliary Tract ◽

Risk Ratio ◽

Meta Analysis ◽

Postoperative Mortality ◽

Mean Difference ◽

Complication Rates ◽

Percutaneous Cholecystostomy ◽

Timing Of Cholecystectomy

Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy. This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in less than 8 weeks group. (Mean difference 0.87, p=0.01). Conclusion: Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy.

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