From Physics Olympiads to Medical Research: Lessons Learned

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Ross Operation in Neonates: A Meta-analysis

The Ross operation is the preferred treatment for aortic valve replacement in children. However previous studies indicate that outcomes in neonates are poor. This meta-analysis examines the pooled outcomes of the Ross operation in neonates. Four major databases (PubMed/MEDLINE, EMBASE, Scopus, and ScienceDirect) were searched from inception until May 1, 2020 for studies describing outcomes of the Ross operation in neonates. The primary outcome was early mortality, and secondary outcomes were late mortality and mechanical support. Random-effects models were used to account for possible heterogeneity between studies, and continuity corrections were used to include zero total event trials. Eighteen studies comprising outcomes data on 181 neonates were included in the analysis. Meta-analysis showed a pooled early mortality rate of 24% (95% confidence interval, 12%-38%; I2 = 52%, P for heterogeneity = .01). Meta-regression analysis showed that more recently published studies reported significantly worse early mortality (P = .03). The pooled incidence of postoperative mechanical support was 15% (95% confidence interval, 5%-28%; I2 = 28%, P for heterogeneity = .22). No evidence of publication bias was found according to Egger’s test (bias coefficient = 0.21, P = .57). The neonatal Ross operation carries a high early mortality rate. The treatment of unrepairable aortic valves in neonates remains an unsolved problem in congenital cardiac surgery

Comparison of intensive versus conventional insulin therapy in traumatic brain injury: a meta-analysis of randomized controlled trials

<p><i>Objective</i>: To compare intensive insulin therapy (IIT) and conventional insulin therapy (CIT) on clinical outcomes of patients with traumatic brain injury (TBI).</p> <p><i>Methods</i>: MEDLINE, EMBASE, Google Scholar, ISI Web of Science, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing IIT to CIT in patients with TBI. Study-level characteristics, intensive care unit (ICU) events, and long-term functional outcomes were extracted from the articles. Meta-analysis was performed with random-effect models.</p> <p><i>Results</i>: Seven RCTs comprising 1070 patients were included. Although IIT was associated with better neurologic outcome (GOS > 3) (RR=0.87, 95% CI=0.78-0.97; P=0.01; I²=0%), sensitivity analysis revealed that one study influenced this overall estimate (RR=0.90, 95% CI=0.80–1.01, P=0.07; I²=0%). IIT was strongly associated with higher risk of hypoglycaemia (RR=5.79, 95% CI=3.27–10.26, P<0.01; I²=38%). IIT and CIT did not differ in terms of early or late mortality (RR=0.96, 95% CI=0.79–1.17, P=0.7; I²=0%), infection rate (RR=0.82, 95% CI=0.59–1.14, P=0.23; I²=68%), or ICU length of stay (SMD= –0.14, 95% CI=–0.35 to 0.07, P=0.18; I²=45%0.)</p> <p><i>Conclusions</i>: IIT did not improve long-term neurologic outcome, mortality, or infection rate and was associated with increased risk of hypoglycaemia. Additional well-designed RCTs with defined TBI subgroups should be performed to generate more powerful conclusions.</p

Ultrafiltration in cardiac surgery: Results of a systematic review and meta-analysis

: Ultrafiltration is used with cardiopulmonary bypass to reduce the effects of hemodilution and restore electrolyte balance. We performed a systematic review and meta-analysis to analyze the effect of conventional and modified ultrafiltration on intraoperative blood transfusion.: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, we systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane Library to perform a meta-analysis of studies of randomized controlled trials (RCTs) and observational studies evaluating conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) on the primary outcome of intraoperative red cell transfusions.: A total of 7 RCTs ( = 928) were included, comparing modified ultrafiltration ( = 473 patients) to controls ( = 455 patients) and 2 observational studies ( = 47,007), comparing conventional ultrafiltration ( = 21,748) to controls ( = 25,427). Overall, MUF was associated with transfusion of fewer intraoperative red cell units per patient ( = 7); MD -0.73 units; 95% CI -1.12 to -0.35 = 0.04; for heterogeneity = 0.0001, = 55%) compared to controls. CUF was no difference in intraoperative red cell transfusions compared to controls ( = 2); OR 3.09; 95% CI 0.26-36.59; = 0.37; for heterogeneity = 0.94, = 0%. Review of the included observational studies revealed an association between larger volumes (\u3e2.2 L in a 70 kg patient) of CUF and risk of acute kidney injury (AKI).: The results of this systematic review and meta-analysis suggest that MUF is associated with fewer intraoperative red cell transfusions. Based on limited studies, CUF does not appear to be associated with a difference in intraoperative red cell transfusion