Random-effects Model Analysis Research Articles

Adjuvant immunotherapy in high-risk muscle-invasive urothelial cancer: an updated meta-analysis of randomized controlled trials

Introduction: Neoadjuvant cisplatin-based chemotherapy followed by radical surgery is the standard treatment for muscle-invasive urothelial carcinoma (MIUC). The Checkmate-274 and AMBASSADOR trials have demonstrated improvements in disease-free survival (DFS) with adjuvant immunotherapy. Consequently, this meta-analysis aimed to assess the effectiveness of strategies involving checkpoint inhibitors in managing high-risk MIUC. Patients and Methods: We searched PubMed, Embase, Cochrane, ClinicalTrials.gov, EAU24, and ASCO GU abstracts for randomized controlled trials (RCTs) comparing adjuvant PD-1 and PD-L1 inhibitors against control (placebo or observation) for MIUC. Outcomes included DFS, grade ≥ 3 adverse events (AEs), and overall survival (OS). Heterogeneity was assessed using I2 statistics, employing a random-effects model for analysis. Results: In a cohort of 2,220 patients from three RCTs, 1,113 (50.14%) underwent adjuvant immunotherapy. This treatment significantly increased DFS (HR 0.76; 95% CI 0.65-0.90; p < 0.01), particularly in lower tract tumors (HR 0.71; 95% CI 0.56-0.91; p < 0.01). No substantial DFS improvement surfaced in the upper tract subgroup (p = 0.28) (p-interaction = 0.01). PD-L1 status (p-interaction = 0.83) and previous neoadjuvant chemotherapy (p-interaction = 0.11) did not significantly affect outcomes. However, immunotherapy correlated with higher grade ≥ 3 AEs (RR 1.47; p<0.01), with no notable difference in OS (p=0.07). Conclusions: Adjuvant PD-1/PD-L1 inhibitors notably enhance MIUC DFS, particularly in lower tract tumors, regardless of PD-L1 status. These findings support immunotherapy, especially anti-PD1, as a valuable adjuvant treatment strategy for high-risk MIUC patients. Micro abstractThis meta-analysis investigates the use of adjuvant anti-PD1/PDL1 therapy for high-risk muscle-invasive urothelial cancer (MIUC). By analyzing data from three randomized controlled trials involving 2,220 patients, the study demonstrates that immune checkpoint inhibitors, particularly PD1 inhibitors, significantly improve disease-free survival, regardless of PD-L1 status. These findings support considering ICIs as a viable adjuvant treatment option for patients with MIUC.

Effects of Integrated Care Approaches to Address Co-occurring Depression and Diabetes: A Systematic Review and Meta-analysis.

Depressive symptoms frequently co-occur with diabetes and, when unaddressed, can function to worsen diabetes control and increase the risk of diabetes-related morbidity. Integrated care (IC) approaches aim to improve outcomes among people with diabetes and depression, but there are no current meta-analyses examining their effects. In our study we summarize the effects of IC approaches to address depression and diabetes and examine moderating effects of IC approaches (e.g., behavioral intervention used; type of IC approach). A systematic search was conducted of PubMed, PsycInfo, CINAHL, and ProQuest. Two reviewers triaged abstracts and full-text articles to identify relevant articles. Randomized controlled trials with enrollment of participants with diabetes and depressive symptoms and with provision of sufficient data on depression scores and hemoglobin A1c were included. Two reviewers extracted demographic information, depression scores, diabetes outcomes, intervention details, and the risk of bias for each study. From 517 abstracts, 75 full-text reports were reviewed and 31 studies with 8,843 participants were analyzed. Among 26 studies with reporting of HbA1c, IC approaches were associated with a significant between-group difference regarding the percent decrease of HbA1c (d = -0.36, 95% CI -0.52 to -0.21). Studies that included a combination of behavioral interventions (behavioral activation with cognitive behavioral therapy) showed greater reductions in HbA1c. Among 23 studies with reporting of depressive symptoms, the pooled effect of IC approaches lowered depressive scores by 0.72 points (95% CI -1.15 to -0.28). The inclusion of a wide range of IC approaches increased study heterogeneity. A random effects model and sensitivity analyses mitigated this limitation. IC approaches are associated with improved glycemia and depressive symptoms in comparison with treatment as usual.

The Effect of Interest Rates and Inflation on Economic Growth in ASEAN-5 Countries

This study aims to empirically test the effect of interest rates and inflation on economic growth, with gross capital formation as a control variable. This research uses panel data from 5 ASEAN countries, namely Indonesia, Malaysia, the Philippines, Singapore, and Thailand in 2004 – 2021 and was tested using the Random Effect Model (REM) analysis technique. The results of this study explain that interest rates and inflation have a simultaneous effect on economic growth. Another finding from this study is that interest rates have a significantly negative effect on economic growth and inflation has a significant positive effect on economic growth. However, this study is subject to several limitations. First, it solely focuses on ASEAN-5 countries, thus limiting the generalizability of the findings to other developed and developing nations. Second, the study’s reliance on annual data from 2004 to 2021 excludes more recent data, potentially overlooking current economic trends. Third, the static panel method utilized with the REM analysis only provides a broad overview of the relationships between interest rates, inflation, and economic growth, lacking deeper insights into long-term and short-term dynamics. Fourth, while the study covers the period including the COVID-19 pandemic, it fails to thoroughly explore its impact and provide detailed explanations. Thus, future research should consider expanding the scope beyond ASEAN-5, incorporating more recent data, employing dynamic panel methods, and thoroughly investigating the implications of significant events such as the COVID-19 pandemic on the examined relationships.

Effectiveness of ethnomathematics-based learning on students’ mathematical literacy: a meta-analysis study

This study aims to determine the effectiveness of ethnomathematics-based learning on students’ mathematical literacy through a meta-analysis study. Primary studies were collected from Google Scholar and ERIC databases based on the inclusion criteria. The results of the literature review obtained 16 studies, either from theses, proceedings, or journal articles. Furthermore, the effect sizes were combined according to the Random Effects Model (REM) and data analysis using CMA v3 and R Studio (Meta Package). The calculation results obtained an overall effect size which indicates that ethnomathematics-based learning has a “strong” effect on students’ mathematical literacy when compared to conventional learning. As a result of the moderator category analysis, it was found that the effect sizes differed significantly according to students’ regional demographics, independent variables, and subject matter. However, it does not show significant differences when based on the duration of the meeting, education level, sample size, experimental design, type and year of publication. Thus, it can be said that ethnomathematics-based learning can be an effective learning model for increasing students’ understanding of mathematical literacy, especially in the Kalimantan Island region, recommended to be integrated with the Ethnomathematics Pop Up Book and Visual Thinking learning model, and Probability & Sets and Transformation Geometry materials, using Nonequivalent Control Group Design are recommended to be taught through this learning model.

Long-term outcomes of glued (sutureless) amniotic membrane transplantation in acute Stevens-Johnson syndrome/toxic epidermal necrolysis: a comparative study

PurposeTo compare the effectiveness and efficiency of a glued (sutureless) technique for amniotic membrane transplantation (AMT) with a traditional sutured one in the setting of acute Stevens-Johnson syndrome/toxic epidermal necrolysis...

Association of endometrial cancer risk with hypertension- an updated meta-analysis of observational studies

Endometrial cancer is one of the most common gynaecological cancers in the developed countries. The aim of this study was to determine the impact of hypertension on endometrial cancer risk. Databases: PubMed, Embase and the Cochrane Library were searched from January 2000 to June 2024. We used DerSimonian-Laird random-effects model for analysis. Risk estimates were extracted by two authors and summarized using meta-analytic methods. A total of 26 observational studies with 207,502 endometrial cancer cases were included in the study. Overall meta-analysis demonstrates significant association between hypertension and endometrial cancer risk (RR = 1.37, 95% CI: 1.27–1.47, p < 0.001). Subgroup analysis of the risk of endometrial cancer shows statistically significant higher risk in patients with BMI ≥ 30 kg/m2, diabetics, women who had their first menstrual period at the age of 11 years or earlier, and who had never given birth. Findings of this comprehensive review and meta-analysis indicate that hypertension is associated with higher overall risk of endometrial cancer.

Meal replacements on obesity and leptin: a systematic review and meta-analysis.

The global prevalence of obesity and overweight is a significant concern in the field of public health. Numerous interventional studies have been conducted to assess the possible meal replacements (MRs) effect on anthropometric indicators and indices and laboratory test that reflect obesity. However, there are no comprehensive results in this field. The study aim was to understand the possible effects of MRs on body weight, body mass index (BMI), fat mass, waist circumferences (WC), and leptin levels. A systematic search was conducted in five electronic databases in order to find randomized clinical trials (RCTs) that examined the possible MRs effect on obesity. Analyses were performed in R software, version 4.2.1. The random-effects model analysis was used to provide pooled mean difference and 95% confidence intervals (95% CI). Seventy studies were included. Body weight (WMD: -3.35 kg, 95% CI: -4.28 to -2.42), BMI (WMD: -1.12 kg/m2, 95% CI: -1.51 to -0.72), fat mass (WMD: -2.77 kg, 95% CI: -3.59 to -1.6), WC (WMD: -2.82 cm, 95% CI: -3.51 to -2.12) were significantly reduced after MRs compared to control. No significant effect was observed on leptin (WMD: -3.37 ng/ml, 95% CI: -8.23 to 1.49). Subgroup analyses indicated that impact of total MRs on anthropometric factors was greater in comparison to partial MRs. Considering other lifestyle factors, MRs can lead to anthropometric indicators and indices reduction.

A Systematic Review and Meta-Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children.

Acute otitis media (AOM) is a common childhood infection. Recurrent AOM affects a subset of children, resulting in an adverse impact on quality of life, socioeconomic disadvantage, and risk of long-term sequelae. Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance. A comprehensive literature search was undertaken using Medline (1946-October 2023) and Embase (1974-October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the I2 statistic. The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. assessment of antimicrobial agents and outcomes in children with risk factors. Assessment of qualitative data was performed on 20 studies (n = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta-analysis on nine pre-PCV studies (n = 1087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45-0.77). Families and clinicians must balance marginal short-medium term benefit (based on pre-PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.

Prevalence and associated factors of post-traumatic stress disorder in pediatric populations in Africa: a systematic review and meta-analysis

IntroductionPost-traumatic stress disorder (PTSD) is a prevalent challenge faced by individuals following traumatic events. Given the substantial impact of PTSD on the well-being of young people, comprehensive assessment of the available evidence can inform more effective prevention and intervention strategies to support the mental health and resilience of children in the African context. Despite its high incidence, there has been no up-to-date systematic synthesis of evidence to measure the magnitude of PTSD in pediatric populations in Africa. This systematic review and meta-analysis aim to quantify the prevalence of PTSD and identify associated factors in this vulnerable population.MethodsA systematic search was conducted across multiple databases, including PubMed, Embase, Scopus, Science Direct, and the search engines Google Scholar and Google, covering the period from 2014 up to May 15, 2024. The primary objective of this search was to identify relevant studies. Subsequently, a meta-analysis was performed using random-effects models to estimate the pooled effect size for each outcome of interest. Additionally, subgroup analysis was conducted to explore potential sources of heterogeneity, with study characteristics considered as covariates.ResultsThe pooled prevalence estimate for post-traumatic stress disorder (PTSD) among pediatric individuals was 36% (95% CI: 28–44%). Notably, significant heterogeneity existed among the studies (I2 = 98.41%, p value < 0.001), prompting us to employ a random effect model analysis. Furthermore, our meta-analysis revealed that children above 14 years of age and those who experienced family deaths due to traumatic events were significantly associated with PTSD.ConclusionThis systematic review and meta-analysis revealed that the prevalence of PTSD among pediatric individuals aged 0–18 years in Africa was high. Notably, older children and those who experienced family deaths due to traumatic events were at a significantly higher risk of developing PTSD. These findings underscore the need for early intervention, age-specific support, and trauma-informed care to address the mental health challenges faced by pediatric populations.

Prevalence of stroke in Bangladesh: A systematic review and meta-analysis

BackgroundStroke is a major health concern in Bangladesh due to its high incidence and effect on rates of morbidity and death. The morbidity due to stroke in Bangladesh is indeed increasing. This study aimed to find the pooled prevalence of stroke in Bangladesh. MethodsAn extensive search was conducted using PubMed, MEDLINE, and Google Scholar databases. I2 and Q-tests were employed to evaluate the heterogeneity. A random-effects model and subgroup analysis were performed due to the significant heterogeneity. We used Egger's test and funnel plot to look at publication bias. Meta-regression was carried out to analyze how different study variables influenced the effect estimates and to explore sources of heterogeneity across studies. The GRADE approach was used to evaluate the overall quality of the evidence, and the Joanna Briggs Institute tool was used to assess the risk of bias. Sensitivity analysis was conducted to evaluate the robustness of the meta-analysis results. STATA version 17 was used for analysis. ResultsWe selected eleven (n = 1577293) studies that met the inclusion criteria for the final synthesis. In Bangladesh, the overall pooled prevalence of stroke was 1.10 % (95 % CI: 0.70–1.51). Subgroup analysis showed that the prevalence of stroke was 1.14 % (95 % CI: 0.58–1.70) from 2005 to 2014 and 1.04 % (95 % CI: 0.40–1.68) from 2015 to 2024. ConclusionStroke prevalence in Bangladesh is significantly high. The country's healthcare system faces adequate stroke prevention and treatment challenges. Improving healthcare services and public health education are crucial to addressing this increasing public health issue.

Effect of deep brain stimulation on postoperative body mass index: A systematic review and meta-analysis.

Deep Brain Stimulation (DBS) is FDA-approved for several movement disorders; such as Parkinson's disease, dystonia, and neuropsychiatric disorders. There are various reports of Body mass index (BMI) changes following different DBS targets in various disorders. A comprehensive systematic review and meta-analysis were conducted to investigate the impact of DBS on patients' Body Mass Index (BMI) and provide an in-depth overview of its underlying mechanisms. We conducted research according to PRISMA guidelines. Our study assessed comprehensively electronic databases, including Pubmed, Scopus, Embase, web of science, and the Cochrane Library, up to May 2024. The random-effect model analysis was performed by the Comprehensive Meta-analysis software (CMA) version 3.0. As well, Cochran's Q test was used to determine the statistical heterogeneity of included studies. This systematic review ultimately included 49 studies, 46 of which entered the meta-analysis. The total number of patients was 1478, consisting of Parkinson's disease (PD), dystonia, and the obsessive compulsive disorder (OCD) patients. The most common DBS target was subthalamic nucleus, followed by globus pallidus internus (GPi). Our meta-analysis depicted the BMI of participants significantly mount after DBS electrode implantation (SMD = -0.542, 95%CI: -0.678 to -0.406, and P-value < 0.001). However, moderate to high heterogeneity was detected among the studies (I2 = 67.566%). Additionally, the Daily energy intake (DEI) of patients significantly decreased after DBS (SMD: 0.457, 95%CI; 0.205 to 0.709, and P-value < 0.001). STN and GPi DBS can lead to weight gain through distinct central pathways in various movement and neuropsychiatric disorders, posing a potential risk for obesity, insulin resistance, and metabolic syndrome.

Financial Inclusion, Environmental Quality, and Economic Development in Asian Economies: A Panel Data Analysis

The objective of this study is to explore the effect of Financial Inclusion and Environmental Quality on Economic Development of some selected Asian economies. For this purpose, panel data of some Asian economies has been taken from 2004 to 2023 from the World Development Indicators. The results are estimated by using the Fixed Effect Model and Random Effect Model, descriptive statistics, correlation, and causality analysis. The results of Fixed Effect model reveal that GDP is significantly increased by Internet Subscribers &amp; Mobile users (Financial Inclusion variables), FDI, Government expenditure and Carbon dioxide emission while GDP is insignificantly increased by energy use in the Asian economies. The Fixed Effect model suggests policy implications for Asian economies, focusing on digital connectivity, FDI attraction, targeted public expenditure, sustainable growth practices, and energy efficiency.

ThP3.5 - A systematic review of comparing the outcomes of per-oral endoscopic myotomy vs pneumatic dilation in patients diagnosed with achalasia

Abstract Objective The objective of this meta-analysis is to compare the success rate of per-oral endoscopic myotomy (POEM) versus pneumatic dilation (PD) for patients with achalasia. Methods Studies reporting success rates and symptoms in patients undergoing POEM versus PD were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Four studies on 319 patients reporting success rates and Eckardt scores were included. In the random effect model analysis, the success rate [odds ratio (OR) 6.22, 95%, CI (3.23, 11.97), Z = 5.47, p = 0.00001] favoured the PD and there was no heterogeneity (Tau2 = 0; Chi2 = 1.29, df = 2 (P = 0.53; I2 = 0 %) among included studies. Eckardt scores [mean difference -0.36, 95%, CI (-0.76, 0.03), Z = 1.79, p = 0.07] suggesting the achalasia symptoms severity was also similar in both interventions. There was moderate heterogeneity (Tau2 = 0.10; Chi2 = 7.47, df = 3 (P = 0.06; I2 = 60 %) among the included studies. Conclusion The POEM seems to be more successful when compared to the PD for patients with achalasia. On comparison of Eckardt score, there was no statistical difference seen between the two groups.

WP1.7 - A systematic review and a meta-analysis of randomised control trials of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair

Abstract Objective The objective of this meta-analysis is to compare the outcomes of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair. Methods Studies reporting the patient outcomes were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Seven studies on 1,333 patients reporting post-operative outcomes were included. In the random effect model analysis, the severe pain at the end of the follow-up period [odds ratio (OR) 0.45, 95%, CI (0.10, 2.08), Z = 1.03, p = 0.30] was similar in both the groups with high heterogeneity (Tau2 = 0.97; Chi2 = 4.45, df = 1 (P = 0.03; I2 = 78 %) among included studies. Hypoesthesia at 6-month follow-up period [odds ratio 1.00, 95%, CI (0.47, 2.15), Z = 0.00, p = 1.00] suggests comparable outcomes in both groups with no heterogeneity among the included studies. The absence of pain reported by patients at the 6-month follow-up period [odds ratio 0.96, 95%, CI (0.72, 1.27), Z = 0.28, P = 0.78] suggests comparable outcomes in both groups with no heterogeneity among the included studies. Conclusion Post-operative outcomes like chronic groin pain, hypoesthesia or no pain reported by patients were similar in both groups. There was a paucity of data, therefore a major multicentre randomised control trial is recommended to strengthen the findings of this meta-analysis.

SP1.2 - Laparoscopic versus Robotic ventral hernia repair: a systematic review and meta-analysis comparing the perioperative outcomes randomised controlled trials

Abstract Objective The objective of this meta-analysis is to compare the perioperative surgical outcomes and cost-effectiveness of robotic incisional/ventral hernia repair (RIVHR) versus laparoscopic incisional/ventral hernia repair (LIVHR). Methods Randomised control trials (RCTs) reporting perioperative outcomes and costs in patients undergoing RIVHR versus LIVHR were selected from medical electronic databases and meta-analysis was conducted under the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Four RCTs on 337 patients reporting perioperative outcomes and cost comparison were included. In the random effect model analysis, the duration of operation [standardized mean difference (SMD) -48.07, 95%, CI (-78.06, -18.07), z = 3.14, p = 0.002] was shorter and cost was lower [SMD 0.82, 95%, CI (-1.48, -0.16), z = 2.45, p = 0.01] in the LIVHR group but with significant statistical heterogeneity. However, the variables of hernia recurrence [risk ratio (RR) 2.29, 95%, CI (0.73, 7.12), z = 1.43, p = 0.15] and surgical site complications [RR 0.85, 95%, CI (0.48, 1.50), z = 0.55, p = 0.58] were statistically similar in both groups without any statistical heterogeneity among the included studies. Conclusion The RIVHR does not offer any superiority over LIVHR in all perioperative variables and it is not cost effective. Due to the paucity of the RCTs, a major multi-centre RCT is needed to validate these findings.

ThP7.13 - A systematic review of the perioperative outcomes of surgical fixation versus conservative approach for severe rib fractures

Abstract Objective The objective of this meta-analysis is to compare the patient outcomes for severe rib fractures being managed by operative or non-operative treatment. Methods Studies reporting patient outcomes in patients undergoing surgical fixation or conservative approach were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Three studies on 258 patients reporting patient outcomes were included. In the random effect model analysis, the total hospital stay [mean difference -1.44, 95%, CI (-2.88, 0.00), Z = 1.96, p = 0.05] was comparable between the two groups with no heterogeneity among included studies. The intensive care stay [mean difference -2.36, 95%, CI (-5.92, 1.21), Z = 1.30, p = 0.20] and mortality [odds ratio 1.08, 95%, CI (0.11, 10.31), Z = 0.07, p = 0.94] was comparable between the two groups but with moderate heterogeneity among included studies. Pneumonia was more common in patients of the non-operative group [odds ratio 0.35, 95%, CI (0.15, 0.82), Z = 2.41, p = 0.02] with no heterogeneity among included studies. Conclusion Pneumonia was more common in patients in the patients managed with the conservative approach. Other patient outcomes were comparable between the two groups. Due to the paucity of data, multiple other crucial variables could not be assessed and a major multi-centre randomised control trial is needed to confirm the findings of this meta-analysis.

SP4.6 - Endoscopic versus laparoscopic management of pancreatic pseudocyst - A systematic review and meta-analysis

Abstract Objective The aim of this meta-analysis is to compare the postoperative surgical outcomes of endoscopic versus laparoscopic management of pancreatic pseudocyst. Methods Two randomised control trials (RCTs) and four comparative trials reporting postoperative outcomes for patients undergoing treatment with endoscopic transgastric or transduodenal drainage versus laparoscopic cyst-gastrectomy or cyst-jejunostomy for the pancreatic pseudocyst were selected from medical electronic databases and meta-analysis was conducted by the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.4. Results Two RCTs and four comparative trials on 401 patients reporting postoperative outcomes were included. In the random effect model analysis, the overall success rate [odds ratio (OR) 0.81, 95%, CI (0.38, 1.72), Z = 0.54, P = 0.59] was comparable between the two groups with no heterogeneity among the included studies. Adverse events after the procedure was also comparable between the two groups [OR 0.72, 95%, CI (0.34, 1.50), Z = 0.89, P = 0.37] with no heterogeneity among the included studies. Hospital stay was shorter in the endoscopic group [Mean difference -2.71, 95%, CI (-4.14, -1.27), Z = 3.69, P = 0.0002] with high statistical heterogeneity among the included studies. Conclusion The patients managed with endoscopic procedures had shorter hospital stay, but the incidence of adverse post-procedure outcomes and overall success rate were comparable between the two groups. Due to the paucity of the RCTs, a major multi-centre RCT is needed to strengthen the findings of this systematic review.

SP2.11 - Continuous versus interrupted closure of midline laparotomy wound with absorbable suture material - A systematic review and meta-analysis of randomised controlled trials

Abstract Objective The objective of this meta-analysis is to compare the postoperative surgical outcomes of continuous versus interrupted closure of the midline laparotomy wound with absorbable suture material. Methods Randomised control trials (RCTs) reporting postoperative outcomes for patients undergoing closure with continuous versus interrupted closure of midline laparotomy wound with absorbable suture material were selected from medical electronic databases and meta-analysis was conducted by the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Four RCTs on 2,198 patients reporting postoperative outcomes were included. In the random effect model analysis, the wound dehiscence [odds ratio (OR) 0.93, 95%, CI (0.52, 1.64), Z = 0.26, P = 0.79] was comparable between the two groups with no heterogeneity among the included studies. Incisional hernia was also comparable between the two groups [OR 0.82, 95%, CI (0.59, 1.14), Z = 1.19, P = 0.23] with mild heterogeneity among the included studies. Wound infection was also comparable between the two groups [OR 1.30, 95%, CI (0.78, 2.17), Z = 1.01, P = 0.31] with moderate statistical heterogeneity among the included studies. Conclusion The continuous suturing closure had no superiority over interrupted closure for the midline laparotomy wound on comparing wound dehiscence, incisional hernia and wound infection. Due to the paucity of the RCTs, a major multi-centre RCT is needed to validate these findings.

The anterior and medial open approaches yield superior outcomes compared to the lateral and posterior open approaches in supracondylar humerus fractures in children: a systematic review and network meta-analysis.

This study aimed to perform a systematic review and network meta-analysis (NMA) to examine which open approach is superior in terms of outcomes and complications in the treatment of pediatric supracondylar humerus fractures. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to December 2022 and screened for relevant studies. Data were collected regarding patient demographics, Flynn's functional and cosmetic outcomes, and complications. Unsatisfactory Flynn's and complications were considered negative events. Comparisons of outcomes from aggregate data from each surgical approach using relative risk (RR) with a 95% confidence interval (95% CI) were performed. The NMA of overall negative events was conducted using a Bayesian hierarchical random-effects model analysis. A total of 26 studies involving 1461 patients were included; 459 (31.4%) patients underwent a closed reduction and percutaneous pinning (CRPP), 84 (5.7%) an anterior approach, 240 (16.4%) a medial, 220 (15%) a lateral, and 458 (31.3%) a posterior. The lateral and posterior approaches demonstrate a higher risk of negative event in the NMA compared to CRPP [RR = 2 (1.03, 3.85); RR = 2.63 (1.96, 3.57), respectively], anterior approach [RR = 3.33 (1.11, 10); RR = 4.35 (1.49, 12.5), respectively], and medial approach [RR = 1.82 (1.16, 2.86); RR = 2.38 (1.23, 4.76), respectively]. The medial approach resulted in a similar negative event rate compared to the anterior [RR = 1.82 (0.58, 5.88)]. The anterior and medial open approaches yield superior functional and cosmetic outcomes with fewer complications compared to the lateral and posterior.

Long-term efficacy of total versus posterior partial fundoplication in patients with gastro-oesophageal reflux disease: a systematic review and meta-analysis.

Laparoscopic fundoplication remains the standard treatment for patients with severe gastro-oesophageal reflux disease (GORD). Multiple randomised controlled trials (RCTs) have compared the two most commonly performed surgical techniques, total and posterior partial fundoplication (Nissen [NF] and Toupet [TF]), in terms of symptom control and treatment failure in patients without subsequent dysmotility disorders. We aimed to conduct a systematic review and meta-analysis of these two techniques with regard to the long-term effect on reflux control and associated dysphagia. The MEDLINE®, Embase®, PubMed® and Cochrane Library databases were searched, and all the relevant published RCTs were shortlisted according to the inclusion criteria. The summated outcomes of long-term results relating to the recurrence of GORD and dysphagia were evaluated in a meta-analysis using RevMan software. Eight studies (all RCTs) on 1,545 patients undergoing NF or TF were eligible for inclusion in this meta-analysis. There were 799 patients in the NF group and 746 in the TF group. In the random effects model analysis, the incidence of long-term recurrence of GORD was not statistically different between the NF and TF cohorts (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.34-1.41, z=1.01, p=0.31). However, the incidence of long-term dysphagia was statistically lower in the TF group (OR: 2.92, 95% CI: 1.49-5.72, z=3.13, p=0.002) with low between-study heterogeneity (I2=0%). The findings of this systematic review and meta-analysis on symptomatic GORD appear to be in favour of partial posterior fundoplication (TF) as the optimal treatment. It provides equivalent outcomes in reflux symptom control with a lower risk of postoperative dysphagia compared with total fundoplication (NF).