Gallbladder Retrieval From Epigastric Versus Umbilical Port in Laparoscopic Cholecystectomy: A PRISMA-Compliant Meta-Analysis

2019 ◽  
Vol 27 (2) ◽  
pp. 150-159
Author(s):  
Francesco Mongelli ◽  
Davide La Regina ◽  
Irin Zschokke ◽  
Marcello Ceppi ◽  
Antonjacopo Ferrario di Tor Vajana ◽  
...  

Purpose. To date, no evidence supports the retrieval of the gallbladder through a specific trocar site, and this choice is left to surgeons’ preference. The aim of this meta-analysis was to investigate the influence of the trocar site used to extract the gallbladder on postoperative outcomes. Methods. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Google Scholar, Cochrane Library, and EMBASE databases was performed. Terms used were: (“gallbladder” OR “cholecystectomy”) AND “umbilical” AND (“epigastric” OR “subxiphoid”). Randomized trials comparing the gallbladder retrieval from different trocar sites were considered for further analysis. Results. Literature search revealed 145 articles, of which 7 matched inclusion criteria and reported adequate data about postoperative pain, operative time, port-site infections, and hernias. A total of 876 patients were included, and the gallbladder was extracted through epigastric or umbilical trocar site in 441 and in 435 patients, respectively. A statistically significant difference among groups was noted in terms of postoperative pain at 1, 6, 12, and 24 hours in favor of the umbilical trocar site ( P < .001). No significant differences were noted in postoperative hernia and infection rate, nor in terms of operative time. Conclusions. This meta-analysis shows a statistically significant reduction in terms of postoperative pain at 1, 6, 12, and 24 hours after surgery when the gallbladder is extracted through the umbilical port. Retrieval time, infections, and hernias rate implicate no contraindication for the choice of a specific trocar site to extract specimens. Despite limitations of this study, the umbilical trocar should be favored as the first choice to retrieve the gallbladder.

2020 ◽  
Vol 45 (6) ◽  
pp. 589-597
Author(s):  
BGS Casado ◽  
EP Pellizzer ◽  
JR Souto Maior ◽  
CAA Lemos ◽  
BCE Vasconcelos ◽  
...  

Clinical Relevance The use of laser light during bleaching will not reduce the incidence or severity of sensitivity and will not increase the degree of color change compared with nonlaser light sources. SUMMARY Objective: To evaluate whether the use of laser during in-office bleaching promotes a reduction in dental sensitivity after bleaching compared with other light sources. Methods: The present review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and is registered with PROSPERO (CDR42018096591). Searches were conducted in the PubMed/Medline, Web of Science, and Cochrane Library databases for relevant articles published up to August 2018. Only randomized clinical trials among adults that compared the use of laser during in-office whitening and other light sources were considered eligible. Results: After analysis of the texts retrieved during the database search, six articles met the eligibility criteria and were selected for the present review. For the outcome dental sensitivity, no significant difference was found favoring any type of light either for intensity (mean difference [MD]: −1.60; confidence interval [CI]: −3.42 to 0.22; p=0.09) or incidence (MD: 1.00; CI: 0.755 to 1.33; p=1.00). Regarding change in tooth color, no significant differences were found between the use of the laser and other light sources (MD: −2.22; CI: −6.36 to 1.93; p=0.29). Conclusions: Within the limitations of the present study, laser exerts no influence on tooth sensitivity compared with other light sources when used during in-office bleaching. The included studies demonstrated that laser use during in-office bleaching may have no influence on tooth color change.


2020 ◽  
Author(s):  
Ruojing Bai ◽  
Shiyun Lv ◽  
Hao Wu ◽  
Lili Dai

Abstract Background: Global antiretroviral therapy has entered the era of integrase strand transfer inhibitor (INSTI). Because INSTIs have the advantages of high antiviral efficacy, rapid virus inhibition, and good tolerance, they have become the first choice in international acquired immunodeficiency syndrome (AIDS) treatment guidelines. However, they may also increase the risk of obesity. There are differences in the effects of different INSTIs on weight gain in Human immunodeficiency virus (HIV) infection / AIDS patients, but there is no evidence-based medical evidence. This study aimed to assess the effect of different INSTIs on body weight in HIV/AIDS patients.Methods: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database, and Wanfang databases were searched by computer to screen the relevant literature on INSTI treatment of HIV/AIDS patients, extract the data on weight changes in the literature, and perform network meta-analysis using Stata16.0 software.Results: Eight articles reported weight changes in HIV/AIDS patients, and weight gain was higher after treatment with dolutegravir (DTG) than with elvitegravir (EVG) in HIV/AIDS patients, and the difference was statistically significant [MD = 1.13, (0.18, 2.07)]. The network meta-analysis's consistency test results showed no overall and local inconsistency, and there was no significant difference in the results of the direct and indirect comparison (P > 0.05). The rank order of probability was DTG (79.2%) > Bictegravir (BIC) (77.9%) > Raltegravir (RAL) (33.2%) > EVG (9.7%), suggesting that DTG may be the INSTI drug that causes the most significant weight gain in HIV/AIDS patients.Conclusion: According to the literature data analysis, among the existing INSTIs, DTG may be the drug that causes the highest weight gain in HIV/AIDS patients, followed by BIC.


2021 ◽  
Author(s):  
Kanthika Wasinpongwanich ◽  
Tanawin Nopsopon ◽  
Krit Pongpirul

Purpose Surgical treatment is mandatory in some patients with lumbar spine diseases. To obtain spine fusion, many operative techniques were developed with different fusion rates and clinical results. This study aimed to collect randomized controlled trial (RCT) data to compare fusion rate, clinical outcomes, complications among Transforaminal Lumbar Interbody Fusion (TLIF), and other techniques for lumbar spine diseases. Methods A systematic literature search of PubMed, Embase, Scopus, Web of Science, and CENTRAL databases was searched for studies up to 13 February 2020. The meta-analysis was done using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complication in TLIF and other techniques for lumbar diseases. Results The literature search identified 3,682 potential studies, 15 RCTs (915 patients) were met our inclusion criteria and were included in the meta-analysis. Compared to other techniques, TLIF had slightly lower fusion rate (RR=0.84 [95% CI 0.72, 0.97], p=0.02, I2=0.0%) at 1-year follow-up while there was no difference on fusion rate at 2-year follow up (RR=1.06 [95% CI 0.96, 1.18], p=0.27, I2=69.0%). The estimated risk ratio of total adverse events (RR=0.90 [95% CI 0.59, 1.38], p=0.63, I2=0.0%) and revision rate (RR=0.78 [95%CI 0.34, 1.79], p=0.56, I2=39.0%) showed no difference. TLIF had approximately half an hour more operative time than other techniques (MD=31.88 [95% CI 5.33, 58.44], p=0.02, I2=92.0%). There was no significant difference between TLIF and other techniques in terms of the blood loss, and clinical outcomes. Conclusions Besides fusion rate at 1-year follow-up and operative time, our study demonstrated similar outcomes of TLIF with other techniques for lumbar diseases in regard to fusion rate, clinical outcomes, and complications.


2016 ◽  
Vol 41 (3) ◽  
pp. E7 ◽  
Author(s):  
Mingliang He ◽  
Leping Ouyang ◽  
Shengwen Wang ◽  
Meiguang Zheng ◽  
Anmin Liu

OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25–0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8–23), operative time was shorter (mean difference [MD], −12.84; 95% CI −20.68 to −5.00; p = 0.001), and blood loss was less (MD −9.93, 95% CI −17.56 to −2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD −1.77, 95% CI −3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liping Gou ◽  
Zhenghao Wang ◽  
Ye Zhou ◽  
Xiaofeng Zheng

Abstract Background A systematic review and meta-analysis was conducted to compare the safety and efficiency of nephroscopy and cystoscopy in transurethral cystolithotripsy (TUCL) for bladder stones (BS). Methods The PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases were searched up to January 2021 for studies assessing the effect of different types of endoscopes among patients who underwent TUCL. The search strategy and study selection process were in accordance with the PRISMA statement. Results Five randomized controlled trials were included in the meta-analysis. The results showed no difference in stone-free rate (RR = 1.00, CI = 0.98–1.02, p = 1.00) between the two groups and nonsignificant heterogeneity (I2 = 0%, p = 1.00), and all patients were rendered stone free. Use of the nephroscope significantly shortened the operative time compared with the cystoscope group (RR= − 26.26, CI = − 35.84 to − 16.68, p < 0.00001), and there was significant heterogeneity (I2= 87%, p < 0.00001). There was no significant difference in mean urethral entries (RR = 0.66, CI = − 0.71 to − 2.04, p = 0.35), hospitalization (MD = 0.08, 95% CI = − 0.07 to 0.23, p = 0.31) or total complication rate (RR=1.37, 95% CI = 0.47–4.00, p = 0.56) between the two groups. Conclusions In conclusion, this systematic review demonstrates that both nephroscopy and cystoscopy have high stone clearance efficiency, low rates of complications and short hospitalizations. The mean urethral entries depend on the treatment method for large stone fragments. However, the use of nephroscopy can significantly reduce the operative time.


2021 ◽  
pp. 152660282110586
Author(s):  
Yu Li ◽  
Wenhao Cui ◽  
Jukun Wang ◽  
Chao Zhang ◽  
Tao Luo

Objective: The objective of the present study was to compare the effectiveness of high-pressure balloon (HPB) versus conventional balloon (CB) angioplasty in treating arteriovenous fistula (AVF) stenosis. Materials and Methods: A meta-analysis was conducted using data acquired from PubMed, EMBASE, the Cochrane Library, SinoMed, CNKI, WanFang, and VIP databases from the time the databases were established to December 2020. All analyses included in the studies comprised the subgroups of HPB and CB. The patency rates of AVF were compared between 2 groups at 3, 6, and 12 months after operation. Results: Seven studies comprising 364 patients were included in the meta-analyses. The pooled results revealed that restenosis rate of AVFs treated with HPB was significantly lower than that of AVFs treated with CB at 3 months (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.16 to 0.61, p<0.001) and 6 months after operation (OR= 0.29, 95% CI = 0.11 to 0.79, p = 0.01). In addition, the technical success rate of HPB groups was higher (OR = 0.13, 95% CI = 0.05 to 0.36, p<0.001). However, no significant difference was observed between HPB and CB groups at 12 months after operation (OR = 0.68, 95% CI = 0.30 to 1.52, p = 0.35). No significant publication bias was observed in the analyses. Conclusion: High-pressure balloon is a potential option for the treatment of AVF stenosis, with a lower 3- and 6-month restenosis rate than CB. However, 12-month patency rate of HPB was not superior to CB. Therefore, further studies should be conducted to investigate the mechanisms of restenosis after angioplasty.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Chang-yuan Zhang ◽  
Check Agingu ◽  
James Kit Hon Tsoi ◽  
Hao Yu

Background. Monolithic restorations made of translucent yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) have become popular over the past few decades. However, whether aging affects the color and translucency of monolithic translucent Y-TZP is unclear. Objective. The aim of this systematic review and meta-analysis of in vitro studies was to evaluate the effects of aging on the color and translucency of monolithic translucent Y-TZP ceramics. Materials and Methods. This systematic review/meta-analysis was reported according to the PRISMA statement and registered in the OSF registries (https://osf.io/5qjmu). Four databases including Medline via the PubMed, Embase, and Web of Science databases and the Cochrane Library were searched using no publication year and language limits. The last search was executed on November 20, 2020. In vitro studies comparing the translucency and/or color of monolithic translucent Y-TZP ceramics before and after simulated aging were selected. Meta-analyses were performed using Review Manager software (version 5.3, Cochrane Collaboration, Oxford, UK) with random-effects models at a significance level of 0.05. A risk-of-bias assessment was also performed for the included studies. Results. Of the 188 potentially relevant studies, 13 were included in the systematic review. The hydrothermal aging duration ranged from 1 to 100 h at relatively similar temperatures (~134°C). In the general meta-analyses, the aged Y-TZP ceramics exhibited similar translucency parameter (TP), L ∗ , and b ∗ values compared with the nonaged controls ( P = .73 , P = .49 , and P = .62 , respectively). Moreover, there was a significant difference between the aged and nonaged Y-TZP ceramics in the a ∗ value ( P = .03 ; MD = − 0.26 ; 95% CI = − 0.51   to − 0.02 ), favoring the nonaged Y-TZP ceramics. The subgroup analyses showed that the duration of aging contributed to changes in the translucency and color of the Y-TZP ceramics. Conclusions. The optical properties of monolithic translucent Y-TZP ceramics were stable after hydrothermal aging at 134°C and 0.2 MPa for ≤20 h. Moreover, clinically unacceptable changes in the translucency and color of monolithic translucent Y-TZP ceramics were found after hydrothermal aging for >20 h.


2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Lei Zhong ◽  
Xiao-Wei Ji ◽  
Hai-Li Wang ◽  
Guang-Ming Zhao ◽  
Qing Zhou ◽  
...  

Abstract Background Norepinephrine (NE) has currently been the first-choice vasopressor in treating septic shock despite generally insufficient for patients with refractory septic shock. The aim of this update meta-analysis was to assess the safety and efficacy of a combination of non-catecholamine vasopressors (vasopressin/pituitrin/terlipressin/selepressin/angiotensin II) and NE versus NE in managing adult septic shock patients. Methods We conducted this study of literatures published from the inception to April 30, 2020, using PubMed, Embase, and the Cochrane Library databases without language restriction. Randomized controlled trials comparing NE with non-catecholamine vasopressors among adult septic shock patients were included in this meta-analysis. Pooled effects of relative risk (RR) or standard mean difference (SMD) and corresponding 95% confidence interval (CI) were calculated using a random-effects model. Results Twenty-three studies covering 4380 participants were finally enrolled. The combined analysis of non-catecholamine vasopressors resulted in a nonsignificant reduction in 90-day/ICU/hospital mortality except for a decreased in 28-day mortality (n = 4217; RR, 0.92; 95% CI 0.86–0.99; P = 0.02). This favorable result was subsequently verified by the subgroup analyses of low risk of bias studies (RR = 0.91, 95% CI = 0.84 to 0.98; P = 0.02) and catecholamine-resistant refractory shock patients group (RR, 0.84; 95% CI = 0.70–1.00; P = 0.048). The pooled analysis of non-catecholamine vasopressors showed a 14% higher success rate of shock reversal at 6 h, a 29% decreased risk of continuous renal replacement therapy, but a 51% increased risk of hyponatremia and a 2.43 times higher risk of digital ischemia. Besides, the pooled data showed that non-catecholamine vasopressors decreased heart rate (HR) (SMD, − 0.43; 95% CI − 0.66 – − 0.19; P < 0.001), serum creatinine (− 0.15; 95% CI − 0.29 – − 0.01; P = 0.04), and the length of mechanical ventilation (MV) (− 0.19; 95% CI − 0.31 – − 0.07; P < 0.01, but there was no significant difference in other parameters. Conclusions Current pooled results suggest that the addition of NE to non-catecholamine vasopressors was associated with a marginally significant reduction in 28-day mortality. Moreover, they were able to shorten the length of MV, improved renal function, decreased HR, and increased the 6-h shock reversal success rate at the expense of increased the risk of hyponatremia and digital ischemia.


2015 ◽  
Vol 27 (9) ◽  
pp. 1429-1438 ◽  
Author(s):  
Zheng-Yu Wang ◽  
Zhen-Min Han ◽  
Qi-Fei Liu ◽  
Wei Tang ◽  
Kui Ye ◽  
...  

ABSTRACTBackground:The etiology and pathogenesis of neurodegenerative disorders has yet to be elucidated, so their differential diagnosis is a challenge. This is especially true in differentiating Alzheimer's disease (AD), dementia with Lewy bodies (DLB), Parkinson disease (PD), and multiple system atrophy (MSA).Methods:A total of 11 eligible articles were identified by search of electronic databases including PubMed, Springer Link, Elsevier, and the Cochrane Library, up to June 2014. In meta-analyses, standardized mean differences (SMD), with 95% confidence intervals (CI), comparing cerebrospinal fluid (CSF) measures of α-synuclein between the above conditions were calculated using random-effects models.Results:CSF α-synuclein concentrations were significantly higher in AD compared to DLB [SMD: 0.32, 95% CI: (0.02, 0.62), z = 2.07, P = 0.038]; PD [SMD: 0.87, 95% CI: (0.15, 1.58), z = 2.38, P = 0.017]; or MSA [SMD: 1.14, 95% CI: (0.15, 2.14), z = 2.25, P = 0.025]. However, no significant difference was found between patients with AD and neurological cognitively normal controls [SMD: 0.02, 95% CI: (−0.21, 0.24), z = 0.13, P = 0.894].Conclusions:Results of these meta-analysis suggest that quantification of CSF α-synuclein could help distinguish AD from other neurodegenerative disorders such as DLB, PD, or MSA.


2019 ◽  
Author(s):  
Xueling Zhang ◽  
Dehong Cao ◽  
Peizhen Han ◽  
Zhengju Ren ◽  
Jia Wang ◽  
...  

Abstract Background: Renal cyst is prevailing around the world and symptomatic renal cysts are recommended to be treated in the EUA guidelines. Currently, aspiration-sclerotherapy (AS) and laparoscopic de-roofing (LD) are the main therapies of symptomatic renal cysts. This article aims to compare the clinical efficiency between them in the management of renal cysts through meta-analysis of comparative studies. Method: A comprehensive literature search was performed by PubMed, MEDLINE, EMBASE and the Cochrane Library to ascertain the relevant studies published up to March 2019. Articles with English full-text comparing aspiration-sclerotherapy and laparoscopic de-roofing in renal cyst treatment were included. Results: Our searches of literature generated 6 studies (1547 patients incorporated) comparing AS with LD in the impacts of renal cyst therapy. Of these, 6 studies contained 1106 and 441 patients who were treated with AS and LD, respectively. The outcome of this meta-analysis indicated that although AS group had shorter treatment time (MD:-51.10; 95% CI:-73.01 to -29.20; p<0.01), radiological successful rate (RR: 0.64; 95%CI: 0.53 to 0.77) are higher in LD group, which also had less recurrence rate (RR: 4.96; 95%CI: 2.28 to 10.81; p<0.01). No statistically significant difference was showed in symptomatic successful rate (RR: 0.90; 95%CI: 0.79 to 1.03;P=0.13) and complications (RR: 2.11; 95% CI: 0.47 to 9.52; P=0.33). Conclusion: In our meta-analysis, laparoscopic de-roofing is superior to aspiration-sclerotherapy in radiological successful rate and recurrence, but the treatment time is longer.


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