The introduction of minimally invasive surgery in other gynecologic cancers has shown benefits with similar oncologic outcomes. However, the biology and complexity of surgery for ovarian cancer may preclude this approach for ovarian cancer patients. Our objective is to assess feasibility to achieve complete cytoreductive surgery after neoadjuvant chemotherapy for stage IIIC-IV ovarian cancer patients via minimally invasive surgery. Our data sources include PubMed, Embase, Scopus, Biosis, Clinicaltrials.gov, and the Cochrane Library. Meta-analysis was performed using the random-effects model with DerSimonian and Laird estimator for the amount of heterogeneity to estimate the pooled outcomes. A funnel plot and Egger's regression test were used to test publication bias. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the studies. There were 6 studies (3 prospective, 3 retrospective) that met the criteria for meta-analysis with a total of 3231 patients, 567 were in the minimally invasive group and 2664 in the laparotomy group. Both groups were similar in stage and serous histology. Complete cytoreductive surgery was achieved in 74.50% (95% CI 40.41-97.65%) and 53.10% (95% CI 4.88-97.75%) of patients in the minimally invasive and laparotomy groups, respectively. There was no statistical significant difference between these 2 pooled proportions (p = 0.52). Three studies compared minimally invasive surgery vs laparotomy. No significant difference was observed between the 2 groups in obtaining complete cytoreductive surgery [OR = 0.90 (95% CI 0.70-1.16; p = 0.43)]. A symmetrical funnel plot indicated no publication bias. The pooled proportion for grade> 2 postoperative complications was not significant among the laparoscopy group [3.11% (95% CI 0.00-10.24%; p = 0.15)]. Complete cytoreductive surgery appears feasible and safe with minimally invasive surgery in selected advanced ovarian cancer patients after neoadjuvant chemotherapy.

Background: Nocturnal symptoms in Parkinson's disease and their related burdens on patients are often treated after management of daytime manifestations. In order to better understand the unmet needs of nocturnal symptoms management, we sought to analyze the characteristics of nocturnal symptoms and their associated burden from patients' perspectives in 2016 to 2018 and explore whether there were any changes in participants' needs over time across 3 years. Overall symptoms (occurring at day or night) were collected to contrast and compare whether the unmet healthcare needs related to nocturnal symptoms and to overall symptoms are different. Methods: We used a contemporary Social Listening big-data technique to analyze large amounts of Parkinson's disease symptoms in patient-doctor and patient-patient dialogues available from social media platforms in 2016 to 2018 in China. These symptoms were classi ed as either overall symptoms or nocturnal symptoms. We used share of voice (SOV) of symptoms as a proportion of total dialogues per year to re ect the characteristics of symptoms from patients' perspectives. Negative sentiment score of symptoms was analyzed to nd out their related burden on patients. Results: We found that SOV for overall motor symptoms was 79% and had not increased between 2016 and 2018 (79%, p = 0.5), but SOV for non-motor symptoms (69% in 2018) had grown by 7% in 2018 (p < 0.01). SOV for motor complications was 9%, and had increased by 6% (p < 0.01) by 2018. The SOV of motor symptoms was signi cantly larger than non-motor symptoms and motor complications (p < 0.01) in each year. The SOV of non-motor symptoms was larger than that of motor complication (p < 0.01). For nocturnal symptoms, 45% of the analyzed PD population reported nocturnal symptoms in 2018, growing by 6% from 2016 (p < 0.01). SOV for nocturnal-occurring motor symptoms was higher than most nonmotor symptoms (except insomnia). However, non-motor symptoms had the higher increases in SOV. Non-motor symptoms evoked higher negative sentiment regardless of whether they occurred during the day or night. For symptoms that can occur at either day or night, each nocturnal symptom was rated with a higher negative sentiment score than the same symptom during the day, regardless of the type of symptom. Conclusions: The growing share of voice and the greater negative sentiment of nocturnal symptoms from patients' perspectives suggest that management of nocturnal symptoms is an unmet need of patients with Parkinson's disease. A greater emphasis on detecting nocturnal symptoms and treating them with 24-hour care is encouraged. Background Parkinson's disease (PD) is the most common movement disorder of the central nervous system [1]. It is estimated that PD affects 1-2% of the population above 65 years of age worldwide [2]. In China, the overall prevalence has been estimated at 190 per 100,000 individuals, with an overall incidence of 362 per 100,000 person years [3]. PD is characterized by both motor and non-motor system manifestations. Motor sympto...

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IntroductionMethicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of infection in humans. Beta-lactam antibiotics are the preferred agents, with anti-staphylococcal penicillins (ASPs) or the first-generation cephalosporin, cefazolin, favored by clinicians. Recent studies comparing the two strategies suggest similar outcomes between the agents. The purpose of this meta-analysis was to explore differences between cefazolin and ASPs for the treatment of MSSA infections.MethodsWe performed a meta-analysis with trial sequential analysis (TSA) of observational or cohort studies using a random-effects model. Two blinded reviewers independently assessed studies for inclusion, risk of bias, and data extraction. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, and antibiotic discontinuation due to adverse events. Subgroup analyses were conducted for the primary outcome by type of ASP, studies with a high percentage of deep-seated infections, and studies of low to moderate risk of bias.ResultsAfter performing a comprehensive search of the literature, and screening for study inclusion, 19 studies (13,390 patients) were included in the final meta-analysis. Fifteen of the 19 studies (79%) were judged as having a low or moderate risk of bias. Use of cefazolin was associated with lower all-cause mortality [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.56–0.91, p = 0.006, I2 = 28%], clinical failure (OR 0.55, 95% CI 0.41–0.74, p < 0.001, I2 = 0%), and antibiotic discontinuation due to adverse events (OR 0.25, 95% CI 0.16–0.39, p < 0.001, I2 = 23%). Infection recurrence was higher in the cefazolin patients (OR 1.41, 95% CI 1.04–1.93, p = 0.03, I2 = 0%).ConclusionThis meta-analysis demonstrated that the use of cefazolin was associated with significant reductions in all-cause mortality, clinical failure, and discontinuation due to adverse events, but was associated with an increased risk of infection recurrence.FundingUniversity of Florida Open Access Publishing Fund funded the Rapid Service Fees.Trial registrationPROSPERO International Prospective Register of Systematic Reviews (study ID: CRD42018106442).Electronic supplementary materialThe online version of this article (10.1007/s40121-019-00259-4) contains supplementary material, which is available to authorized users.