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Journal of Robotic Surgery Jun 2024This systematic review of randomized controlled trials (RCTs) aims to compare important clinical, functional, and radiological outcomes between robotic-assisted total... (Meta-Analysis)
Meta-Analysis Comparative Study Review
Clinical, functional, and radiological outcomes of robotic assisted versus conventional total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
This systematic review of randomized controlled trials (RCTs) aims to compare important clinical, functional, and radiological outcomes between robotic-assisted total hip arthroplasty (RATHA) and conventional total hip arthroplasty (COTHA) in patients with hip osteoarthritis. We identified published RCTs comparing RATHA with COTHA in Ovid MEDLINE, EMBASE, Scopus, and Cochrane Library. Two reviewers independently performed study screening, risk of bias assessment and data extraction. Main outcomes were major complications, revision, patient-reported outcome measures (PROMs), and radiological outcomes. We included 8 RCTs involving 1014 patients and 977 hips. There was no difference in major complication rate (Relative Risk (RR) 0.78; 95% Confidence Interval (CI) 0.22 to 2.74), revision rate (RR 1.33; 95%CI 0.08 to 22.74), and PROMs (standardized mean difference 0.01; 95%CI - 0.27 to 0.30) between RATHA and COTHA. RATHA resulted in little to no effects on femoral stem alignment (mean difference (MD) - 0.57 degree; 95%CI - 1.16 to 0.03) but yielded overall lower leg length discrepancy (MD - 4.04 mm; 95%CI - 7.08 to - 1.0) compared to COTHA. Most combined estimates had low certainty of evidence mainly due to risk of bias, inconsistency, and imprecision. Based on the current evidence, there is no important difference in clinical and functional outcomes between RATHA and COTHA. The trivial higher radiological accuracy was also unlikely to be clinically meaningful. Regardless, more robust evidence is needed to improve the quality and strength of the current evidence.PROSPERO registration: the protocol was registered in the PROSPERO database (CRD42023453294). All methods were carried out in accordance with relevant guidelines and regulations.
Topics: Humans; Arthroplasty, Replacement, Hip; Robotic Surgical Procedures; Randomized Controlled Trials as Topic; Osteoarthritis, Hip; Treatment Outcome; Postoperative Complications; Patient Reported Outcome Measures; Reoperation; Radiography; Female; Male
PubMed: 38888718
DOI: 10.1007/s11701-024-01949-z -
Clinical Cardiology Jun 2024Long-term follow-up results of various trials comparing Zotarolimus eluting stents (ZES) with Everolimus eluting stents (EES) have been published recently. Additionally,... (Comparative Study)
Comparative Study Meta-Analysis
Temporal Trends in the Outcomes of Percutaneous Coronary Intervention With Zotarolimus Eluting Stents Versus Everolimus Eluting Stents: A Meta-Analysis of Randomized Controlled Trials.
INTRODUCTION
Long-term follow-up results of various trials comparing Zotarolimus eluting stents (ZES) with Everolimus eluting stents (EES) have been published recently. Additionally, over the last decade, there have been new trials comparing the ZES with various commercially available EES. We aim to conduct an updated meta-analysis in light of new evidence from randomized controlled trials (RCTs) to provide comprehensive evidence regarding the temporal trends in the clinical outcomes.
METHODS
A comprehensive literature search was conducted across PubMed, Cochrane, and Embase. RCTs comparing ZES with EES for short (<2 years), intermediate (2-3 years), and long-term follow-ups (3-5 years) were included. Relative risk was used to pool the dichotomous outcomes using the random effects model employing the inverse variance method. All statistical analysis was conducted using Revman 5.4.
RESULTS
A total of 18 studies reporting data at different follow-ups for nine trials (n = 14319) were included. At short-term follow-up (<2 years), there were no significant differences between the two types of stents (all-cause death, cardiac death, Major adverse cardiovascular events (MACE), target vessel myocardial infarction, definite or probable stent thrombosis or safety outcomes (target vessel revascularization, target lesion revascularization, target vessel failure, target lesion failure). At intermediate follow-up (2-3 years), EES was superior to ZES for reducing target lesion revascularization (RR = 1.28, 95% CI = 1.05-1.58, p < 0.05). At long-term follow-up (3-5 years), there were no significant differences between the two groups for any of the pooled outcomes (p > 0.05).
CONCLUSION
ZES and EES have similar safety and efficacy at short, intermediate, and long-term follow-ups.
Topics: Humans; Cardiovascular Agents; Coronary Artery Disease; Drug-Eluting Stents; Everolimus; Percutaneous Coronary Intervention; Prosthesis Design; Randomized Controlled Trials as Topic; Risk Factors; Sirolimus; Time Factors; Treatment Outcome
PubMed: 38888152
DOI: 10.1002/clc.24306 -
BMC Urology Jun 2024The aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign... (Meta-Analysis)
Meta-Analysis Comparative Study
PURPOSE
The aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia.
METHODS
The literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques.
RESULTS
The study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery.
CONCLUSION
Theoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.
Topics: Humans; Male; Prostatic Hyperplasia; Network Meta-Analysis; Treatment Outcome; Laser Therapy; Prostatectomy; Lasers, Solid-State
PubMed: 38886739
DOI: 10.1186/s12894-024-01517-5 -
BMC Women's Health Jun 2024Major depressive disorder (MDD) is a highly prevalent mental health disorder with females experiencing higher rates of depression (11.6%), anxiety (15.7%) and...
BACKGROUND
Major depressive disorder (MDD) is a highly prevalent mental health disorder with females experiencing higher rates of depression (11.6%), anxiety (15.7%) and physiological distress (14.5%) than males. Recently, the Endocannabinoid system (ECS) has been proposed to be a key contributing factor in the pathogenesis and symptom severity of MDD due to its role in neurotransmitter production, inflammatory response and even regulation of the female reproductive cycle. This review critically evaluates evidence regarding ECS levels in female-sexed individuals with depressive disorders to further understand ECS role.
MATERIALS AND METHODS
A systematic literature review of available research published prior to April 2022 was identified using PubMed (U.S. National Library of Medicine), CINAHL (EBSCO), Web of Science, AMED and Scopus (Elsevier). Studies were included if they reported ECS analysis of female-sexed individuals with depression and were excluded if they did not differentiate results between sexes, assessed mental health conditions other than depression, tested efficacy of endocannabinoid/n-acylethanolamine/cannabis or marijuana administration and that were unable to be translated. Critical appraisal of each included study was undertaken using the Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews.
RESULTS
The 894 located citations were screened for duplicates (n = 357) and eligibility by title and abstract (n = 501). The full text of 33 studies were reviewed, and 7 studies were determined eligible for inclusion. These studies indicated that depressed female-sexed individuals have altered levels of ECS however no significant pattern was identified due to variability of study outcomes and measures, limiting overall interpretation.
DISCUSSION
This review suggests potential involvement of ECS in underlying mechanisms of MDD in female sexed-individuals, however no pattern was able to be determined. A major contributor to the inability to attain reliable and valid understanding of the ECS levels in female-sexed individuals with depression was the inconsistency of depression screening tools, inclusion criteria's and analysis methods used to measure eCBs. Future studies need to implement more standardised methodology to gain a deeper understanding of ECS in female-sexed individuals with depressive disorders. TRIAL REGISTRATION : This review was submitted to PROSPERO for approval in April 2022 (Registration #CRD42022324212).
Topics: Humans; Endocannabinoids; Female; Depressive Disorder, Major; Sex Factors; Male
PubMed: 38886733
DOI: 10.1186/s12905-024-03168-y -
Annals of Surgery Open : Perspectives... Mar 2024Guidelines advise to perform endoscopic surveillance following ileocolic resection (ICR) in Crohn disease (CD) for timely diagnosis of recurrence. This study aims to...
OBJECTIVE
Guidelines advise to perform endoscopic surveillance following ileocolic resection (ICR) in Crohn disease (CD) for timely diagnosis of recurrence. This study aims to assess the variation in endoscopic recurrence (ER) rates in patients after ICR for CD using the most commonly used classification systems, the Rutgeerts score (RS) and modified Rutgeerts score (mRS) classifications.
METHODS
A systematic literature search using MEDLINE, Embase, and the Cochrane Library was performed. Randomized controlled trials and cohort studies describing ER < 12 months after an ICR for CD were included. Animal studies, reviews, case reports (<30 included patients), pediatric studies, and letters were excluded. The Newcastle-Ottawa Quality Assessment Scale and Cochrane Collaboration's tool were used to assess risk of bias. Main outcome was the range of ER rates within 12 months postoperatively, defined as RS ≥ i2 and/or mRS ≥ i2b. A proportional meta-analysis was performed. The final search was performed on January 4, 2022. The study was registered at PROSPERO, CRD42022363208.
RESULTS
Seventy-six studies comprising 7751 patients were included. The weighted mean of ER rates in all included studies was 44.0% (95% confidence interval, 43.56-44.43). The overall range was 5.0% to 93.0% [interquartile range (IQR), 29.2-59.0]. The weighted means for RS and mRS were 44.0% and 41.1%, respectively. The variation in ER rates for RS and mRS were 5.0% to 93.0% (IQR, 29.0-59.5) and 19.8% to 62.9% (IQR, 37.3-46.5), respectively. Within studies reporting both RS and mRS, the weighted means for ER were 61.3% and 40.6%, respectively.
CONCLUSIONS
This study demonstrates a major variation in ER rates after ICR for CD, suggesting a high likelihood of inadequate diagnosis of disease recurrence, with potentially impact on quality of life and health care consumption. Therefore, there is an important need to improve endoscopic scoring of recurrent disease.
PubMed: 38883962
DOI: 10.1097/AS9.0000000000000397 -
Frontiers in Endocrinology 2024The progression of carotid intima-media thickness (cIMT) can partially predict the occurrence of future cardiovascular events. This network meta-analysis compared the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The progression of carotid intima-media thickness (cIMT) can partially predict the occurrence of future cardiovascular events. This network meta-analysis compared the effects of 14 antidiabetic drugs (acarbose, alogliptin, exenatide, glibenclamide, glimepiride, ipragliflozin, metformin, nateglinide, pioglitazone, rosiglitazone, sitagliptin, tofoglifozin, troglitazone, voglibose) on the progression of cIMT.
METHOD
PubMed, EMBASE, Cochrane Library, and Web of Science were searched to screen all clinical trials of treatment of cIMT with hypoglycemic agents before March 1, 2024. The differences in the changes in cIMT between the treatment group and control group were evaluated.
RESULT
After screening 8395 citations, 25 studies (6675 patients) were included. The results indicated that exenatide had the best efficacy in slowing down cIMT progress, and exenatide [MD=-0.13,95%CI (-0.25, -0.01)], alogliptin [MD=-0.08,95%CI (-0.13, -0.02)] and metformin [MD=-0.05, 95%CI (-0.09, -0.02)] are more effective than placebo.
CONCLUSION
Long-term treatment of exenatide, alogliptin, and metformin may be more effective than other hypoglycemic drugs in slowing the progression of cIMT.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024519474.
Topics: Humans; Hypoglycemic Agents; Carotid Intima-Media Thickness; Network Meta-Analysis; Disease Progression; Diabetes Mellitus, Type 2
PubMed: 38883606
DOI: 10.3389/fendo.2024.1403606 -
Acta Medica Philippina 2024To gather, summarize, and appraise the available evidence on: 1) the accuracy of chest CT scan in diagnosing COVID-19 among children, and 2) the characteristic chest CT...
OBJECTIVES
To gather, summarize, and appraise the available evidence on: 1) the accuracy of chest CT scan in diagnosing COVID-19 among children, and 2) the characteristic chest CT scan findings associated with COVID-19 pneumonia in children.
METHODS
We comprehensively searched databases (MEDLINE, COCHRANE), clinical trial registries, bibliographic lists of selected studies, and unpublished data for relevant studies. Guide questions from the Painless Evidence Based Medicine and the National Institutes of Health Quality Assessment Tools were used to assess study quality.
RESULTS
A poor quality study showed 86.0% (95% CI 73.8, 93.0) sensitivity and 75.9% (95% CI 67.1, 83.0) specificity of chest CT scan in diagnosing COVID-19 in children. Thirty-nine observational studies describing chest CT scan in children with COVID-19 showed abnormal findings in 717 of 1028 study subjects. Common chest CT scan findings in this population include: 1) ground glass opacities, patchy shadows, and consolidation, 2) lower lobe involvement, and 3) unilateral lung lesions.
CONCLUSION
Studies which investigate the accuracy of chest CT scan in the diagnosis of COVID-19 in children are limited by heterogeneous populations and small sample sizes. While chest CT scan findings such as patchy shadows, ground glass opacities, and consolidation are common in children with COVID-19, these may be similar to the imaging findings of other respiratory viral illnesses.
PubMed: 38882921
DOI: 10.47895/amp.v58i7.6385 -
European Journal of Medical Research Jun 2024Glaucoma is the most common cause of irreversible blindness in the world. It is associated with elevated intraocular pressure (IOP). Fluctuations in tonometer readings...
Glaucoma is the most common cause of irreversible blindness in the world. It is associated with elevated intraocular pressure (IOP). Fluctuations in tonometer readings have implications for glaucoma research, where accurate IOP measurements are vital for evaluating disease progression and treatment efficacy. Researchers should carefully select the appropriate tonometer and consider biases associated with different tonometers. Validation against standard measurements can improve IOP measurement accuracy in rat models. In conclusion, this systematic review will emphasize on the importance of selecting the appropriate tonometer for IOP measurement in rat models, considering potential biases and their implications for glaucoma research. Accurate and consistent IOP measurement in rat models is crucial for understanding glaucoma pathophysiology and developing effective treatments. This systematic review aims to assess agreement among tonometers used for measuring IOP in Wistar rat models primarily focusing on TonoLab, TonoVet, and Tono-pen. The review was conducted using PRISMA guidelines. Two articles were included for qualitative synthesis. The studies compared manometric IOP with TonoLab, rebound tonometer, and Tono-pen XL readings. It was observed that TonoLab consistently underestimated IOP, while Tono-pen XL tended to overestimate IOP compared to manometric measurements. The study's findings will help researchers in making decisions about tonometer selection, leading to more reliable outcomes in glaucoma research using rat models. Further research, specifically RCT's (randomized controlled trial) is needed to confirm the results and enhance IOP measurement precision in rat models.
Topics: Animals; Intraocular Pressure; Tonometry, Ocular; Rats; Rats, Wistar; Glaucoma; Disease Models, Animal
PubMed: 38880889
DOI: 10.1186/s40001-024-01927-z -
The Lancet. Psychiatry Jul 2024Many patients with schizophrenia have symptoms that do not respond to antipsychotics. This condition is called treatment-resistant schizophrenia and has not received... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many patients with schizophrenia have symptoms that do not respond to antipsychotics. This condition is called treatment-resistant schizophrenia and has not received specific attention as opposed to general schizophrenia. Psychological and psychosocial interventions as an add-on treatment to pharmacotherapy could be useful, but their role and comparative efficacy to each other and to standard care in this population are not known. We investigated the efficacy, acceptability, and tolerability of psychological and psychosocial interventions for patients with treatment-resistant schizophrenia.
METHODS
In this systematic review and network meta-analysis (NMA), we searched for published and unpublished randomised controlled trials (RCTs) through a systematic database search in BIOSIS, CINAHL, Embase, LILACS, MEDLINE, PsychInfo, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform for articles published from inception up to Jan 31, 2020. We also searched the Cochrane Schizophrenia Group registry for studies published from inception up to March 31, 2022, and PubMed and Cochrane CENTRAL for studies published from inception up to July 31, 2023. We included RCTs that included patients with treatment-resistant schizophrenia. The primary outcome was overall symptoms. We did random-effects pairwise meta-analyses and NMAs to calculate standardised mean differences (SMDs) or risk ratios with 95% CIs. No people with lived experience were involved throughout the research process. The study protocol was registered in PROSPERO, CRD42022358696.
FINDINGS
We identified 30 326 records, excluding 24 526 by title and abstract screening. 5762 full-text articles were assessed for eligibility, of which 5540 were excluded for not meeting the eligibility criteria, and 222 reports corresponding to 60 studies were included in the qualitative synthesis. Of these, 52 RCTs with 5034 participants (1654 [33·2%] females and 3325 [66·8%] males with sex indicated) comparing 20 psychological and psychosocial interventions provided data for the NMA. Mean age of participants was 38·05 years (range 23·10-48·50). We aimed to collect ethnicity data, but they were scarcely reported. According to the quality of evidence, cognitive behavioural therapy for psychosis (CBTp; SMD -0·22, 95% CI -0·35 to -0·09, 35 trials), virtual reality intervention (SMD -0·41, -0·79 to -0·02, four trials), integrated intervention (SMD -0·70, -1·18 to -0·22, three trials), and music therapy (SMD -1·27, -1·83 to -0·70, one study) were more efficacious than standard care in reducing overall symptoms. No indication of publication bias was identified.
INTERPRETATION
We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice. Other psychological and psychosocial interventions showed promising results but need further investigation.
FUNDING
DAAD-ASFE.
Topics: Humans; Network Meta-Analysis; Psychosocial Intervention; Schizophrenia, Treatment-Resistant; Randomized Controlled Trials as Topic; Psychotherapy; Antipsychotic Agents; Treatment Outcome; Schizophrenia
PubMed: 38879276
DOI: 10.1016/S2215-0366(24)00136-6 -
Journal of Foot and Ankle Research Jun 2024The objective of this systematic review is to determine the benefits and harms of heel lifts to any comparator for lower limb musculoskeletal conditions. (Review)
Review
INTRODUCTION
The objective of this systematic review is to determine the benefits and harms of heel lifts to any comparator for lower limb musculoskeletal conditions.
METHODS
Ovid MEDLINE, Ovid AMED, Ovid EMCARE, CINAHL Plus and SPORTDiscus were searched from inception to the end of May 2024. Randomised, quasi-randomised or non-randomised trials comparing heel lifts to any other intervention or no-treatment were eligible for inclusion. Data was extracted for the outcomes of pain, disability/function, participation, participant rating of overall condition, quality of life, composite measures and adverse events. Two authors independently assessed risk of bias and certainty of evidence using the GRADE approach at the primary time point 12 weeks (or next closest).
RESULTS
Eight trials (n = 903), investigating mid-portion Achilles tendinopathy, calcaneal apophysitis and plantar heel pain were included. Heel lifts were compared to exercise, ultrasound, cryotherapy orthotics, stretching, footwear, activity modification, felt pads and analgesic medication. No outcome was at low risk of bias and few effects (2 out of 47) were clinically important. Low-certainty evidence (1 trial, n = 199) indicates improved pain relief (55.7 points [95% CI: 50.3-61.1], on a 100 mm visual analogue scale) with custom orthotics compared to heel lifts at 12 weeks for calcaneal apophysitis. Very low-certainty evidence (1 trial, n = 62) indicates improved pain and function with heel lifts over indomethacin (35.5 points [95% CI: 21.1-49.9], Foot Function Index) at 12 months for plantar heel pain.
CONCLUSIONS
Few trials have assessed the benefits and harms of heel lifts for lower limb musculoskeletal conditions. Only two outcomes out of 47 showed clinically meaningful between group differences. However, due to very low to low certainty evidence we are unable to be confident in the results and the true effect may be substantially different.
REGISTRATION
PROSPERO registration number CRD42022309644.
Topics: Humans; Heel; Treatment Outcome; Musculoskeletal Diseases; Male; Female; Lower Extremity; Randomized Controlled Trials as Topic; Pain Measurement; Tendinopathy; Adult
PubMed: 38878299
DOI: 10.1002/jfa2.12031