Systematic review and meta-analysis on juvenile primary spontaneous pneumothorax: Conservative or surgical approach first?

Background Primary spontaneous pneumothorax (PSP) prevalence is typically higher in juvenile patients than in adults. We aimed to evaluate the optimal treatment for primary spontaneous pneumothorax and its efficacy and safety in juveniles. Materials and methods We searched PubMed, Embase, and Cochrane databases for eligible studies published from database inception to October 10, 2020, and conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary and secondary outcomes were recurrence rate and hospital stay length, respectively. Odds ratios (OR) and mean differences were used for quantitatively analyzing binary and continuous outcomes, respectively. In total, nine retrospective studies with 1,452 juvenile patients (aged <21) were included for the quantitative analysis. The surgical approach led to a lower recurrence rate than did conservative approaches (OR: 1.95, 95% confidence interval: 1.15–3.32). Moreover, the recurrence rate was low in patients who underwent conservative treatment first and received surgery later. Conclusions Surgical approach for first-line management might have a greater effect on recurrence prevention than do conservative approaches. An upfront surgery might be an optimal choice for juvenile primary spontaneous pneumothorax.

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Impact of Chemotherapy in the Adjuvant Setting of Early Stage Uterine Leiomyosarcoma: A Systematic Review and Updated Meta-Analysis

Cancers ◽

10.3390/cancers12071899 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1899

Author(s):

Alessandro Rizzo ◽

Margherita Nannini ◽

Annalisa Astolfi ◽

Valentina Indio ◽

Pierandrea De Iaco ◽

...

Keyword(s):

Systematic Review ◽

Recurrence Rate ◽

Locoregional Recurrence ◽

Early Stage ◽

Meta Analysis ◽

Distant Recurrence ◽

Uterine Leiomyosarcoma ◽

Primary Surgery ◽

Locoregional Recurrence Rate ◽

Meta Analyses

Background: Although the use of adjuvant chemotherapy (AC) appears to be increasing over the past few years, several clinical trials and previous meta-analyses failed to determine whether AC could improve clinical outcomes in uterine leiomyosarcoma (uLMS). The aim of this systematic review and meta-analysis was to compare AC (with or without radiotherapy) versus observation (obs) after primary surgery in early stage uLMS. Materials and Methods: Randomized controlled (RCTs) and non-randomized studies (NRSs) were retrieved. Outcomes of interest were as follows: distant recurrence rate, locoregional recurrence rate and overall recurrence rate. Results about distant recurrence rate, locoregional recurrence rate and overall recurrence rate were compared by calculating odds ratios (ORs) with 95% confidence intervals (CIs); ORs were combined with Mantel–Haenszel method. Results: Nine studies were included in the analysis, involving 545 patients (AC: 252, obs: 293). Compared with obs, AC did not reduce locoregional and distant recurrence rate, with a pooled OR of 1.36 and 0.63, respectively. Similarly, administration of AC did not decrease overall recurrence rate in comparison to obs. Conclusion: According to our results, AC (with or without radiotherapy) did not decrease recurrence rate in early stage uLMS; thus, the role of AC in this setting remains unclear.

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Leishmanicidal effects of resveratrol and its derivatives: a systematic review and meta-Analysis

10.21203/rs.3.rs-25274/v1 ◽

2020 ◽

Author(s):

Nasrin Amiri Dashatan ◽

Marzieh Ashrafmansouri ◽

Mehdi Koushki ◽

Nayebali Ahmadi

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Data Extraction ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Protective Effects ◽

Random Effects Models ◽

Important Health ◽

Mean Differences ◽

Meta Analyses

Abstract Background Leishmaniasis is one of the most important health problems worldwide. The evidence has suggested that resveratrol and its derivatives have anti-leishmanial effects; however, the results are inconsistent and inconclusive. The aim of this study was to assess the effect of resveratrol and its derivatives on the Leishmania viability through a systematic review and meta-analysis of available relevant studies. Methods The electronic databases PubMed, ScienceDirect, Embase, Web of Science and Scopus were queried between October 2000 and April 2020 using a comprehensive search strategy. The eligible articles selected and data extraction conducted by two reviewers. Mean differences of IC50 (concentration leading to reduction of 50% of Leishmania) for each outcome was calculated using random-effects models. Sensitivity analyses and prespecified subgroup were conducted to evaluate potential heterogeneity and the stability of the pooled results. Publication bias was evaluated using the Egger’s and Begg’s tests. We also followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for this review. Results Ten studies were included in the meta-analysis. We observed that RSV and its derivatives had significant reducing effects on Leishmania viability in promastigote [24.02 µg/ml; (95% CI 17.1, 30.8); P < 0.05; I2 = 99.8%; P heterogeneity = 0.00] and amastigote [18.3 µg/ml; (95% CI 13.5, 23.2); P < 0.05; I2 = 99.6%; P heterogeneity = 0.00] stages of Leishmania. A significant publication bias was observed in the meta-analysis. Sensitivity analyses showed a similar effect size while reducing the heterogeneity. Subgroup analysis indicated that the pooled effects of leishmanicidal of resveratrol and its derivatives were affected by type of stilbenes and Leishmania species. Conclusions Our findings clearly suggest that the strategies for the treatment of leishmaniasis should be focused on natural products such as RSV and its derivatives. Further study is needed to identify the mechanisms mediating this protective effects of RSV and its derivatives in leishmaniasis.

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Effects of the endocrine disruptor vinclozolin in male reproduction: a systematic review and meta-analysis†

Biology of Reproduction ◽

10.1093/biolre/ioab018 ◽

2021 ◽

Author(s):

Mariana Feijó ◽

Roberta V L Martins ◽

Sílvia Socorro ◽

Luísa Pereira ◽

Sara Correia

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Meta Analysis ◽

Endocrine Disrupting Chemicals ◽

Reproductive Organs ◽

Male Reproduction ◽

Mean Differences ◽

Trim And Fill ◽

Meta Analyses ◽

Q Statistic

Abstract Endocrine-disrupting chemicals have become an issue of scientific and public discussion. Vinclozolin (VNZ) is a fungicide that competitively antagonizes the binding of natural androgens to their receptor, disturbing the function of tissues that are sensitive to these hormones, as is the case of the male reproductive organs. A systematic review with meta-analyses of rodent studies was conducted to answer the following question: Does exposure to VNZ affect sperm parameters and testicular/epididymal weight? The methodology was prespecified according to the Cochrane Handbook for Systematic Reviews and PRISMA recommendations. Sixteen articles met the inclusion criteria, comprising a total of 1189 animals. The risk of publication bias was assessed using the Trim and Fill adjustment, funnel plot, and Egger regression test. Heterogeneity and inconsistency across the findings were tested using the Q-statistic and I2 of Higgins, respectively. Sensitivity was also analyzed. Statistical analysis was performed on Comprehensive Meta-Analysis software (Version 2.0), using random models and weighted mean differences along with a 95% confidence interval. Sperm motility, counts, daily sperm production (evidence of publication bias), and epididymis weight were decreased in VNZ-treated animals. Exposure length and dose, as well as the time point of exposure, influenced the obtained results. Despite the moderate/high heterogeneity observed, the sensitivity analysis overall demonstrated the robustness of the findings. The quality scores of the included studies were superior to 4 in a total of 9, then classified as good. The obtained data corroborate the capability of VNZ exposure to disrupt spermatogenic output and compromise male fertility.

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Ameloblastoma em maxila: sugestão de abordagem cirúrgica

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v7i12.3097 ◽

2019 ◽

Vol 7 (12) ◽

Author(s):

Thalles Moreira Suassuna ◽

Júlio Leite de Araújo-Júnior ◽

Tácio Candeia Lyra ◽

Joaquim Celestino da Silva-Neto ◽

José Wilson Noleto ◽

...

Keyword(s):

Systematic Review ◽

Recurrence Rate ◽

Surgical Approach ◽

Femoral Condyle ◽

Meta Analysis ◽

Infratemporal Fossa ◽

Le Fort ◽

Maxillary Defect ◽

Le Fort I ◽

Head Neck

Introdução: O ameloblastoma é um tumor benigno, localmente invasivo, originário do epitélio odontogênico e é a neoplasia odontogênica mais comum. Apresentam crescimento lento e sua ocorrência na maxila é pouco frequente. Objetivo: Discutir os métodos de tratamento para os ameloblastomas em maxila e demonstrar a utilidade da osteotomia Le Fort I na abordagem destas lesões. Material e Método: Estudo descritivo de relato de caso. Resultados: Observou-se a erradicação da lesão com uma abordagem de baixa morbidade e que permitiu bom resultado estético e funcional. Conclusão: A ressecção é o método mais indicado para tratamento dos ameloblastomas sólidos, e a sua realização utilizando a osteotomia Le Fort I podem trazer vantagens tanto no trans quanto no pós-operatório.Descritores: Ameloblastoma; Maxila; Osteotomia de Le Fort.ReferênciasKreppel M, Zöller J. Ameloblastoma - Clinical, radiological, and therapeutic findings. Oral Dis. 2018;24(1-2):63-6.Taylor EM, Wu W, Kamali W, Ferraro P, Upton N, Lin J et al. Medial femoral condyle flap reconstruction of a maxillary defect with a 3D printing template. J Reconstr Microsurg Open. 2017;2:e63-8.Menezes LM, Souza CEL, Carneiro JT, Silva Kataoka MS, Júnior SDMA, Pinheiro, JDJV. Maxillary ameloblastoma in an elderly patient: report of a surgical approach. Hum Pathol. 2017;10:25-9.Laborde A, Nicot R, Wojcik T, Ferri J, Raoul G. Ameloblastoma of the jaws: Management and recurrence rate. Eur Ann Otorhinolaryngol Head Neck Dis. 2017;134(1):7-11. Milman T, Ying GS, Pan W, LiVolsi V. Ameloblastoma: 25 year experience at a single institution. Head Neck Pathol. 2016;10(4):513-20.Pogrel MA, Montes DM. Is there a role for enucleation in the management of ameloblastoma? Int J Oral Maxillofac Surg. 2009;38(8):807-12.Antonoglou GN, Sándor GK. Recurrence rates of intraosseous ameloblastomas of the jaws: a systematic review of conservative versus aggressive treatment approaches and meta-analysis of non-randomized studies. J Craniomaxillofac Surg. 2015;43(1):149-57.Almeida RA, Andrade ES, Barbalho JC, Vajgel A, Vasconcelos BC. Recurrence rate following treatment for primary multicystic ameloblastoma: systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2016;45(3):359-67.Rizzitelli A, Smoll N, Chae M, Rozen WM, Hunter-Smith DJ. Incidence and overall survival of malignant ameloblastoma. PLoS One. 2015;10(2):e0117789.Nastri AL, Wiesenfeld D, Radden BG, Eveson J, Scully C. Maxillary ameloblastoma: a retrospective study of 13 cases. Br J Oral Maxillofac Surg. 1995;33(1):28-32.Guha A, Hart L, Polachova H, Chovanec M, Schalek P. Partial maxillectomy for ameloblastoma of the maxilla with infratemporal fossa involvement: A combined endoscopic endonasal and transoral approach. J Stomatol Oral Maxillofac Surg. 2018;119(3):212-15.Quick-Weller J, Koch F, Dinc N, Lescher S, Baumgarten P, Harter P et al. Intracranial ameloblastoma arising from the maxilla: an interdisciplinary surgical approach. J Neurol Surg A Cent Eur Neurosurg. 2017;78(5):582-87.Abtahi MA, Zandi A, Razmjoo H, Ghaffari S, Abtahi SM, Jahanbani-Arkadani H et al. Orbital invasion of ameloblastoma: a systematic review apropos of a rare entity. J Curr Ophthalmol. 2018;30(1):23-34.Bettoni J, Neiva C, Fanous A, Olivetto M, Demarteleire S, Demarteleire C et al. Brain ameloblastoma: metastasis or local extension report of a case and literature review. J Stomatol Oral Maxillofac Surg. 2018;119(5):436-39.Yang R, Liu Z, Peng C, Cao W, Ji T. Maxillary ameloblastoma: factors associated with risk of recurrence. Head Neck. 2017;39(5):996-1000.Kamalpathey LCK, Sahoo MGNK, Chattopadhyay CPK, Issar MY. Access Osteotomy in the Maxillofacial Skeleton. Ann Maxillofac Surg. 2017;7(1):98-103.Alexander R, Weber WD, Theodos LV, Friedman JS. The treatment of large benign maxillary tumors via Le Fort I downfracture: report of two cases and review of the literature. J Oral Maxillofac Surg. 1992;50(5):515-7.Catunda IS, Melo AR, Medeiros Júnior R, Queiroz IV, Neto F, Leão JC. Osteotomia Le Fort I: Aspectos de interesse no tratamento de nasoangiofibroma juvenil. Rev cir traumatol buco-maxilo-fac. 2011;11(4):9-12.Symington OG, Caminiti MF. Le Fort 1 down fracture approach for the treatment of a posterior maxillary ameloblastoma. J Can Dent Assoc. 1995;61(12):1048-52.Iwaki LC, Tolentino ES, Lustosa RM, Jacomacci WP, Casaroto AR, Leite PC et al. Le Fort I osteotomy for the removal of a rare unicystic ameloblastoma lesion in the maxillary sinus. Gen Dent. 2016;64(3):16-9.

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Reliability of Mouse Behavioural Tests of Anxiety: a Systematic Review and Meta-Analysis on the Effects of Anxiolytics.

10.1101/2021.07.28.454267 ◽

2021 ◽

Author(s):

Marianna Rosso ◽

Robin Wirz ◽

Ariane Vera Loretan ◽

Nicole Alessandra Sutter ◽

Charlène Tatiana Pereira da Cunha ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Risk Of Bias ◽

Control Treatment ◽

Test Results ◽

Animal Models Of Anxiety ◽

Mean Differences ◽

Behavioural Tests ◽

Meta Analyses ◽

Quality Checklist

Animal research on anxiety and anxiety disorders relies on valid animal models of anxiety. However, the validity of widely used rodent behavioural tests of anxiety has repeatedly been questioned, as they often fail to produce consistent results across independent replicate studies using different study populations or different anxiolytic compounds. In this study, we assessed the sensitivity of behavioural tests of anxiety in mice to detect anxiolytic effects of drugs prescribed to treat anxiety in humans. To this end, we conducted a pre-registered systematic review of studies reporting tests of anxiolytic compounds against a control treatment using common behavioural tests of anxiety in mice. PubMed and EMBASE were searched on August 21 st 2019 for studies published in English and 814 papers were identified for inclusion. Risk of bias was assessed based on Syrcle’s risk of bias tool and the Camarades study quality checklist on a randomly selected subsample of 180 papers. Meta-analyses on effect sizes of treatments using standardized mean differences (Hedges’ g) showed that only two of 17 test measures reliably detected effects of anxiolytic compounds other than diazepam. Further, we report considerable variation in both direction and size of effects of most anxiolytics on most outcome variables, indicating poor replicability of test results. This was corroborated by high heterogeneity in most test measures. Finally, we found an overall high risk of bias. Our findings indicate a general lack of sensitivity of common behavioural tests of anxiety in mice to anxiolytic compounds and cast serious doubt on both construct and predictive validity of most of those tests. The use of animals to model human conditions can be justified only if the expected results are informative, reproducible, and translatable. In view of scientifically valid and ethically responsible research, we call for a revision of behavioural tests of anxiety in mice and the development of more predictive tests .

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The Effects of Sesame Consumption on Glycemic Control in Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/2873534 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Alireza Yargholi ◽

Mohammad Hasan Najafi ◽

Mohammad Ali Zareian ◽

Jessie Hawkins ◽

Laila Shirbeigi ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Diabetic Patients ◽

Online Searching ◽

Glycemic Indices ◽

Mean Differences ◽

Meta Analyses ◽

Natural Herb

Objectives. In recent years, diabetes has become a global health problem that creates a tremendous economic burden for many countries. Clinical trials evaluating the hypoglycemic effects of sesame consumption have produced conflicting results. This systematic review and meta-analysis was conducted to evaluate the effectiveness of sesame as a popular natural herb on glycemic indices in adults. Methods. The search for related articles in PubMed, Scopus, Google Scholar, and Cochrane library was conducted through May 2021. Results were reported as weighted mean differences (WMD) with 95% confidence intervals (CI) using a random-effects model. Results. A total of 605 studies were identified through online searching, and a total of eight RCTs representing 382 participants were included in this study. The meta-analyses revealed that sesame consumption significantly decreases serum fasting blood sugar (FBS): (WMD: −28.23 mg/dl; 95% CI (−39.16, −17.13), I2 = 97.6%; 95% CI (96, 98)), and hemoglobin A1c (HbA1c): (WMD: −1.00%; 95% CI (−1.11, −0.88), I2 = 0%; 95% CI (0, 79)) as compared to the control group. Conclusion. This study provides evidence of the hypoglycemic effects of sesame consumption, particularly in diabetic patients. Additional RCTs on sesame and its preparations should be conducted in different populations to increase generalizability.

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Evaluation of Wearable Technology in Dementia: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2020.501104 ◽

2021 ◽

Vol 7 ◽

Author(s):

Alanna C. Cote ◽

Riley J. Phelps ◽

Nina Shaafi Kabiri ◽

Jaspreet S. Bhangu ◽

Kevin “Kip” Thomas

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Wearable Technology ◽

Physiological Data ◽

Web Searches ◽

Random Effects Models ◽

Cochrane Database ◽

Study Heterogeneity ◽

Mean Differences ◽

Meta Analyses

Background: The objective of this analysis was to systematically review studies employing wearable technology in patients with dementia by quantifying differences in digitally captured physiological endpoints.Methods: This systematic review and meta-analysis was based on web searches of Cochrane Database, PsycInfo, Pubmed, Embase, and IEEE between October 25–31st, 2017. Observational studies providing physiological data measured by wearable technology on participants with dementia with a mean age ≥50. Data were extracted according to PRISMA guidelines and methodological quality assessed independently using Downs and Black criteria. Standardized mean differences between cases and controls were estimated using random-effects models.Results: Forty-eight studies from 18,456 screened abstracts (Dementia: n = 2,516, Control: n = 1,224) met inclusion criteria for the systematic review. Nineteen of these studies were included in one or multiple meta-analyses (Dementia: n = 617, Control: n = 406). Participants with dementia demonstrated lower levels of daily activity (standardized mean difference (SMD), −1.60; 95% CI, −2.66 to −0.55), decreased sleep efficiency (SMD, −0.52; 95% CI, −0.89 to −0.16), and greater intradaily circadian variability (SMD, 0.46; 95% CI, 0.27 to 0.65) than controls, among other measures. Statistical between-study heterogeneity was observed, possibly due to variation in testing duration, device type or patient setting.Conclusions and Relevance: Digitally captured data using wearable devices revealed that adults with dementia were less active, demonstrated increased fragmentation of their sleep-wake cycle and a loss of typical diurnal variation in circadian rhythm as compared to controls.

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Effect of Fasting and Postprandial Blood Samples in Results of Thyroid Function Tests Among Euthyroid People and Patients with Thyroid Problems: A Systematic Review and Meta-Analysis

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.108 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S53-S53

Author(s):

S A Almuhaidib

Keyword(s):

Systematic Review ◽

Serum Sample ◽

Thyroid Function ◽

Full Text ◽

Meta Analysis ◽

Thyroid Function Tests ◽

Blood Samples ◽

Function Tests ◽

Mean Differences ◽

Meta Analyses

Abstract Introduction/Objective Thyroid disorders are considered to have a significant global health impact, affecting around 200 million people, and about 5% of all populations are diagnosed with hypothyroidism. Thyroid problems are mainly diagnosed by the laboratory’s thyroid function tests (TSH, FT4, and FT3), and currently, there is no special guideline for a preferred sample to test the thyroid functions. Aim To investigate whether using a fasting serum sample or postprandial serum sample could affect the results of the thyroid function tests in both euthyroid people and patients with thyroid problems. Methods/Case Report • A systematic search was done on PubMed, EMBASE, Google Scholar, Semantic Scholar, and manual searches with cross-referencing. • PECOS framework was used for developing the research question. • PRISMA guidelines used for the methodology. • Two meta-analyses for TSH and FT4 were done based on the participant’s thyroid status, and one meta-analysis done for the FT3 for all. • Statistical analyses were done using Revman5 software. Results (if a Case Study enter NA) • Ten full-text studies and three abstracts were included for the systematic review, and for meta-analysis, nine full-text studies and two abstracts. • Based on the Cochrane rule of thumbs of the effect size interpretations, the meta-analyses result showed a statistically significant moderate effect for TSH mean differences; Mean of fasting blood sample > mean of the postprandial sample. • TSH effect for euthyroid people based on results of 9 studies from 641 participants (MD, 0.58; Fixed, 95% CI: [0.44 to 0.73], p. <.00001). • TSH results for all based on results of 11 studies from 921 participants (SMD, 0.46; Random, 95% CI: [0.31 to 0.61], p. <.00001). • No statistically significant effect for FT4 and FT3 mean differences results. • Publication bias is suggested for TSH and FT3 results due to the asymmetrical appearance, but not for FT4. Conclusion • In conclusion, the use of fasting blood samples would have a significantly higher TSH result value compared to the postprandial blood samples. Hence, it may help introduce a new guideline to standardize the blood sampling status for the TSH test screening and diagnosis. Alternatively, different reference ranges depending on the sampling status might be suggested, which might help promote the patients’ quality of life and reduce healthcare costs.

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Outcomes of North American, Japanese, and European extensive-disease small cell lung cancer (ED-SCLC) patients under irinotecan-platinum or etoposide-platinum therapy: Systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e18534 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e18534-e18534

Author(s):

Joao Paulo Da S.N. Lima ◽

Andre Deeke Sasse ◽

Emma C. Sasse ◽

Lucas Vieira dos Santos

Keyword(s):

Systematic Review ◽

North American ◽

Meta Analysis ◽

Geographic Origin ◽

First Line ◽

First Line Therapy ◽

Geographic Origins ◽

One Year ◽

Meta Analyses ◽

The Impact

e18534 Background: Superiority of irinotecan-platinum (IP) regimens over etoposide-platinum (EP) in ED-SCLC has been extensively debated, with ethnic and pharmacogenomics issues hypothesized as causes of the divergent findings. We undertook a systematic review to scrutinize the data according to geographic origin. Methods: Randomized controlled trials comparing first-line EP doublets versus IP in ED-SCLC patients were searched in major meeting proceedings and databases. The outcomes were overall survival (OS), one-year survival, two-year survival, and safety. Meta-analyses were performed using random-effects model. Subgroup analyses and meta-regression were undertaken to compare and measure the impact of geographical origin of study over the estimated effect size. Results: Seven studies (2,029 patients) were included. IP improved OS worldwide (HR = 0.83; 95% CI 0.76-0.92; P>0.001; I²=0%). However, the impact of IP on OS was different according to geographic origin, with relevant benefit for Japanese, little benefit for North American/Australian and intermediate for European patients (P for interaction = 0.029, table 1). One year survival was homogenously improved from 34% with EP to 40% with IP (P=0.006). IP improved two year survival just for Japanese and European patients but not to North American ones (Table). Toxicity was not impacted by trial origin. Conclusions: IP improved survival for both Western and Eastern patients, but seems to exist a gradient of benefit according to geographic origins, with maximal benefit for Japanese, some relevant for European ones and little, if any, for North American/Australian patients. These findings should be taken in account when considering IP or EP as first-line therapy for ED-SCLC patients worldwide. [Table: see text]

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Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis

European Journal of Pediatric Surgery ◽

10.1055/s-0039-1697959 ◽

2019 ◽

Vol 30 (06) ◽

pp. 490-496 ◽

Cited By ~ 1

Author(s):

Sarah Kher Ru Sim ◽

Shireen Anne Nah ◽

Amos Hong Pheng Loh ◽

Lin Yin Ong ◽

Yong Chen

Keyword(s):

Hospital Stay ◽

Recurrence Rate ◽

Spontaneous Pneumothorax ◽

Meta Analysis ◽

Primary Spontaneous Pneumothorax ◽

Systemic Review ◽

High Recurrence Rate ◽

Chemical Pleurodesis ◽

Significant Difference ◽

Observational Cohort

Abstract Introduction Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP. Materials and Methods Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed. Results Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59–5.67; p = 0.0007; I 2 = 19%). Hospital stay was also slightly shorter in the chemical pleurodesis group (pooled mean difference [MD] = 0.42 days; 95% CI = 0.12–0.72; p = 0.005; I 2 = 0%). There was no statistically significant difference in postoperative complications (pooled OR = 1.18; 95%CI = 0.40–3.48; p = 0.76; I 2 = 71%) and operative time (pooled MD = 3.50; 95%CI = −7.28 to 14.28; p = 0.52; I 2 = 99%) between these two groups. Conclusion Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.

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