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Liver Transplantation : Official... Dec 2017The efficacy of cold in situ perfusion and static storage of the liver is a possible determinant of transplantation outcomes. The aim of this study was to determine... (Meta-Analysis)
Meta-Analysis Review
The efficacy of cold in situ perfusion and static storage of the liver is a possible determinant of transplantation outcomes. The aim of this study was to determine whether there is evidence to substantiate a preference for a particular perfusion route (aortic or dual) or perfusion/preservation solution in donation after brain death (DBD) liver transplantation. The Embase, MEDLINE, and Cochrane databases were used (1980-2017). Random effects modeling was used to estimate effects on transplantation outcomes based on (1) aortic or dual in situ perfusion and (2) the use of University of Wisconsin (UW), histidine tryptophan ketoglutarate (HTK), Celsior, and/or Institut Georges Lopez-1 (IGL-1) solutions for perfusion/preservation. A total of 22 articles were included (2294 liver transplants). The quality of evidence ranged from very low to moderate Grading of Recommendations, Assessment, Development and Evaluations score. Meta-analyses were conducted for 14 eligible studies. Although there was no difference in the primary nonfunction (PNF) rate, a higher peak alanine aminotransferase (ALT) was recorded in dual compared with aortic-only UW-perfused livers (standardized mean difference, 0.24; 95% confidence interval, 0.01-0.47); a back-table portal venous flush was undertaken in the majority of aortic-only perfused livers. There were no relevant differences in peak enzymes, PNF, thrombotic graft loss, biliary complications, or 1-year graft survival in comparisons between dual-perfused livers using UW, HTK, Celsior, or IGL-1. In conclusion, there is no significant evidence that aortic-only perfusion of the DBD liver compromises transplantation outcomes, and it may be favored because of its simplicity. However, there is currently insufficient evidence to advocate for the use of any particular perfusion/preservation fluid over the others. Liver Transplantation 23 1615-1627 2017 AASLD.
Topics: Allografts; Cold Ischemia; Graft Survival; Humans; Liver; Liver Transplantation; Organ Preservation; Organ Preservation Solutions; Perfusion; Practice Guidelines as Topic; Tissue and Organ Procurement; Treatment Outcome
PubMed: 28734125
DOI: 10.1002/lt.24829 -
Transplant International : Official... 2022Currently, static cold storage (SCS) of hearts from donations after brainstem death remains the standard clinically. However, machine perfusion (MP) is considered an... (Review)
Review
Currently, static cold storage (SCS) of hearts from donations after brainstem death remains the standard clinically. However, machine perfusion (MP) is considered an approach for donor organ management to extend the donor pool and/or increase the utilization rate. This review summarizes and critically assesses the available clinical data on MP in heart transplantation. We searched Medline (PubMed), Cochrane, Embase, and clinicaltrials.gov, along with reference lists of the included publications and identified 40 publications, including 18 articles, 17 conference abstracts, and five ongoing clinical trials. Two types of MP were used: hypothermic MP (HMP) and normothermic MP (NMP). Three studies evaluated HMP, and 32 evaluated NMP. Independent of the system, MP resulted in clinical outcomes comparable to traditional SCS. However, NMP seemed especially beneficial for high-risk cases and donation after circulatory death (DCD) hearts. Based on currently available data, MP is non-inferior to standard SCS. Additionally, single-centre studies suggest that NMP could preserve the hearts from donors outside standard acceptability criteria and DCD hearts with comparable results to SCS. Finally, HMP is theoretically safer and simpler to use than NMP. If a machine malfunction or user error occurs, NMP, which perfuses a beating heart, would have a narrower margin of safety. However, further well-designed studies need to be conducted to draw clear conclusions.
Topics: Heart; Heart Transplantation; Humans; Organ Preservation; Perfusion; Tissue Donors
PubMed: 35401041
DOI: 10.3389/ti.2022.10258 -
Transplantation Reviews (Orlando, Fla.) Jul 2017We reviewed the evidence for ex-vivo Supplemental Oxygen during Hypothermic preservation (SOH) for deceased donor kidneys. Bibliographic databases were searched for... (Review)
Review
We reviewed the evidence for ex-vivo Supplemental Oxygen during Hypothermic preservation (SOH) for deceased donor kidneys. Bibliographic databases were searched for human and animal studies of SOH in kidney transplantation reporting on patient or animal survival rate, discard rate, technical complications or renal function outcomes. We make special reference to a specific subgroup: supplemental oxygen applied during cold perfusion, referred to as Hypothermic Oxygenated Perfusion (HOP). Four human and 25 animal studies were identified. The data present conflicting results but suggest that the effects of oxygen on restoring kidney function during preservation may be of value for DCD kidneys and/or kidneys that have undergone a period of hypotension, warm ischemia or poor perfusion in the donor. There is very little information available from human or animal studies. This work highlights to the transplant community that far more high quality clinical studies are required to understand this technology and its role before widespread clinical introduction.
Topics: Humans; Kidney Transplantation; Organ Preservation; Oxygen
PubMed: 28259374
DOI: 10.1016/j.trre.2017.02.001 -
Vox Sanguinis Jul 2015The implementation of electronic remote blood issue (ERBI) may provide safety and efficiency gains for transfusion medicine. This systematic review's objective was to... (Review)
Review
BACKGROUND AND OBJECTIVES
The implementation of electronic remote blood issue (ERBI) may provide safety and efficiency gains for transfusion medicine. This systematic review's objective was to assess whether ERBI affects incidents of adverse events, time taken for blood issue and delivery, and cross-match to transfusion ratios, among other measures of safety and efficiency. The review also sought to uncover barriers and facilitators of ERBI implementation.
MATERIALS AND METHODS
We searched four aggregated electronic databases (Medline, EMBASE, CINAHL and BIOSIS) up to 19 July 2012, with an updated search performed on 5 March 2014 for studies on ERBI. No specific study design criteria were used in the initial inclusion due to the low number of studies on ERBI.
RESULTS
A total of 4758 citations were initially identified; after 1844 duplicates were removed, 2612 citations were excluded on the basis of the abstract. Two reviewers evaluated a total of 302 full-text articles independently; of these, seven citations were eligible for inclusion. An updated search and the authors' own collections confirmed an additional five citations, totalling 13 citations and six studies within these.
CONCLUSION
There is insufficient evidence to demonstrate whether ERBI significantly impacts safety and efficiency of blood transfusion and delivery processes. Rigorously designed studies to assess safety and efficiency outcomes are required using proxy or corollary measures. A number of positive results were reported, however, and most studies included suggestions for facilitating ERBI implementation.
Topics: Blood Grouping and Crossmatching; Blood Transfusion; Databases, Factual; Humans; Transfusion Medicine
PubMed: 25827223
DOI: 10.1111/vox.12240 -
European Journal of Obstetrics,... Nov 2020Endometriosis is a common chronic inflammatory disorder, often causing both pain and infertility. It is estimated that 25-50 % of patients undergoing fertility...
Endometriosis is a common chronic inflammatory disorder, often causing both pain and infertility. It is estimated that 25-50 % of patients undergoing fertility treatments have had endometriosis as it involves an impairment of the ovarian reserve. For these reasons, endometriosis has been highlighted as a condition that may require a fertility preservation procedure, while being benign in nature. The aim of this review is to summarize the current evidence on fertility preservation techniques for patients affected by endometriosis, focusing on the main characteristics of the different approaches. A systematic review of literature was performed by searching in the main electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library), from their inception to February 2020 for studies testing fertility preservation (FP) techniques. Only scientific publications in English were included. Risk of Bias Assessment was performed. Eight articles were included in the study: 3 case reports (one paper reporting 2 cases), 1 prospective longitudinal analysis with only 1 reported case with criteria for inclusion in the review, 2 retrospective observational studies and 2 retrospective cohort studies. The results of our analysis showed embryo (1 article), oocyte (4 articles) and ovarian tissue cryopreservation (3 articles) as preservation methods proposed in international literature for patients with endometriosis. Only few authors reported details on successive outcomes. After ovarian tissue transplantation, 1 pregnancy with IVF and 1 case of endocrine function/ovulation recovery were described; six of 16 endometriotic patients, who underwent embryo cryopreservation, experienced livebirths after successive embryo-transfer; in a large series of 485 patients performing oocyte cryopreservation, an overall cumulative live-birth rate/patient of 46.4 % (225 babies) was reported. Based on the risk of premature ovarian failure related to endometriosis, the offer of FP techniques to these patients has significantly increased, as well as the reported experiences in recent medical literature. However, further studies concerning risks, benefits, effectiveness and cost-effectiveness are needed.
Topics: Cryopreservation; Endometriosis; Female; Fertility Preservation; Humans; Pregnancy; Prospective Studies; Retrospective Studies
PubMed: 33011504
DOI: 10.1016/j.ejogrb.2020.09.045 -
Clinical Oral Implants Research Sep 2023Fundamentally, this review addresses the following question: In partially or fully edentulous patients, do implant-supported dental prostheses preserve orofacial tissues... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Fundamentally, this review addresses the following question: In partially or fully edentulous patients, do implant-supported dental prostheses preserve orofacial tissues when compared to conventional prostheses or no therapy?
MATERIALS AND METHODS
This study was conducted according to the 2020 PRISMA guidelines for systematic reviews. Electronic searches were conducted at PubMed and Embase databases followed by manual search. Clinical studies comparing the effect of implant-supported prostheses with conventional rehabilitation or no treatment on alveolar bone resorption, remaining teeth, and jaw muscle thickness were considered for inclusion. A qualitative synthesis was conducted with all included studies, and data from selected studies were pooled quantitatively to perform a meta-analysis.
RESULTS
A total of 14 studies were selected for analysis. Six studies reported on the effect of implant therapy on alveolar bone resorption (n = 453), six on the remaining teeth (n = 1014), while four studies evaluated masseter muscle thickness (n = 158). The results of the meta-analyses assessing alveolar bone resorption in the posterior mandible and in the anterior area of the maxilla, both fixed and random effects models, yielded no benefit of rehabilitation with implant-supported prostheses when compared to conventional prostheses. For masseter bone thickness, however, a significant benefit for implant-supported prosthesis was observed.
CONCLUSIONS
This systematic review and meta-analysis were unable to unequivocally answer the focus question. There are some indicators of the benefit of implant-supported prostheses over conventional prostheses or no therapy in preserving orofacial tissues, particularly for masseter muscle thickness. However, the evidence is still insufficient to confirm such perception.
Topics: Humans; Alveolar Bone Loss; Databases, Factual; Mandible; Masseter Muscle; Dental Implantation
PubMed: 37750525
DOI: 10.1111/clr.14106 -
Artificial Organs May 2016Organ preservation solution has been designed to attenuate the detrimental effects during the ischemic period. The aim of this study was to systematically evaluate the... (Meta-Analysis)
Meta-Analysis Review
Organ preservation solution has been designed to attenuate the detrimental effects during the ischemic period. The aim of this study was to systematically evaluate the evidence comparing preservation solutions for heart preservation. Studies were searched in PubMed, Embase, the Cochrane Library, the Transplant Library, and the International Clinical Trials Registry Platform. The primary outcomes were patient survival and donor heart dysfunction. The secondary outcomes were in-hospital mortality and enzyme gene expression. The University of Wisconsin solution (UW) was associated with a significantly improved survival at 30 days and 90 days (hazard ratio = 1.16, 95% confidence interval [CI] = 1.11-1.22, P < 0.00001; risk difference [RD] = 0.03, 95% CI = 0.01-0.05, P = 0.002), compared with Celsior. Hearts preserved with UW exhibited less ischemic necrosis than those preserved with Celsior (RD = -0.07, 95% CI = -0.08 to 0.05, P < 0.00001). UW was associated with better survival compared with histidine-tryptophan-ketoglutarate solution (HTK). There was no statistical difference in donor heart dysfunction and in-hospital mortality outcomes when comparing HTK with Celsior solution. During static cold storage preservation, this study suggests that UW solution has better clinical outcomes for heart transplantation compared with the other two organ preservation solutions. Besides, the protective effect of Celsior solution is similar to HTK solution in donor heart preservation.
Topics: Adenosine; Allografts; Allopurinol; Disaccharides; Electrolytes; Glucose; Glutamates; Glutathione; Heart; Heart Transplantation; Histidine; Humans; Insulin; Mannitol; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose
PubMed: 26526678
DOI: 10.1111/aor.12585 -
Sexual Medicine Reviews Oct 2021The most common cause of patient dissatisfaction after penile prosthesis placement is penile shortening compared with one's memory of a natural erection. Surgical... (Review)
Review
INTRODUCTION
The most common cause of patient dissatisfaction after penile prosthesis placement is penile shortening compared with one's memory of a natural erection. Surgical techniques as well as preoperative and postoperative protocols have been reported to preserve and possibly enhance penile length in someone undergoing penile prosthesis surgery.
OBJECTIVES
This article presents a description of as well as the authors' experience with presurgical protocols, intraoperative techniques, and postsurgical protocols that allow for preservation or enhancement of penile length for patients who undergo inflatable penile prosthesis insertion.
METHODS
An extensive, systematic literature review was performed using PubMed searching for key terms including penile lengthening, inflatablepenile prosthesis, penile girth, buried penis, and penile enhancement. All articles with subjective and/or objective penile length outcomes were reviewed.
RESULTS
Several preoperative treatment protocols were found for penile length preservation and enhancement, which included use of a vacuum erection device as well as traction therapy. Intraoperative techniques included cavernosal sparing, channeling without dilatation, circumferential penile degloving, ventral phalloplasty, suprapubic lipectomy, liposuction, suspensory ligament release, sliding technique, modified sliding technique, multislice technique, and aggressive implant sizing. Postoperative protocols included early device inflation and cycling. Table 1 summarizes and compares the various preoperative, intraoperative, and postoperative strategies identified during literature review with their corresponding reported length gain.
CONCLUSIONS
Many preoperative, intraoperative, and postoperative surgical techniques can be performed by high-volume implanters to improve one's perceived or true penile length. In the hands of experienced, high-volume implanters, these techniques can be very meaningful for patients undergoing penile prosthesis insertion, particularly those who are concerned with penile length. Shah B, Kent M, Valenzuela R. Advanced Penile Length Restoration Techniques to Optimize Penile Prosthesis Placement Outcomes. Sex Med Rev 2021;9:641-649.
Topics: Humans; Male; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Sex Reassignment Surgery
PubMed: 32653404
DOI: 10.1016/j.sxmr.2020.05.007 -
BioMed Research International 2019This is a systematic review and meta-analysis of current evidence that aims at comparing the clinical outcomes of remnant-preserving anterior cruciate ligament... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This is a systematic review and meta-analysis of current evidence that aims at comparing the clinical outcomes of remnant-preserving anterior cruciate ligament reconstruction (ACLR) and standard ACLR.
METHODS
A systematic review of randomized controlled studies and cohort studies comparing remnant-preserving ACLR with standard ACLR with a minimum level of evidence of II was performed. Studies were included by strict inclusion and exclusion criteria. Extracted data were summarized as preoperative conditions, postoperative clinical outcomes, and postoperative complications. When feasible, meta-analysis was performed with RevMan5.3 software. Study methodological quality was evaluated with the modified Coleman methodology score (CMS).
RESULTS
Eleven studies ( = 466 remnant-preserving and = 536 standard) met the inclusion criteria. The mean modified CMS for all included studies was 85.8 (range: 77-92 on a 100-point scale). In total, 466 patients underwent remnant-preserving ACLR by 3 different procedures: standard ACLR plus tibial remnant tensioning ( = 283), selective-bundle augmentation ( = 49), and standard ACLR plus tibial remnant sparing ( = 134). Remnant-preserving ACLR provided a superior outcome of postoperative knee anterior stability (WMD = -0.42, 95% CI, -0.66, -0.17; < 0.01) and Lysholm score (WMD = 2.01, 95% CI, 0.53 to 3.50; < 0.01). There was no significant difference between the two groups with respect to second-look arthroscopy (OR = 1.38, 95% CI, 0.53, 3.62; =0.51), complications (OR = 1.24 95% CI, 0.76, 2.02; =0.39), International Knee Documentation Committee (IKDC) subject scores, IKDC grades, Lachman test, and pivot-shift test.
SUMMARY/CONCLUSION
Remnant-preserving ACLR promotes similar graft synovial coverage and revascularization to standard ACLR. Equivalent or superior postoperative knee stability and clinical scores were observed for remnant-preserving ACLR compared with standard ACLR. No significant difference in the total complication rate between the groups was evident.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Humans; Knee Joint; Tibia; Treatment Outcome
PubMed: 31886174
DOI: 10.1155/2019/1652901 -
Food & Function Jan 2023Anthocyanins have multiple health benefits. However, they are prone to degradation during gastrointestinal digestion, impeding their utilization. Various encapsulation... (Meta-Analysis)
Meta-Analysis Review
Anthocyanins have multiple health benefits. However, they are prone to degradation during gastrointestinal digestion, impeding their utilization. Various encapsulation systems have been proposed to improve their bioaccessibility and bioavailability. This review aims to provide a systematic evaluation and meta-analysis of published studies examining the effect of microencapsulation on the bioaccessibility of anthocyanins. A comprehensive and systematic literature search of three databases (Scopus, PubMed, and Web of Science) was conducted. Studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and were reviewed independently by two investigators. Overall, 34 articles were included in the systematic review and 24 were included in the meta-analysis. The fold changes in bioaccessibility between encapsulated and non-encapsulated anthocyanins from eligible studies were calculated. The median and 95% confidence intervals (CI) of the fold changes for spray-drying (median 1.23, 95% CI 0.91-1.92), freeze-drying (median 1.19, 95% CI 0.61-1.28), simple coacervation (median 1.80, 95% CI 1.41-3.20), and complex coacervation (median 1.61, 95% CI 0.21-25.00) were calculated. Simple coacervation showed a promising protection against degradation during digestion. However, when a large number of anthocyanins cannot be released from the microparticles during digestion, encapsulation impedes the bioaccessibility of anthocyanins.
Topics: Anthocyanins; Biological Availability; Freeze Drying
PubMed: 36594512
DOI: 10.1039/d2fo01997c