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International Journal of Surgery... Jan 2024Emerging remote-access surgical methods are utilized to treat differentiated thyroid cancer. The study aimed to compare the surgical integrity, safety, efficacy, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Emerging remote-access surgical methods are utilized to treat differentiated thyroid cancer. The study aimed to compare the surgical integrity, safety, efficacy, and postoperative experience of patients among common surgical methods.
METHODS
The PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2023. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome.
RESULTS
Thirty-two studies comprising 7042 patients were included. Robotic bilateral axillo-breast approach (RBABA) and robotic gasless transaxillary approach (RGAA) retrieved fewer lymph nodes (LNs) than open thyroidectomy (OT). RBABA showed a significantly lower permanent recurrent laryngeal nerve (RLN) palsy rate than OT. According to SUCRA values, endoscopic transoral approach (EOA) ranked the highest in retrieved LNs (0.84), the proportion of stimulated serum thyroglobulin less than 1.0 ng/ml (0.77), and the pain score (0.77). Endoscopic bilateral areola approach (EBAA) ranked the highest in the transient RLN palsy rate (0.72). The endoscopic gasless transaxillary approach (EGAA) ranked the highest in the transient hypoparathyroidism rate (0.78). RBABA ranked the highest in the rate of permanent RLN palsy (0.94) and hypoparathyroidism (0.77). OT ranked the highest in operative time (0.92).
CONCLUSIONS
Each surgical method of total thyroidectomy has benefits and limitations. EOA performed the best in maintaining surgical integrality and reducing the pain score, while taking a long operative time. Generally, RBABA showed the best advantage in protecting parathyroid glands and RLN but with the longest operative time. OT had the best advantage in operative time. Therefore, OT and EOA are ideal methods for patients with a higher risk of central LN metastasis. RBABA and EOA may not be suitable for elderly patients or those with high anesthesia risk.
Topics: Humans; Aged; Thyroidectomy; Bayes Theorem; Network Meta-Analysis; Thyroid Neoplasms; Vocal Cord Paralysis; Hypoparathyroidism; Adenocarcinoma; Pain; Retrospective Studies
PubMed: 37916941
DOI: 10.1097/JS9.0000000000000819 -
Surgery For Obesity and Related... Mar 2024Bariatric surgery has been associated with numerous micronutrient deficiencies. Several observational studies have found that these deficiencies are more common in...
BACKGROUND
Bariatric surgery has been associated with numerous micronutrient deficiencies. Several observational studies have found that these deficiencies are more common in racially/ethnically minoritized patients.
OBJECTIVES
To conduct a systematic review to investigate whether racially/ethnically minoritized patients experience worse nutritional outcomes after bariatric surgery.
SETTING
University of Wisconsin-Madison.
METHODS
PubMed, CINAHL, PsychINFO, and Cochrane databases were queried. We searched for manuscripts that reported micronutrient levels or conditions related to micronutrient deficiencies according to race/ethnicity (White, African American/Black, and Hispanic) after laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between 2002 and 2022. Eleven micronutrients (vitamins A, B1 [thiamine], B12, D, E, K, calcium, copper, folate, iron, and zinc), and four conditions (anemia, bone loss, fractures, and hyperparathyroidism) were assessed.
RESULTS
Abstracts from 953 manuscripts were screened; 18 full-text manuscripts were reviewed for eligibility, and ten met the inclusion criteria. Compared to White patients, African Americans had a higher prevalence of thiamine, vitamin D, and vitamin A deficiencies. There were no differences in calcium and vitamin B12 deficiencies. The other six micronutrients were not assessed according to race/ethnicity. Hyperparathyroidism was more prevalent in African Americans than White patients in the three studies that evaluated it. The prevalence of fractures was mixed. Anemia and bone loss were not evaluated according to race/ethnicity.
CONCLUSIONS
Although the literature on micronutrient outcomes following bariatric surgery according to race/ethnicity is limited, African Americans appear to experience a higher prevalence of vitamin deficiencies and associated conditions. Qualitative and quantitative research to explore these disparities is warranted.
Topics: Humans; Obesity, Morbid; Calcium; Malnutrition; Bariatric Surgery; Gastric Bypass; Vitamins; Micronutrients; Thiamine; Anemia; Hyperparathyroidism
PubMed: 37891101
DOI: 10.1016/j.soard.2023.09.022 -
Gynecologie, Obstetrique, Fertilite &... 2023There is no specific recommendation for management in pregnant women: the aim of this review, based on a clinical case study, is to clarify its development,...
OBJECTIVE
There is no specific recommendation for management in pregnant women: the aim of this review, based on a clinical case study, is to clarify its development, complications, risk factor and treatment.
METHODS
A review of the literature was performed by consulting the Pubmed, Cochrane Library, and Science Direct databases.
RESULTS
Primary hyperparathyroidism is defined as excessive production of parathyroid hormone resulting in hypercalcemia. The prevalence of primary hyperparathyroidism during pregnancy is not known. Indeed, the symptomatology, related to hypercalcemia, is not very specific and easily confused with the clinical manifestations of pregnancy. The physiological changes specific to the pregnant state frequently lead to a slight hypocalcemia which may complicate the diagnosis of primary hyperparathyroidism. Primary hyperparathyroidism results from a parathyroid adenoma in the majority of cases and is detected by ultrasound during pregnancy. Primary hyperparathyroidism in pregnancy causes significant risks to both mother and fetus. The maternal complication rate is 14-67%, however, the most serious complication is hypercalcemic crisis, which requires increased surveillance in the postpartum period. Obstetrical complications are also induced by primary hyperparathyroidism, such as acute polyhydramnios, or intrauterine growth retardation. The fetal complication rate can reach 45-80% of cases with neonatal hypocalcemia as the main complication. If medical treatment is based on hyperhydration, only surgical treatment is curative.
CONCLUSION
Surgery should be proposed to symptomatic patients or those with high blood calcium levels, discussed in interdisciplinary committee and should be organized ideally in the second trimester to avoid maternal and fetal complications.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Hypercalcemia; Hyperparathyroidism, Primary; Hypocalcemia; Pregnancy Complications
PubMed: 37827286
DOI: 10.1016/j.gofs.2023.10.003 -
Brazilian Journal of Otorhinolaryngology 2023The scope of surgical resection for paratracheal (level VI) lymph nodes in patients with Papillary Thyroid Carcinoma (PTC) remains debatable. The aim of our study was to... (Meta-Analysis)
Meta-Analysis Comparative Study Review
OBJECTIVE
The scope of surgical resection for paratracheal (level VI) lymph nodes in patients with Papillary Thyroid Carcinoma (PTC) remains debatable. The aim of our study was to evaluate the effectiveness and safety of prophylactic ipsilateral Central Neck lymph node Dissection (CND) versus bilateral CND at the time of total thyroidectomy for Clinically Node-negative (cN0) unilateral PTC.
METHODS
A systematic retrieval of electronic databases, including Pubmed, Web of Science, and the China Journal Net, was conducted from January 1990 to September 2021. Outcome data of interest included transient hypoparathyroidism, permanent hypoparathyroidism, transient Recurrent Laryngeal Nerve (RLN) injury, permanent RLN injury and local recurrence. We constructed the summary Odds Ratios (ORs) and 95% Confidence Intervals (CIs) for every study with either fixed or random effect models.
RESULTS
A full total of 1792 patients from 6 studies were enrolled. Our meta-analysis showed that transient hypoparathyroidism was significantly more frequent in bilateral CND group (OR=0.58; 95% CI 0.44-0.76). The prevalence of permanent hypoparathyroidism was significantly higher in bilateral CND group patients compared to those in ipsilateral CND group (OR=0.26; 95% CI 0.15-0.45). On the other hand, our meta-analysis indicated that there were no significant differences in the incidence of transient RLN injury, permanent RLN injury and local recurrence.
CONCLUSIONS
Compared with bilateral CND, the rate of temporary and permanent hypoparathyroidism in ipsilateral CND is lower, but the local recurrence is similar. It may be presumptuous to suggest that ipsilateral CND is an adequate treatment for cN0 unilateral PTC.
Topics: Humans; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy; Hypoparathyroidism; Neck Dissection; Lymph Node Excision; Neoplasm Recurrence, Local
PubMed: 37716097
DOI: 10.1016/j.bjorl.2023.101318 -
International Journal of Surgery... Dec 2023
Meta-Analysis
A commentary on 'The role of rapid intraoperative parathyroid hormone (ioPTH) assay in determining outcome of parathyroidectomy in primary hyperparathyroidism: A systematic review and meta-analysis'.
Topics: Humans; Parathyroid Hormone; Parathyroidectomy; Hyperparathyroidism, Primary; Monitoring, Intraoperative; Retrospective Studies
PubMed: 37702567
DOI: 10.1097/JS9.0000000000000716 -
Endocrine Nov 2023Multiple endocrine neoplasia type 1 (MEN1) is a rare syndrome that combines endocrine and non-endocrine tumors. Thymic neuroendocrine tumors are uncommon components that...
BACKGROUND
Multiple endocrine neoplasia type 1 (MEN1) is a rare syndrome that combines endocrine and non-endocrine tumors. Thymic neuroendocrine tumors are uncommon components that predict poor prognosis in patients with MEN1. We aimed to summarize the clinical characteristics of thymoma in MEN1 by reviewing the current reports from the literature.
METHODS
A patient with multiple endocrine neoplasia type 1 (parathyroid hyperplasia, pituitary adenoma, and insulinoma) was found to have a 2 × 1.5 cm thymic mass during long-term follow-up. Thoracoscope surgery was performed, and a histopathology examination revealed WHO Type B3 thymoma. A pathogenic mutation of c.783 + 1G > A in the MEN1 gene was identified. We further searched PubMed and EMBASE for thymoma in association with MEN1.
RESULTS
A comprehensive overview of the literature concerning characteristics of MEN1-related thymoma was summarized. Clinical characteristics and differences between thymoma and thymic carcinoid are highlighted.
CONCLUSIONS
Besides carcinoid, other tumors, including thymoma, need to be identified for thymic space-occupying lesions in MEN1 patients. The impact of thymoma on the long-term prognosis of MEN1 patients needs further investigation.
Topics: Humans; Multiple Endocrine Neoplasia Type 1; Thymoma; Thymus Neoplasms; Carcinoid Tumor; Pancreatic Neoplasms
PubMed: 37668926
DOI: 10.1007/s12020-023-03440-5 -
Frontiers in Endocrinology 2023Autosomal dominant hypocalcemia (ADH1) is a genetic disorder characterized by low serum calcium and low or inappropriately normal levels of parathyroid hormone. The...
Autosomal dominant hypocalcemia (ADH1) is a genetic disorder characterized by low serum calcium and low or inappropriately normal levels of parathyroid hormone. The disease is caused by a heterozygous activating mutation of the calcium-sensing receptor () gene, encoding a G-Protein-coupled cell membrane sensor of extracellular calcium concentration mainly expressed by parathyroid glands, renal tubules, and the brain. ADH1 has been linked to 113 unique germline mutations, of which nearly 96% are missense mutations. There is often a lack of a clear genotype/phenotype correlation in the reported literature. Here, we described a case series of 6 unrelated ADH1 probands, each one bearing a gain-of-function mutation, and two children of one of these cases, matching our identified mutations to the same ones previously reported in the literature, and comparing the clinical and biochemical characteristics, as well as the complication profile. As a result of these genetic and clinical comparisons, we propose that a genotype/phenotype correlation may exist because our cases showed similar presentation, characteristics, and severity, with respect to published cases with the same or similar mutations. We also contend that the severity of the presentation is highly influenced by the specific variant. These findings, however, require further evaluation and assessment with a systematic review.
Topics: Gain of Function Mutation; Receptors, Calcium-Sensing; Calcium; Research; Mutation
PubMed: 37654565
DOI: 10.3389/fendo.2023.1215036 -
Updates in Surgery Oct 2023This study aimed to conduct a systematic review and meta-analysis to compare the surgical outcomes of the transoral endoscopic thyroidectomy vestibular approach (TOETVA)... (Meta-Analysis)
Meta-Analysis
This study aimed to conduct a systematic review and meta-analysis to compare the surgical outcomes of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT). We carried out a systematic literature search of PubMed, Web of Science, Cochrane Library, and Google Scholar on studies comparing TOETVA and TORT until January 2023. A total of five articles published between 2018 and 2023 that matched the inclusion criteria were included in the systematic review and meta-analysis. The studies included 641 patients (394 TOETVA patients and 247 TORT patients). TOETVA group was associated with a significantly shorter operative time with a mean difference of 60.08 min [95% confidence interval (CI) - 83.95 to - 36.20; P < 0.001). Transient recurrent laryngeal nerve palsy was more common in the TOETVA group than the TORT group (OR 3.00; 95% CI 1.14-7.88; P = 0.03). There were no significant differences in the other outcomes, including the length of hospital stay, postoperative pain scores, number of central lymph nodes retrieved, permanent recurrent laryngeal nerve injuries, and transient and permanent hypoparathyroidism. The TOETVA group was associated with shorter operative time and more transient recurrent laryngeal nerve palsy than the TORT group. Each procedure has its benefits and limitations. The surgical approach should be determined by considering the patient's characteristics and preferences, as well as the surgeon's preference and area of expertise.
Topics: Humans; Thyroidectomy; Robotic Surgical Procedures; Vocal Cord Paralysis; Natural Orifice Endoscopic Surgery; Hypoparathyroidism; Thyroid Neoplasms
PubMed: 37556081
DOI: 10.1007/s13304-023-01623-3 -
Frontiers in Endocrinology 2023This study aimed to systematically review research on cinacalcet and secondary hyperparathyroidism (SHPT) using machine learning-based statistical analyses. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
This study aimed to systematically review research on cinacalcet and secondary hyperparathyroidism (SHPT) using machine learning-based statistical analyses.
METHODS
Publications indexed in the Web of Science Core Collection database on Cinacalcet and SHPT published between 2000 and 2022 were retrieved. The R package "Bibliometrix," VOSviewer, CiteSpace, meta, and latent Dirichlet allocation (LDA) in Python were used to generate bibliometric and meta-analytical results.
RESULTS
A total of 959 articles were included in our bibliometric analysis. In total, 3753 scholars from 54 countries contributed to this field of research. The United States, Japan, and China were found to be among the three most productive countries worldwide. Three Japanese institutions (Showa University, Tokai University, and Kobe University) published the most articles on Cinacalcet and SHPT. Fukagawa, M.; Chertow, G.M.; Goodman W.G. were the three authors who published the most articles in this field. Most articles were published in , , and . Research on Cinacalcet and SHPT has mainly included three topics: 1) comparative effects of various treatments, 2) the safety and efficacy of cinacalcet, and 3) fibroblast growth factor-23 (FGF-23). Integrated treatments, cinacalcet use in pediatric chronic kidney disease, and new therapeutic targets are emerging research hotspots. Through a meta-analysis, we confirmed the effects of Cinacalcet on reducing serum PTH ( = -0.56, 95% = -0.76 to -0.37, = 0.001) and calcium ( = -0.93, 95% = -1.21to -0.64, = 0.001) and improving phosphate ( = 0.17, 95% = -0.33 to -0.01, = 0.033) and calcium-phosphate product levels ( = -0.49, 95% = -0.71 to -0.28, = 0.001); we found no difference in all-cause mortality ( = 0.97, 95% = 0.90 to 1.05, = 0.47), cardiovascular mortality ( = 0.69, 95% = 0.36 to 1.31, = 0.25), and parathyroidectomy ( = 0.36, 95% = 0.09 to 1.35, = 0.13) between the Cinacalcet and non-Cinacalcet users. Moreover, Cinacalcet was associated with an increased risk of nausea ( = 2.29, 95% = 1.73 to 3.05, = 0.001), hypocalcemia ( = 4.05, 95% = 2.33 to 7.04, = 0.001), and vomiting ( = 1.90, 95% = 1.70 to 2.11, = 0.001).
DISCUSSION
The number of publications indexed to Cinacalcet and SHPT has increased rapidly over the past 22 years. Literature distribution, research topics, and emerging trends in publications on Cinacalcet and SHPT were analyzed using a machine learning-based bibliometric review. The findings of this meta-analysis provide valuable insights into the efficacy and safety of cinacalcet for the treatment of SHPT, which will be of interest to both clinical and researchers.
Topics: Child; Humans; Calcimimetic Agents; Calcium; Cinacalcet; Hyperparathyroidism, Secondary; Phosphates; United States; Machine Learning
PubMed: 37538795
DOI: 10.3389/fendo.2023.1146955 -
Cardiovascular Journal of Africa Jul 2023In dialysis patients, vascular calcification is a common complication and is closely related to the morbidity and mortality of cardiovascular disease. We performed a... (Review)
Review
BACKGROUND
In dialysis patients, vascular calcification is a common complication and is closely related to the morbidity and mortality of cardiovascular disease. We performed a systematic review to determine the efficacy and safety of sodium thiosulfate (STS) in the progression of vascular calcification in dialysis patients with end-stage renal disease.
METHODS
The PubMed, Web of Science, Embase, Cochrane Library, Wanfang, CNKI, China Biology Medicine disc and Weipu databases were searched up to 9 March 2022 for clinical trials to synthesise findings on the efficacy and safety of STS in the progression of vascular calcification in dialysis patients. The primary outcome was coronary artery calcification scores (CACS) or abdominal aortic calcification scores (AACS) or Kauppila index. The secondary outcome was pulse-wave velocity (PWV). Laboratory data were shown in safety data. A random-effect model was used to provide the summary measures of effect [standardised mean difference (SMD) and 95% confidence interval (CI)].
RESULTS
Seven randomised, controlled trials and one nonrandomised, controlled trial involving 370 patients were included. Six studies reported that the progression of CACS or AACS was slower in the intravenous STS group compared with the control group (SMD -3.24, 95% CI: -5.29, -1.18, = 0.002). Two studies showed the increase in PWV was less in the STS group compared with the control group (SMD -0.52, 95% CI: -0.92, -0.13, = 0.009). During the trial period, a lower high-sensitivity C-reactive protein level (SMD 1.61, 95% CI: 0.19, 3.04, = 0.03), a decrease in serum bicarbonate level (SMD 0.67, 95% CI: 0.22, 1.11, = 0.003) and an increase in serum phosphate level (SMD -0.32, 95% CI: -0.62, -0.03, = 0.03) were noted in the intravenous STS group compared with the control group. However, serum calcium and parathyroid hormone levels showed no difference between the two groups after the trials. The most common adverse events were temporary nausea and vomiting, which occurred in 12.5 to 75% of patients.
CONCLUSIONS
Intravenous STS may slow down the progression of vascular calcification and ameliorate arterial stiffness in dialysis patients. Reliably defining the efficacy and safety of intravenous STS in attenuating the progression of vascular calcification requires a high-quality trial with a large sample size.
PubMed: 37526956
DOI: 10.5830/CVJA-2023-020