Factors Associated with Increased Risk of Recurrence following Treatment of Trigger Finger with Corticosteroid Injection

Introduction  The aim of the study was to estimate recurrence rates, time to recurrence, and predisposing factors for recurrence of trigger finger when treated with corticosteroid (CS) injection as primary treatment. Materials and Methods  In a retrospective chart review, we identified primary trigger fingers treated with CS injection as primary treatment. Affected hand and finger, recurrence, time to recurrence, duration of symptoms, secondary treatment type, and comorbidities were recorded. A total of 539 patients were included with a mean follow-up of 47.6 months Results  In total, 330/539 (61%) recurrences were registered. Mean time to recurrence was 312 days. Increased risk of recurrence was seen after treatment of the third finger (relative risk [RR]: 1.22; 95% confidence interval [CI]: 1.06–1.39). Several comorbidities were associated with increased risk of recurrence: carpal tunnel syndrome (RR: 1.27; 95% CI: 1.07–1.52), thyroid disease (RR: 1.45; 95% CI: 1.15–1.83), or shoulder diseases (RR: 1.58; 95% CI: 1.36–1.83). Conclusion  We found a recurrence rate after primary treatment of CS injection for trigger finger of 61%. Most recurrences happened within 2 years and we found treatment of third finger, carpal tunnel syndrome, shoulder, or thyroid disease to be associated with an increased risk of recurrence of symptoms.     

Percutaneous Release,Open Surgery,or Corticosteroid Injection,Which Is the Best Treatment Method for Trigger Digits?

Background

Percutaneous A1 pulley release surgery for trigger digit (finger or thumb) has gained popularity in recent decades. Although many studies have reported the failure rate and complications of percutaneous release for trigger digit, the best treatment for trigger digit remains unclear.

Questions/purposes

Our aim was to identify the relative risk of treatment failure, level of satisfaction, and frequency of complications, comparing percutaneous release with open surgery or corticosteroid injections for adult patients with trigger digits.

Methods

We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs), comparing percutaneous release with open surgery or corticosteroid injections. Seven RCTs involving 676 patients were identified. Methodologic quality was assessed by the Detsky quality scale. After data extraction, we compared results using a fixed meta-analysis model.

Results

There were no differences in the failure rate (risk ratio [RR] = 0.93; 95% CI, 0.14–6.25) and complication frequency (RR = 0.83; 95% CI, 0.15–4.72) between patients undergoing percutaneous release and open surgery. Patients treated with percutaneous release had fewer failures (RR = 0.07; 95% CI, 0.02–0.21) and a greater level of satisfaction (RR = 2.01; 95% CI, 1.62–2.48) compared with the patients treated with corticosteroid injections. We found no difference in complication frequency between percutaneous release and corticosteroid injection (RR = 3.19; 95% CI, 0.51–19.91).

Conclusions

The frequencies of treatment failure and complications were no different between percutaneous release surgery and open surgery for trigger digit in adults. Patients treated with percutaneous releases were less likely to have treatment failure than patients treated with corticosteroid injections.     

Prevalence and factors associated with pressure injury in patients undergoing open heart surgery: A systematic review and meta-analysis

Pressure injuries (PIs) are one of the major and costliest medical problems with severe implications for patients. Cardiovascular surgery patients are at the higher risk of developing surgery-related PIs. So this study was conducted with the aim of investigating the prevalence and factors associated with PIs in patients undergoing open heart surgery. We identified articles through electronic databases such as Web of Science, Scopus, PubMed, ProQuest; and Persian Databases: SID, Magiran and Irandoc without restriction on language or publication period (from inception through June 2022). Finally, 17 studies that fulfilled eligibility criteria were included in final systematic review and meta-analysis. Data analyses were conducted using STATA version 14. The pooled prevalence of PI in patients undergoing open heart surgery was 24.06% (95% CI: 17.85–30.27). High heterogeneity was observed across the included studies (I² = 96.0, P < 0.000). The prevalence by gender was reported as 25.19% (95% CI: 13.45–36.93) in men and 33.36% (95 CI%: 19.99–46.74) in women. The result showed there was statistically significant association between PI and Female sex (Pooled Est: 1.551, 95% CI: 1.199–2.006, z = 3.345, P = 0.001), diabetes (Pooled Est: 1.985, 95% CI: 1.383–2.849, z = 3.719, P = 0.000), advanced age (SMD: 0.33 years; 95% CI: 0.09–0.57), Duration of surgery (SMD: 0.47; 95% CI: 0.19–0.75) and preoperative serum albumin level (SMD: 0.56; 95% CI: 0.14–0.98). The relatively high PIs incidence among patients undergoing open heart surgery suggests that typical PI prevention methods are insufficient for this population. Targeted prevention measures must be developed and implemented.     

Is unilateral pedicle screw fixation as effective as bilateral pedicle screw fixation in transforaminal lumbar interbody fusion: a meta-analysis of randomized controlled trials

Purpose

This meta-analysis aimed to investigate whether unilateral pedicle screw fixation (UPSF) is comparable to bilateral pedicle screw fixation (BPSF) in transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases.

Methods

Up to September 2022, established electronic literature databases including PubMed, Web of Science, EMBASE, and the Cochrane Library were systematically searched. Randomized controlled trials (RCTs) published in English that compared the efficacy of UPSF versus BPSF in TLIF were included. The methodological quality was evaluated, relevant data was extracted, and suitable meta-analysis was carried out. Data of fusion rate, complications, cage migration, visual analog scale (VAS), and Oswestry Disability Index (ODI), total blood loss (TBL), operation time, and hospital stay were extracted and analyzed. Pooled mean differences and risk ratio (RR) along with 95% confidence intervals (95% CI) were calculated for the results.

Results

Ten RCTs including 614 patients (UPSF = 294, BPSF = 320) were included in our meta-analysis. There were no significant differences in terms of fusion rate, VAS (VAS-BP and VAS-LP), ODI, complications, or hospital stay between UPSF and BPSF groups (P > 0.05, respectively). The UPSF group clearly had the advantage of less blood loss (SMD = −2.99, 95% CI [−4.54, −1.45], P = 0.0001) and operation time (SMD = −2.05, 95% CI [−3.10, −1.00], P = 0.0001). However, UPSF increased cage migration more than BPSF (10.7% vs 4.8%, RR = 2.23, 95% CI [1.07, 4.65],  P = 0.03).

Conclusion

According to the findings of this meta-analysis, UPSF is just as effective as BPSF in TLIF and may reduce blood loss and operation time. Nevertheless, UPSF may result in more cage migration than BPSF.

     

Meta-Analysis on Microdiscectomy and Sequestrectomy for Lumbar Disc Herniation

Purpose: Lumbar disc herniation (LDH) is a common cause of low back pain and mainly occurs in patients aged 24 to 45 years. To further compare the efficacy of microdiscectomy and sequestrectomy, we made quantitative evaluation of clinical studies published so far by meta-analysis in order to provide information for clinical decision. Methods: Literatures reporting randomized controlled studies that compared the efficacy of microdiscectomy and sequestrectomy for LDH were retrieved from major databases using predefined inclusion and exclusion criteria. Results: Meta-analysis showed that microdiscectomy resulted in higher low back pain VAS score (standard mean difference, SMD = 0.86, 95% confidential interval, CI: 0.19, 1.53; P = 0.01) and there was not statistically significant difference in the incidence of re-operation (odd ratio, OR = 0.85, 95% CI: 0.46, 1.85; P = 0.60) and neuropathic pain VAS scores (SMD = 0.51, 95% CI: ?0.16, 1.18; P = 0.14) between the methods. Conclusion: Both microdiscectomy and sequestrectomy had good curative results in the treatment of LDH. In low back pain VAS score, the former was better than the latter, while in the analgesic usage rate, the latter was superior to the former. In clinical practice, the choice of surgical method should be considered on the basis of actual situations.     

Early versus late weightbearing in conservative management of acute achilles tendon rupture: A systematic review and meta-analysis of randomized controlled trials

BackgroundAchilles tendon rupture (ATR) is one of the most frequently encountered injuries in Sports Medicine. ATR can be managed surgically or conservatively followed by early functional rehabilitation or cast immobilization. The aim of the present systematic review and meta-analysis was to provide an update about the role of early weightbearing (WB) versus late WB on the clinical outcomes of adults with acute ATR.MethodsWe performed a systematic literature search in Web of Science, Ovid, Medline/PubMed, and CENTRAL. We included randomized controlled trials (RCTs) that compared early WB, defined as weight-bearing within 4 weeks of treatment, to late WB for individuals with acute (<14 days) ATR. We sought to evaluate the following outcomes: re-rupture rate, Achilles Tendon Rupture Score (ATRS), return to pre-injury sport activity, time to return to work, and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes while the risk ratio (RR) was used to represent dichotomous outcomes.ResultsA total of 9 RCTs that enrolled 1046 participants were deemed eligible. There was no significant difference between early WB and late WB in terms of re-rupture rate (RR=0.75, 95% CI 0.49 to 1.16), ATRS (SMD=0.06, 95% CI –0.03 to 0.16), return to pre-injury sport activity (RR=1.05, 95% CI 0.86 to 1.28), time to return to work (SMD=0.03, 95% CI –0.20 to 0.26), or adverse event rate (RR=1.87, 95% CI 0.53 to 6.63).ConclusionThis meta-analysis shows no difference in the functional outcomes and patient-reported outcomes between early functional rehabilitation and cast immobilization for conservatively treat individuals with acute ATR.     

Short leg cast versus orthotic removable support for the management of pseudo-Jones avulsion fracture: A systematic review and meta-analysis

BackgroundThe fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture.MethodsWe searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P <0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes.ResultsA total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74).ConclusionThe current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture.     

A Study of Incidence of AKI in Critically Ill Patients

Background: There have been many studies to estimate the incidence of acute kidney injury (AKI) in critically ill patients. However, results were variable due to the non-usage of uniform criteria and retrospective design of most studies. There are no new studies from the developing countries looking at AKI in these patients since adoption of uniform Acute Kidney Injury Network (AKIN) criteria. Methods: In this prospective observational study from a tertiary care hospital in India, we enrolled 100 consecutively admitted critically ill patients and followed them during hospital stay. AKI was defined by AKIN criteria. Both the groups of patients, those who developed AKI and those who did not develop AKI, were then followed during the course of their hospital stay. Results: AKI occurred in 33 patients with an incidence rate of 17.3 per person year. Thirty-one out of 33 (93.9%) patients died in the AKI group, whereas 31 out of 67 (53.7%) patients died in the non-AKI group. Independent risk factors for AKI were older age (adjusted relative risk (RR) = 4.42, 95% CI = 2.57–5.23), septic shock (adjusted RR = 2.82, 95% CI = 1.43–3.80), prolonged duration of mechanical ventilation (adjusted RR = 2.35, 95% CI = 1.09–3.6), higher acute physiology and chronic health evaluation II (APACHE II) score (adjusted RR = 2.74, 95% CI = 1.28–4.13), and higher sequential organ failure assessment (SOFA) score (adjusted RR = 2.53, 95% CI = 1.04–4.08). Development of AKI was an independent risk factor for mortality (adjusted RR = 1.76, 95% CI = 1.25–1.84). Conclusion: Older patients, those with septic shock, and those requiring prolonged mechanical ventilation had increased risk for AKI. AKI was an independent predictor of mortality.     

Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta‐Analysis

This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case–control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle–Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = −0.11; 95% CI: [−0.21 to −0.01], p = 0.03), but not at 3 months (MD = −0.21; 95% CI: [−0.41–0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [−0.13–0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = −0.28; 95% CI: [−0.62–0.05], p = 0.10), 3 months (MD = −1.52; 95% CI: [−3.11–0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [−0.13–0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [−1.69–2.30], p = 0.77) or anterior vertebral body height (SMD = −0.01; 95% CI: [−0.26–0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = −8.60; 95% CI: [−13.75 to −3.45], p = 0.001), cement infusion volume (MD = −0.82; 95% CI: [−1.50 to −0.14], P = 0.02), and dose of fluoroscopy (SMD = −1.22; 95% CI: [−1.84 to −0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27–0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.     

Optimal management of distal ureteric strictures following renal transplantation: a systematic review

Our objective was to define optimal management of distal ureteric strictures following renal transplantation. A systematic review on PubMed identified 34 articles (385 patients). Primary endpoints were success rates and complications of specific primary and secondary treatments (following failure of primary treatment). Among primary treatments (n = 303), the open approach had 85.4% success (95% CI 72.5–93.1) and the endourological approach had 64.3% success (95% CI 58.3–69.9). Among secondary treatments (n = 82), the open approach had 93.1% success (95% CI 77.0–99.2) and the endourological approach had 75.5% success (95% CI 62.3–85.2). The most common primary open treatment was ureteric reimplantation (n = 33, 81.8% success, 95% CI 65.2–91.8). The most common primary endourological treatment was dilation (n = 133, 58.6% success, 95% CI 50.1–66.7). Fourteen complications, including death (4 weeks post‐op) and graft loss (12 days post‐op), followed endourological treatment. One complication followed open treatment. This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures following renal transplantation. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post‐transplant distal ureteric strictures. We also outline a post‐transplant ureteric stricture evaluation and treatment algorithm.     

The effectiveness and safety of rituximab as induction therapy in ABO-compatible non-sensitized renal transplantation: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The objective of this systematic review and meta-analysis was to evaluate the effectiveness and safety of rituximab as induction therapy in ABO-compatible, non-sensitized renal transplantation. Methods: A literature search for randomized controlled trials (RCTs) was performed from inception through February 2015. Studies that reported relative risks or hazard ratios comparing the risks of biopsy-proven acute rejection (BPAR), graft loss, leukopenia, infection or mortality in ABO-compatible, non-sensitized renal transplant recipients who received rituximab as induction therapy versus controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method. Results: Four RCTs with 480 patients were included in the meta-analysis. Pooled RR of BPAR in recipients with rituximab induction was 0.90 (95% CI 0.50–1.60). Compared to placebo, the risk of BPAR in rituximab group was 0.76 (95% CI 0.51–1.14, I²?=?0). The risk of leukopenia was increased in rituximab group with the pooled RR of 8.22 (95% CI 2.08–32.47). There were no statistical differences in the risks of infection, graft loss and mortality at 3–6 months after transplantation with pool RRs of 1.02 (95% CI 0.85–1.21), 0.55 (95% CI 0.21–1.48) and 0.58 (95% CI 0.17–1.99), respectively. Conclusion: This meta-analysis demonstrated insignificant reduced risks of BPAR, graft loss or mortality among in ABO-compatible, non-sensitized renal transplant recipients with rituximab induction. Although rituximab induction significantly increases risk of leukopenia, it appears to be safe with no significant risk of infection.     

In-hospital nursing care intervention increasing the effect of vacuum sealing drainage on wound healing: A meta-analysis

Vacuum sealing drainage (VSD) could effectively drain superficial wounds and deep tissues, which is beneficial for wound healing. More incentives in nursing care to improve the therapeutic effect of VSD on wound healing were further investigated. Different databases were retrieved for full-text publications about the comparison between intervention nursing care and regular nursing care. Heterogeneity was detected by I² method, and a random-effect model was applied for data pooling if there existed heterogeneity. Publication bias was analysed by a funnel plot. Eight studies with 762 patients were included for final meta-analysis. In the nursing care intervention group, shorter hospital stay duration (pooled SMD = −2.602, 95% confidence interval: −4.052–−1.151), shorter wound healing time (pooled SMD = −1.105, 95% confidence interval: −1.857–−0.353), lower pain score (pooled SMD = −2.490, 95% confidence interval: −3.521–−1.458), lower drainage tube blocked rate (pooled RR = 0.361, 95% confidence interval: 0.268–0.486), and higher nursing satisfaction (pooled RR = 1.164, 95% confidence interval: 1.095–1.237) was confirmed. More active and incentive nursing care could significantly improve the therapeutic effect of VSD on wound healing, in terms of hospitalisation time, wound healing time, painful symptoms, drainage tube blockage, and nursing satisfaction.     

髂筋膜间隙阻滞对老年患者髋部骨折手术围术期镇痛的影响Meta分析

目的 采用Meta分析的方法系统评价髂筋膜间隙阻滞(FICB)对老年患者髋部骨折手术围术期镇痛效果及安全性的影响.方法 检索Medline、Ovid、Cochrane、Embase、知网、万方、维普等数据库,收集1996—2020年发表的FICB用于老年患者髋部骨折手术的随机对照试验(RCT),对照组在围术期给予生理盐...     

Efficacy and safety of tacrolimus versus corticosteroid as initial monotherapy in adult-onset minimal change disease: a meta-analysis

Objective

The objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus corticosteroid as initial monotherapy in adult-onset minimal change disease (MCD) patients.

Methods

Databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched from the inception to March 20, 2021. Eligible studies comparing TAC monotherapy and corticosteroid as initial monotherapy for adult-onset MCD patients were included. Data were analyzed using Review Manager Version 5.3.

Results

Four randomized controlled trials (RCTs) involving 196 patients were included in the meta-analysis. For initial monotherapy for adult-onset MCD, TAC and corticosteroid had similar complete remission (OR 1.06, 95% CI 0.47–2.41, P?=?0.89), total remission (OR 1.30, 95% CI 0.39–4.35, P?=?0.67), relapse rate (OR 0.63, 95% CI 0.28–1.42, P?=?0.26). Main drug-related adverse effects of two therapeutic regimens had no difference concerning infection (OR 0.54, 95% CI 0.23–1.27, P?=?0.15), glucose intolerance (OR 0.55, 95% CI 0.16–1.84, P?=?0.33) and acute renal failure (OR 1.37, 95% CI 0.36–7.31, P?=?0.71).

Conclusion

TAC monotherapy is comparable with corticosteroid monotherapy in initial therapy of MCD. To further confirm the conclusion, more large multicenter RCTs are necessary.

     

Prognostic value of pathologic fracture in patients with high grade localized osteosarcoma: A systemic review and meta‐analysis of cohort studies

Consensus has not been reached regarding the ability of pathologic fracture to predict local recurrence and survival in osteosarcoma. We aim to review the available evidence to examine the association between pathologic fracture and osteosarcoma prognosis. A comprehensive literature search for relevant studies published until March 2014 was performed using PubMed, Cochrane and Web of Science. The studies investigating pathologic fracture of osteosarcoma patients were systematically analyzed. The overall relative risk (RR) was estimated using a fixed‐effect model or random‐effect model according to heterogeneity between the trials. We included nine cohort studies involving 2,187 patients (311 with pathologic fracture and 1,876 without fracture) for the analysis of survival rate and local recurrence. Studies were assessed for quality using the Newcastle–Ottawa Assessment Scale. In the fixed‐effects model, the meta‐analysis showed that pathologic fracture in osteosarcoma patients predicted poor 3‐year overall survival (OS) (RR = 1.86, 95% CI: 1.37–2.53, p < 0.001) and 5‐year OS (RR = 1.34, 95% CI: 1.06–1.70, p = 0.016). Similarly, pathologic fracture was significantly correlated with worse 3‐year event free survival (EFS) (RR = 1.52, 95% CI: 1.21–1.92, p < 0.001) and 5‐year EFS (RR = 1.24, 95% CI: 1.03–1.49, p = 0.021), whereas no significant association was noted with local recurrence (RR = 1.30, 95% CI: 0.84–2.02, p = 0.233). The meta‐analysis confirmed that pathologic fracture in osteosarcoma was a prognostic marker for both OS and EFS but not for local recurrence. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:131–139, 2015.     

Reimplantation versus remodeling: a meta-analysis

Abstract Background: Reimplantation and remodeling procedure are two different techniques for valve–sparing aortic root surgery. A number of comparative series have been published but, to date, there has been no meta‐analysis comparing outcomes following the two techniques. Methods: This meta‐analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews. A public domain database (MEDLINE) was searched to identify relevant series. Pooled risk ratios (RR) were calculated using fixed effects models for early (30‐day) mortality, late deaths, and reoperation related to moderate or severe aortic insufficiency (AI) during follow‐up. Results: The search identified seven eligible series, totaling 672 patients (367 reimplantation patents). There was no significant difference in early (30‐day) mortality (pooled RR 1.06; 95% CI 0.36 to 3.10; p = 0.92) and late deaths (pooled RR 0.57; 95% CI 0.18 to 1.87; p = 0.36) between reimplantation and remodeling groups. However, reimplantation technique has less chance for reoperation related to moderate or severe AI during follow‐up (pooled RR 0.46; 95% CI 0.23 to 0.92; p = 0.03). Conclusion: Comparing with remodeling, reimplantation technique has less chance for reoperation related to moderate or severe AI during long‐term follow‐up. (J Card Surg 2011;26:82‐87)     

Meta-analysis of the effect of bariatric surgery on physical activity

BackgroundObesity leads to impairment of physical activity as measured by an inability to perform activities of daily living. Literature on the effect of bariatric surgery on physical activity is conflicting.ObjectiveThe aim of this study was to perform a meta-analysis of the effect of bariatric surgery on physical activity from studies employing objective measurement and self-reporting of physical activity before and after bariatric surgery.MethodsBibliographic databases were searched systematically for relevant literature until December 31, 2018. Studies employing objective and self-reported measurement of physical activity were included. Study quality was assessed using Risk of Bias in Nonrandomized Studies - of Interventions tool. Meta-analysis was performed using random effects model and presented as standardized mean difference (SMD) with 95% confidence intervals (CI).ResultsTwenty studies identified 5886 patients suitable for the analysis. Physical activity showed significant improvement at 0–6 months (SMD: .50; 95% CI: .25–.76; P = .0001), >6–12 months (SMD: .58; 95% CI: .26–.91; P = .0004), and >12–36 months (SMD: .82; 95% CI: .27–1.36; P = .004) after bariatric surgery. Self-reported assessment after bariatric surgery showed significant improvement at 0–6 months (SMD: .65; 95% CI: .29–1.01; P = .0004), >6 to 12 months (SMD: .53; 95% CI: .18–.88; P = .003), and >12–36 months (SMD: .51; 95% CI: .46–.55; P < .00001). Objective assessment after bariatric surgery did not show improvement at 0–6 months (SMD: .31; 95%CI:?.05–.66; P = .09), but showed significant improvement at >6–12 months (SMD: .85; 95% CI:?.07–1.62; P = .03), and >12–36 months (SMD: 1.99; 95% CI: 1.13–2.86; P < .00001) after bariatric surgery.ConclusionsBariatric surgery improves physical activity significantly in a population with obesity up to 3 years after surgery. Objective measurement of physical activity does not show significant improvement within 6 months of bariatric surgery but begins to improve at >6 months. Self-reported measurement of physical activity begins to show improvement within 6 months of a bariatric procedure.     

Effects of exercise in treating patients with venous leg ulcers: A systematic review and meta-analysis

To determine the effects of exercise on VLU healing and exercise adherence, and to provide evidence for clinical practice and scientific investigation. PubMed, Embase and Scopus were searched from inception to 31st March, 2022. Pooled relative risks (RRs), standardised mean differences (SMDs), adherence rate with respective 95% confidence intervals (CIs) were calculated. Quality assessment of included studies were performed using the Cochrane Collaboration risk of bias evaluation. Heterogeneity between enrolled studies was evaluated. We identified eight randomised control studies (RCTs) that met the inclusion criteria. The pooled RR for healing rate was 1.38 (95% CI: 1.14 to 1.66; P = 0.0008) with no significant heterogeneity between component studies (I² = 0%, P = 0.96). SMD for differences of total range of ankle joint motion (ROAM) at the end and at the initiation of follow-up in the intervention and control groups was 0.87 (95% CI: 0.22, 1.52; P = 0.0091), no significant heterogeneity was detected (I² = 59%, P = 0.0622). Pooled adherence rate was 64% (95% CI: 53%, 75%) with no significant heterogeneity. Exercise manifested positive effects on VLU healing, range of ankle mobility compared with the control group. Patients' adherence to the exercise regimens was favourable.     

The effect of placing prophylactic abdominal drainage tube after hepatobiliary surgery on postoperative infection: A systematic review and meta-analysis

Whether prophylactic abdominal drainage tube is routinely placed in patients after hepatobiliary surgery remains controversial. To evaluate the effect of prophylactic abdominal drainage tube placement after hepatobiliary surgery on postoperative infection. Randomized controlled trials on the placement of prophylactic abdominal drainage tube after hepatobiliary surgery were collected through a computerized search of PubMed, Embase, Conchrane Library and Web of Science databases, with a time range from the establishment of the database to August 2023. After two researchers independently screened the literature, extracted information, and evaluated the quality of the included studies. Finally, 13 studies were included, including 3620 patients, and the results showed that there was no statistically significant difference in postoperative infection rate between the drainage group (1840 patients and the non-drainage group [1783 patients] [relative risk, RR = 1.17, 95% confidence interval, CI: 0.94–1.47, p = 0.16]. Compared with the drainage group, the incidence of infectious abdominal fluid in the non-drainage group was lower (RR = 2.09, 95% CI: 1.57–2.80, p < 0.00001), and the incidence of postoperative bile leakage was lower (RR = 1.77, 95% CI: 1.27–2.47, p < 0.001) and shorter hospital stays after surgery (mean difference = 1.27, 95% CI: 0.32–2.22, p = 0.009). In conclusion, placing a prophylactic abdominal drainage tube after hepatobiliary surgery does not reduce postoperative infection rates compared with no drainage.     

Cinacalcet versus standard treatment for chronic kidney disease: a systematic review and meta-analysis

Background: Chronic kidney disease-mineral and bone disorders (CKD-MBD) have been associated with poor health outcomes, including diminished quality and length of life. Standard management for CKD-MBD includes phosphate restricted diet, vitamin D and phosphate binders. Persistently elevated parathyroid hormone levels may require the addition of cinacalcet hydrochloride (cinacalcet), which sensitizes calcium receptors in the parathyroid gland.

Purpose: The objective of this systematic review is to compare, in patients with CKD-MBD the effect of cinacalcet versus standard treatment on patient-important outcomes, including parathyroidectomy, fractures, hospitalizations due to cardiovascular events, cardiovascular mortality, all-cause mortality, and intermediate outcomes, in particular Kidney Disease Outcome Quality Initiative targets.

Methods: Data sources included MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and Web of Science from 1996 to June 2015. Teams of two reviewers, independently and in duplicate, screened titles and abstracts and potentially eligible full text reports to determine eligibility, and subsequently abstracted data and assessed risk of bias in eligible trials. We calculated the effect estimates (risk ratios or mean differences) and 95% confidence intervals, as well as statistical measures of variability in results across studies using random effect models. We used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to rate quality of evidence about estimates of effect on an outcome-by-outcome basis for all outcomes. We presented our results with a GRADE summary table.

Results: Twenty-four trials including 8311 CKD patients proved eligible. The results left considerable uncertainty regarding the impact of cinacalcet on reducing fractures (relative risk [RR] 0.59, 95% confidence interval [CI] 0.13–2.60; heterogeneity: p?=?0.03, I²=?78%; very low quality evidence), and indicated that cinacalcet did not reduce hospitalizations due to cardiovascular events (RR 0.93, 95% CI 0.85–1.02, moderate quality of evidence), cardiovascular mortality (RR 0.95, 95% CI 0.84–1.07; heterogeneity p=?0.61, high quality evidence) or all-cause mortality (RR 0.96, 95% CI 0.89–1.04; heterogeneity: p=?0.98, I²=?0%; moderate quality evidence). Cinacalcet reduced the need for parathyroidectomy (RR 0.30, 95% CI 0.22–0.42; heterogeneity: p=?0.70, I²=?0%; absolute effect 55 fewer per 1000 [95% CI 61 fewer to 45 fewer], high quality of evidence). The most common adverse event associated with cinacalcet therapy was gastrointestinal side effects. Cinacalcet increased nausea (RR 2.16, 95% CI 1.46–3.21, absolute effect 158 more per 1000 [95% CI 82 more to 302 more]) and vomiting (RR 2.15, 95% CI 1.66–2.80, absolute effect 63 more per 1000 [95% CI 109 more to 171 more]). Cinacalcet treatment increased the rate of hypocalcemia (RR 6.0, 95% CI 3.65–9.87; heterogeneity: p=?0.71, I²=?0%, absolute effect 20 more per 1000 [95% CI 11 more to 36 more], high quality of evidence).

Conclusions: In the hands of clinicians participating in these studies, cinacalcet decreased the rate of parathyroidectomy but had no influence on mortality. Patients and clinicians can trade of the benefit of fewer parathyroidectomies against the adverse effects.