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European Journal of Surgical Oncology :... Sep 2016Preoperative biliary drainage (PBD) with stenting increases complications compared with surgery without PBD. Metallic stents are considered superior to plastic stents... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Preoperative biliary drainage (PBD) with stenting increases complications compared with surgery without PBD. Metallic stents are considered superior to plastic stents when considering stent-related complications. Aim of the present systematic review and meta-analysis is to compare the rate of endoscopic re-intervention before surgery and postoperative outcomes of metal versus plastic stents in patients with resectable periampullary or pancreatic head neoplasms.
METHODS
We conducted a bibliographic research using the National Library of Medicine's PubMed database, including both randomized controlled trials (RCTs) and non-RCTs. Quantitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Statistical heterogeneity was assessed using the I(2) tests.
RESULTS
One RCT and four non-RCTs were selected, including 704 patients. Of these, 202 patients (29.5%) were treated with metal stents and 502 (70.5%) with plastic stents. The majority of patients (86.4%) had pancreatic cancer. The rate of endoscopic re-intervention after preoperative biliary drainage was significantly lower in the metal stent (3.4%) than in the plastic stent (14.8%) group (p < 0.0001). The rate of postoperative pancreatic fistula was significantly lower in the meta stent group as well (5.1% versus 11.8%, p = 0.04). The rate of post-operative surgical complications and of - post-operative mortality did not differ between the two groups.
CONCLUSIONS
Although the present systematic review and meta-analysis demonstrates that metal stent are more effective than plastic stents for PBD in patients with resectable periampullary tumors, randomized controlled trials are needed in order to confirm these data with a higher level of evidence.
Topics: Ampulla of Vater; Biliary Tract Surgical Procedures; Drainage; Humans; Jaundice, Obstructive; Metals; Pancreatectomy; Pancreatic Neoplasms; Plastics; Postoperative Complications; Preoperative Care; Risk Factors; Stents
PubMed: 27296728
DOI: 10.1016/j.ejso.2016.05.001 -
Journal of Dentistry Nov 2023To compare the clinical performance (retention, secondary caries, marginal adaptation, marginal discoloration, and postoperative hypersensitivity) of self-adhesive... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To compare the clinical performance (retention, secondary caries, marginal adaptation, marginal discoloration, and postoperative hypersensitivity) of self-adhesive flowable composite resins (SAFCs) and flowable composite resins (FCs) in permanent teeth with occlusal cavities.
DATA
Randomized controlled trials (RCTs) of SAFCs versus FCs with a follow-up length of at least one year. No restrictions were placed on language or publication date.
SOURCES
Five databases, including PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials, were searched manually by browsing ten related journals. On 14 June 2023, all electronic and manual searches were updated.
STUDY SELECTION
Five RCTs with 138 participants were included. Cochrane's risk of bias tool (2.0) was implemented in selected studies, and the GRADE tool was utilised to evaluate the evidence quality. To summarize the effects of the treatments and pool the data, a random-effects model was used.
CONCLUSIONS
According to the modified United States Public Health Service Evaluation (USPHS) criteria, there was no discernible difference between the groups during the two-year follow-up period (maximum follow-up time). Nevertheless, FCs applied with the etch-and-rinse mode demonstrated superior marginal adaptation and marginal discoloration at the two-year follow-up (relative risk = 3.21 [1.50 to 6.83], 3.40 [1.10, 10.48]). The evidence for marginal discoloration at any recall time and marginal adaptation at the one-year follow-up was graded as moderate quality due to inconsistency. Moreover, low-quality evidence for marginal adaptation at two-year follow-up was due to imprecision and inconsistency.
CLINICAL SIGNIFICANCE
SAFCs exhibited clinical performance comparable to that of FCs in occlusal cavities. Further high-quality clinical trials are needed to provide solid evidence to support the clinical application of SAFCs.
REGISTRATION
PROSPERO (CRD42022374983).
Topics: Humans; Resin Cements; Dental Cements; Composite Resins; Dentition, Permanent; Dental Caries; Dental Marginal Adaptation; Dental Restoration, Permanent
PubMed: 37683798
DOI: 10.1016/j.jdent.2023.104691 -
Clinical Oral Investigations Dec 2023To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties. (Review)
Review
OBJECTIVE
To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties.
METHODS
MEDLINE (PubMed), Scopus, and Web of Science searches were conducted for in vitro studies focusing on occlusal splint materials. Two reviewers performed an assessment of the identified studies and data abstraction independently, and this was complimented by an additional hand search. The articles were limited to those in the English language that were published between January 1, 2012, and December 1, 2022.
RESULTS
The initial search yielded 405 search results of which 274 were selected for full-text review following abstract evaluation. 250 articles that did not meet the inclusion criteria were excluded, and the remaining 25 articles (with 1 article identified from the reference lists of included articles) providing mechanical and chemical values were used in this review. Poly methyl methacrylate (PMMA) -based occlusal splint materials showed the highest values in terms of hardness, wear resistance, flexural strength, flexural modulus, e-modulus, and fracture toughness. The material group with the highest water sorption and water solubility was 3D printed (PR) splint materials. In addition, the lowest degree of double bond conversion was also observed in this group of materials.
CONCLUSIONS
The outcome of this review suggests that mechanically and chemically acceptable properties can be attained with PMMA-based occlusal splint materials using both conventional and digital production methods. PR splint materials should not be considered as the primary choice for long-term treatments due to their low mechanical and chemical properties.
CLINICAL RELEVANCE
This review provides clinical recommendations for selecting the appropriate material and fabrication method for occlusal splints while taking the patients' needs and the materials´ mechanical and chemical properties into account.
Topics: Humans; Occlusal Splints; Polymethyl Methacrylate; Flexural Strength; Splints; Water
PubMed: 37910242
DOI: 10.1007/s00784-023-05360-0 -
Journal of Dentistry Sep 2021This systematic review and meta-analysis evaluated the effects of non-thermal atmospheric plasma (NTAP) treatment on dentin wetting and adhesive-dentin bond strength. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review and meta-analysis evaluated the effects of non-thermal atmospheric plasma (NTAP) treatment on dentin wetting and adhesive-dentin bond strength.
DATA/SOURCES
This report followed the PRISMA 2020 statement. Two reviewers conducted literature search of MEDLINE, Web of Science and Scopus databases up to the end of November 2020. Included in vitro studies compared the effect of NTAP on treated dentin of non-carious, intact, extracted human third molar teeth with different control groups. Studies with no adequate methods, missing data, lack of control group, or those using animal teeth were excluded. The random effects model was used to summarize the treatment effect with standardized mean difference (SMD) and 95% CI. Risk of bias was assessed using the custom Cochrane Collaboration's tool.
STUDY SELECTION/RESULTS
Seventeen studies met inclusion criteria. The effects on dentin wetting were reported in favor of NTAP (SMD -5.38; 95% CI [-6.97, -3.78]; p<0.00001; I2=81%). Regarding adhesive-dentin bond strength, statistically significant differences between the NTAP and control group were in favor of NTAP in the short-term (SMD 1.92; 95%CI [1.35, 2.50]; p<0.00001; I2=97%), and long-term (SMD 3.28; 95%CI [2.46, 4.09]; p<0.00001; I2=97%). A limitation of meta-analysis is moderate heterogeneity caused by methodological differences and lack of data, which was evaluated through risk of bias and sensitivity analysis.
CONCLUSIONS
NTAP substantially improves dentin wetting and adhesive-dentin bond strength with 30 seconds exposure time and up to 10 mm tip-to-surface distances being sufficient for positive NTAP effects on bonding efficiency.
FUNDING
ON172207 and III41008 from the Ministry of Education, Science and Technological Development, Republic of Serbia. NP is funded by MESTD grant number 451-03-68/2020-14/200024.
CLINICAL SIGNIFICANCE
This systematic review and meta-analysis substantiate potential applicability of NTAP treatment of dentin in improving adhesive bonding clinically. Further research should be based on the optimized parameters such as time and distance with additional refinement of NTAP power.
Topics: Animals; Dental Bonding; Dental Cements; Dentin; Dentin-Bonding Agents; Humans; Materials Testing; Plasma Gases; Resin Cements
PubMed: 34363890
DOI: 10.1016/j.jdent.2021.103765 -
Ecological Applications : a Publication... Mar 2020As a consequence of the global ubiquity of plastic pollution, scientists, decision-makers, and the public often ask whether macroplastics (>5 mm) and microplastics... (Meta-Analysis)
Meta-Analysis
As a consequence of the global ubiquity of plastic pollution, scientists, decision-makers, and the public often ask whether macroplastics (>5 mm) and microplastics (<5 mm) have a realized ecological threat. In 2016, we conducted a systematic review of the literature and made a call for further research testing hypotheses about ecological effects. In the subsequent years, the amount of relevant research has risen tremendously. Here, we reassess the literature to determine the current weight of evidence about the effects of plastic pollution across all levels of biological organization. Our data spans marine, freshwater, and terrestrial environments. We extracted data from 139 lab and field studies testing 577 independent effects across a variety of taxa and with various types, sizes, and shapes of plastic. Overall, 59% of the tested effects were detected. Of these, 58% were due to microplastics and 42% were due to macroplastics. Of the effects that were not detected, 94% were from microplastics and 6% were from macroplastics. We found evidence that whether or not an effect is detected, as well as the severity and direction of the effect, is driven by dose, particle shape, polymer type, and particle size. Based on our analyses, there is no doubt that macroplastics are causing ecological effects, however, the effects of microplastics are much more complex. We also assessed the environmental relevancy of experimental studies by comparing the doses used in each exposure to the concentrations and sizes of microplastics found in the environment. We determined that only 17% of the concentrations used in experimental studies have been found in nature, and that 80% of particle sizes used in experiments fall below the size range of the majority of environmental sampling. Based on our systematic review and meta-analysis, we make a call for future work that recognizes the complexity of microplastics and designs tests to better understand how different types, sizes, shapes, doses, and exposure durations affect wildlife. We also call for more ecologically and environmentally relevant studies, particularly in freshwater and terrestrial environments.
Topics: Environmental Monitoring; Environmental Pollution; Fresh Water; Microplastics; Plastics; Water Pollutants, Chemical
PubMed: 31758826
DOI: 10.1002/eap.2044 -
Knee Surgery, Sports Traumatology,... Sep 2022Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly... (Meta-Analysis)
Meta-Analysis Review
Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials.
PURPOSE
Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly crosslinked polyethylene (HXLPE) has been proven effective in reducing osteolysis and loosening revisions while improving long-term survival and performance in total hip arthroplasty; nevertheless, this superiority is not demonstrated in TKA. The aim of this systematic review and meta-analysis was to examine whether HXLPE improved overall survival and postoperative functional and radiological outcomes compared to conventional polyethylene (CPE) in TKA.
METHODS
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a literature search of five databases (PubMed, Medline, Scopus, Science Direct and Embase) was made. A PICOS model was performed. The initial screening identified 2541 studies. Each eligible clinical article was analysed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE). Only randomised clinical trials (RCTs) of LoE 1 and 2 were included. The methodological quality of the articles was assessed using the Risk of Bias 2 (RoB 2) tool.
RESULTS
Six clinical studies were included in the final study. This systematic review and meta-analysis were registered on the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2285 knees were included. Eight outcomes (total reoperations, reoperations for prosthesis loosening and infections, radiolucent lines, osteolysis, mechanical failure, postoperative KSS knee score and function score) were analysed. For none of them, a statistically significant difference was found about the superiority of HXLPE over CPE (p > 0.05).
CONCLUSIONS
There were no statistically significant differences between HXLPE and CPE for TKA concerning clinical, radiological, and functional outcomes; nevertheless, HXLPE did not show higher failure rates or complications and can be safely used for TKA.
LEVEL OF EVIDENCE
II.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Osteolysis; Polyethylene; Polyethylenes; Prosthesis Design; Prosthesis Failure; Randomized Controlled Trials as Topic
PubMed: 35182171
DOI: 10.1007/s00167-022-06879-7 -
The Journal of Prosthetic Dentistry Aug 2022Which surface treatment provides the optimal bond strength (BS) for the repair of resin nanoceramics (RNCs) and polymer-infiltrated ceramics (PICs) is unclear. (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Which surface treatment provides the optimal bond strength (BS) for the repair of resin nanoceramics (RNCs) and polymer-infiltrated ceramics (PICs) is unclear.
PURPOSE
The purpose of this systematic review and meta-analysis of in vitro studies was to determine the best surface treatment protocols for the repair of PICs and RNCs.
MATERIAL AND METHODS
The PubMed, Scopus, and Web of Science electronic databases were searched to select in vitro studies in English up to March 2020. Studies with fewer than 5 specimens, those that did not evaluate the BS of PICs or RNCs, and those with aging for fewer than 30 days and 5000 cycles were excluded. Data sets were extracted, and the mean differences were analyzed by using a systematic review software program.
RESULTS
Among 284 potentially eligible studies, 21 were selected for full-text analysis, and 9 were included in the systematic review, of which 6 were used in the meta-analysis. The meta-analyses were performed for each treatment surface versus their respective control group and their combinations according to material: RNCs and PICs. For RNCs, airborne-particle abrasion with aluminum oxide (AlO) treatment was statistically higher than tribochemical silica airborne-particle abrasion (CoJet) (P=.02, I=90%) and that in the hydrofluoric acid (HF) (P<.001, I=0%) groups and was statistically similar to diamond rotary instrument grinding (P=.40, I=54%). For PICs, the treatment with hydrofluoric acid (HF) was statistically significantly higher than with CoJet (P=.03, I=62%) and airborne-particle abrasion with AlO (P<.001, I=98%).
CONCLUSIONS
The best surface treatment protocol for repair varied according to the restorative material. HF followed by silanization is suggested for PICs, and airborne-particle abrasion with AlO or preparation with a diamond rotary instrument for RNCs.
Topics: Aluminum Oxide; Ceramics; Dental Bonding; Diamond; Hydrofluoric Acid; Materials Testing; Polymers; Resin Cements; Silanes; Surface Properties; Zirconium
PubMed: 33573835
DOI: 10.1016/j.prosdent.2020.06.009 -
Clinical Oral Investigations Feb 2021This systematic review and meta-analysis compared the effects of immediate and delayed post space preparation on apical sealing. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This systematic review and meta-analysis compared the effects of immediate and delayed post space preparation on apical sealing.
MATERIALS AND METHOD
Two independent authors conducted a systematic search (PubMed/Medline, Cochrane Library, and other databases, until February 2020) and a risk of bias evaluation. Only in vitro studies that compared the effects of immediate and delayed post space preparations on apical filling and adhesion of the post were eligible.
RESULT
Of the 742 articles retrieved, 32 were included. Most of the studies used single-rooted human teeth and rotary files for root canal preparation, a single-cone technique for the filling protocol, and rotary instruments for post space preparation. Various delayed preparation times were evaluated: 8-72 h, 5-30 days (mainly 7 days), and 4 months. In nine studies, the delayed groups showed more apical leakage, while four studies reported more leakage in the immediate groups; ten studies found no significant difference. One study found more bacterial penetration in the delayed group, whereas three studies showed no significant difference. One study reported more voids in the delayed group, while another found no such difference. Three studies showed better post-bond strength in the delayed group, one in the immediate group, whereas three found no significant difference in post-bond strength. Three studies employing varied sealers for root canal fillings were considered for meta-analysis. Two subgroup analyses were also performed (one concerning the use of resin-based sealers (AH Plus), another for zinc oxide-eugenol-based sealers). The results of the meta-analysis showed that a delayed post space preparation led to a significantly higher apical leakage than an immediate preparation (mean difference = 0.41 mm, confidence interval = 0.24-0.59, p < 0.001).
CONCLUSION
Delayed post space preparation seems to negatively influence apical sealing; however, further studies are needed to determine the influence of the timing of post space preparation on the other parameters.
CLINICAL RELEVANCE
Immediate post space preparation may be the safest clinical choice to prevent apical leakage.
Topics: Dental Leakage; Epoxy Resins; Gutta-Percha; Humans; Post and Core Technique; Root Canal Filling Materials; Root Canal Obturation; Root Canal Preparation
PubMed: 33417064
DOI: 10.1007/s00784-020-03690-x -
PloS One 2018Provisional restorations represent an important phase during the rehabilitation process, knowledge of the mechanical properties of the available materials allows us to... (Comparative Study)
Comparative Study Meta-Analysis Review
Provisional restorations represent an important phase during the rehabilitation process, knowledge of the mechanical properties of the available materials allows us to predict their clinical performance. At present, there is no systematic review, which supports the clinicians' criteria, in the selection of a specific material over another for a particular clinical situation. The purpose of this systematic review and meta-analysis was to assess and compare the mechanical properties of dimethacrylates and monomethacrylates used in fabricating direct provisional restorations, in terms of flexural strength, fracture toughness and hardness. This review followed the PRISMA guidelines. The searches were conducted in PubMed, Embase, Web of Science, Scopus, the New York Academy of Medicine Grey Literature Report and were complemented by hand-searching, with no limitation of time or language up to January 10, 2017. Studies that assess and compare the mechanical properties of dimethacrylate- and monomethacrylate-based provisional restoration materials were selected. A quality assessment of full-text articles were performed according to modified ARRIVE and CONSORT criteria and modified Cochrane Collaboration's tool for in vitro studies. Initially, 256 articles were identified. After removing the duplicates and applying the selection criteria, 24 articles were included in the qualitative synthesis and 7 were included in the quantitative synthesis (meta-analysis). It may be concluded that dimethacrylate-based provisional restorations presented better mechanical behavior than monomethacrylate-based ones in terms of flexural strength and hardness. Fracture toughness showed no significant differences. Within the monomethacrylate group, polymethylmethacrylate showed greater flexural strength than polyethylmethacrylate.
Topics: Dental Materials; Humans; Materials Testing; Polymethacrylic Acids; Stress, Mechanical
PubMed: 29489883
DOI: 10.1371/journal.pone.0193162 -
Scientific Reports Jan 2023Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI)... (Meta-Analysis)
Meta-Analysis
Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that resistance to topical biocides may be emergeing, although the potential clinical implications remain unclear. The objective of this systematic review was to determine whether the minimum bactericidal concentration (MBC) of topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. We included studies reporting the MBC of laboratory and clinical isolates of common microbes to CHX and PVI. We excluded studies using non-human samples and antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses and the change in MBC over time was explored using meta-regression. Seventy-nine studies were included, analysing 6218 microbes over 45 years. Most studies investigated CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in the MBC of CHX to Staphylococci or Streptococci over time. Overall, we find no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. This provides reassurance and confidence in the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.
Topics: Humans; Anti-Infective Agents, Local; Povidone-Iodine; Chlorhexidine; Preoperative Care; Surgical Wound Infection
PubMed: 36611032
DOI: 10.1038/s41598-022-26658-1