BACKGROUND Endoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction(MDBO).AIM To compare the safety and efficacy of plastic stent(PS)vs self-expanding met...BACKGROUND Endoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction(MDBO).AIM To compare the safety and efficacy of plastic stent(PS)vs self-expanding metal stent(SEMS)placement for treatment of MDBO.METHODS This meta-analysis was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.A comprehensive search was performed in MEDLINE,Cochrane,Embase,Latin American and Caribbean Health Sciences Literature,and grey literature to identify randomized clinical trials(RCTs)comparing clinical success,adverse events,stent dysfunction rate,reintervention rate,duration of stent patency,and mean survival.Risk difference(RD)and mean difference(MD)were calculated and heterogeneity was assessed with I2 statistic.Subgroup analyses were performed by SEMS type.RESULTS Twelve RCTs were included in this study,totaling 1005 patients.There was no difference in clinical success(RD=-0.03,95%confidence interval[CI]:-0.01,0.07;I 2=0%),rate of adverse events(RD=-0.03,95%CI:-0.10,0.03;I2=57%),and mean patient survival(MD=-0.63,95%CI:-18.07,19.33;I2=54%)between SEMS vs PS placement.However,SEMS placement was associated with a lower rate of reintervention(RD=-0.34,95%CI:-0.46,-0.22;I2=57%)and longer duration of stent patency(MD=125.77 d,95%CI:77.5,174.01).Subgroup analyses revealed both covered and uncovered SEMS improved stent patency compared to PS(RD=152.25,95%CI:37.42,267.07;I2=98%and RD=101.5,95%CI:38.91,164.09;I2=98%;respectively).Stent dysfunction was higher in the covered SEMS group(RD=-0.21,95%CI:-0.32,-0.1;I²=205%),with no difference in the uncovered SEMS group(RD=-0.08,95%CI:-0.56,0.39;I²=87%).CONCLUSION While both stent types possessed a similar clinical success rate,complication rate,and patient-associated mean survival for treatment of MDBO,SEMS were associated with a longer duration of stent patency compared to PS.展开更多
The present study analyzed new and recast Ni-Cr alloys, regarding the relationship between the applied force and the deformation in cantilevered bar segments, with dimensions of 4.0 mm, 3.5 mm, 3.0 mm in thickness, 4....The present study analyzed new and recast Ni-Cr alloys, regarding the relationship between the applied force and the deformation in cantilevered bar segments, with dimensions of 4.0 mm, 3.5 mm, 3.0 mm in thickness, 4.5 mm width and 15 mm length, on a universal testing machine “EMIC”. The bars in the tests were initially obtained acrylic resin by 4.8 mm wide × 4.3 mm thick × 4 cm long. We obtained 30 bars divided into two groups, with 15 to test new alloys and 15 with alloys recast. The alloy used was Tilite. For the application of the load, the bars were attached to “EMIC” where the active tip of 200 kgf load cell was at a specific point of the bar (15 mm) with a speed of 0.5 mm per minute. The data showed statistically significant differences in relation to alloys and thickness among the bars, and all thicknesses evaluated were different. Thus, it was concluded that there was statistically significant difference between the groups and their variables, and that the alloys recast could be reused at least 1 time, without loss of properties.展开更多
文摘BACKGROUND Endoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction(MDBO).AIM To compare the safety and efficacy of plastic stent(PS)vs self-expanding metal stent(SEMS)placement for treatment of MDBO.METHODS This meta-analysis was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.A comprehensive search was performed in MEDLINE,Cochrane,Embase,Latin American and Caribbean Health Sciences Literature,and grey literature to identify randomized clinical trials(RCTs)comparing clinical success,adverse events,stent dysfunction rate,reintervention rate,duration of stent patency,and mean survival.Risk difference(RD)and mean difference(MD)were calculated and heterogeneity was assessed with I2 statistic.Subgroup analyses were performed by SEMS type.RESULTS Twelve RCTs were included in this study,totaling 1005 patients.There was no difference in clinical success(RD=-0.03,95%confidence interval[CI]:-0.01,0.07;I 2=0%),rate of adverse events(RD=-0.03,95%CI:-0.10,0.03;I2=57%),and mean patient survival(MD=-0.63,95%CI:-18.07,19.33;I2=54%)between SEMS vs PS placement.However,SEMS placement was associated with a lower rate of reintervention(RD=-0.34,95%CI:-0.46,-0.22;I2=57%)and longer duration of stent patency(MD=125.77 d,95%CI:77.5,174.01).Subgroup analyses revealed both covered and uncovered SEMS improved stent patency compared to PS(RD=152.25,95%CI:37.42,267.07;I2=98%and RD=101.5,95%CI:38.91,164.09;I2=98%;respectively).Stent dysfunction was higher in the covered SEMS group(RD=-0.21,95%CI:-0.32,-0.1;I²=205%),with no difference in the uncovered SEMS group(RD=-0.08,95%CI:-0.56,0.39;I²=87%).CONCLUSION While both stent types possessed a similar clinical success rate,complication rate,and patient-associated mean survival for treatment of MDBO,SEMS were associated with a longer duration of stent patency compared to PS.
文摘The present study analyzed new and recast Ni-Cr alloys, regarding the relationship between the applied force and the deformation in cantilevered bar segments, with dimensions of 4.0 mm, 3.5 mm, 3.0 mm in thickness, 4.5 mm width and 15 mm length, on a universal testing machine “EMIC”. The bars in the tests were initially obtained acrylic resin by 4.8 mm wide × 4.3 mm thick × 4 cm long. We obtained 30 bars divided into two groups, with 15 to test new alloys and 15 with alloys recast. The alloy used was Tilite. For the application of the load, the bars were attached to “EMIC” where the active tip of 200 kgf load cell was at a specific point of the bar (15 mm) with a speed of 0.5 mm per minute. The data showed statistically significant differences in relation to alloys and thickness among the bars, and all thicknesses evaluated were different. Thus, it was concluded that there was statistically significant difference between the groups and their variables, and that the alloys recast could be reused at least 1 time, without loss of properties.
