Shilin Zheng

and 6 more

Purpose: Magnetic Resonance-High Intensity Focused Ultrasound (MR-HIFU) has revolutionized the treatment of Uterine fibroids. Usually, they are associated with prolonged heavy bleeding during the menstrual period, sacral pain, and increased frequency of UTIs, secondary dysmenorrhea, constipation, and pregnancy-associated problems. It also impacts usual activities, which lead to diminished quality of life and rising healthcare costs. Generally, surgery is the only choice for uterine fibroids; however, MR-HIFU is an entirely non-invasive novel therapy, preferred in pregnancy desiring females. Excluding trials with stringent treatment protocols that are no longer used, the efficacy of Magnetic Resonance-High Intensity Focused Ultrasound (MRHIFU) therapy for uterine fibroids is being re-evaluated. Methods: RCTs, Prospective or Retrospective non-randomized, and cross-over studies that considered clinically symptomatic uterine fibroid treatment were included. The author has searched the data in Cochrane Library, PubMed/MEDLINE, SCOPUS, EMBASE databases. Meta-Analysis was performed using NCSS software, and data were analyzed at a 95% confidence level with a level of precision at 0.05. The NPV%, tSSS change%, and QoL were computed. Meta-Regression was done to evaluate the association between the different parameters. Results: The overall effect of NPV% was 70.24, where the 95% confidence interval ranged from 61.9% to 78.16%. The overall impact of tSSS% change is near 50% after the follow-up of 3 months, 6 months, and 12 months in the included studies. There was a significant improvement in the health-related quality of life (Hr-QoL). Conclusion: The efficacy of MR-HIFU therapy was improved as treatment protocols aimed for total ablation. On the other hand, regulated studies are required to determine the function of MR-HIFU in the treatment of uterine fibroids.

Ke Yang

and 3 more

Background: Pediatric Emergency Care Applied Research Network (PECARN) is a useful Clinical Decision Support Tool (CDST) to identify traumatic brain injuries and reduce the use of head CT scans among pediatric patients. The present Meta-analysis aims to evaluate the diagnostic accuracy of the PECARN rule from 2009 to 2020 in children with a very low risk of blunt head trauma. Methods: A detailed search was conducted from the databases of Medline (via PubMed), Cinahl (via Ebsco), Scopus, Web of Sciences, from 2009 till the end of December 2020 using the keywords like decrease use of CT scan, blunt head trauma (BHT) combined with accuracy, Pediatric Emergency Care Applied Research Network (PECARN) OR Clinical Decision Support Tool (CDST). Studies showing the diagnostic accuracy of the PECARN rule in children younger than 18 years of age with minor BHT were included. Results: 13 studies were included in the present analysis. Pooled sensitivity of 0.08, (95% confidence interval of 0.074 - 0.087), pooled specificity of 0.20 ( 95% CI of 0.196 - 0.213) and diagnostic odds ratio of 0.004 (95% CI of 0.000-0.1666) was in <2 years of age. The overall sensitivity of 0.07, specificity of 0.66, and diagnostic odds ratio of 0.54 (95% CI of 0.10 -2.78) was seen in ≥2 years of age. Overall sensitivity of 0.13 (95% CI 0.12-0.14), specificity of 0.81 (95% CI 0.80-0.82) and diagnostic odds ratio of 0.79 (95% CI of 0.08 -7.71) was in 0-18 years of age. Conclusion: The present analysis indicates the PECARN decision tool as an accurate CDST in low-risk minor blunt head trauma cases in children below two years of age and can become a useful tool in reducing Head CT’s scan overuse in pediatric emergency departments.