RATIONALIZATION OF SURGICAL TREATMENT FOR HEMORRHAGIC MOYAMOYA DISEASE: FROM LABORATORY BENCH RESEARCH, BIOMECHANICS TO META-ANALYSIS

2019 ◽  
Vol 19 (05) ◽  
pp. 1950035
Author(s):  
ZHI-QUN JIANG ◽  
YAN CHEN ◽  
CHUN-HUI ZENG ◽  
JIU-GENG FENG ◽  
YI-LV WAN ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Moyamoya Disease ◽  
Lower Risk ◽  
Perioperative Complications ◽  
Meta Analysis ◽  
Current Evidence ◽  
Case Control Studies ◽  
Bypass Group ◽  
Choice Of Procedure ◽  
Surgical Methods

Background and purpose: Surgery is recommended as the treatment of choice for hemorrhagic Moyamoya disease (MMD). The rationale of surgery and the choice of procedure are poorly understood. The aim of this paper is to present latest evidence, from cellular, biomechanical and population data, surgical treatment options and their effect on the outcome of hemorrhagic MMD. Methods: We systematically reviewed the latest evidence from cellular, biomechanical and populational studies including our own meta-analysis for rationalization of management of MMD. We searched major databases from inception to latest articles available till October 2018. All major breakthroughs including basic research to randomized controlled trials (RCTs) and human case–control studies related to hemorrhagic MMD were included. Our meta-analysis was performed in accordance to the standard Cochrane. Result: Evidence at cellular, biomechanical and RCT levels was presented. For our meta-analysis, we included eight studies, totaling at 632 patients. Our results rationalized the use of surgical methods in support of surgical management of MMD. We showed that surgery in MMD resulted in a significant lower risk of future stroke ([Formula: see text], 95% [Formula: see text]–0.38). Among different surgical methods, the indirect bypass group had a lower risk for sedentary stroke risk reduction compared with the direct bypass group (RR[Formula: see text]=[Formula: see text]3.36, 95% CI[Formula: see text]=[Formula: see text]1.53–7.36). No significant differences were observed in perioperative complications between the two methods. Conclusion: Surgery remains a mainstay for the management of MMD. We concluded that current evidence in biomechanical and our own meta-analysis is in support of surgery being an effective management of hemorrhagic MMD. We deduced insights into research for early detection, characterization and follow up of patients with MMD.

scholarly journals Surgical treatment of patients with sagittal imbalance of degenerative etiology: a comparison of two methods

2020 ◽  
Vol 27 (3) ◽  
pp. 16-26
Author(s):  
Evgenii S. Baykov ◽  
Alexey V. Peleganchuk ◽  
Abdugafur J. Sanginov ◽  
Olga N. Leonova ◽  
Aleksandr V. Krutko
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Perioperative Complications ◽  
Sagittal Imbalance ◽  
Radiological Parameters ◽  
Results Of Treatment ◽  
Group I ◽  
Surgical Methods ◽  
Group Ii ◽  
Clinical And Radiological Results

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine. Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later. Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001). Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.

scholarly journals Efficacy of various core decompression techniques versus non-operative treatment for osteonecrosis of the femoral head: a systemic review and network meta-analysis of randomized controlled trials

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Quanzhe Liu ◽  
Wenlai Guo ◽  
Rui Li ◽  
Jae Hyup Lee
Keyword(s):  
Surgical Treatment ◽  
Bone Graft ◽  
Statistical Difference ◽  
Radiographic Progression ◽  
Meta Analysis ◽  
Core Decompression ◽  
Systemic Review ◽  
Current Evidence ◽  
Cochrane Library ◽  
Non Surgical Treatment

Abstract Background Various Joint-preserving therapy (JPT) methods have been performed and tried in recent decades, but their results and efficacy were inconsistent and controversial. The purpose of this study is to evaluate its effectiveness and whether there are statistical differences in treatment between different interventions based on published RCT studies. Methods Following the PRISMA-NMA checklist, Medline, EMBASE, Web of Science, and Cochrane Library databases were searched and collected related RCT studies. The sources were searched from inception up to October 30, 2020. The primary outcomes including the rate of radiographic progression and conversion to THA and the secondary outcome -Harris Hip Scores (HHS) were extracted and compared in a Network meta-analysis. Results Seventeen RCT studies involving 784 patients (918 hips) with seven interventions including CD (core decompression), CD + BG (bone graft), CD + TI (tantalum rod implantation), CD + CT (Cell therapy), CD + BG + CT, VBG (vascularized bone graft), and nonsurgical or conservative treatment for ONFH were evaluated. In the radiographic progression results, CD + CT showed a relatively better result than CD, CD + BG and non-surgical treatment, the surface under the cumulative ranking curve (SUCRA) plot displayed that CD + CT (96.4%) was the best, followed by CD (64.1%).In conversion to THA results, there were no significant differences between the JPT methods and non-surgical treatment. In HHS, there was also no significant difference, other than CD + BG showed a statistical difference than non-surgical treatment only in terms of Cis, but the SUCRA was highest in non-surgical treatment (80.5%) followed by CD + CT (72.8%). Conclusions This Net-work meta-analysis demonstrated that there was no statistical difference in the outcome of radiographic progression and conversion to THA, also in HHS, other than CD + CT showed a relatively superior result in radiographic progression than nonsurgical treatment, namely, it’s maybe an effective method for delaying disease progression or reducing disease development based on current evidence.

Abstract MP26: Biomarkers of n-6 Polyunsaturated Fatty Acids and CVD Risk: A Global Pooling Project of 19 Cohort Studies

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Matti Marklund ◽  
Tzu-An Chen ◽  
Janette de Goede ◽  
Fumiaki Imamura ◽  
Federica Laguzzi ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Lower Risk ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Case Control Studies ◽  
Cvd Risk ◽  
Incidence And Mortality ◽  
Tissue Biomarker ◽  
Cvd Mortality

Background: Despite cholesterol-lowering and other potential beneficial properties of dietary linoleic acid (LA; 18:2n-6), LA has been considered pro-inflammatory and is a precursor to arachidonic acid (AA; 20:4n-6), which has also been considered harmful for CVD. Thus, the role of n-6 fatty acids in CVD prevention remains debated. Objective: To investigate across harmonized global studies the relation of circulating/tissue biomarker levels of LA and AA with incidence of CVD, CHD, and stroke. Methods: We conducted a pooled analysis within a global consortium of prospective cohort or nested case-control studies having circulating or tissue biomarker measures of LA and AA. Each study ascertained CVD risk, including incident CVD, CHD, ischemic stroke (IS), and/or CVD mortality in adults with no prevalent CVD at baseline. Standardized individual-level analysis was conducted in each study using pre-specified models, exposures, outcomes, and covariates. Study-specific estimates were pooled using inverse variance-weighted fixed effects meta-analysis. Results: We evaluated 19 studies, including 6,569 total CVD events, 2,407 CVD deaths, 6,557 CHD events, and 2,237 IS events (values may not sum due to cohort-specific outcomes). In continuous (90th vs 10th percentile) multivariable-adjusted analyses, higher levels of both LA and AA were associated with lower risk of incident CVD, with modest between-compartment heterogeneity (I2=33-35%) (Figure). LA and AA were inversely associated with CVD mortality, with RRs (95% CI): LA 0.81 (0.73 - 0.90) and AA 0.90 (0.81 - 0.99). LA, but not AA, was associated with lower risk of incident CHD and IS, with RRs (95% CI) 0.94 (0.88 - 0.99) and 0.80 (0.69 - 0.92), respectively. Conclusions: Based on harmonized analysis of multiple studies on free-living populations, biomarker levels of the two major n-6 fatty acids are associated with lower risk of CVD incidence and mortality. Relevance of potential differences in compartment-specific associations requires further investigation.

scholarly journals Usefulness of surgical treatment for asymptomatic patients with extra-peritoneal desmoid-type fibromatosis: a systematic review and meta-analysis

2020 ◽  
Vol 50 (5) ◽  
pp. 574-580
Author(s):  
Munehisa Kito ◽  
Akira Ogose ◽  
Masahiro Yoshida ◽  
Yoshihiro Nishida
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Progressive Disease ◽  
Meta Analysis ◽  
Case Series ◽  
Case Control ◽  
Case Control Studies ◽  
Exacerbation Rate ◽  
Asymptomatic Patients ◽  
Non Surgical Treatment

Abstract Objective The purpose of this systematic review is to assess and compare the efficacy of surgical treatment for patients with asymptomatic extra-peritoneal desmoid-type fibromatosis to the wait-and-see policy by evaluating (1) the exacerbation rate (exacerbation; recurrence after surgery or progressive disease following non-surgical treatment) and (2) treatment-associated complications in extra-peritoneal desmoid-type fibromatosis. Methods We evaluated documents published between 1 January 1990 and 31 August 2017. The risk of bias in the selected literature was analyzed using the Cochrane Collaboration Risk of Bias Tool. Quality of evidence was evaluated using Grading of Recommendation, Assessment, Development and Evaluation approach. Results One prospective cohort study, four case–control studies and five case series studies were identified. Meta-analysis was performed to evaluate the exacerbation rate after treatment on one prospective cohort study and four case–control studies. In comparing surgical and non-surgical treatments, the exacerbation rate was significantly higher in the surgical treatment group (odds ratio: 1.32, 95% confidence interval 1.01–1.73, P = 0.05). However, in the case series study, the recurrence rate was 23.4% for the surgical treatment group, while the progressive disease rate was 28.1% for the non-surgical treatment group. The postoperative complication rates associated with surgical treatment in the two studies were 20.8 and 17.2%, respectively. Conclusions When considering the exacerbation rate, non-surgical treatment might be appropriate for asymptomatic patients with extra-peritoneal desmoid-type fibromatosis. However, if patients with tumor-related symptoms opt for surgery, including those who face difficulties due to the presence of tumors, it is important to fully explain to them the possibility that the recurrence rate and treatment-associated functional failures may increase depending on the site of occurrence.

scholarly journals Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults

2018 ◽  
Vol 128 (3) ◽  
pp. 793-799 ◽  
Author(s):  
Jin Pyeong Jeon ◽  
Jeong Eun Kim ◽  
Won-Sang Cho ◽  
Jae Seung Bang ◽  
Young-Je Son ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Stroke Prevention ◽  
Fixed Effects ◽  
Bypass Surgery ◽  
Perioperative Complications ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Treatment Modalities ◽  
Fixed Effects Model ◽  
Direct Bypass

OBJECTIVEThe purpose of this study was to evaluate treatment outcomes of future stroke prevention, perioperative complications, and angiographic revascularization in adults with symptomatic moyamoya disease (MMD) according to treatment modalities and surgical techniques.METHODSA systemic literature review was performed based on searches of the PubMed, Embase, and Cochrane Central databases. A fixed-effects model was used in cases of heterogeneity less than 50%. Publication bias was determined by Begg’s funnel plot, Egger’s test of the intercept, and the Begg and Mazumdar rank correlation test.RESULTSEleven articles were included in the meta-analysis. Bypass surgery significantly decreased the future stroke events compared with conservative treatments in adult MMD (odds ratio [OR] 0.301, p < 0.001). Direct bypass showed better future stroke prevention than indirect bypass (OR 0.494, p = 0.028). There was no meaningful difference in perioperative complications between direct and indirect bypass (OR 0.665, p = 0.176). Direct bypass was associated with better angiographic outcomes than indirect bypass (OR 6.832, p < 0.001).CONCLUSIONSBypass surgery can be effective in preventing future stoke events in adults with MMD. Direct bypass seems to provide better risk reduction with respect to stroke than indirect bypass in these patients.

Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis

Pain Medicine ◽  
2019 ◽  
Author(s):  
Kelsey L Corcoran ◽  
Lori A Bastian ◽  
Craig G Gunderson ◽  
Catherine Steffens ◽  
Alexandria Brackett ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Spinal Pain ◽  
Chiropractic Care ◽  
Current Evidence ◽  
Inverse Association ◽  
Case Control Studies ◽  
Opioid Prescription

Abstract Objective To investigate the current evidence to determine if there is an association between chiropractic use and opioid receipt. Design Systematic review and meta-analysis. Methods The protocol for this review was registered on PROSPERO (CRD42018095128). The MEDLINE, PubMed, EMBASE, AMED, CINAHL, and Web of Science databases were searched for relevant articles from database inception through April 18, 2018. Controlled studies, cohort studies, and case–control studies including adults with noncancer pain were eligible for inclusion. Studies reporting opioid receipt for both subjects who used chiropractic care and nonusers were included. Data extraction and risk of bias assessment were completed independently by pairs of reviewers. Meta-analysis was performed and presented as an odds ratio with 95% confidence interval. Results In all, 874 articles were identified. After detailed selection, 26 articles were reviewed in full, and six met the inclusion criteria. Five studies focused on back pain and one on neck pain. The prevalence of chiropractic care among patients with spinal pain varied between 11.3% and 51.3%. The proportion of patients receiving an opioid prescription was lower for chiropractic users (range = 12.3–57.6%) than nonusers (range = 31.2–65.9%). In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers (odds ratio = 0.36, 95% confidence interval = 0.30–0.43, P < 0.001, I2 = 92.8%). Conclusions This review demonstrated an inverse association between chiropractic use and opioid receipt among patients with spinal pain. Further research is warranted to assess this association and the implications it may have for case management strategies to decrease opioid use.

scholarly journals Association between Estrogen Receptor-αGene XbaI and PvuII Polymorphisms and Periodontitis Susceptibility: A Meta-Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Hong Weng ◽  
Chao Zhang ◽  
Yuan-Yuan Hu ◽  
Rui-Xia Yuan ◽  
Hong-Xia Zuo ◽  
...  
Keyword(s):  
Estrogen Receptor ◽  
Chronic Periodontitis ◽  
Meta Analysis ◽  
Current Evidence ◽  
Case Control Studies ◽  
Chinese Han ◽  
Female Population ◽  
Increased Risk ◽  
Pvuii Polymorphism ◽  
Xbai Polymorphism

Background. Certain studies have previously explored the association between the estrogen receptor-α(ER-α) gene polymorphisms and periodontitis susceptibility, although the current results are controversial. The present study, using meta-analysis, aimed to investigate the nature of the genetic susceptibility of the ER-αfor developing periodontitis.Methods. A comprehensive literature search of PubMed, Embase, CNKI, and Wanfang databases was conducted up to January 8, 2015. Statistical manipulation was performed using Stata version 13.0 software. Odds ratios (ORs) and corresponding 95% confident intervals (CIs) were calculated to estimate the association in five genetic models.Results. A total of 17 eligible case-control studies from seven identified publications consisting of nine studies for the XbaI polymorphism and eight studies for the PvuII polymorphism were included in the meta-analysis. We found elevated risk of periodontitis in XbaI XX genotype carriers. Moreover, subgroup analyses demonstrated increased risk for chronic periodontitis of XbaI XX genotype carriers, specifically in the Chinese Han female population. No significant association was observed between PvuII polymorphism and periodontitis.Conclusion. Current evidence indicated that the homozygote (XX) genotype of ER-αgene XbaI polymorphism, but not PvuII mutation, may increase the risk of chronic periodontitis, specifically in the Chinese Han female population.

scholarly journals Impact of XPF rs2276466 polymorphism on cancer susceptibility: a meta-analysis

2019 ◽  
Vol 39 (5) ◽  
Author(s):  
Yezhou Liu ◽  
Kun Liu ◽  
Xueru Zhao ◽  
Yidan Sun ◽  
Ning Ma ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Gastrointestinal Cancer ◽  
Cancer Susceptibility ◽  
Excision Repair ◽  
Meta Analysis ◽  
Complementation Group ◽  
Current Evidence ◽  
Case Control Studies ◽  
Summary Estimate ◽  
The Impact

Abstract Association between the xeroderma pigmentosum complementation group F (XPF)rs2276466 located in the excision repair cross complementation group 4 (ERCC4) gene and cancer susceptibility has been widely investigated. However, results thus far have remained controversial. A meta-analysis was performed to identify the impact of this polymorphism on cancer susceptibility. PubMed, Embase and Science-Web databases were searched systematically up to May 20, 2018, to obtain all the records evaluating the association between the rs2276466 polymorphism and the risk of all types of cancers. We used the odds ratio (OR) as a measure of effect, and pooled the data in a Mantel-Haenszel weighed random-effects meta-analysis to provide a summary estimate of the impact of this polymorphism on gastrointestinal cancer, neurogenic cancer and other cancers (breast cancer and SCCHN). All the analyses were carried out in STATA 14.1.11 case–control studies that consisted of 5730 cases and 6756 controls, were eventually included in our meta-analysis. The significant association was observed between the XPFrs2276466 polymorphism and neurogenic cancer susceptibility (recessive model: OR = 1.648, 95% CI = 1.294–2.098, P<0.001). Furthermore, no significant impact of this polymorphism was detected on decreased gastrointestinal cancer risk (dominant model: OR = 1.064, 95%CI = 0.961–1.177, P = 0.233). The rs2276466 polymorphism might play different roles in carcinogenesis of various cancer types. Current evidence did not suggest that this polymorphism was directly associated with gastrointestinal susceptibility. However, this polymorphism might contribute to increased neurogenic cancer risk. More preclinical and epidemiological studies are still imperative for further evaluation

scholarly journals Bone Marrow-Derived Cell Therapies to Heal Long-Bone Nonunions: A Systematic Review and Meta-Analysis—Which Is the Best Available Treatment?

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Silvia Palombella ◽  
Silvia Lopa ◽  
Silvia Gianola ◽  
Luigi Zagra ◽  
Matteo Moretti ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Healing ◽  
Healing Rate ◽  
Meta Analysis ◽  
Long Bone ◽  
Current Evidence ◽  
Positive Trend ◽  
Case Control Studies ◽  
Cell Therapies

Nonunions represent one of the major indications for clinical settings with stem cell-based therapies. The objective of this research was to systematically assess the current evidence for the efficacy of bone marrow-derived cell-based approaches associated or not with bone scaffolds for the treatment of nonunions. We searched MEDLINE (PubMed) and CENTRAL up to July 2019 for clinical studies focused on the use of cell-based therapies and bone marrow derivatives to treat bone nonunions. Three investigators independently extracted the data and appraised the risk of bias. We analysed 27 studies including a total number of 347 participants exposed to four interventions: bone marrow concentrate (BMAC), BMAC combined with scaffold (BMAC/Scaffold), bone marrow-derived mesenchymal stromal cells (BMSCs), and BMSC combined with scaffold (BMSC/Scaffold). Two controlled studies showed a positive trend in bone healing in favour of BMAC/Scaffold or BMSC/Scaffold treatment against bone autograft, although the difference was not statistically significant (RR 0.11, 95% CI -0.05; 0.28). Among single cohort studies, the highest mean pooled proportion of healing rate was reported for BMAC (77%; 95% CI 63%-89%; 107 cases, n=8) and BMAC/Scaffold treatments with (71%; 95% CI 50%-89%; 117 cases, n=8) at 6 months of follow-up. At 12 months of follow-up, an increasing proportion of bone healing was observed in all the treatment groups, ranging from 81% to 100%. These results indicate that BMAC or BMAC/Scaffold might be considered as the primary choice to treat nonunions with a successful healing rate at a midterm follow-up. Moreover, this meta-analysis highlighted that the presence of a scaffold positively influences the healing rate at a long-term follow-up. More case-control studies are still needed to support the clinical improvement of cell-based therapies against autografts, up to now considered as the gold standard for the treatment of nonunions.

Meta-analysis of surgical methods for pharmacoresistant temporal lobe epilepsy

2020 ◽  
pp. 70-76
Author(s):  
G. E. Chmutin ◽  
M. I. Livshits ◽  
A. M. Levov ◽  
B. I. Oleynikov ◽  
M. A. Kolcheva ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Meta Analysis ◽  
Treatment Options ◽  
Medical Group ◽  
Pharmacoresistant Epilepsy ◽  
Surgical Methods ◽  
Clinically Significant ◽  
One Year

In the presented literature review, we conducted a meta-analysis of the effectiveness of 3 surgical treatment options for patients with pharmacoresistant temporal lobe epilepsy. Despite the widespread use of the new type of antiepileptic drugs, there are still more than 30 % of patients with epilepsy, which developed into pharmacoresistant epilepsy. Wiebe S. et al. conducted a randomized control trail (RCT) and proved that the one-year recovery rate of patients with temporal lobe epilepsy with surgical treatment was significantly higher than that with medication treatment (58 % vs. 8 %). This study proves that surgery can be effective in treating pharmacoresistant temporal lobe epilepsy [10]. Additionally, it was found that the surgically treated patients at 6 months postoperative follow-up achieved a positive minimum clinically significant change (MCID) in quality of life in epilepsy (QOLIE)-89, compared to those in the medical group (56,0 % vs. 11,0 %, p < 0,001), while 62.0 % of the surgical group achieved a positive MCID value on QOLIE-31 (p < 0,001) compared to 17,0 % in the medical group.

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