Complication Differences Between the Tumescent and Non-Tumescent Dissection Techniques for Mastectomy: A Meta-Analysis

PurposeWe conducted a systematic literature search and pooled data from studies to compare the incidence of complications between the tumescent and non-tumescent techniques for mastectomy.MethodsWe searched PubMed, Embase, BioMed Central, Ovid, and CENTRAL databases for studies comparing the two mastectomy techniques up to November 1st, 2020. We used a random-effects model to calculate odds ratios (OR) with 95% confidence intervals (CI).ResultsNine studies were included with one randomized controlled trial (RCT). Meta-analysis indicated no statistically significant difference in the incidence of total skin necrosis (OR 1.18 95% CI 0.71, 1.98 I2 = 82% p=0.52), major skin necrosis (OR 1.58 95% CI 0.69, 3.62 I2 = 71% p=0.28), minor skin necrosis (OR 1.11 95% CI 0.43, 2.85 I2 = 72% p=0.83), hematoma (OR 1.19 95% CI 0.80, 1.79 I2 = 4% p=0.39), and infections (OR 0.87 95% CI 0.54, 1.40 I2 = 54% p=0.56) between tumescent and non-tumescent groups. Analysis of studies using immediate alloplastic reconstruction revealed no statistically significant difference in the incidence of explantation between the two groups (OR 0.78 95% CI 0.46, 1.34 I2 = 62% p=0.37). Multivariable-adjusted ORs on total skin necrosis were available from three studies. Pooled analysis indicated no statistically significant difference between tumescent and non-tumescent groups (OR 1.72 95% CI 0.72, 4.13 I2 = 87% p=0.23).ConclusionLow-quality evidence derived mostly from non-randomized studies is indicative of no difference in the incidence of skin necrosis, hematoma, seroma, infection, and explantation between the tumescent and non-tumescent techniques of mastectomy. There is a need for high-quality RCTs to further strengthen the evidence.

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Abstract 12022: Long-Term Clinical Outcomes of Everolimus-Eluting Stents versus Sirolimus-Eluting Stents: Systematic Review and a Meta-Analysis of 14 Randomized Control Trials, Focused on Stent Thrombosis

Circulation ◽

10.1161/circ.130.suppl_2.12022 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

TOSHIAKI TOYOTA ◽

Hiroki Shiomi ◽

Takeshi Morimoto ◽

Takeshi Kimura

Keyword(s):

Clinical Outcomes ◽

Stent Thrombosis ◽

Controlled Trial ◽

Meta Analysis ◽

Target Lesion ◽

Pooled Analysis ◽

Significant Difference ◽

Artery Disease

Background: We sought to compare the long-term clinical outcomes between everolimus-eluting stent (EES) and sirolimus-eluting stents (SES) with a meta-analysis method. The long-term clinical outcomes, especially stent thrombosis (ST), after EES versus SES implantation has not been clearly defined among trials directly comparing the 2 types of stents. Methods: We searched PubMed, Cochrane database, and ClinicalTrials.gov. for trials comparing outcomes between EES (Xience V/Promus) and SES (Cypher select/Cypher select plus) in patients with native coronary artery disease using randomized controlled trial (RCT) design. We selected the article reporting the longest follow-up outcomes from each RCT. The outcome measure was all-cause death, myocardial infarction (MI), definite ST, and target-lesion revascularization (TLR). ST was further classified as those occurring early (<=30 days), late (30-365 days), or very late (<365 days). Results: We identified 14 RCT comparing EES and SES including 2 trials reporting the longest follow-up outcomes as a pooled analysis. We analyzed 13,434 randomly assigned patients with the weighted follow-up period of 2.1 years (Follow-up <=1-year: 7 trials, and 3191 patients; >1-year: 7 trials, and 10243 patients). EES as compared to SES was associated with significantly lower risks for overall ST, and early ST (pooled odds ratio (OR) 0.49, 95% confidence interval (CI) 0.30-0.81, P=0.01, and OR 0.42, 95% CI 0.18-0.99, P=0.046, respectively), while there was no significant difference in the risk for late ST and very late ST (OR 0.49, 95% CI 0.17-1.43, P=0.19, and OR 0.66, 95% CI 0.23-1.85, P=0.43, respectively). EES as compared to SES was also associated with significantly lower risks for TLR (OR 0.84, 95% CI 0.71-0.99, P=0.04). There was no significant difference in the risk for all-cause death, and MI between EES and SES. (OR 0.91, 95% CI 0.78-1.07, P=0.11, and OR 0.92, 95% CI 0.75-1.13, P=0.44, respectively). Conclusions: In the current meta-analysis of 14 RCT directly comparing EES with SES, implantation of EES as compared to SES implantation was associated with significantly lower risk for definite ST and TLR.

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Changing evidence over time: updated meta-analysis regarding anti-TNF efficacy in childhood chronic uveitis

Rheumatology ◽

10.1093/rheumatology/keaa595 ◽

2020 ◽

Author(s):

Ilaria Maccora ◽

Eleonora Fusco ◽

Edoardo Marrani ◽

Athimalaipet V Ramanan ◽

Gabriele Simonini

Keyword(s):

Observational Studies ◽

Primary Outcome ◽

Controlled Trial ◽

Meta Analysis ◽

Pooled Analysis ◽

Primary Outcome Measure ◽

Systemic Steroid ◽

Biologic Treatment ◽

Chronic Uveitis ◽

Randomized Controlled

Abstract Objective To summarize evidence regarding efficacy of anti-TNFα in childhood chronic uveitis, refractory to common DMARDs. Methods An updated systematic search was conducted between November 2012 and January 2020. Studies investigating the efficacy of anti-TNFα therapy, in children of ages <16 years, as the first biologic treatment for childhood chronic uveitis, refractory to topical and/or systemic steroid and at least one DMARD were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation according to Standardization of Uveitis Nomenclature Working Group criteria. A combined estimate of the proportion of children responding to etanercept (ETA), infliximab (INF), and adalimumab (ADA) was determined. Results We identified 1677 articles of which 37 articles were eligible. Three were randomized controlled trials, one on ETA and two on ADA, and were excluded from pooled analysis. From the observational studies, a total of 487 children were identified: 226 received ADA, 213 INF and 48 ETA. The proportion of responding children was 86% (95% CI: 76%, 95%) for ADA, 68% (95% CI: 50%, 85%) for INF and 36% (95% CI: 9%, 67%) for ETA. Pooled analysis showed clear differences (χ2 = 32.2, P < 0.0001): ADA and INF were both significantly superior to ETA (χ2 = 26.8, P < 0.0001, and χ2 = 7.41, P < 0.006, respectively), ADA significantly superior to INF (χ2 = 13.4, P < 0.0002). Conclusion This meta-analysis, consistent with recent randomized controlled trial data, suggests the efficacy of ADA and INF in childhood chronic uveitis treatment. However, ADA results were superior to those of INF in this clinical setting.

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A Meta-analysis of Outcomes After Routine Aspiration of the Gallbladder During Cholecystectomy

International Surgery ◽

10.9738/1361.1 ◽

2011 ◽

Vol 96 (1) ◽

pp. 21-27 ◽

Cited By ~ 4

Author(s):

M. R. S. Siddiqui ◽

M. S. Sajid ◽

A. Nisar ◽

H. Ali ◽

A. Zaborszky ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Random Effects ◽

Meta Analysis ◽

Gallbladder Perforation ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Random Effects Model ◽

Infection Rates ◽

Randomized Controlled ◽

Significant Difference

Abstract We conducted a meta-analysis of published literature comparing outcomes after aspirating (ASP) the gallbladder versus nonaspiration (NASP). Electronic databases were searched from January 1985 to November 2009. A meta-analysis was performed to obtain a summative outcome. Two randomized, controlled trials involving 360 patients were analyzed. A total of 180 patients were in the ASP group, and 180 were in the NASP group. There was no significant increase in operative time in the ASP group compared with the NASP group [random-effects model: standardized mean difference, −0.72; 95% confidence interval (CI), −2.16, 0.71; z = 0.99; df = 1; P = 0.32], but there was significant heterogeneity among trials (Q = 42.4; P < 0.001; I2 = 98%). Patients undergoing ASP were less likely to have a gallbladder perforation [random-effects model: risk ratio (RR), 0.42; 95% CI, 0.19, 0.96; z = 2.05; df = 1; P < 0.05], but no difference was found regarding the loss of gallstones (random-effects model: RR, 1.33; 95% CI, 0.30, 5.85; z = 0.38; df = 1; P = 0.70). No difference was seen for liver bed bleeding (P = 0.43) or overall 30-day infection rates (P = 0.66). After aspiration, gallbladder perforation rates may be lower. This does not appear to translate into decreased loss of gallstones or infection rates. There was no significant difference between techniques in blood loss from the liver bed. Further randomized, controlled trials and follow-up studies are required to confirm these results and to establish long-term sequelae.

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Impact of Adjuvant Use of Midodrine to Intravenous Vasopressors: A Systematic Review and Meta-Analysis

Critical Care Research and Practice ◽

10.1155/2021/5588483 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Ahmad Al-Abdouh ◽

Sadam Haddadin ◽

Atul Matta ◽

Ahmad Jabri ◽

Mahmoud Barbarawi ◽

...

Keyword(s):

Retrospective Studies ◽

Controlled Trial ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Inclusion Criteria ◽

Randomized Controlled ◽

Icu Length Of Stay ◽

Significant Difference ◽

Risk Ratios

Purpose. To evaluate the efficacy and safety of midodrine use in intensive care units (ICU) to facilitate weaning off intravenous vasopressors (IVV). Methods. We searched PubMed/MEDLINE, Cochrane library, and Google Scholar (inception through October 18th, 2020) for studies evaluating adjuvant use of midodrine to IVV in the ICU. The outcomes of interest were ICU length of stay (LOS), hospital LOS, mortality, IVV reinstitution, ICU readmission, and bradycardia. Estimates were pooled using the random-effects model. We reported effect sizes as standardized mean difference (SMD) for continuous outcomes and risk ratios (RRs) for other outcomes with a 95% confidence interval (CI). Results. A total of 6 studies were found that met inclusion criteria and had sufficient data for our quantitative analysis (1 randomized controlled trial and 5 retrospective studies). A total of 2,857 patients were included: 600 in the midodrine group and 2,257 patients in the control group. Midodrine use was not associated with a significant difference in ICU LOS (SMD 0.16 days; 95% CI −0.23 to 0.55), hospital LOS (SMD 0.03 days; 95% CI −0.33 to 0.0.39), mortality (RR 0.87; 95% CI 0.52 to 1.46), IVV reinstitution (RR 0.47; 95% CI 0.17 to 1.3), or ICU readmission (RR 1.03; 95% CI 0.71 to 1.49) when compared to using only IVV. However, there were higher trends of bradycardia with midodrine use that did not reach significance (RR 7.64; 95% CI 0.23 to 256.42). Conclusion. This meta-analysis suggests that midodrine was not associated with a significant decrease in ICU LOS, hospital LOS, mortality, or ICU readmissions.

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Probiotics combined with aminosalicylic acid affiliates remission of ulcerative colitis: a meta-analysis of randomized controlled trial

Bioscience Reports ◽

10.1042/bsr20180943 ◽

2019 ◽

Vol 39 (1) ◽

Cited By ~ 8

Author(s):

Lijun Peng ◽

Yan Zhong ◽

Aiping Wang ◽

Zhisheng Jiang

Keyword(s):

Ulcerative Colitis ◽

Remission Rate ◽

Controlled Trial ◽

Meta Analysis ◽

Aminosalicylic Acid ◽

Evaluation Indicator ◽

Randomized Controlled ◽

Clinical Remission Rate ◽

Remission Maintenance ◽

Significant Difference

Abstract We conducted a meta-analysis to evaluate the effect of probiotic combined with aminosalicylic on induction remission maintenance treatment of ulcerative colitis (UC). We conducted systematic searches in several Chinese and English databases from inception to June 2018, screening randomized controlled trials about effect of probiotics combined with aminosalicylic acid on UC. The evaluation indicator was the rate of remission. The relative risk (RR) and 95% confidence interval (CI) were calculated. A total of 27 studies with 1942 patients were included. The results indicated that the remission rate was significantly higher in the group using probiotics combined with aminosalicylic acid than that in the group using aminosalicylic acid alone (RR = 1.40, 95% CI: 1.27–1.53, P=0.000). The subgroup analysis indicated that probiotics combined with aminosalicylic acid can significantly elevate the remission rate in both mild to moderate (RR = 1.33, 95% CI: 1.16–1.54, P=0.000) and active stage (RR = 1.40, 95% CI: 1.27–1.64, P=0.000) UC. In different number of bacterium, drug types and treatment periods, the combination with probiotics can significantly increase the remission rate UC. The funnel plot shows slight publication bias. Probiotics in conjunction with aminosalicylic can obviously increase the clinical remission rate of activity UC than drug alone. There was no significant difference between combined with mesalazine group and salicylazosulfapyridine group.

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Comment on: Gao B, Lu Q, Wan R, Wang Z, Yang Y, Chen Z, Wang Z. “Monthly versus quarterly fremanezumab for the prevention of migraine: a systemic review and meta-analysis from randomized controlled trials”. Naunyn Schmiedebergs Arch Pharmacol. 2021 Apr;394(4):819–828. Epublished November 2020

Naunyn-Schmiedeberg s Archives of Pharmacology ◽

10.1007/s00210-021-02156-5 ◽

2021 ◽

Author(s):

Steve Barash ◽

Verena Ramirez Campos ◽

Xiaoping Ning ◽

Maurice T. Driessen ◽

Lynda J. Krasenbaum ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Episodic Migraine ◽

Pooled Analysis ◽

Systemic Review ◽

Controlled Trials ◽

Randomized Controlled ◽

Study Results ◽

Significant Difference ◽

Dosing Regimens

AbstractRecently, Gao et al. published an article titled “Monthly versus quarterly fremanezumab for the prevention of migraine: a systemic review and meta-analysis from randomized controlled trials” which concluded that monthly administration of fremanezumab led to significant reduction in monthly migraine days (MMD) when compared to quarterly fremanezumab. We have noted a critical flaw in Gao et al. meta-analysis wherein the authors have mistakenly utilized standard error values in place of standard deviation values in performing their pooled analyses. This error directly impacts the study results and conclusions. In this brief communication, we present revised analysis using correct methods. Using the correct SD values, our pooled analysis showed no significant difference in mean change from baseline in MMD between the two fremanezumab dosing regimens (P = 0.17). Furthermore, in the corrected subgroup analyses by type of migraine, there were no significant differences in mean change from baseline in MMD between monthly fremanezumab and quarterly fremanezumab (chronic migraine, P = 0.50; episodic migraine, P = 0.69). Overall, results from our corrected meta-analyses show that there is no significant difference in migraine prevention efficacy between monthly and quarterly fremanezumab dosing.

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Effectiveness of ketamine-propofol sedation for reducing respiratory adverse events compared to propofol sedation: A Meta-Analysis of randomized controlled trials

10.21203/rs.3.rs-84973/v1 ◽

2020 ◽

Author(s):

Ting Wen ◽

Shibiao Chen ◽

Lili Zhao ◽

Yang Zhang

Keyword(s):

Adverse Events ◽

Respiratory Depression ◽

Meta Analysis ◽

Pooled Analysis ◽

Cochrane Library ◽

Central Apnea ◽

Propofol Sedation ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

Significant Difference

Abstract ObjectiveThe objective of our review was to determine whether ketamine-propofol had an advantage in reducing respiratory adverse events compared to propofol for procedural sedation.MethodsElectronic databases including Web of Science, The Cochrane Library, PubMed, Medline, Embase, Google Scholar were searched to identify potential studies. All randomized controlled studies from their inception to May 2020 comparing ketamine-propofol sedation with propofol sedation were identified. Pooled analysis and subgroup analysis were conducted using Stata software. The quality assessment of all included studies was completed by using the Cochrane Collaboration's tool for assessing risk of bias.ResultsA total of 21 studies involving 3669 individuals were included. The most common respiratory adverse events (all reported per 100 sedations) were: hypoxia(KP 10.9%; P 17.0%), respiratory depression(KP 6.9%; P 14.9%), central apnea(KP 5.9%; P 8.0%). Pooling these 21 studies, subjects with ketamine-propofol had significant lower incidence of respiratory adverse events than those with propofol (RR: 0.55, 95% CI: 0.41–0.74). When stratified by study population, no significant difference was observed in reducing respiratory adverse events between ketamine-propofol sedation and propofol sedation among children (RR: 0.74, 95% CI: 0.46–1.20). However, significant differences were discerned definitely among adults(RR: 0.48, 95% CI: 0.39–0.60).ConclusionIn summary, Our results suggested hypoxia, respiratory depression, central apnea were most common respiratory adverse events in propofol sedation. However, ketamine-propofol sedation had an advantage in reducing the incidence of respiratory adverse events compared with propofol sedation, especially in adults.

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Cartilage Restoration of the Knee

The American Journal of Sports Medicine ◽

10.1177/0363546515589167 ◽

2015 ◽

Vol 44 (7) ◽

pp. 1888-1895 ◽

Cited By ~ 57

Author(s):

Raman Mundi ◽

Asheesh Bedi ◽

Linda Chow ◽

Sarah Crouch ◽

Nicole Simunovic ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Randomized Trials ◽

Meta Analysis ◽

Pooled Analysis ◽

Cartilage Defects ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference ◽

Standardized Mean Difference

Background: Focal cartilage defects of the knee are a substantial cause of pain and disability in active patients. There has been an emergence of randomized controlled trials evaluating surgical techniques to manage such injuries, including marrow stimulation (MS), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OAT). Purpose: A meta-analysis was conducted to determine if any single technique provides superior clinical results at intermediate follow-up. Study Design: Systematic review and meta-analysis of randomized controlled trials. Methods: The MEDLINE, EMBASE, and Cochrane Library databases were systematically searched and supplemented with manual searches of PubMed and reference lists. Eligible studies consisted exclusively of randomized controlled trials comparing MS, ACI, or OAT techniques in patients with focal cartilage defects of the knee. The primary outcome of interest was function (Lysholm score, International Knee Documentation Committee score, Knee Osteoarthritis Outcome Score) and pain at 24 months postoperatively. A meta-analysis using standardized mean differences was performed to provide a pooled estimate of effect comparing treatments. Results: A total of 12 eligible randomized trials with a cumulative sample size of 765 patients (62% males) and a mean (±SD) lesion size of 3.9 ± 1.3 cm2 were included in this review. There were 5 trials comparing ACI with MS, 3 comparing ACI with OAT, and 3 evaluating different generations of ACI. In a pooled analysis comparing ACI with MS, there was no difference in outcomes at 24-month follow-up for function (standardized mean difference, 0.47 [95% CI, –0.19 to 1.13]; P = .16) or pain (standardized mean difference, –0.13 [95% CI, –0.39 to 0.13]; P = .33). The comparisons of ACI to OAT or between different generations of ACI were not amenable to pooled analysis. Overall, 5 of the 6 trials concluded that there was no significant difference in functional outcomes between ACI and OAT or between generations of ACI. Conclusion: There is no significant difference between MS, ACI, and OAT in improving function and pain at intermediate-term follow-up. Further randomized trials with long-term outcomes are warranted.

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Brief Report: Exercise and Blood Pressure in Older Adults—An Updated Look

International Journal of Hypertension ◽

10.1155/2018/6548659 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

George A. Kelley ◽

Kristi S. Kelley

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Resistance Training ◽

Resistance Exercise ◽

Random Effects ◽

Controlled Trial ◽

Meta Analysis ◽

Calculated Data ◽

Random Effects Model ◽

Randomized Controlled

Background/Objectives. Raised blood pressure is a major problem in older adults. Using a random-effects model, a recent meta-analysis reported statistically significant reductions in both resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) as a result of aerobic, resistance, and combined aerobic and resistance exercise in adults ≥65 years. To provide more objective information regarding this nonpharmacologic approach, this study applied more robust methods to this data. Design. Meta-analysis of 41 randomized controlled trials representing 96 groups (52 exercise; 44 control). Setting. Any location where a randomized controlled trial could be conducted. Participants. Adults ≥65 years. Intervention. Trials ≥2 weeks that included aerobic, resistance, and/or combined aerobic and resistance exercise as the intervention. Measurements. The recently developed inverse heterogeneity model (IVhet) was used to pool findings and the Doi plot was used to examine for small-study effects. Absolute and relative differences between the IVhet and random-effects model were also calculated. Data were reported using the mean difference (exercise minus control) with nonoverlapping 95% confidence intervals considered statistically significant. Results. Statistically significant reductions in resting blood pressure were found as a result of aerobic exercise (SBP, -4.7 mmHg, 95% CI, -7.7 to -1.8; DBP, -2.0 mmHg, 95% CI -3.13 to -0.9), SBP but not DBP for resistance training (SBP, -7.0 mmHg, 95% CI, -10.5 to -3.4; DBP, -1.2 mmHg, 95% CI -2.7 to 0.3), and both SBP and DBP for combined aerobic and resistance training (SBP, -5.5 mmHg, 95% CI, -8.3 to -2.7; DBP, -3.7 mmHg, 95% CI -4.8 to -2.7). Conclusions. Exclusive of changes in DBP congruent with resistance training, exercise (aerobic, resistance, and combined aerobic and resistance) reduces resting SBP and DBP in older adults. These findings have practical implications when considering exercise for the prevention and treatment of raised blood pressure in older adults.

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Abstract 046: PCSK9 Inhibitors in Familial Hypercholesterolemia: a Meta-analysis of 9 Randomized Controlled Trials

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.046 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Avinainder Singh ◽

Simon C Gaviria ◽

Lourdes Chada ◽

Omar Abu Qamar ◽

Omar Soliman ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Familial Hypercholesterolemia ◽

Meta Analysis ◽

Pooled Analysis ◽

Mean Difference ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Pcsk9 Inhibitors ◽

Randomized Controlled ◽

Significant Difference

Background: The prevalence of Familial Hypercholesterolemia (FH) is estimated to be 1 in 250 US adults. The advent of PCSK9 inhibitors has led a to a paradigm shift in the management of these patients. The purpose of this study was to analyze the efficacy of PCSK9 inhibitors in patients with heterozygous or homozygous FH. Methods: Pubmed, EMBASE and clinicaltrials.gov were searched for randomized controlled trials of PCSK9 inhibitors. Trials that exclusively recruited FH patients or those that reported data separately for FH patients were included. The primary outcome of this analysis was mean difference in LDL-C in patients treated with a PCSK9 inhibitor compared with placebo. Secondary endpoints were change in other lipids and incidence of adverse events. A random effects model was used to analyze the pooled estimates. Results: A pooled analysis of 9 trials with a total of 1361 patients was performed. Overall the mean difference in LDL-C reduction with PCSK9 inhibition was -48.6% (95% CI: -51.3 to -45.9; p<0.001), as compared with placebo. There was no significant difference in LDL-C reduction between trials using alirocumab vs. those using evolocumab. There was significant heterogeneity among the included trials I 2 =75.9%. The risk of bias in all included studies was low. Conclusions: Among patients with FH, PCSK9 inhibitors were highly effective and reduced LDL-C levels by nearly 50% compared with placebo. No differences in magnitude of reduction were observed between alirocumab and evolocumab.

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