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Surgery Sep 2021The primary objective was to assess the perioperative efficacy of the preoperative use of progressive pneumoperitoneum or Botulinum Toxin A injections in ventral hernia... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The primary objective was to assess the perioperative efficacy of the preoperative use of progressive pneumoperitoneum or Botulinum Toxin A injections in ventral hernia repair.
METHODS
Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar were systematically searched. Studies in English reporting on fascial closure, indications, complications or postoperative outcomes in adult patients that had undergone progressive pneumoperitoneum, Botulinum Toxin A injections, or both before ventral hernia repair were included. Study quality was assessed with the Oxford Levels of Evidence guidelines and the Methodological Index for Non-Randomized Studies criteria. A pooled fascial closure rate and recurrence rate were calculated with random effects models.
RESULTS
Twenty studies were included from the 905 identified, comprising the use progressive pneumoperitoneum (n = 11), Botulinum Toxin A (n = 6), and both techniques (n = 3). The overall fascial closure rate was 0.94 (95% confidence interval 0.89-0.98). Indications for the use of progressive pneumoperitoneum or Botulinum Toxin A were based on objective (eg, computed tomography measurements) or subjective measures (eg, foreseen surgical problems). In contrast to the use of Botulinum Toxin A, reported complications with the use of progressive pneumoperitoneum were ample and sometimes severe. The cumulative reported recurrence rate was 0.03 (95% confidence interval 0.01-0.06).
CONCLUSION
Preoperative progressive pneumoperitoneum and Botulinum Toxin A can facilitate fascial closure without causing significant numbers of adverse events. Botulinum Toxin A qualifies for low-threshold use, yet progressive pneumoperitoneum should be used cautiously owing to a larger number of complications. Definitive recommendations cannot be made as the quality of included studies is low, bias is present, and comparative information is scarce. Registration number Information about the design and conduct of this systematic review has been registered on PROSPERO, registration number CRD42020181679.
Topics: Abdominal Muscles; Botulinum Toxins, Type A; Fascia; Hernia, Ventral; Herniorrhaphy; Humans; Injections, Intramuscular; Neuromuscular Agents; Pneumoperitoneum, Artificial; Preoperative Care; Surgical Mesh
PubMed: 33888320
DOI: 10.1016/j.surg.2021.03.027 -
Translational Psychiatry Apr 2021Exposure to early life stress (ELS) causes abnormal hippocampal development and functional deficits in rodents and humans, but no meta-analysis has been used yet to... (Meta-Analysis)
Meta-Analysis
Exposure to early life stress (ELS) causes abnormal hippocampal development and functional deficits in rodents and humans, but no meta-analysis has been used yet to quantify the effects of different rodent models of ELS on hippocampal-dependent memory. We searched PubMed and Web of Science for publications that assessed the effects of handling, maternal separation (MS), and limited bedding and nesting (LBN) on performance in the Morris water maze (MWM), novel object recognition (NOR), and contextual fear conditioning (CFC). Forty-five studies met inclusion criteria (n = 451-763 rodents per test) and were used to calculate standardized mean differences (Hedge's g) and to assess heterogeneity, publication bias, and the moderating effects of sex and species (rats vs. mice). We found significantly lower heterogeneity in LBN compared to handling and MS with no consistent effects of sex or species across the three paradigms. LBN and MS caused similar cognitive deficits in tasks that rely heavily on the dorsal hippocampus, such as MWM and NOR, and were significantly different compared to the improved performance seen in rodents exposed to handling. In the CFC task, which relies more on the ventral hippocampus, all three paradigms showed reduced freezing with moderate effect sizes that were not statistically different. These findings demonstrate the utility of using meta-analysis to quantify outcomes in a large number of inconsistent preclinical studies and highlight the need to further investigate the possibility that handling causes different alterations in the dorsal hippocampus but similar outcomes in the ventral hippocampus when compared to MS and LBN.
Topics: Animals; Mice; Rats; Hippocampus; Maternal Deprivation; Memory; Stress, Psychological
PubMed: 33879774
DOI: 10.1038/s41398-021-01352-4 -
BJS Open Mar 2021Ventra hernias are increasing in prevalence and many recur despite attempted repair. To date, much of the literature is underpowered and divergent. As a result there is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ventra hernias are increasing in prevalence and many recur despite attempted repair. To date, much of the literature is underpowered and divergent. As a result there is limited high quality evidence to inform surgeons succinctly which perioperative variables influence postoperative recurrence. This systematic review aimed to identify predictors of ventral hernia recurrence.
METHODS
PubMed was searched for studies reporting prognostic data of ventral hernia recurrence between 1 January 1995 and 1 January 2018. Extracted data described hernia type (primary/incisional), definitions of recurrence, methods used to detect recurrence, duration of follow-up, and co-morbidity. Data were extracted for all potential predictors, estimates and thresholds described. Random-effects meta-analysis was used. Bias was assessed with a modified PROBAST (Prediction model Risk Of Bias ASsessment Tool).
RESULTS
Screening of 18 214 abstracts yielded 274 individual studies for inclusion. Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade III-IV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
CONCLUSION
This study summarized the current evidence base for predicting ventral hernia recurrence. Results should inform best practice and future research.
Topics: Hernia, Ventral; Herniorrhaphy; Humans; Laparoscopy; Randomized Controlled Trials as Topic; Recurrence; Surgical Mesh; Suture Techniques; Treatment Outcome
PubMed: 33839749
DOI: 10.1093/bjsopen/zraa071 -
Cureus Mar 2021Attention-deficit hyperactivity disorder (ADHD) is a neuropsychological disorder that causes inattentiveness, hyperactivity, and impulsiveness in patients. Ventral... (Review)
Review
Attention-deficit hyperactivity disorder (ADHD) is a neuropsychological disorder that causes inattentiveness, hyperactivity, and impulsiveness in patients. Ventral striatal hypo-responsiveness, orbitofrontal cortex, and dopaminergic status in the brain are related to the pathogenesis of ADHD. Reinforcement tasks by monetary incentive delay (MID) was shown to produce more responsiveness in patients. In this study, we reviewed how reinforcement interventions and compensatory mechanisms affect the behavior of ADHD patients. This systematic review was undertaken as per the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, and PubMed database was used for literature search. The quality appraisal was completed using the Newcastle-Ottawa scale, and nine case-control studies were included in this systematic review. A total of 976 participants were included, with 493 cases and 330 controls. The studies included discuss reinforcement, attention networks, and compensatory mechanisms. Our review concludes that reinforcement improves responsiveness to gain and loss of rewards in ADHD patients. Reward processing is selectively associated with the salience network. While ADHD, predominantly the inattentive type, is insensitive to stimuli, ADHD combined type and controls showed similar responsiveness. The right visual cortex may also be related to compensatory mechanisms in ADHD. As we only included case-control studies from the last eight years, in the English language, we might have missed some relevant studies related to this research. Because the included studies have a relatively small sample size, we recommend future studies to explore larger cohorts of patients to improve the reliability of findings pertinent to this field.
PubMed: 33833929
DOI: 10.7759/cureus.13718 -
Current Neuropharmacology 2022Default Mode Network (DMN) is recognized to be involved in the generation and propagation of epileptic activities in various epilepsies. Converging evidence has... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Default Mode Network (DMN) is recognized to be involved in the generation and propagation of epileptic activities in various epilepsies. Converging evidence has suggested disturbed Functional Connectivity (FC) in epilepsies, which was inferred to be related to underlying pathological mechanisms. However, abnormal changes of FC in DMN revealed by different studies are controversial, which obscures the role of DMN in distinct epilepsies.
OBJECTIVE
The present work aims to investigate the voxel-wise FC in DMN across epilepsies Methods: A systematic review was conducted on 22 published articles before October 2020, indexed in PubMed and Web of Science. A meta-analysis with a random-effect model was performed using the effect-size signed differential mapping approach. Subgroup analyses were performed in three groups: Idiopathic Generalized Epilepsy (IGE), mixed Temporal Lobe Epilepsy (TLE), and mixed Focal Epilepsy (FE) with different foci.
RESULTS
The meta-analysis suggested commonly decreased FC in mesial prefrontal cortices across different epilepsies. Additionally decreased FC in posterior DMN was observed in IGE. The TLE showed decreased FC in temporal lobe regions and increased FC in the dorsal posterior cingulate cortex. Interestingly, an opposite finding in the ventral and dorsal middle frontal gyrus was observed in TLE. The FE demonstrated increased FC in the cuneus.
CONCLUSION
The current findings revealed both common and specific alterations of FC in DMN across different epilepsies, highlighting the contribution of these dysfunctions to epileptic activities and cognitive behaviors in patients. Furthermore, the current study provided powerful evidence to support DMN as a potential candidate for effective intervention in epilepsy.
Topics: Brain Mapping; Default Mode Network; Epilepsy, Temporal Lobe; Humans; Magnetic Resonance Imaging; Prefrontal Cortex
PubMed: 33823767
DOI: 10.2174/1570159X19666210325130624 -
Annals of Medicine and Surgery (2012) Mar 2021Given the risk of surgical site infection (SSI), the use of mesh in contaminated ventral hernia repair (VHR) is not standardized and still a clinical dilemma. This... (Review)
Review
BACKGROUND
Given the risk of surgical site infection (SSI), the use of mesh in contaminated ventral hernia repair (VHR) is not standardized and still a clinical dilemma. This meta-analysis aimed to assess whether mesh use increased the risk of SSI in patients following VHR in contaminated field.
METHODS
We performed a systematic review of published literature. Studies comparing the mesh repair and anatomic repair, the use of mesh in different Center for Disease Control and Prevention (CDC) wound classes and mesh repair with synthetic mesh or other type of meshes to treat complicated and contaminated VHR were considered for analysis. The main outcome was SSI incidence.
RESULTS
Six studies compared mesh and suture repairs. No significant difference in SSI incidence was observed between patients with complicated VHR in the mesh and suture repair groups.Five studies analyzed mesh repair in patients by field contamination level. There was no significant difference between the use of mesh in clean-contaminated, contaminated and dirty field versus clean wound class. Moreover, there was no significant difference between the use of mesh in clean-contaminated and contaminated cases.Four studies compared mesh repair technique with synthetic mesh or other type of meshes were included. The incidence of SSI was significantly lower in the synthetic mesh group.
CONCLUSIONS
The use of mesh repair in the management of complicated VHR compared to suture repair is not associated with an increased incidence of SSI even in potentially contaminated fields.
PubMed: 33680450
DOI: 10.1016/j.amsu.2021.02.019 -
Brain Imaging and Behavior Oct 2021Knowing target regions undergoing strfuncti changes caused by behavioural interventions is paramount in evaluating the effectiveness of such practices. Here, using a... (Meta-Analysis)
Meta-Analysis Review
Knowing target regions undergoing strfuncti changes caused by behavioural interventions is paramount in evaluating the effectiveness of such practices. Here, using a systematic review approach, we identified 25 peer-reviewed magnetic resonance imaging (MRI) studies demonstrating grey matter changes related to mindfulness meditation. An activation likelihood estimation (ALE) analysis (n = 16) revealed the right anterior ventral insula as the only significant region with consistent effect across studies, whilst an additional functional connectivity analysis indicates that both left and right insulae, and the anterior cingulate gyrus with adjacent paracingulate gyri should also be considered in future studies. Statistical meta-analyses suggest medium to strong effect sizes from Cohen's d ~ 0.8 in the right insula to ~ 1 using maxima across the whole brain. The systematic review revealed design issues with selection, information, attrition and confirmation biases, in addition to weak statistical power. In conclusion, our analyses show that mindfulness meditation practice does induce grey matter changes but also that improvements in methodology are needed to establish mindfulness as a therapeutic intervention.
Topics: Brain; Cerebral Cortex; Gray Matter; Humans; Magnetic Resonance Imaging; Mindfulness
PubMed: 33624219
DOI: 10.1007/s11682-021-00453-4 -
BJS Open Jan 2021This systematic review and meta-analysis aimed to compare recurrence rates of rectal prolapse following ventral mesh rectopexy (VMR) and suture rectopexy (SR). (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
This systematic review and meta-analysis aimed to compare recurrence rates of rectal prolapse following ventral mesh rectopexy (VMR) and suture rectopexy (SR).
METHODS
MEDLINE, Embase, and the Cochrane Library were searched for studies reporting on the recurrence rates of complete rectal prolapse (CRP) or intussusception (IS) after SR and VMR. Results were pooled and procedures compared; a subgroup analysis was performed comparing patients with CRP and IS who underwent VMR using biological versus synthetic meshes. A meta-analysis of studies comparing SR and VMR was undertaken. The Methodological Items for Non-Randomized Studies score, the Newcastle-Ottawa Scale, and the Cochrane Collaboration tool were used to assess the quality of studies.
RESULTS
Twenty-two studies with 976 patients were included in the SR group and 31 studies with 1605 patients in the VMR group; among these studies, five were eligible for meta-analysis. Overall, in patients with CRP, the recurrence rate was 8.6 per cent after SR and 3.7 per cent after VMR (P < 0.001). However, in patients with IS treated using VMR, the recurrence rate was 9.7 per cent. Recurrence rates after VMR did not differ with use of biological or synthetic mesh in patients treated for CRP (4.1 versus 3.6 per cent; P = 0.789) and or IS (11.4 versus 11.0 per cent; P = 0.902). Results from the meta-analysis showed high heterogeneity, and the difference in recurrence rates between SR and VMR groups was not statistically significant (P = 0.76).
CONCLUSION
Although the systematic review showed a higher recurrence rate after SR than VMR for treatment of CRP, this result was not confirmed by meta-analysis. Therefore, robust RCTs comparing SR and biological VMR are required.
Topics: Digestive System Surgical Procedures; Humans; Intussusception; Randomized Controlled Trials as Topic; Rectal Prolapse; Recurrence; Surgical Mesh; Sutures
PubMed: 33609376
DOI: 10.1093/bjsopen/zraa037 -
Journal of Gastrointestinal Surgery :... May 2021Portal annular pancreas (PAP) is an anatomic variation due to aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein. In this article, we... (Review)
Review
INTRODUCTION
Portal annular pancreas (PAP) is an anatomic variation due to aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein. In this article, we present a case report with a systematic review of literature of patients undergoing major pancreatic surgery with associated PAP. We also intend to discuss and suggest possible surgical strategies to minimise major postoperative complications.
METHODS
A systematic literature search was conducted using the terms "circumportal," "periportal," "pancreas," "annular pancreas," "portal annular pancreas" and "pancreas anomaly." All articles describing portal annular pancreas with surgical resection were included.
RESULTS
We identified a total of 53 patients of PAP from 29 articles, who underwent pancreatic resection with a median age of 65 years. POPF (postoperative pancreatic fistula) was demonstrated in 42.55% of patients and 34% had CR (clinically relevant)-POPF. Following pancreaticoduodenectomy, pancreatic stump was reconstructed in all patients with either pancreaticojejunostomy or pancreaticogastrostomy. Standard line of pancreatic transection, i.e., division of anteportal portion at the pancreatic neck and stapling of the retroportal process, resulted in 71% incidence of CR-POPF, whereas it was only 16% when extended resection was performed to achieve single pancreatic stump and 12.5% when retroportal portion was sutured or ligated. Amongst distal pancreatic resections, 66% had POPF and 33% developed CR-POPF.
CONCLUSION
It is of utmost importance for pancreatic surgeons to diligently look for and identify PAP in the preoperative imaging. Additional imaging in the form of MRCP helps to define abnormal pancreatic ductal anatomy. Surgeons need to be cognisant of pancreatic stump management in patients with PAP to reduce associated higher rates of POPF.
Topics: Aged; Humans; Pancreas; Pancreatic Diseases; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications
PubMed: 33555524
DOI: 10.1007/s11605-021-04927-0 -
PloS One 2021Functional neuroimaging is a powerful and versatile tool to investigate central lower urinary tract (LUT) control. Despite the increasing body of literature there is a... (Meta-Analysis)
Meta-Analysis
PURPOSE
Functional neuroimaging is a powerful and versatile tool to investigate central lower urinary tract (LUT) control. Despite the increasing body of literature there is a lack of comprehensive overviews on LUT control. Thus, we aimed to execute a coordinate based meta-analysis of all PET and fMRI evidence on descending central LUT control, i.e. pelvic floor muscle contraction (PFMC) and micturition.
MATERIALS AND METHODS
A systematic literature search of all relevant libraries was performed in August 2020. Coordinates of activity were extracted from eligible studies to perform an activation likelihood estimation (ALE) using a threshold of uncorrected p <0.001.
RESULTS
20 of 6858 identified studies, published between 1997 and 2020, were included. Twelve studies investigated PFMC (1xPET, 11xfMRI) and eight micturition (3xPET, 5xfMRI). The PFMC ALE analysis (n = 181, 133 foci) showed clusters in the primary motor cortex, supplementary motor cortex, cingulate gyrus, frontal gyrus, thalamus, supramarginal gyrus, and cerebellum. The micturition ALE analysis (n = 107, 98 foci) showed active clusters in the dorsal pons, including the pontine micturition center, the periaqueductal gray, cingulate gyrus, frontal gyrus, insula and ventral pons. Overlap of PFMC and micturition was found in the cingulate gyrus and thalamus.
CONCLUSIONS
For the first time the involved core brain areas of LUT motor control were determined using ALE. Furthermore, the involved brain areas for PFMC and micturition are partially distinct. Further neuroimaging studies are required to extend this ALE analysis and determine the differences between a healthy and a dysfunctional LUT. This requires standardization of protocols and task-execution.
Topics: Humans; Likelihood Functions; Pelvic Floor; Urinary Tract; Urinary Tract Physiological Phenomena; Urination
PubMed: 33534812
DOI: 10.1371/journal.pone.0246042