A systematic review of surgical procedures on thoracic myelopathy

Abstract Purpose The surgical treatment of thoracic myelopathy is still controversial and also a challenge for spine surgeons. Therefore, the objective of this study was to review the related literature on the surgical treatment of thoracic myelopathy and try to define treatment guidelines for spine surgeons on thoracic myelopathy. Methods Relevant literatures were searched based on the PubMed, EMBASE, and Cochrane Library between January 2008 and December 2018. Some data on the characteristics of patients were extracted, including number of patients, mean age, surgical procedures, blood loss, complications, and pre-/post-operation modified JOA score. Recovery rate was used to assess the effect of surgery outcome, and the safety was evaluated by blood loss and incidence of complications. Results Thirty-five studies met the inclusion criteria and were retrieved. A total of 2183 patients were included in our systematic review, with the average age of 55.2 years. There were 69.8% patients diagnosed as ossification of ligamentum flavum (OLF), 20.0% as ossification of posterior longitudinal ligament (OPLL), 9.3% as disk herniation (DH), and 0.9% as others including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). The volume of blood loss was more in the treatment of circumferential decompression (CD) than posterior decompression (PD), and the incidence of complications was higher in CD (P < 0.05). The volume of blood loss in minimally invasive surgery (MIS) was lowest and the incidence of complications was 19.2%. Post-operation recovery rate was 0.49 in PD, 0.35 in CD, and 0.29 in MIS while the recovery rate was 0.54 in PD, 0.55 in CD, and 0.49 in MIS at the last follow-up. When focusing on the OLF specifically, incidence of complications in PD was much lower than CD, with less blood loss and higher recovery rate. Focusing on the OPLL specifically, incidence of complications in PD was much lower than CD, with less blood loss while there was no statistical difference in recovery rate between these two methods. Conclusions This systematic review showed that posterior decompression for thoracic myelopathy is safer and better than circumferential decompression according to the complication rate and surgical outcome. And we should also consider the location of compression before the operation.

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The Use of Robotics in Surgery of Benign Liver Diseases: A Systematic Review

Surgical Innovation ◽

10.1177/15533506211031414 ◽

2021 ◽

pp. 155335062110314

Author(s):

Konstantinos Tsekouras ◽

Eleftherios Spartalis ◽

Nikolaos Mamakos ◽

Gerasimos Tsourouflis ◽

Nikolaos I. Nikiteas ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Robotic Surgery ◽

Complication Rate ◽

Liver Diseases ◽

Cochrane Library ◽

Widespread Application ◽

Number Of Patients ◽

Feasible Option ◽

Benign Liver

Background. Surgical treatment of benign liver diseases (BLD) remains a field of conflict, due to increased risk and high complication rate. However, the introduction of minimally invasive surgery has led to increased number of patients with BLD being treated surgically, with similar outcomes and fewer complications. Current data support the application of laparoscopic surgery (LS) and robotic surgery (RS) in surgical treatment of liver malignancies, but there are insufficient data concerning the application of robotic surgery in BLD. In the present systematic review, we aimed to evaluate the application of RS in BLD surgery. Methods. After a thorough search of Medline, Scopus, and Cochrane Library, 12 studies were considered eligible with a total number of 115 patients with BLD. Discussion. In brief, RS appears to be a safe and feasible option for BLD surgery. When compared to open surgery, RS is associated with lower blood loss, shorter length of stay, and fewer complication rate. Regarding LS, the peri- and postoperative outcomes were similar, but RS can overcome the technical limitations of LS. However, the cost of RS remains a major drawback in its widespread application. Conclusions. Considering our findings, RS can be a safe and feasible option for BLD surgery, but further studies are needed to justify the introduction of RS in liver surgery and to define the type of patients that will benefit the most from it.

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Surgical Treatment of Sprengel’s Deformity: A Systematic Review and Meta-Analysis

Children ◽

10.3390/children8121142 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1142

Author(s):

Paola Zarantonello ◽

Giovanni Luigi Di Gennaro ◽

Marco Todisco ◽

Piergiorgio Cataldi ◽

Stefano Stallone ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Surgical Procedures ◽

Meta Analysis ◽

Demographic Data ◽

Surgical Techniques ◽

Cochrane Library ◽

Major Complications ◽

Sprengel’S Deformity ◽

Almost All

(1) Background: Sprengel’s deformity (SD) is a rare congenital anomaly caused by failure in the descent of the scapula. We aimed to systematically review the current literature reporting data from children undergoing surgery for SD, in order to explore the rate of success and complications of the different surgical techniques, possibly providing recommendations about the management of SD in children. (2) Methods: we electronically searched the literature from Ovid, MEDLINE and the Cochrane Library databases. Demographic data, surgical procedures, outcomes and complications were analyzed. We categorized surgical procedures into five groups. (3) Results: 41 articles met the inclusion criteria, showing a poor overall study quality; 674 patients (711 shoulders) were analyzed. Green’s and Woodward’s procedures, both aiming the scapular relocation in a more anatomical position, were the most commonly used techniques. We counted 168 adverse events (18 major complications). The best clinical and cosmetic results seem to be achieved when surgery is performed in children aged less than eight years. (4) Conclusions: this paper represents the first systematic review reporting qualitative and quantitative data about the surgical treatment of SD. Surgery for SD seems to be effective in increasing the shoulder’s range of motion and improving the cosmetic appearance in almost all cases, with a low rate of major complications.

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O42: THE ROLE OF TOURNIQUETS IN TRANSTIBIAL AMPUTATION FOR PERIPHERAL VASCULAR DISEASE: A SYSTEMATIC REVIEW & META-ANALYSIS

British Journal of Surgery ◽

10.1093/bjs/znab117.042 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

D Cagney ◽

J Byrne ◽

GJ Fulton ◽

BJ Manning ◽

HP Redmond

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Revision Surgery ◽

Lower Limb ◽

Cochrane Library ◽

Peripheral Vascular ◽

Operative Blood Loss ◽

Transfusion Requirements

Abstract Introduction The use of lower limb tourniquets is traditionally discouraged in severe atherosclerotic disease. However, blood loss and increased transfusion requirements are associated with post-operative morbidity in patients undergoing major lower limb amputation. The aim of this systematic review is to summarise and pool the available data to determine the impact of tourniquet application when performing trans-tibial amputation for peripheral vascular disease. Method This systematic review was conducted according to PRISMA guidelines. A systematic search of Medline, Embase and Cochrane Library was undertaken for articles which compared the use of a tourniquet versus no tourniquet in patients undergoing trans-tibial amputation for peripheral vascular disease. The main outcomes included intra-operative blood loss, post-operative transfusion requirement, need for revision surgery and 30-day mortality. Result Four studies met the inclusion criteria for quantitative analysis with a total of 267 patients. A tourniquet was used in 130 patients. Both groups were matched for age, gender, co-morbidities and pre-operative haemoglobin. In patients undergoing trans-tibial amputation, tourniquets were associated with significantly lower intra-operative blood loss (Mean difference= -147.6mls; P=0.03) and lower transfusion requirements (pooled odds ratio (OR), 0.12, p=0.03). The need for stump revision (OR, 0.7; p=0.48), proceeding to transfemoral amputation within 30 days (OR, 0.67; p=0.25) and 30-day mortality (OR, 0.65; p=0.41) all favoured tourniquet use but the differences were not found to be significant. Conclusion Tourniquets can reduce intra-operative blood loss and transfusion requirements in patients undergoing trans-tibial amputation without increasing ischaemic complications and need for revision surgery. Take-home message Tourniquets are safe to use in trans-tibial amputation for severe peripheral vascular disease and can reduce intra-operative blood loss without increasing ischaemic complications.

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Diagnostic Role of 18F-PSMA-1007 PET/CT in Prostate Cancer Staging: A Systematic Review

Diagnostics ◽

10.3390/diagnostics11030552 ◽

2021 ◽

Vol 11 (3) ◽

pp. 552

Author(s):

Salam Awenat ◽

Arnoldo Piccardo ◽

Patricia Carvoeiras ◽

Giovanni Signore ◽

Luca Giovanella ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Diagnostic Accuracy ◽

Metastatic Disease ◽

Cancer Staging ◽

Relevant Information ◽

Cochrane Library ◽

Number Of Patients ◽

Pet Ct

Background: The use of prostate-specific membrane antigen (PSMA)-targeted agents for staging prostate cancer (PCa) patients using positron emission tomography/computed tomography (PET/CT) is increasing worldwide. We performed a systematic review on the role of 18F-PSMA-1007 PET/CT in PCa staging to provide evidence-based data in this setting. Methods: A comprehensive computer literature search of PubMed/MEDLINE and Cochrane Library databases for studies using 18F-PSMA-1007 PET/CT in PCa staging was performed until 31 December 2020. Eligible articles were selected and relevant information was extracted from the original articles by two authors independently. Results: Eight articles (369 patients) evaluating the role of 18F-PSMA-1007 PET/CT in PCa staging were selected. These studies were quite heterogeneous, but, overall, they demonstrated a good diagnostic accuracy of 18F-PSMA-1007 PET/CT in detecting PCa lesions at staging. Overall, higher primary PCa aggressiveness was associated with higher 18F-PSMA-1007 uptake. When compared with other radiological and scintigraphic imaging methods, 18F-PSMA-1007 PET/CT had superior sensitivity in detecting metastatic disease and the highest inter-reader agreement. 18F-PSMA-1007 PET/CT showed similar results in terms of diagnostic accuracy for PCa staging compared with PET/CT with other PSMA-targeted tracers. Dual imaging with multi-parametric magnetic resonance imaging and 18F-PSMA-1007 PET/CT may improve staging of primary PCa. Notably, 18F-PSMA-1007-PET/CT may detect metastatic disease in a significant number of patients with negative standard imaging. Conclusions: 18F-PSMA-1007 PET/CT demonstrated a good accuracy in PCa staging, with similar results compared with other PSMA-targeted radiopharmaceuticals. This method could substitute bone scintigraphy and conventional abdominal imaging for PCa staging. Prospective multicentric studies are needed to confirm these findings.

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Effectiveness and safety of inpatient versus extended venous thromboembolism (VTE) prophylaxis with heparin following major pelvic surgery for malignancy: protocol for a systematic review

Systematic Reviews ◽

10.1186/s13643-019-1179-1 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Bridget Heijkoop ◽

Natalie Parker ◽

George Kiroff ◽

Daniel Spernat

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Systematic Reviews ◽

Pelvic Surgery ◽

Current Evidence ◽

Cochrane Library ◽

Vte Prophylaxis ◽

Optimum Duration ◽

Number Of Patients ◽

Increased Risk

Abstract Background Venous thromboembolism (VTE) is a common postoperative complication associated with significant morbidity and mortality. The use of prophylactic heparin postoperatively reduces this risk, and the use of extended duration prophylaxis is becoming increasingly common. Malignancy and pelvic surgery both independently further increase the risk of postoperative VTE and patients undergoing major pelvic surgery for malignancy are at particularly high risk of VTE. However, the optimum duration of prophylaxis specifically in this population currently remains unclear. Methods We will conduct a systematic review of literature in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.,2011) to evaluate current evidence of the effectiveness and safety of inpatient versus extended VTE prophylaxis with heparin (all forms) following major pelvic surgery for malignancy. We will search PubMed, EMBASE, and the Cochrane Library. Regarding safety, Food and Drug Administration (FDA), and Therapeutic Goods Administration (TGA) websites will be searched, including all levels of evidence. Results will be the postoperative timeframe in which a VTE event can be considered to have been provoked by the surgery, and the number of patients needed to treat with both inpatient and extended prophylaxis to prevent a VTE event in this timeframe, comparing these to determine if there is a significant benefit from extended prophylaxis. Discussion This systematic review will aim to identify the postoperative period in which patients undergoing major pelvic surgery for malignancy are at further increased risk of VTE as a result of their surgery and the optimum duration of heparin VTE prophylaxis with heparin to reduce this risk. Determining this will allow evidence-based recommendations to be made for the optimum duration of heparin VTE prophylaxis post major pelvic surgery for malignancy, leading to improved standards of care that are consistent between different providers and institutions. Systematic review registration In accordance with guidelines, our systematic review was submitted to PROSPERO for consideration of registration on 16/12/17 and was registered on 12/1/18 with the registration number CRD42018068961, and it was last updated on December 1, 2018.

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Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-019-1249-4 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Kassahun Gebeyehu Yazew ◽

Chanyalew Worku Kassahun ◽

Amare Wondim Ewnetie ◽

Habtamu Kerebih Mekonen ◽

Endalamaw Salilew Abagez

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Congestive Heart Failure ◽

Health Care Providers ◽

Recovery Rate ◽

Severe Acute Malnutrition ◽

Meta Analysis ◽

Acute Malnutrition ◽

Cochrane Library ◽

Care Providers

Abstract Background Severe acute malnutrition affects more than 20 million children. Africa is pointed out as a region where the problem is highly prevalent. There were individual studies on the recovery rate and its determinants among children with severe acute malnutrition in Ethiopia. But, there is no national pooled estimate. Therefore, this systematic review and meta-analysis aimed to estimate the recovery rate and determinants among children with severe acute malnutrition admitted to the therapeutic feeding unit in Ethiopia. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed in this study. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, and EMBASE. The statistical analysis was conducted using STATA version-11 software. The pooled prevalence was estimated with 95% confidence intervals using a random-effects model. Result A total of 12 studies were included with 2658 participants in the analysis. The overall pooled estimated recovery rate among children with severe acute malnutrition admitted to the inpatient therapeutic feeding unit in Ethiopia was 72.02 % (CI, 64.83, 79.22%). In the subgroup analysis, the highest estimate (80.29%) was observed in studies conducted in Oromia regional state, while 68.63% was observed in studies Southern Nation Nationality of people region 68.63%. Children who had no congestive heart failure were 4.88 times (OR, 4.88; 95% CI, 2.246, 10.586) more likely to recover than their counterparts. Conclusion The recovery rate among severe acute malnourished children on the therapeutic feeding unit in Ethiopia lied within the international minimum sphere. Hence, health care providers shall strengthen the management of severe acute malnutrition and management other co-morbidities like congestive heart failure. Systematic review registration PROSPERO CRD42019119124

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Global prevalence of depression in HIV/AIDS: a systematic review and meta-analysis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001952 ◽

2019 ◽

pp. bmjspcare-2019-001952 ◽

Cited By ~ 2

Author(s):

Sepide Rezaei ◽

Saba Ahmadi ◽

Jeiran Rahmati ◽

Hossein Hosseinifard ◽

Afsaneh Dehnad ◽

...

Keyword(s):

Systematic Review ◽

Prevalence Rate ◽

Meta Analysis ◽

Total Sample ◽

Developed Countries ◽

Cochrane Library ◽

Underdeveloped Countries ◽

Global Prevalence ◽

Number Of Patients ◽

Hiv Aids

IntroductionThe incidence of some fatal diseases, including HIV/AIDS, accompanied by depression has become a significant concern in developed, developing and underdeveloped countries. A great deal of time and money are spent on controlling and reducing the complications of this infection across the world. Accordingly, the main purpose of this study was to clarify the global prevalence rate of depression in patients living with HIV/AIDS via a systematic review and meta-analysis.MethodologyAll articles in English, published between 2000 and 2018, were systematically searched from the original databases of Web of Science, PubMed, Scopus, Cochrane Library, Google Scholar and Embase. As a result, a total of 118 articles were identified.ResultsThe total sample size in these articles was 51143 people, and the number of patients suffering from moderate and severe levels of depression was 14 942. The results of the analysis based on the random-effects (DerSimonian and Laird) model revealed that the prevalence rate of depression in patients with HIV/AIDS was 31% (95% CI 28% to 34%), with a 98% heterogeneity index which was reported significant. Meanwhile, the highest prevalence rate of depression based on continent was in South America at 44% (95% CI 35% to 53%) and the lowest rate was in Europe at 22% (95% CI 17% to 27%).ConclusionIn general, there was a higher prevalence rate of depression in developing and underdeveloped countries than in developed countries, which could be attributed to the advancement of science and the possibilities for early diagnosis of this syndrome.Trial registration numberCRD42019119137.

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Systematic Review and Meta-Analysis of Rituximab for Steroid-Dependent or Frequently Relapsing Nephrotic Syndrome in Children

Frontiers in Pediatrics ◽

10.3389/fped.2021.626323 ◽

2021 ◽

Vol 9 ◽

Author(s):

Xia Gao ◽

Yan Wang ◽

Zichuan Xu ◽

Huiying Deng ◽

Huabin Yang ◽

...

Keyword(s):

Systematic Review ◽

Nephrotic Syndrome ◽

Assessment Tool ◽

Meta Analysis ◽

Biomedical Literature ◽

Cochrane Library ◽

Control Group ◽

Frequently Relapsing Nephrotic Syndrome ◽

Steroid Dependent ◽

Number Of Patients

Objective: To explore the effectiveness and safety of rituximab (RTX) for steroid-dependent or frequently relapsing nephrotic syndrome via a systematic review and meta-analysis.Methods: All the literature about RTX therapy for childhood nephrotic syndrome (NS) on PubMed, Web of Science, Cochrane Library, EMBASE, and Chinese biomedical literature database published before November 1, 2019, were conducted and selected according to the preset criteria. The Cochrane bias risk assessment tool was used to evaluate the quality of the literature included. The outcome data were analyzed by RevMan 5.3 software.Results: There were six RCT studies that met the inclusion criteria with a moderate quality after evaluation. At the end of the treatment, the relapse rate of NS in the RTX group reduced significantly when compared with that in the control group [odds ratio (OR) = 0.11, 95% confidence interval (CI) (0.03, 0.43), p = 0.001]. The number of patients in the RTX group used less steroid or/and calcineurin inhibitors significantly than that in the control group [OR = 0.05, 95% CI (0.01, 0.28), p = 0.0007]. For children who were steroid-dependent, RTX treatment significantly reduced the dosage of the steroid, compared with that in control [standardized mean difference (SMD) = −1.49, 95% CI (−2.00, −0.99), p < 0.00001]. There was no significant reduction in protein excretion between the two groups [SMD = −0.33, 95% CI (−0.71, 0.04), p = 0.08]. Fewer serious adverse reactions of RTX in the six studies were reported and most adverse events were mild.Conclusion: RTX is effective and safe for children with steroid-dependent or frequently relapsing nephrotic syndrome.Systematic Review Registration: Identifier: CRD 42020150933. https://www.crd.york.ac.uk/prospero/. This review has been registered to the PROSPERO on 27 Feb 2020.

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The effectiveness of surgical procedures to prevent post-hysterectomy pelvic organ prolapse: a systematic review of the literature

International Urogynecology Journal ◽

10.1007/s00192-020-04572-2 ◽

2020 ◽

Author(s):

Greta Lisa Carlin ◽

Barbara Bodner-Adler ◽

Heinrich Husslein ◽

Magdalena Ritter ◽

Wolfgang Umek

Keyword(s):

Systematic Review ◽

Pelvic Organ Prolapse ◽

Surgical Procedures ◽

Surgical Procedure ◽

De Novo ◽

Pelvic Organ ◽

Complete Analysis ◽

Cochrane Library ◽

Published Data ◽

Review Of The Literature

Abstract Introduction and hypothesis Hysterectomy is one of the most commonly performed gynecological surgical procedures. One of the long-term risks associated with hysterectomy is the occurrence of pelvic organ prolapse (POP). To prevent post-hysterectomy POP, several suspension procedures are routinely performed at the time of hysterectomy. We performed a systematic review of published data in order to define the most effective surgical procedures for the prevention of post-hysterectomy POP. Methods We performed a systematic review of the literature by searching PubMed, the Cochrane Library, EMBASE, Ovid MEDLINE, and clinicaltrials.gov up to 24 May 2020. The search strategy included the keywords hysterectomy, post-hysterectomy, prolapse, colposuspension, culdoplasty, McCall, and combinations thereof. The inclusion criterion was a surgical procedure at the time of hysterectomy to prevent de novo POP. The outcome was incidence of post-hysterectomy POP. Results Six out of 553 retrieved studies met the methodological criteria for complete analysis. In this review, 719 women aged over 18 years were included. Only 2 studies were designed as prospective trials; however, only 1 compared women undergoing a procedure at the time of hysterectomy with controls. The prevalence of post-hysterectomy prolapse varied from 0% to 39%. Conclusion A systematic review of published literature suggests that performing variations of McCall culdoplasty at the time of hysterectomy might be the most effective prophylactic surgical procedure for preventing post-hysterectomy pelvic organ prolapse.

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Responses to ARUBA: a systematic review and critical analysis for the design of future arteriovenous malformation trials

Journal of Neurosurgery ◽

10.3171/2015.6.jns15619 ◽

2017 ◽

Vol 126 (2) ◽

pp. 486-494 ◽

Cited By ~ 34

Author(s):

Elsa Magro ◽

Jean-Christophe Gentric ◽

Tim E. Darsaut ◽

Daniela Ziegler ◽

Michel W. Bojanowski ◽

...

Keyword(s):

Systematic Review ◽

Fundamental Problem ◽

English Literature ◽

Clinical Care ◽

Cochrane Library ◽

Trial Methodology ◽

Number Of Patients ◽

Enrollment Rates ◽

French And English ◽

Primary Hypothesis

OBJECTIVE The ARUBA study (A Randomized Trial of Unruptured Brain Arteriovenous Malformations [AVMs]) on unruptured brain AVMs has been the object of comments and editorials. In the present study the authors aim to systematically review critiques, discuss design issues, and propose a framework for future trials. METHODS The authors performed a systematic review of the French and English literature on the ARUBA study published between January 2006 and February 2015. The electronic search, including the Cochrane Library, MEDLINE (PubMed and Ovid), CINAHL, and EMBASE databases, was complemented by hand searching and cross-referencing. The comments were categorized as items related to the design, the conduct, and the analysis and interpretation of the trial. RESULTS Thirty-one articles or letters were identified. The pragmatic design, with heterogeneity of patients and lack of standardization of the treatment arm, were frequently stated concerns. The choice of outcome measures was repeatedly criticized. During the trial, low enrollment rates, selection bias, and premature interruption of enrollment were frequent comments. The short follow-up period, the lack of subgroup analyses, the lack of details on the results of the various treatments, and a contentious interpretation of results were noted at the analysis stage. A fundamental problem was the primary hypothesis testing conservative management. The authors believe that other trials are needed. Future trials could be pragmatic, test interventions stratified at the time of randomization, and look for long-term, hard clinical outcomes in a large number of patients. CONCLUSIONS In the authors' view, the ARUBA trial is a turning point in the history of brain AVM management; future trials should aim at integrating trial methodology and clinical care in the presence of uncertainty.

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