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Actas Urologicas Espanolas Sep 2022Urinary fistula is expected to become more frequent in urological practice as a result of expanding indication of partial nephrectomy given it's oncological results... (Review)
Review
INTRODUCTION
Urinary fistula is expected to become more frequent in urological practice as a result of expanding indication of partial nephrectomy given it's oncological results equivalent to those of radical nephrectomy but at a lower risk of progression to chronic kidney disease, lower cardiovascular morbidity, and overall mortality.
OBJECTIVES
Review and compare different techniques of contemporary active management for urinary fistula after partial nephrectomy.
METHODS
A systematic literature search on the MEDLINE database was conducted in March 2020, combining the terms: "urine leak", "urine leakage", "urinary leak" and "urinary fistula", with: "partial nephrectomy", "nephron sparing surgery" and "renal sparing surgery". This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only articles related to active treatment were eligible. Abstracts in English and Spanish from the last two decades were screened. No restriction based on study design nor the length of follow-up.
PRIMARY OUTCOMES
1) Leak resolution rate 2) Time course of leak resolution and 3) Number of interventions needed for resolution.
RESULTS
Multiple studies were found. There were no randomized controlled trials. Urinary fistula can be solved in many ways with active treatment, with a high success rate (97.5%), an average of 1.4 intervention-per-patients and a mean time for leak resolution of 11 days (median of 3 days).
CONCLUSION
There is a high risk of bias due to the study's methodology. There is a broad range of effective alternatives and various approaches to solve urinary fistula in an appropriate timing.
Topics: Humans; Kidney; Kidney Neoplasms; Nephrectomy; Urinary Fistula
PubMed: 35780049
DOI: 10.1016/j.acuroe.2022.06.004 -
Deutsches Arzteblatt International Oct 2015Most meniscus lesions are of non-traumatic origin. The indications for partial meniscectomy are controversial. (Comparative Study)
Comparative Study Review
BACKGROUND
Most meniscus lesions are of non-traumatic origin. The indications for partial meniscectomy are controversial.
METHODS
We systematically searched the literature for randomized controlled trials (RCTs) comparing partial meniscectomy with non-surgical treatment.
RESULTS
Of 6870 articles retrieved by the literature search, we were able to include six in this systematic review. Five trials showed no difference between the clinical outcomes of patients who underwent arthroscopic partial meniscectomy and those who underwent control treatment (arthroscopic lavage, physiotherapy, glucocorticoids). In three trials, however, symptoms improved in 21-30% of the patients in the physiotherapy group only after they underwent arthroscopic partial meniscectomy (crossover design). In two trials, the percentage of patients who crossed over from one treatment arm to the other was markedly lower; in one, the frequency of crossing over was not reported. In one RCT, the patients who underwent arthroscopic partial meniscectomy had significantly less pain and other symptoms. Five of the six trials had acceptable scores for method, but all had weaknesses. These mainly concerned the description of the surgical techniques and the failure to take account of analgesic use-in particular, the use of non-steroidal antiinflammatory drugs (NSAIDs).
CONCLUSION
For most patients with non-traumatic meniscus lesions, surgical and non-surgical treatments seem to be of equal value; only one of the six included trials revealed lower pain and symptom scores after arthroscopic partial meniscectomy. In multiple trials, however, the crossover analysis showed that non-surgical treatment fails for some patients. These patients may benefit from arthroscopic partial meniscectomy. Further trials are needed to better define this subgroup of patients.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Combined Modality Therapy; Evidence-Based Medicine; Humans; Knee Injuries; Physical Therapy Modalities; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 26554420
DOI: 10.3238/arztebl.2015.0705 -
American Journal of Medical Genetics.... Sep 2016Over the last decade, several advances in ultrasound techniques, increasing availability of whole genome microarray testing, and overall expansion of our knowledge about... (Meta-Analysis)
Meta-Analysis Review
Over the last decade, several advances in ultrasound techniques, increasing availability of whole genome microarray testing, and overall expansion of our knowledge about the human genome have drastically enhanced our ability to detect chromosomal abnormalities prenatally. Despite that, genotype-phenotype correlation is difficult to establish for many chromosomal aberrations, particularly for those that are rare, as it requires thorough analysis of a significant number of cases. This in turn increases the burden of the obstetric provider to appropriately counsel a patient regarding prognosis and pregnancy options in these complicated situations. Our experience in prenatal diagnosis and management of a fetus with multiple anomalies and partial trisomy for the 14q11-q24.2 prompted a comprehensive analysis of the relevant literature. Although complete non-mosaic trisomy 14 is associated with first trimester miscarriages, partial trisomy 14q is a rare condition with undefined genotype-phenotype correlation, preventing accurate prenatal counseling, and informed decision making. We performed a systematic literature review, that aimed to summarize prenatal and postnatal findings of individual case reports on 51 patients with partial trisomy 14q in order to elucidate genotype-phenotype correlation, and to supply healthcare professionals with recommendation on essential fetal and parental testing for accurate diagnosis, pregnancy outcomes, and proper family counseling. Comparison of the clinical findings among the patients with partial 14q trisomy suggest that the resulting phenotype is likely to be influenced by the extent of the 14q trisomy segment, associated chromosomal imbalances, parental origin of the rearrangement, and dosage of the genes within the imprinted 14q32 cluster. © 2016 Wiley Periodicals, Inc.
Topics: Chromosomes, Human, Pair 14; Comparative Genomic Hybridization; Disease Management; Female; Genetic Association Studies; Genetic Counseling; Genetic Testing; Humans; In Situ Hybridization, Fluorescence; Oligonucleotide Array Sequence Analysis; Polymorphism, Single Nucleotide; Pregnancy; Pregnancy Outcome; Trisomy; Ultrasonography, Prenatal
PubMed: 27286879
DOI: 10.1002/ajmg.a.37793 -
Neuroscience and Biobehavioral Reviews Apr 2022Dopaminergic dysfunction is thought to be central to schizophrenia symptomatology. Previous meta-analyses of prodopaminergic drugs in schizophrenia have important... (Meta-Analysis)
Meta-Analysis Review
Dopaminergic dysfunction is thought to be central to schizophrenia symptomatology. Previous meta-analyses of prodopaminergic drugs in schizophrenia have important limitations, and also did not include dopamine D2/D3 partial agonists. We investigated the effect of medications which increase dopamine signalling on schizophrenia symptoms by meta-analysing double-blind, placebo-controlled RCTs. 59 RCTs were included: 29 of prodopaminergic treatments, 30 of partial agonists. Partial agonists were significantly superior to placebo against positive (SMD=-0.33,p = 1.2 ×10), negative (SMD=-0.29,p = 2.2 × 10-) and total symptoms (SMD =-0.39,p = 1.7 × 10) in schizophrenia. There were no significant differences between pooled pro-dopaminergic drugs and placebo in any symptom domain. In subgroup analysis of five studies where patients were selected for negative symptom severity, ar/modafinil was superior to placebo against negative symptoms (SMD=-0.34,p = 0.037). These data favour the clinical use of partial agonists for negative symptoms in schizophrenia, with clinically meaningful effect sizes. Our findings also suggest a benefit for ar/modafinil in patients with predominant negative symptoms. Future trials of other prodopaminergic therapies and dopamine partial agonists in patients with predominant negative symptoms are warranted.
Topics: Antipsychotic Agents; Dopamine; Dopamine Agonists; Humans; Randomized Controlled Trials as Topic; Schizophrenia
PubMed: 35131396
DOI: 10.1016/j.neubiorev.2022.104568 -
BJU International Oct 2023To perform a systematic review and network meta-analysis (NMA) to determine the advantages and disadvantages of open (OPN), laparoscopic (LPN), and robot-assisted... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review and network meta-analysis (NMA) to determine the advantages and disadvantages of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomy (RAPN) with particular attention to intraoperative, immediate postoperative, as well as longer-term functional and oncological outcomes.
METHODS
A systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-NMA guidelines. Binary data were compared using odds ratios (ORs). Mean differences (MDs) were used for continuous variables. ORs and MDs were extracted from the articles to compare the efficacy of the various surgical approaches. Statistical validity is guaranteed when the 95% credible interval does not include 1.
RESULTS
In total, there were 31 studies included in the NMA with a combined 7869 patients. Of these, 33.7% (2651/7869) underwent OPN, 20.8% (1636/7869) LPN, and 45.5% (3582/7689) RAPN. There was no difference for either LPN or RAPN as compared to OPN in ischaemia time, intraoperative complications, positive surgical margins, operative time or trifecta rate. The estimated blood loss (EBL), postoperative complications and length of stay were all significantly reduced in RAPN when compared with OPN. The outcomes of RAPN and LPN were largely similar except the significantly reduced EBL in RAPN.
CONCLUSION
This systematic review and NMA suggests that RAPN is the preferable operative approach for patients undergoing surgery for lower-staged RCC.
Topics: Humans; Kidney Neoplasms; Robotics; Network Meta-Analysis; Treatment Outcome; Robotic Surgical Procedures; Nephrectomy; Postoperative Complications; Laparoscopy; Retrospective Studies
PubMed: 37259476
DOI: 10.1111/bju.16093 -
International Journal of... 2015Tongue cancer is known to negatively affect both speech and swallowing function; however this is the first review to report speech-language pathology (SLP) intervention... (Review)
Review
PURPOSE
Tongue cancer is known to negatively affect both speech and swallowing function; however this is the first review to report speech-language pathology (SLP) intervention for both functions following partial glossectomy.
METHOD
Using a PRISMA approach, systematic screening of nine databases was undertaken. Original studies reporting SLP rehabilitation for speech and/or swallowing dysfunction with participants following partial glossectomy as primary cancer treatment were included.
RESULT
These studies are discussed in terms of SLP assessment and intervention trends as well as quality according to current research method standards (levels of evidence, Pedro-P, SCED) in order to determine suitability for guiding current clinical practice.
CONCLUSION
Publications were few (n = 7) and mostly of non-experimental design. This review highlights the gap in evidence and questions the rationale of current SLP rehabilitation following partial glossectomy.
Topics: Deglutition Disorders; Glossectomy; Humans; Speech Disorders; Speech-Language Pathology; Tongue Neoplasms
PubMed: 25515427
DOI: 10.3109/17549507.2014.979880 -
Clinical Oral Implants Research Sep 2015The aim of this systematic review was to identify and summarize the available literature related to CAD/CAM-fabricated implant-supported restorations. (Review)
Review
OBJECTIVES
The aim of this systematic review was to identify and summarize the available literature related to CAD/CAM-fabricated implant-supported restorations.
MATERIALS AND METHODS
A systematic review of the literature was conducted using the Cochrane Library and the US Library of Medicine, National Institute of Health databases (Pubmed). Several search runs with specific search terms were performed and combined. All published papers available on the databases up to January 15, 2015 were considered with primarily no restrictions.
RESULTS
About 12 of 3484 identified papers met the inclusion criteria and were analyzed in the present review. One paper reported results on implant-supported single crowns (SCs), one on partial fixed dental prostheses (FDPs), and 10 papers reported results on full-arch screw-retained FDPs. Publications on SCs and FDPs were very limited but it was possible to identify 10 papers reporting adequate results on full-arch screw-retained FDPs. Survival rates ranged between 92% and 100% with observation times of 1-10 years.
CONCLUSION
The available data provided promising results for CAD/CAM-fabricated implant-supported restorations; nonetheless, current evidence is limited due to the quality of available studies and the paucity of data on long-term clinical outcomes of 5 years or more. In the sense of an evidence-based dentistry, the authors recommend further studies designed as randomized controlled clinical trials and reported according to the CONSORT statement.
Topics: Computer-Aided Design; Crowns; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Denture, Partial, Fixed; Evidence-Based Dentistry; Humans
PubMed: 26061615
DOI: 10.1111/clr.12633 -
European Archives of... Jan 2018Controversies exist regarding the treatment of advanced laryngeal carcinomas. The purpose of this systematic review was to evaluate the oncologic outcomes of both... (Meta-Analysis)
Meta-Analysis Review
GOAL
Controversies exist regarding the treatment of advanced laryngeal carcinomas. The purpose of this systematic review was to evaluate the oncologic outcomes of both transoral laser and open partial laryngectomies for advanced (T3-T4) squamous cell laryngeal cancers management.
INTRODUCTION
A systematic review of literature was led searching for articles mentioning the following terms: advanced (T3-T4) laryngeal cancer AND laser; AND open partial laryngectomy; AND transoral laser microsurgery; AND cordectomy; AND conservative surgery; AND tracheohyoidopexy or tracheohyoidoepiglottopexy; AND supratracheal partial laryngectomy; AND supracricoid partial laryngectomy; AND cricohyoidopexy or cricohyoidoepiglottopexy. Then a quantitative analysis was carried on papers published after 1980.
DISCUSSION
The search identified 110 publications, and a total of 21 articles satisfied inclusion criteria and were selected for quantitative synthesis. 10 out of 21 studies had a good quality score, 10 were fair and only one rated a poor score. The pooled disease-free survival (DFS) was 79% (95% CI 74-85), and pooled overall survival (OS) was 71% (95% CI 64-78) at 5 years from all 1921 patients included in the study, with significant heterogeneity (I = 89.7% and I = 90.4%), respectively. Significant heterogeneity value (p = 0.118) was seen by comparing transoral laser and open partial laryngectomies in terms of DFS.
CONCLUSION
The two surgical techniques are both valid conservative surgical options for advanced laryngeal cancer treatment.
Topics: Conservative Treatment; Humans; Laryngeal Neoplasms; Laryngectomy; Laser Therapy; Neoplasm Staging; Survival Analysis; Treatment Outcome
PubMed: 29119321
DOI: 10.1007/s00405-017-4799-x -
The Journal of Dermatological Treatment Feb 2022For severe cases of lichen planopilaris (LPP), unresponsive to first line therapy, systemic or potent agents may be required for disease control. There have been several... (Meta-Analysis)
Meta-Analysis
BACKGROUND
For severe cases of lichen planopilaris (LPP), unresponsive to first line therapy, systemic or potent agents may be required for disease control. There have been several reports of the off-label use of mycophenolate mofetil (MMF) in patients with LPP or have developed adverse effects to initial agents.
METHODS
A systematic review and meta-analysis was performed according to recommended Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies with ≥5 cases reporting the outcomes of MMF in LPP were pooled and a meta-analysis of proportion was performed. Case reports were excluded from analysis.
RESULTS
A total of six studies were identified and included for meta-analysis, comprising 94 LPP patients. The pooled proportion of any good response (partial or complete) was 69.2% (95% confidence interval (CI): 47.8-77). The pooled proportion of complete response was 20% (95% CI: 10.1-36.3). The pooled proportion of partial responses was 49.2% (95% CI: 30.5-63.7). Side effects occurred in 16.9% (95% CI: 17.6-33.2). of cases, which included elevated LFTs, edema, hyperlipidemia, anemia, herpes zoster infection, photosensitivity, and urinary tract infection.
CONCLUSION
The current evidence for MMF remains limited. However, it appears to be a potential treatment option for patients with severe or recalcitrant LPP who have failed hydroxychloroquine and other immunosuppressants.
Topics: Humans; Hydroxychloroquine; Immunosuppressive Agents; Lichen Planus; Mycophenolic Acid; Remission Induction
PubMed: 32281437
DOI: 10.1080/09546634.2020.1755416 -
Frontiers in Physiology 2017The European Space Agency has recently announced to progress from low Earth orbit missions on the International Space Station to other mission scenarios such as... (Review)
Review
The European Space Agency has recently announced to progress from low Earth orbit missions on the International Space Station to other mission scenarios such as exploration of the Moon or Mars. Therefore, the Moon is considered to be the next likely target for European human space explorations. Compared to microgravity (μg), only very little is known about the physiological effects of exposure to partial gravity (μg < partial gravity <1 g). However, previous research studies and experiences made during the Apollo missions comprise a valuable source of information that should be taken into account when planning human space explorations to reduced gravity environments. This systematic review summarizes the different effects of partial gravity (0.1-0.4 g) on the human musculoskeletal, cardiovascular and respiratory systems using data collected during the Apollo missions as well as outcomes from terrestrial models of reduced gravity with either 1 g or microgravity as a control. The evidence-based findings seek to facilitate decision making concerning the best medical and exercise support to maintain astronauts' health during future missions in partial gravity. The initial search generated 1,323 publication hits. Out of these 1,323 publications, 43 studies were included into the present analysis and relevant data were extracted. None of the 43 included studies investigated long-term effects. Studies investigating the immediate effects of partial gravity exposure reveal that cardiopulmonary parameters such as heart rate, oxygen consumption, metabolic rate, and cost of transport are reduced compared to 1 g, whereas stroke volume seems to increase with decreasing gravity levels. Biomechanical studies reveal that ground reaction forces, mechanical work, stance phase duration, stride frequency, duty factor and preferred walk-to-run transition speed are reduced compared to 1 g. Partial gravity exposure below 0.4 g seems to be insufficient to maintain musculoskeletal and cardiopulmonary properties in the long-term. To compensate for the anticipated lack of mechanical and metabolic stimuli some form of exercise countermeasure appears to be necessary in order to maintain reasonable astronauts' health, and thus ensure both sufficient work performance and mission safety.
PubMed: 28860998
DOI: 10.3389/fphys.2017.00583