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Muir D, Orlando C, Newton B. Impact of summer programmes on the outcomes of disadvantaged or 'at risk' young people: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1406. [PMID: 38873396 PMCID: PMC11170337 DOI: 10.1002/cl2.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 06/15/2024]
Abstract
Review Rationale and Context Many intervention studies of summer programmes examine their impact on employment and education outcomes, however there is growing interest in their effect on young people's offending outcomes. Evidence on summer employment programmes shows promise on this but has not yet been synthesised. This report fills this evidence gap through a systematic review and meta-analysis, covering summer education and summer employment programmes as their contexts and mechanisms are often similar. Research Objective The objective is to provide evidence on the extent to which summer programmes impact the outcomes of disadvantaged or 'at risk' young people. Methods The review employs mixed methods: we synthesise quantitative information estimating the impact of summer programme allocation/participation across the outcome domains through meta-analysis using the random-effects model; and we synthesise qualitative information relating to contexts, features, mechanisms and implementation issues through thematic synthesis. Literature searches were largely conducted in January 2023. Databases searched include: Scopus; PsychInfo; ERIC; the YFF-EGM; EEF's and TASO's toolkits; RAND's summer programmes evidence review; key academic journals; and Google Scholar. The review employed PICOSS eligibility criteria: the population was disadvantaged or 'at risk' young people aged 10-25; interventions were either summer education or employment programmes; a valid comparison group that did not experience a summer programme was required; studies had to estimate the summer programme's impact on violence and offending, education, employment, socio-emotional and/or health outcomes; eligible study designs were experimental and quasi-experimental; eligible settings were high-income countries. Other eligibility criteria included publication in English, between 2012 and 2022. Process/qualitative evaluations associated with eligible impact studies or of UK-based interventions were also included; the latter given the interests of the sponsors. We used standard methodological procedures expected by The Campbell Collaboration. The search identified 68 eligible studies; with 41 eligible for meta-analysis. Forty-nine studies evaluated 36 summer education programmes, and 19 studies evaluated six summer employment programmes. The number of participants within these studies ranged from less than 100 to nearly 300,000. The PICOSS criteria affects the external applicability of the body of evidence - allowances made regarding study design to prioritise evidence on UK-based interventions limits our ability to assess impact for some interventions. The risk of bias assessment categorised approximately 75% of the impact evaluations as low quality, due to attrition, losses to follow up, interventions having low take-up rates, or where allocation might introduce selection bias. As such, intention-to-treat analyses are prioritised. The quality assessment rated 93% of qualitative studies as low quality often due to not employing rigorous qualitative methodologies. These results highlight the need to improve the evidence. Results and Conclusions Quantitative synthesis The quantitative synthesis examined impact estimates across 34 outcomes, through meta-analysis (22) or in narrative form (12). We summarise below the findings where meta-analysis was possible, along with the researchers' judgement of the security of the findings (high, moderate or low). This was based on the number and study-design quality of studies evaluating the outcome; the consistency of findings; the similarity in specific outcome measures used; and any other specific issues which might affect our confidence in the summary findings.Below we summarise the findings from the meta-analyses conducted to assess the impact of allocation to/participation in summer education and employment programmes (findings in relation to other outcomes are also discussed in the main body, but due to the low number of studies evaluating these, meta-analysis was not performed). We only cover the pooled results for the two programme types where there are not clear differences in findings between summer education and summer employment programmes, so as to avoid potentially attributing any impact to both summer programme types when this is not the case. We list the outcome measure, the average effect size type (i.e., whether a standardised mean difference (SMD) or log odds ratio), which programme type the finding is in relation to and then the average effect size along with its 95% confidence interval and the interpretation of the finding, that is, whether there appears to be a significant impact and in which direction (positive or negative, clarifying instances where a negative impact is beneficial). In some instances there may be a discrepancy between the 95% confidence interval and whether we determine there to be a significant impact, which will be due to the specifics of the process for constructing the effect sizes used in the meta-analysis. We then list the I 2 statistic and the p-value from the homogeneity test as indications of the presence of heterogeneity. As the sample size used in the analysis are often small and the homogeneity test is known to be under-powered with small sample sizes, it may not detect statistically significant heterogeneity when it is in fact present. As such, a 90% confidence level threshold should generally be used when interpreting this with regard to the meta-analyses below. The presence of effect size heterogeneity affects the extent to which the average effects size is applicable to all interventions of that summer programme type. We also provide an assessment of the relative confidence we have in the generalisability of the overall finding (low, moderate or high) - some of the overall findings are based on a small sample of studies, the studies evaluating the outcome may be of low quality, there may be wide variation in findings among the studies evaluating the outcome, or there may be specific aspects of the impact estimates included or the effect sizes constructed that affect the generalisability of the headline finding. These issues are detailed in full in the main body of the review. -Engagement with/participation in/enjoyment of education (SMD):∘Summer education programmes: +0.12 (+0.03, +0.20); positive impact; I 2 = 48.76%, p = 0.10; moderate confidence.-Secondary education attendance (SMD):∘Summer education programmes: +0.26 (+0.08, +0.44); positive impact; I 2 = N/A; p = N/A; low confidence.∘Summer employment programmes: +0.02 (-0.03, +0.07); no impact; I 2 = 69.98%; p = 0.03; low confidence.-Passing tests (log OR):∘Summer education programmes: +0.41 (-0.13, +0.96); no impact; I 2 = 95.05%; p = 0.00; low confidence.∘Summer employment programmes: +0.02 (+0.00, +0.04); positive impact; I 2 = 0.01%; p = 0.33; low confidence.-Reading test scores (SMD):∘Summer education programmes: +0.01 (-0.04, +0.05); no impact; I 2 = 0.40%; p = 0.48; high confidence.-English test scores (SMD):∘Summer education programmes: +0.07 (+0.00, +0.13); positive impact; I 2 = 27.17%; p = 0.33; moderate confidence.∘Summer employment programmes: -0.03 (-0.05, -0.01); negative impact; I 2 = 0.00%; p = 0.76; low confidence.-Mathematics test scores (SMD):∘All summer programmes: +0.09 (-0.06, +0.25); no impact; I 2 = 94.53%; p = 0.00; high confidence.∘Summer education programmes: +0.14 (-0.09, +0.36); no impact; I 2 = 94.15%; p = 0.00; moderate confidence.∘Summer employment programmes: +0.00 (-0.04, +0.05); no impact; I 2 = 0.04%; p = 0.92; moderate confidence.-Overall test scores (SMD):∘Summer employment programmes: -0.01 (-0.08, +0.05); no impact; I 2 = 32.39%; p = 0.20; high confidence.-All test scores (SMD):∘Summer education programmes: +0.14 (+0.00, +0.27); positive impact; I 2 = 91.07%; p = 0.00; moderate confidence.∘Summer employment programmes: -0.01 (-0.04, +0.01); no impact; I 2 = 0.06%; p = 0.73; high confidence.-Negative behavioural outcomes (log OR):∘Summer education programmes: -1.55 (-3.14, +0.03); negative impact; I 2 = N/A; p = N/A; low confidence.∘Summer employment programmes: -0.07 (-0.33, +0.18); no impact; I 2 = 88.17%; p = 0.00; moderate confidence.-Progression to HE (log OR):∘All summer programmes: +0.24 (-0.04, +0.52); no impact; I 2 = 97.37%; p = 0.00; low confidence.∘Summer education programmes: +0.32 (-0.12, +0.76); no impact; I 2 = 96.58%; p = 0.00; low confidence.∘Summer employment programmes: +0.10 (-0.07, +0.26); no impact; I 2 = 76.61%; p = 0.02; moderate confidence.-Complete HE (log OR):∘Summer education programmes: +0.38 (+0.15, +0.62); positive impact; I 2 = 52.52%; p = 0.06; high confidence.∘Summer employment programmes: +0.07 (-0.19, +0.33); no impact; I 2 = 70.54%; p = 0.07; moderate confidence.-Entry to employment, short-term (log OR):∘Summer employment programmes: -0.19 (-0.45, +0.08); no impact; I 2 = 87.81%; p = 0.00; low confidence.∘Entry to employment, full period (log OR)∘Summer employment programmes: -0.15 (-0.35, +0.05); no impact; I 2 = 78.88%; p = 0.00; low confidence.-Likelihood of having a criminal justice outcome (log OR):∘Summer employment programmes: -0.05 (-0.15, +0.05); no impact; I 2 = 0.00%; p = 0.76; low confidence.-Likelihood of having a drug-related criminal justice outcome (log OR):∘Summer employment programmes: +0.16 (-0.57, +0.89); no impact; I 2 = 65.97%; p = 0.09; low confidence.-Likelihood of having a violence-related criminal justice outcome (log OR):∘Summer employment programmes: +0.03 (-0.02, +0.08); no impact; I 2 = 0.00%; p = 0.22; moderate confidence.-Likelihood of having a property-related criminal justice outcome (log OR):∘Summer employment programmes: +0.09 (-0.17, +0.34); no impact; I 2 = 45.01%; p = 0.18; low confidence.-Number of criminal justice outcomes, during programme (SMD):∘Summer employment programmes: -0.01 (-0.03, +0.00); no impact; I 2 = 2.17%; p = 0.31; low confidence.-Number of criminal justice outcomes, post-programme (SMD):∘Summer employment programmes: -0.01 (-0.03, +0.00); no impact; I 2 = 23.57%; p = 0.37; low confidence.-Number of drug-related criminal justice outcomes, post-programme (SMD):∘Summer employment programmes: -0.01 (-0.06, +0.06); no impact; I 2 = 55.19%; p = 0.14; moderate confidence.-Number of violence-related criminal justice outcomes, post-programme (SMD):∘Summer employment programmes: -0.02 (-0.08, +0.03); no impact; I 2 = 44.48%; p = 0.18; low confidence.-Number of property-related criminal justice outcomes, post-programme (SMD):∘Summer employment programmes: -0.02 (-0.10, +0.05); no impact; I 2 = 64.93%; p = 0.09; low confidence. We re-express instances of significant impact by programme type where we have moderate or high confidence in the security of findings by translating this to a form used by one of the studies, to aid understanding of the findings. Allocation to a summer education programme results in approximately 60% of individuals moving from never reading for fun to doing so once or twice a month (engagement in/participation in/enjoyment of education), and an increase in the English Grade Point Average of 0.08. Participation in a summer education programme results in an increase in overall Grade Point Average of 0.14 and increases the likelihood of completing higher education by 1.5 times. Signs are positive for the effectiveness of summer education programmes in achieving some of the education outcomes considered (particularly on test scores (when pooled across types), completion of higher education and STEM-related higher education outcomes), but the evidence on which overall findings are based is often weak. Summer employment programmes appear to have a limited impact on employment outcomes, if anything, a negative impact on the likelihood of entering employment outside of employment related to the programme. The evidence base for impacts of summer employment programmes on young people's violence and offending type outcomes is currently limited - where impact is detected this largely results in substantial reductions in criminal justice outcomes, but the variation in findings across and within studies affects our ability to make any overarching assertions with confidence. In understanding the effectiveness of summer programmes, the order of outcomes also requires consideration - entries into education from a summer employment programme might be beneficial if this leads towards better quality employment in the future and a reduced propensity of criminal justice outcomes. Qualitative Synthesis Various shared features among different summer education programmes emerged from the review, allowing us to cluster specific types of these interventions which then aided the structuring of the thematic synthesis. The three distinct clusters for summer education programmes were: catch-up programmes addressing attainment gaps, raising aspirations programmes inspiring young people to pursue the next stage of their education or career, and transition support programmes facilitating smooth transitions between educational levels. Depending on their aim, summer education programme tend to provide a combination of: additional instruction on core subjects (e.g., English, mathematics); academic classes including to enhance specialist subject knowledge (e.g., STEM-related); homework help; coaching and mentoring; arts and recreation electives; and social and enrichment activities. Summer employment programmes provide paid work placements or subsidised jobs typically in entry-level roles mostly in the third and public sectors, with some summer employment programmes also providing placements in the private sector. They usually include components of pre-work training and employability skills, coaching and mentoring. There are a number of mechanisms which act as facilitators or barriers to engagement in summer programmes. These include tailoring the summer programme to each young person and individualised attention; the presence of well-prepared staff who provide effective academic/workplace and socio-emotional support; incentives of a monetary (e.g., stipends and wages) or non-monetary (e.g., free transport and meals) nature; recruitment strategies, which are effective at identifying, targeting and engaging participants who can most benefit from the intervention; partnerships, with key actors who can help facilitate referrals and recruitment, such as schools, community action and workforce development agencies; format, including providing social activities and opportunities to support the formation of connections with peers; integration into the workplace, through pre-placement engagement, such as through orientation days, pre-work skills training, job fairs, and interactions with employers ahead of the beginning of the summer programme; and skill acquisition, such as improvements in social skills. In terms of the causal processes which lead from engagement in a summer programme to outcomes, these include: skill acquisition, including academic, social, emotional, and life skills; positive relationships with peers, including with older students as mentors in summer education programmes; personalised and positive relationships with staff; location, including accessibility and creating familiar environments; creating connections between the summer education programme and the students' learning at home to maintain continuity and reinforce learning; and providing purposeful and meaningful work through summer employment programmes (potentially facilitated through the provision of financial and/or non-financial incentives), which makes participants more likely to see the importance of education in achieving their life goals and this leads to raised aspirations. It is important to note that no single element of a summer programme can be identified as generating the causal process for impact, and impact results rather from a combination of elements. Finally, we investigated strengths and weaknesses in summer programmes at both the design and implementation stages. In summer education programmes, design strengths include interactive and alternative learning modes; iterative and progressive content building; incorporating confidence building activities; careful lesson planning; and teacher support which is tailored to each student. Design weaknesses include insufficient funding or poor funding governance (e.g., delays to funding); limited reach of the target population; and inadequate allocation of teacher and pupil groups (i.e., misalignment between the education stage of the pupils and the content taught by staff). Implementation strengths include clear programme delivery guidance and good governance; high quality academic instruction; mentoring support; and strong partnerships. Implementation weaknesses include insufficient planning and lead in time; recruitment challenges; and variability in teaching quality. In summer employment programmes, design strengths include use of employer orientation materials and supervisor handbooks; careful consideration of programme staff roles; a wide range of job opportunities; and building a network of engaged employers. Design weaknesses are uncertainty over funding and budget agreements; variation in delivery and quality of training between providers; challenges in recruitment of employers; and caseload size and management. Implementation strengths include effective job matching; supportive relationships with supervisors; pre-work training; and mitigating attrition (e.g., striving to increase take up of the intervention among the treatment group). Implementation weaknesses are insufficient monitors for the number of participants, and challenges around employer availability.
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Affiliation(s)
- Daniel Muir
- Institute of Employment Studies – Economist FunctionBrightonEast SussexUK
| | - Cristiana Orlando
- Institute of Employment Studies – Economist FunctionBrightonEast SussexUK
| | - Becci Newton
- Institute of Employment Studies – Economist FunctionBrightonEast SussexUK
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Jenkins PE, Proctor K, Snuggs S. Dietary intake of adults with eating disorders: A systematic review and meta-analysis. J Psychiatr Res 2024; 175:393-404. [PMID: 38772131 DOI: 10.1016/j.jpsychires.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
Studies have confirmed the link between altered dietary intake and eating disorders (EDs), although no systematic assessment of this research exists. Rigorous synthesis of dietary intake in anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and similar EDs is needed to explore similarities and differences. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we conducted a systematic review and quantitative synthesis of studies of dietary intake. Searches of three electronic databases resulted in thirty-nine included studies. Meta-analyses of subsets of these studies were undertaken to summarise macronutrient intake across AN, BN, and BED. Study quality was assessed using the American Academy of Nutrition and Dietetics Quality Criteria Checklist, with ratings either Positive (k = 27) or Neutral (k = 12). Adults with AN had low energy intake and those with BED reported elevated macronutrient intake. Individuals with BN reported wide variation in energy intake, including some of the highest estimates. Individuals with AN were likely to under-consume key micronutrients, with sodium potentially over-consumed in BN and BED. Vitamin D was under-consumed across all disorders. This meta-analysis highlights important diagnostic differences and synthesises dietary intake in EDs, with particular relevance to risk assessment and treatment.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom.
| | - Katy Proctor
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom
| | - Sarah Snuggs
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom
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Láinez Ramos-Bossini AJ, Jiménez Gutiérrez PM, Ruiz Santiago F. Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials. LA RADIOLOGIA MEDICA 2024; 129:794-806. [PMID: 38512629 DOI: 10.1007/s11547-024-01809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Lumbar facet joint pain (LFJP) is one of the main causes of chronic low back pain (LBP) and can be treated using radiofrequency (RF) sensory denervation. The aim of this work is to analyze the efficacy of RF in LFJP through a systematic review and meta-analysis of randomized controlled trials (RCTs) with placebo control. MATERIALS AND METHODS A systematic search was conducted in the Medline (PubMed), Scopus, Web of Science databases, and the Cochrane Central Register of Controlled Trials (CENTRAL). The variables of interest were pain, functional status, quality of life (QoL), and global perceived effect (GPE) measured at different time intervals: short (< 3 months), medium (> 3 and < 12 months), and long term (> 12 months). RESULTS Eight RCTs with placebo control were included. RF showed significant benefits over placebo in pain relief in the short (MD - 1.01; 95% CI - 1.98 to -0.04; p = 0.04), medium (MD - 1.42; 95% CI - 2.41 to - 0.43; p = 0.005), and long term (MD - 1.12; 95% CI - 1.57 to - 0.68; p < 0.001), as well as improvement in functional disability in the short (SMD - 0.94; 95% CI - 1.73 to - 0.14; p = 0.02) and long term (SMD - 0.74; 95% CI - 1.09 to - 0.39; p < 0.001). No statistically significant differences were observed in QoL or quantitative GPE, but benefits for RF were observed in dichotomous GPE in the medium (OR 0.19; 95% CI 0.07-0.52; p = 0.001) and long term (OR 0.22; 95% CI 0.06-0.78; p = 0.02). Subgroup analyses showed more benefits for RF in LBP < 1 year in the short term and in RCTs that did not require performing an MRI for patient selection. CONCLUSIONS RF demonstrated significant improvement in pain and functionality, but the benefits in terms of QoL and GPE are inconclusive. Future clinical trials should investigate the long-term effects of RF, its impact on quality of life, and define appropriate criteria for patient selection.
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Affiliation(s)
- Antonio Jesús Láinez Ramos-Bossini
- Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda. Fuerzas Armadas, 18014, Granada, Spain.
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain.
| | - Paula María Jiménez Gutiérrez
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain
- Department of Anesthesiology, Hospital Universitario Virgen de Las Nieves, 18014, Granada, Spain
| | - Fernando Ruiz Santiago
- Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda. Fuerzas Armadas, 18014, Granada, Spain
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain
- Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
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Chen J, Alghamdi AA, Wong CY, Alnaim MF, Kuper G, Zhang J. The Efficacy of Fat Grafting on Treating Post-Mastectomy Pain with and without Breast Reconstruction: A Systematic Review and Meta-Analysis. Curr Oncol 2024; 31:2057-2066. [PMID: 38668055 PMCID: PMC11049271 DOI: 10.3390/curroncol31040152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Post-mastectomy pain syndrome (PMPS), characterized by persistent pain lasting at least three months following mastectomy, affects 20-50% of breast surgery patients, lacking effective treatment options. A review was conducted utilizing EMBASE, MEDLINE, and all evidence-based medicine reviews to evaluate the effect of fat grafting as a treatment option for PMPS from database inception to 29 April 2023 (PROSPERO ID: CRD42023422627). Nine studies and 812 patients in total were included in the review. The overall mean change in visual analog scale (VAS) was -3.6 in 285 patients following fat grafting and 0.5 in 147 control group patients. There was a significant reduction in VAS from baseline in the fat grafting group compared to the control group, n = 395, mean difference = -2.17 (95% CI, -2.95 to -1.39). This significant improvement was also noted in patients who underwent mastectomy without reconstruction. Common complications related to fat grafting include capsular contracture, seroma, hematoma, and infection. Surgeons should consider fat grafting as a treatment option for PMPS. However, future research is needed to substantiate this evidence and to identify timing, volume of fat grafting, and which patient cohort will benefit the most.
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Affiliation(s)
- Jeffrey Chen
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.C.); (C.Y.W.)
| | | | - Chi Yi Wong
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.C.); (C.Y.W.)
| | - Muna F. Alnaim
- College of Medicine, King Faisal University, Al Ahsa 31982, Saudi Arabia;
| | - Gabriel Kuper
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Jing Zhang
- Division of Plastics and Reconstructive Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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Hesmerg MK, Oostenbroek MHW, van der List JP. Lever sign test shows high diagnostic accuracy for anterior cruciate ligament injuries: A systematic review and meta-analysis of 3299 observations. Knee 2024; 47:81-91. [PMID: 38310817 DOI: 10.1016/j.knee.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/05/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Injuries of the anterior cruciate ligament (ACL) are common knee injuries among active and younger patients. The Lever Sign Test (LST) is a relatively newer test, of which the accuracy is disputed in the existing literature. The aim of this study was to assess the accuracy with and without anesthesia of the Lever Sign test in the literature. METHODS PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods. RESULTS After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7-86.9) and specificity was 92.0% (95% CI 82.2-96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0-95.2), specificity was 93.4% (95% CI 84.5-97.3) and the AUC was 91.6%. CONCLUSION The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice.
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Affiliation(s)
- Mees K Hesmerg
- Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
| | - Maurits H W Oostenbroek
- Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands; Northwest Clinics, Department of Orthopaedic Surgery, Alkmaar, The Netherlands
| | - Jelle P van der List
- Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands; Northwest Clinics, Department of Orthopaedic Surgery, Alkmaar, The Netherlands; Atrium Health Wake Forest Baptist, Department of Orthopaedic Surgery and Rehabilitation, Winston Salem, NC, United States
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McGrath S, Zhao X, Ozturk O, Katzenschlager S, Steele R, Benedetti A. metamedian: An R package for meta-analyzing studies reporting medians. Res Synth Methods 2024; 15:332-346. [PMID: 38073145 DOI: 10.1002/jrsm.1686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024]
Abstract
When performing an aggregate data meta-analysis of a continuous outcome, researchers often come across primary studies that report the sample median of the outcome. However, standard meta-analytic methods typically cannot be directly applied in this setting. In recent years, there has been substantial development in statistical methods to incorporate primary studies reporting sample medians in meta-analysis, yet there are currently no comprehensive software tools implementing these methods. In this paper, we present the metamedian R package, a freely available and open-source software tool for meta-analyzing primary studies that report sample medians. We summarize the main features of the software and illustrate its application through real data examples involving risk factors for a severe course of COVID-19.
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Affiliation(s)
- Sean McGrath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - XiaoFei Zhao
- MOE Key Laboratory of Bioinformatics, Bioinformatics Division, BNRIST and Department of Automation, Tsinghua University, Beijing, China
| | - Omer Ozturk
- Department of Statistics, The Ohio State University, Columbus, Ohio, USA
| | | | - Russell Steele
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Iaquinandi F, Mongelli F, Christoforidis D, Cianfarani A, Pini R, Saporito A, Popeskou SG, La Regina D. Laparoscopic vs. ultrasound-guided transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis of randomized trials. Surg Endosc 2024; 38:1119-1130. [PMID: 38253697 DOI: 10.1007/s00464-023-10658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The transversus abdominis plane block (TAPB) is effective for postoperative pain management in patients undergoing colorectal surgery. However, evidence regarding the optimal delivery method, either laparoscopic (L-TAPB) or ultrasound-guided (U-TAPB) is lacking. Our study aimed to compare the effectiveness of these delivery methods. METHODS We carried out a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar databases to include randomized studies comparing patients receiving either L-TAPB or U-TAPB during minimally invasive colorectal surgery. The primary endpoint was opioid consumption in the first 24 h after surgery. Risk of bias was assessed with the RoB-2 tool. Effect size was estimated for each study with 95% confidence interval and overall effect measure was estimated with a random effect model. RESULTS The literature search revealed 294 articles, of which four randomized trials were eligible. A total of 359 patients were included, 176 received a L-TAPB and 183 received a U-TAPB. We established the non-inferiority of L-TAPB, as the absolute difference of - 2.6 morphine-mg (95%CI - 8.3 to 3.0) was below the pooled non-inferiority threshold of 8.1 morphine-mg (low certainty level). No difference in opioid consumption was noted at 2, 6, 12, and 48 h (low to very low certainty level). Postoperative pain, nausea and vomiting were similar between groups at different timepoints (low to very low certainty level). No TAPB-related complications were recorded. Finally, the length of hospital stay was similar between groups. CONCLUSION For postoperative multimodal analgesia both L-TAPB and U-TAPB may result in little to no difference in outcome in patients undergoing colorectal surgery. Registration Prospero CRD42023421141.
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Affiliation(s)
- Fabiano Iaquinandi
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland.
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Dimitri Christoforidis
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Agnese Cianfarani
- Department of Surgery, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Ramon Pini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Sotirios Georgios Popeskou
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
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8
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Wang Q, Chen L. Methotrexate therapy for adult and paediatric moderate-to-severe atopic dermatitis: A PRISMA-compliant meta-analysis of data from daily practice. Australas J Dermatol 2024; 65:114-127. [PMID: 37941136 DOI: 10.1111/ajd.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/20/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
Of the 15 eligible studies identified via electronic searches in MEDLINE, EMBASE and CENTRAL in November 2022 for methotrexate therapy of moderate-to-severe atopic dermatitis, 12 were non-randomized controlled trial (non-RCT) studies with data from 437 patients (235 adults and 202 children). The response rates for short-term therapy were 77% [95% CI 55-99] (four studies; adults) - comparable to 81% [54-100] of RCTs (two studies; adults) (p = 0.63) - and 61% [43-79] (two studies; children), and for medium/long-term therapy were 88.9% [74.3-100.0] (four studies; adults) and 77.7% [61.5-94.0] (three studies; children). Children had a markedly lower rate of treatment discontinuation due to side effects [2.0% (five studies; children) vs. 14.9% (six studies; adults)], but were more likely to experience gastrointestinal disorders {relative risk (RR) 2.0 [1.44-2.71]}, fatigue (RR 2.3 [1.35-3.72]), headache (RR 2.8 [1.23-5.61]), and infections (RR 2.9 [2.18-3.58]). Other adverse events (children vs. adults) included hepatic disorders (32/176 vs. 35/305) and blood and lymphatic system/bone marrow disorders (25/148 vs. 19/184). Four serious adverse events were reported (children). Evidence from daily practice was limited by bias in the selection of participants in the study.
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Affiliation(s)
- Qiaohong Wang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liheng Chen
- Department of Endocrinology, Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
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9
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Xu J, Zhu XM, Ng KC, Alhefzi MM, Avram R, Coroneos CJ. Co-surgeon versus Single-surgeon Outcomes in Free Tissue Breast Reconstruction: A Meta-analysis. J Reconstr Microsurg 2024. [PMID: 38267008 DOI: 10.1055/a-2253-6099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Autologous breast reconstruction offers superior long-term patient reported outcomes compared with implant-based reconstruction. Universal adoption of free tissue transfer has been hindered by procedural complexity and long operative time with microsurgery. In many specialties, co-surgeon (CS) approaches are reported to decrease operative time while improving surgical outcomes. This systematic review and meta-analysis synthesizes the available literature to evaluate the potential benefit of a CS approach in autologous free tissue breast reconstruction versus single-surgeon (SS). METHODS A systematic review and meta-analysis was conducted using PubMed, Embase, and MEDLINE from inception to December 2022. Published reports comparing CS to SS approaches in uni- and bilateral autologous breast reconstruction were identified. Primary outcomes included operative time, postoperative outcomes, processes of care, and financial impact. Risk of bias was assessed and outcomes were characterized with effect sizes. RESULTS Eight retrospective studies reporting on 9,425 patients were included. Compared with SS, CS approach was associated with a significantly shorter operative time (SMD -0.65, 95% confidence interval [CI] -1.01 to -0.29, p < 0.001), with the largest effect size in bilateral reconstructions (standardized mean difference [SMD] -1.02, 95% CI -1.37 to -0.67, p < 0.00001). CS was also associated with a significant decrease in length of hospitalization (SMD -0.39, 95% CI -0.71 to -0.07, p = 0.02). Odds of flap failure or surgical complications including surgical site infection, hematoma, fat necrosis, and reexploration were not significantly different. CONCLUSION CS free tissue breast reconstruction significantly shortens operative time and length of hospitalization compared with SS approaches without compromising postoperative outcomes. Further research should model processes and financial viability of its adoption in a variety of health care models.
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Affiliation(s)
- Joshua Xu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Xi Ming Zhu
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kimberly C Ng
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Ronen Avram
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christopher J Coroneos
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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10
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Al-Asadi M, Sherren M, Abdel Khalik H, Leroux T, Ayeni OR, Madden K, Khan M. The Continuous Fragility Index of Statistically Significant Findings in Randomized Controlled Trials That Compare Interventions for Anterior Shoulder Instability. Am J Sports Med 2024:3635465231202522. [PMID: 38258495 DOI: 10.1177/03635465231202522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Evidence-based care relies on robust research. The fragility index (FI) is used to assess the robustness of statistically significant findings in randomized controlled trials (RCTs). While the traditional FI is limited to dichotomous outcomes, a novel tool, the continuous fragility index (CFI), allows for the assessment of the robustness of continuous outcomes. PURPOSE To calculate the CFI of statistically significant continuous outcomes in RCTs evaluating interventions for managing anterior shoulder instability (ASI). STUDY DESIGN Meta-analysis; Level of evidence, 2. METHODS A search was conducted across the MEDLINE, Embase, and CENTRAL databases for RCTs assessing management strategies for ASI from inception to October 6, 2022. Studies that reported a statistically significant difference between study groups in ≥1 continuous outcome were included. The CFI was calculated and applied to all available RCTs reporting interventions for ASI. Multivariable linear regression was performed between the CFI and various study characteristics as predictors. RESULTS There were 27 RCTs, with a total of 1846 shoulders, included. The median sample size was 61 shoulders (IQR, 43). The median CFI across 27 RCTs was 8.2 (IQR, 17.2; 95% CI, 3.6-15.4). The median CFI was 7.9 (IQR, 21; 95% CI, 1-22) for 11 studies comparing surgical methods, 22.6 (IQR, 16; 95% CI, 8.2-30.4) for 6 studies comparing nonsurgical reduction interventions, 2.8 for 3 studies comparing immobilization methods, and 2.4 for 3 studies comparing surgical versus nonsurgical interventions. Significantly, 22 of 57 included outcomes (38.6%) from studies with completed follow-up data had a loss to follow-up exceeding their CFI. Multivariable regression demonstrated that there was a statistically significant positive correlation between a trial's sample size and the CFI of its outcomes (r = 0.23 [95% CI, 0.13-0.33]; P < .001). CONCLUSION More than a third of continuous outcomes in ASI trials had a CFI less than the reported loss to follow-up. This carries the significant risk of reversing trial findings and should be considered when evaluating available RCT data. We recommend including the FI, CFI, and loss to follow-up in the abstracts of future RCTs.
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Affiliation(s)
- Mohammed Al-Asadi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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11
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Schmidlechner T, Zaddach M, Heinen F, Cornell S, Ramantani G, Rémi J, Vollmar C, Kunz M, Borggraefe I. IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis. J Neurol 2024; 271:177-187. [PMID: 37770569 PMCID: PMC10770207 DOI: 10.1007/s00415-023-12002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE This systematic review aimed to assess the intellectual outcome of children who underwent surgery for epilepsy. METHODS A systematic review of electronic databases was conducted on December 3, 2021, for PubMed and January 11, 2022, for Web of Science. The review was conducted according to the PRISMA guidelines. The included studies reported on intelligence quotient (IQ) or developmental quotient (DQ) before and after epilepsy surgery in children. Studies were included, if the patients had medically intractable epilepsy and if the study reported mainly on curative surgical procedures. We conducted a random-effects meta-analysis to determine the mean change of IQ/DQ. RESULTS Fifty-seven studies reporting on a total of 2593 patients met the inclusion criteria. The mean age at surgery was 9.2 years (± 3.44; range 2.4 months-19.81 years). Thirty-eight studies showed IQ/DQ improvement on a group level, 8 yielded stable IQ/DQ, and 19 showed deterioration. Pooled analysis revealed a significant mean gain in FSIQ of + 2.52 FSIQ points (95% CI 1.12-3.91). The pooled mean difference in DQ was + 1.47 (95% CI - 6.5 to 9.5). The pooled mean difference in IQ/DQ was 0.73 (95% CI - 4.8 to 6.2). Mean FSIQ gain was significantly higher in patients who reached seizure freedom (+ 5.58 ± 8.27) than in patients who did not (+ 0.23 ± 5.65). It was also significantly higher in patients who stopped ASM after surgery (+ 6.37 ± 3.80) than in patients who did not (+ 2.01 ± 2.41). Controlled studies showed a better outcome in the surgery group compared to the non-surgery group. There was no correlation between FSIQ change and age at surgery, epilepsy duration to surgery, and preoperative FSIQ. SIGNIFICANCE The present review indicates that there is a mean gain in FSIQ and DQ in children with medically intractable epilepsy after surgery. The mean gain of 2.52 FSIQ points reflects more likely sustainability of intellectual function rather than improvement after surgery. Seizure-free and ASM-free patients reach higher FSIQ gains. More research is needed to evaluate individual changes after specific surgery types and their effect on long-term follow-up.
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Affiliation(s)
- Tristan Schmidlechner
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Malin Zaddach
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Sonia Cornell
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Jan Rémi
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany.
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
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12
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Levy KH, White CA, Pujari A, Patel AV, Kator JL, Parsons BO, Galatz LM, Cagle PJ. Subacromial Balloon Spacer Implantation Is a Promising Alternative for Patients With Massive Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2024; 40:162-173.e2. [PMID: 37355186 DOI: 10.1016/j.arthro.2023.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To provide an overview of the existing literature on subacromial balloon spacers for the treatment of massive irreparable rotator cuff tears, in an effort to inform surgeons of the procedure's clinical effectiveness. METHODS The PubMed, Scopus, and Ovid EMBASE databases were queried to identify studies evaluating the clinical, radiographic, and patient-reported outcomes of patients indicated for subacromial balloon spacer implantation. The following datapoints were extracted: study demographics, patient baseline characteristics, and postoperative outcomes of interest. Outcomes were evaluated at baseline and at the longest available follow-up period. RESULTS A total 766 patients were included among 22 included studies, with an average follow-up of 27.54 months. Improvements were seen for all clinical and patient-reported outcomes: forward elevation (ranging from 9.20 to 90.00° improvement), external rotation (ranging from 2.00 to 22.00°), abduction (ranging from 14.00 to 95.00°), Total Constant Score (ranging from 7.70 to 50.00), American Shoulder and Elbow Surgeons score (ranging from 24.60 to 59.84), Oxford Shoulder Score (ranging from 7.20 to 22.20), and pain score (ranging from 3.57 to 6.50). Minimal differences were seen in acromiohumeral interval (ranging from -2.00 to 1.27). Reoperation and complication rates ranged from 0% to 33% and 0% to 19.64%, respectively. CONCLUSIONS The short-term results of subacromial balloon spacers for management of massive rotator cuff tears demonstrate clinically relevant improvements in shoulder range of motion and substantial improvements in patient-reported outcome measures. Of note, minimal change in acromiohumeral interval was seen on postoperative radiography, and wide variations in complication and reoperation rates were reported across studies. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Kenneth H Levy
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Christopher A White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Amit Pujari
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Akshar V Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Jamie L Kator
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Paul J Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A..
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13
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van der List JP, Glover MA, Mason TW, Parikh N, Waterman BR. Low Recurrence of Instability and Satisfying Patient-Reported Outcomes Following Various Surgical Treatments of Reverse Hill-Sachs Lesions in the Setting of Posterior Instability: A Systematic Review. Arthroscopy 2023:S0749-8063(23)01016-2. [PMID: 38151167 DOI: 10.1016/j.arthro.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To systematically review the literature and report the outcomes of various surgical treatments for reverse Hill-Sachs lesions (RHSL) in the setting of posterior shoulder instability. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. All studies assessing outcomes of surgical treatment of RHSL from inception to January 2023 were identified in PubMed, Embase, and Cochrane Library. Inclusion criteria consisted of studies reporting outcomes, minimum mean 1-year follow-up, and minimum Level IV evidence. Outcomes were assessed using Forest plots with random effects models using R software. RESULTS A total of 29 studies consisting of 291 patients were included with a mean age of 42 years (range 16-88 years), 87% male gender, and mean follow-up of 4.5 years. The mean size of impacted or affected cartilage was 35%, and time from injury to surgery was mean 15 weeks. Nearly all studies were Level IV evidence, and quality of studies was low. Random effect models were performed, and data are presented as range. A low incidence of instability was noted for all surgical techniques with good patient-reported outcome measures. Most studies reported outcomes of the modified McLaughlin procedure (13 studies, 126 patients) with overall Constant-Murley Score of 65 to 92. Trends were seen towards better Constant-Murley Score and external rotation with a shorter delay between injury, and when arthroscopic and joint preserving treatments were performed. CONCLUSIONS This systematic review showed low rates of instability recurrence, reproducible range of motion, and favorable patient-reported outcome measures were reported following all treatments for RHSLs with posterior instability. There was a significant association between better outcomes and a shorter delay between injury and surgery. The level of evidence is limited, given the small and retrospective studies which can be explained by the rarity of these injuries. LEVEL OF EVIDENCE: Level IV; systematic review of Level IV or better investigations.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A..
| | - Mark A Glover
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Thomas W Mason
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Nihir Parikh
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
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14
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Tayyib NA, Ramaiah P, Alshahrani SH, Margiana R, Almalki SG, Kareem AK, Zabibah RS, Shbeer AM, Ali SHJ, Mustafa YF. Soluble receptor for advanced glycation end products (sRAGE) is associated with obesity rates: a systematic review and meta-analysis of cross-sectional study. BMC Endocr Disord 2023; 23:275. [PMID: 38102636 PMCID: PMC10722718 DOI: 10.1186/s12902-023-01520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Several studies have highlighted the possible positive effects of soluble receptor for advanced glycation end products (sRAGE) against obesity. However, due to their inconsistent results, this systematic review and meta-analysis aimed to quantitatively evaluate and critically review the results of studies evaluating the relationship between sRAGE with obesity among adult population. METHODS In the systematic search, the eligibility criteria were as follows: studies conducted with a cross-sectional design, included apparently healthy adults, adults with obesity, or obesity-related disorders, aged over 18 years, and evaluated the association between general or central obesity indices with sRAGE. RESULTS Our systematic search in electronic databases, including PubMed, Scopus, and Embase up to 26 October, 2023 yielded a total of 21,612 articles. After removing duplicates, screening the titles and abstracts, and reading the full texts, 13 manuscripts were included in the final meta-analysis. According to our results, those at the highest category of circulating sRAGE concentration with median values of 934.92 pg/ml of sRAGE, had 1.9 kg/m2 lower body mass index (BMI) (WMD: -1.927; CI: -2.868, -0.986; P < 0.001) compared with those at the lowest category of sRAGE concentration with median values of 481.88 pg/ml. Also, being at the highest sRAGE category with the median values of 1302.3 pg/ml sRAGE, was accompanied with near 6 cm lower waist circumference (WC) (WMD: -5.602; CI: -8.820, -2.383; P < 0.001 with 86.4% heterogeneity of I2) compared with those at the lowest category of sRAGE concentration with median values of 500.525 pg/ml. Individuals with obesity had significantly lower circulating sRAGE concentrations (WMD: -135.105; CI: -256.491, -13.72; P = 0.029; with 79.5% heterogeneity of I2). According to the subgrouping and meta-regression results, country and baseline BMI were possible heterogeneity sources. According to Begg's and Egger's tests and funnel plots results, there was no publication bias. CONCLUSION According to our results, higher circulating sRAGE concentrations was associated with lower BMI and WC among apparently healthy adults. Further randomized clinical trials are warranted for possible identification of causal associations.
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Affiliation(s)
- Nahla A Tayyib
- Vice Deanship, Postgraduate Research and Scientific Studies, Faculty of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Ria Margiana
- Department of Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Master's Programme Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Andrology Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Sami G Almalki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia
| | - A K Kareem
- Biomedical Engineering Department, Al-Mustaqbal University College, Babylon, Iraq
| | - Rahman S Zabibah
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq
| | - Abdullah M Shbeer
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Saad Hayif Jasim Ali
- Department of medical laboratory, College of Health and Medical Technololgy, Al-Ayen University, Thi-Qar, Iraq
| | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul, 41001, Iraq
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15
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Xia S, Luo L, Wu W, Lu K, Jiang T, Li Y. The role of pudendal nerve block in hemorrhoid surgery: a systematic review and meta-analysis of double-blind randomized controlled trials. Front Med (Lausanne) 2023; 10:1283512. [PMID: 38152300 PMCID: PMC10751314 DOI: 10.3389/fmed.2023.1283512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Background Pudendal nerve block (PNB) is a commonly used anesthesia method that has been widely used in postoperative analgesia for hemorrhoids in recent years. Therefore, we conducted a systematic review and meta-analysis of double-blind randomized controlled trials (RCTs) to analyze the effectiveness of PNB in postoperative analgesia for hemorrhoids. Methods Relevant data and studies published from inception until August 14, 2023, were retrieved from PubMed, Embase, and Web of Science to evaluate the beneficial effects of PNB for analgesia following hemorrhoidectomy. Results This meta-analysis included 6 double-blind RCTs comprising 501 patients. We evaluated the function of PNB in improving outcomes of postoperative analgesia of hemorrhoids. Visual analogue scale (VAS) scores on postoperative within 6 h (MD, -3.04; 95% CI, -4.13 to -1.95; P < 0.0001), 12 h (MD, -3.14; 95% CI, -3.87 to -2.40; P < 0.0001), and 24 h (MD, -2.25; 95% CI, -2.95 to -1.55; P < 0.0001) were enhanced by the application of PNB, but not in 48 h (MD, -2.54; 95% CI, -5.29 to 0.20; P = 0.07). Conclusion Pudendal nerve block (PNB) could effectively relieve postoperative pain of hemorrhoids. However, our results still need to be confirmed by multi-center clinical studies.
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Affiliation(s)
| | | | - Wenjiang Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
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16
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Ta KNT, Bai CH, Chuang KJ. Prevention of Work Absence Due to Back Pain: A Network Meta-Analysis. Eur J Investig Health Psychol Educ 2023; 13:2891-2903. [PMID: 38131899 PMCID: PMC10871117 DOI: 10.3390/ejihpe13120200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
This paper reviewed the most effective strategies for preventing work absence due to back pain (BP) and BP episodes (the number of people reporting back pain). We searched randomized controlled trials (RCTs) of prevention strategies for BP from previous meta-analyses, PubMed, CENTRAL, and Embase and conducted a network meta-analysis. Thirteen RCTs (2033 participants) were included. Low- to high-quality evidence showed that exercise combined with ergonomics, education, back belts, and education combined with ergonomics did not prevent sickness absenteeism or BP episodes. There was moderate-quality evidence that exercise, especially resistance exercise, was the best prevention strategy to reduce the number of people reporting absenteeism due to BP (risk ratio [RR] = 0.10; 95% CI: 0.01 to 0.69). Moderate-quality evidence suggested that resistance and stretching exercises combined with education was the best prevention strategy to reduce pain (RR = 0.80; 95% CI: 0.67 to 0.96) and the number of absenteeism days for BP (standardized mean difference [SMD] = -0.39; 95% CI: -0.77 to -0.02). In conclusion, exercise, especially resistance and stretching exercises, and exercise combined with education were ranked as the best interventions to prevent sickness absenteeism and BP episodes.
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Affiliation(s)
- Kim-Ngan Thi Ta
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 235, Taiwan
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 235, Taiwan
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17
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Abdel Khalik H, Lameire DL, Park LJ, Ayeni OR. The impact of surgical randomised controlled trials on the management of FAI syndrome: a citation analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:6006-6019. [PMID: 37816919 DOI: 10.1007/s00167-023-07608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE To identify and assess the clinical impact of randomised controlled trials (RCTs) assessing the surgical management of femoroacetabular impingement syndrome (FAIS) through a citation analysis. METHODS MEDLINE, EMBASE and CENTRAL were searched from inception to April 22, 2023 for RCTs assessing the surgical management of FAIS. Study characteristics were directly abstracted from included trials and citation metrics were obtained from the Clarivate Web of Knowledge database on May 19, 2023. The continuous fragility index (CFI) was calculated for eligible outcomes. Univariate regression models were used to explore correlations between total citations per year and various study characteristics. RESULTS Ten studies comprising one thousand two hundred ninetypatients were eligible for analysis. Studies were published from 2013 to 2023. Eight countries were represented across various trials with 91% being either North American or European. The mean journal impact factor of published studies was 39.684 (median 2.982; range 1.31-202.73). The mean citation density was 14.17 (range 0.33-48.67). The median CFI was 4.8 (range 1-32.2). Correlation analysis demonstrated strong and statistically significant correlations to study sample size (R = 0.75, p = 0.012), journal impact factor (R = 0.80, p = 0.006) and continuous fragility index (R = 0.95, p = 0.015). CONCLUSION Trials assessing the surgical management of FAIS present with a wide range of clinical uptake based on citation density and are published in journals of broadly variable impact factor. Despite promising citation metrics, high-quality evidence on arthroscopy for FAIS is limited to the United States and Europe with an unclear international impact. Future knowledge translation efforts are warranted to maximise the international uptake of evidence regarding arthroscopic management of FAIS. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Darius L Lameire
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College St Room 508-A, Toronto, ON, M5T 1P5, Canada
| | - Lily J Park
- Division of General Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
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18
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Yap KY, Chi H, Ng S, Ng DHL, Shelat VG. Effect of perioperative branched chain amino acids supplementation in liver cancer patients undergoing surgical intervention: A systematic review. World J Gastrointest Surg 2023; 15:2596-2618. [PMID: 38111761 PMCID: PMC10725538 DOI: 10.4240/wjgs.v15.i11.2596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/15/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Branched chain amino acid (BCAA) supplementation has been associated with favourable outcomes in liver malignancies requiring definitive resection or liver transplantation. Currently, there are no updated systematic reviews evaluating the efficacy of perioperative BCAA supplementation in patients undergoing surgery for liver cancer. AIM To evaluate the efficacy of perioperative BCAA supplementation in patients undergoing surgery for liver cancer. METHODS A systematic review of randomized control trials and observational studies was conducted on PubMed, Embase, Cochrane Library, Scopus, and Web of Science to evaluate the effect of perioperative BCAA supplementation compared to standard in-hospital diet, in liver cancer patients undergoing surgery. Clinical outcomes were extracted, and a meta-analysis was performed on relevant outcomes. RESULTS 16 studies including 1389 patients were included. Perioperative BCAA administration was associated with reduced postoperative infection [risk ratio (RR) = 0.58 95% confidence intervals (CI): 0.39 to 0.84, P = 0.005] and ascites [RR = 0.57 (95%CI: 0.38 to 0.85), P = 0.005]. There was also a reduction in length of hospital stay (LOS) [weighted mean difference (WMD) = -3.03 d (95%CI: -5.49 to -0.57), P = 0.02] and increase in body weight [WMD = 1.98 kg (95%CI: 0.35 to 3.61, P = 0.02]. No significant differences were found in mortality, cancer recurrence and overall survival. No significant safety concerns were identified. CONCLUSION Perioperative BCAA administration is efficacious in reducing postoperative infection, ascites, LOS, and increases body weight in liver cancer patients undergoing surgical resection.
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Affiliation(s)
- Kwan Yi Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - HongHui Chi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Sherryl Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Doris HL Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
| | - Vishal G Shelat
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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19
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Santos A, Braaten K, MacPherson M, Vasconcellos D, Vis-Dunbar M, Lonsdale C, Lubans D, Jung ME. Rates of compliance and adherence to high-intensity interval training: a systematic review and Meta-analyses. Int J Behav Nutr Phys Act 2023; 20:134. [PMID: 37990239 PMCID: PMC10664287 DOI: 10.1186/s12966-023-01535-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND To determine rates of compliance (i.e., supervised intervention attendance) and adherence (i.e., unsupervised physical activity completion) to high-intensity interval training (HIIT) among insufficiently active adults and adults with a medical condition, and determine whether compliance and adherence rates were different between HIIT and moderate-intensity continuous training (MICT). METHODS Articles on adults in a HIIT intervention and who were either insufficiently active or had a medical condition were included. MEDLINE, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science were searched. Article screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using RoB 2.0 or ROBINS-I. Meta-analyses were conducted to discern differences in compliance and adherence between HIIT vs. MICT. Sensitivity analyses, publication bias, sub-group analyses, and quality appraisal were conducted for each meta-analysis. RESULTS One hundred eighty-eight unique studies were included (n = 8928 participants). Compliance to HIIT interventions averaged 89.4% (SD:11.8%), while adherence to HIIT averaged 63% (SD: 21.1%). Compliance and adherence to MICT averaged 92.5% (SD:10.6%) and 68.2% (SD:16.2%), respectively. Based on 65 studies included in the meta-analysis, compliance rates were not different between supervised HIIT and MICT interventions [Hedge's g = 0.015 (95%CI: - 0.088-0.118), p = .78]. Results were robust and low risk of publication bias was detected. No differences were detected based on sub-group analyses comparing medical conditions or risk of bias of studies. Quality of the evidence was rated as moderate over concerns in the directness of the evidence. Based on 10 studies, adherence rates were not different between unsupervised HIIT and MICT interventions [Hedge's g = - 0.313 (95%CI: - 0.681-0.056), p = .096]. Sub-group analysis points to differences in adherence rates dependent on the method of outcome measurement. Adherence results should be interpreted with caution due to very low quality of evidence. CONCLUSIONS Compliance to HIIT and MICT was high among insufficiently active adults and adults with a medical condition. Adherence to HIIT and MICT was relatively moderate, although there was high heterogeneity and very low quality of evidence. Further research should take into consideration exercise protocols employed, methods of outcome measurement, and measurement timepoints. REGISTRATION This review was registered in the PROSPERO database and given the identifier CRD42019103313.
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Affiliation(s)
- Alexandre Santos
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Kyra Braaten
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Megan MacPherson
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Diego Vasconcellos
- Institute for Positive Psychology & Education, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mathew Vis-Dunbar
- Library, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Chris Lonsdale
- Institute for Positive Psychology & Education, Australian Catholic University, Melbourne, Victoria, Australia
| | - David Lubans
- School of Education, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mary E Jung
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada.
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Shigemura T, Yamamoto Y, Maruyama J, Kitamura T, Nakane R, Kawaguchi H, Iida D, Murata Y. Efficacy and safety of pararectus approach for the treatment of acetabular fractures: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2023; 109:103498. [PMID: 36460292 DOI: 10.1016/j.otsr.2022.103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The pararectus (PR) approach combines the advantages of the second window of the ilioinguinal approach and the medial view of the modified Stoppa approach. However, it is unclear whether the PR approach is more effective or safer than the other approaches, as few clinical studies have compared the PR approach with the other approaches. The aim of this study was to provide a systematic review and meta-analysis comparing the PR approach with the other approaches for the treatment of acetabular fractures and to answer the following question: Are the results of the PR approach superior to those of the other approaches in terms of reduction quality, operative time, operative blood loss, complications, and clinical outcomes for treatment of acetabular fractures? PATIENTS AND METHODS A systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value<0.05 was considered to be significant. We calculated the mean differences for continuous data and odds ratio for dichotomous data with 95% confidence intervals for each outcome. Statistical heterogeneity was assessed based on I2 using the standard χ2 test. RESULTS Five studies were included in this meta-analysis. The findings demonstrated that operative blood loss was significantly lower in the PR approach than in the other approaches (p=0.04). There was no significant difference in the rate of anatomical reduction, the operative time, the rate of complications, and the rate of excellent or good clinical score between the PR approach and the other approaches. DISCUSSION The PR approach provided lower operative blood loss, although there was no significant difference in reduction quality, operative time, complications, and excellent or good clinical score between the PR approach and the other approaches. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomonori Shigemura
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan.
| | - Yohei Yamamoto
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan
| | - Juntaro Maruyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Takaki Kitamura
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan
| | - Ryo Nakane
- Department of Orthopaedic Surgery, Kumagaya General Hospital, 4-5-1 Nakanishi, Kumagaya, Saitama 360-8567, Japan
| | - Hiroki Kawaguchi
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan
| | - Daisuke Iida
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan
| | - Yasuaki Murata
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan
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21
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Sandefur EP, Hansen BK, Hackley DT, Schmitt MW, Beck JH, Bravo CJ. The Clinical Outcomes of Radiocapitellar Reconstruction With Radiocapitellar Arthroplasty: A Systematic Review and Meta-Analysis. J Shoulder Elb Arthroplast 2023; 7:24715492231199339. [PMID: 37692057 PMCID: PMC10483965 DOI: 10.1177/24715492231199339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023] Open
Abstract
Background Radiocapitellar arthroplasty fills a treatment void for young patients who experience isolated capitellar fractures or radiocapitellar osteoarthritis who are not candidates for total elbow arthroplasty. The outcomes of this procedure are sparsely reported. We designed a meta-analysis to determine the utility of radiocapitellar arthroplasty with respect to functional and patient reported outcomes. Methods The PubMed database was searched for relevant studies. Only studies published in English language that assessed patient reported outcomes following radiocapitellar arthroplasty were included in this study. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses for 2020. Results The initial review yielded 562 studies that met the criteria. After excluding duplications and confounding factors, eight case series were identified for review. Of the eight studies, seven were eligible for inclusion in the meta-analysis for Mayo Elbow Performance Score, flexion-extension arc, and pronation-supination arc. The pooled standard mean difference was found to be statistically significant between pre-operative and post-operative outcomes for Mayo Elbow Performance Score (SMD = 3.04, 95% CI [2.40, 3.67]), flexion-extension arc (SMD = 1.28, 95% CI [0.73, 1.83]), and pronation-supination arc (SMD = 0.81, 95% CI [0.43, 1.18]). Cochran's Q-test and I2 statistics indicated statistically significant heterogeneity for Mayo Elbow Performance Score (p = .04, I2 = 54%) and flexion-extension arc (p < .01, I2 = 67%). Conclusions Patients undergoing radiocapitellar arthroplasty showed statistically significant improvements in flexion-extension arc, pronation-supination arc, and Mayo Elbow Performance Scores compared to pre-operative measures.
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Affiliation(s)
| | - Brian K Hansen
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Darren T Hackley
- Department of Orthopaedic Surgery, Musculoskeletal Education and Research Center, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, VA, USA
| | - Mark W Schmitt
- Department of Orthopaedic Surgery, Musculoskeletal Education and Research Center, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, VA, USA
| | - Jadon H Beck
- Department of Orthopaedic Surgery, Musculoskeletal Education and Research Center, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, VA, USA
| | - Cesar J Bravo
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Department of Orthopaedic Surgery, Musculoskeletal Education and Research Center, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, VA, USA
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22
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Korytkowski PD, Panzone JM, Aldahamsheh O, Mubarak Alkhayarin M, Omar Almohamad H, Alhammoud A. Open and closed reduction methods for intramedullary nailing of femoral shaft fractures: A systematic review and meta-analysis of comparative studies. J Clin Orthop Trauma 2023; 44:102256. [PMID: 37822478 PMCID: PMC10562845 DOI: 10.1016/j.jcot.2023.102256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/05/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Closed reduction and intramedullary nailing is the preferred surgical intervention for femoral shaft fractures. Open reduction involves opening the fracture site and is performed in various circumstances. Comparative studies of the approaches have conflicting results. We sought to compare the outcomes and complications of open and closed reduction for intramedullary nailing of femoral shaft fractures. Materials and methods Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic review of comparative studies included the databases and registers PubMed (Medline), Embase, Scopus, and Cochrane Central (PROSPERO registration ID: CRD42022325382). Additional studies were identified through hand and citation searching. Two reviewers independently extracted data. The standardized mean difference and 95% confidence intervals were determined for continuous variables, whereas odds ratios and 95% confidence intervals were assessed for dichotomous variables. Results Closed reduction had a higher pooled union rate (93.93%, 92.02%), an increased odds ratio for union (OR = 1.624 [95% CI: 1.004, 2.624]; p = .048), and a faster time to union (SMD = -0.292 [95% CI: -0.549, -0.0.035]; p = .026). There were no differences in operative time (SMD = 0.128 [95% CI: -0.700, 0.956] p = .762) or overall complication rate (OR = 1.314 [95% CI: 0.966, 1.787] p = .082). Conclusions Closed reduction has the advantage of higher union rates, quicker time to union, and lower overall infection compared to open reduction for intramedullary nailing of femoral shaft fractures. Open reduction remains a reasonable alternative with acceptable union rates when closed reduction is not feasible.
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Affiliation(s)
- Paul D. Korytkowski
- State University of New York, Upstate Medical University College of Medicine, Syracuse, NY, USA
- Virtual Spine Surgery Research Academy (VSSRA), USA
| | - John M. Panzone
- State University of New York, Upstate Medical University College of Medicine, Syracuse, NY, USA
- Virtual Spine Surgery Research Academy (VSSRA), USA
- Socially Responsible Surgery Organization, SUNY Upstate Medical University Chapter, Syracuse, NY, USA
| | - Osama Aldahamsheh
- Department of General and Special Surgery, Orthopedic Surgery, Al-Balqa Applied University, Al-Salt, Jordan
- Virtual Spine Surgery Research Academy (VSSRA), USA
| | | | | | - Abduljabbar Alhammoud
- Department of Orthopedic Surgery, University of Arizona College of Medicine, Tuscon, Arizona, USA
- Virtual Spine Surgery Research Academy (VSSRA), USA
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Choudhury AK, Gupta K, Ansari S, Raja BS, Paul S, Kalia RB. Modern implants in total knee arthroplasty are more patellofemoral joint friendly compared to their traditional design: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:5873-5889. [PMID: 36961568 DOI: 10.1007/s00402-023-04832-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Implant designs for total knee arthroplasties (TKA) are continuously evolving to improve outcomes and satisfaction rates after TKA. The present systematic review and meta-analysis aimed to explore the evidence in the literature regarding the outcomes of the Attune knee system over the PFC Sigma knee design and investigate the advantage of one over the other. METHODS A systematic review and meta-analysis of published studies till August 2021 was performed using the defined eligibility criteria. This was a systematic review of the literature published in the Cochrane Central Register of Controlled Trials (CENTRAL) Library, PUBMED, and EMBASE. The analysis included prospective and retrospective comparative trials comparing TKA by PFC sigma or Attune posterior stabilized (PS) or cruciate-retaining (CR), fixed bearing, or rotating platform systems. Patient-reported outcome measures (PROM) and postoperative patellar complications were analysed in the studies utilizing attune knee system (modern implants) to its counterpart PFC sigma (traditional implants) for TKA. Quality assessment was conducted using NIH Quality Assessment Tool for controlled intervention studies (RCTs and case-control studies). RESULTS This review included 3 RCTs and the rest, 10 of which were non-RCT, including 5852 patients. ATTUNE designs suggested a statistically significant improvement in KSS over PFC Sigma designs. Other PROMs such as OKS and WOMAC scores yielded comparable results between the two groups. ATTUNE knee prosthesis did not result in better knee range of motion, patient satisfaction, or radiological outcomes than the PFC design. Regarding the complications, attune knee prosthesis demonstrated favourable results over PFC Sigma for anterior knee pain and patellofemoral (PF) crepitus. CONCLUSIONS The present systematic review highlights better KSS and lesser chances of PF complications favouring a modern implant design over its traditional counterpart. Other patient-reported outcome analyses at a short-term follow-up period were comparable among patients undergoing total knee replacements with two different implant designs. Radiological outcomes for component positioning also suggested similar results among the two groups.
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Affiliation(s)
- Arghya Kundu Choudhury
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Kshitij Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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24
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Farhangi MA, Fathi Azar E, Manzouri A, Rashnoo F, Shakarami A. Prolonged screen watching behavior is associated with high blood pressure among children and adolescents: a systematic review and dose-response meta-analysis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:89. [PMID: 37653414 PMCID: PMC10468885 DOI: 10.1186/s41043-023-00437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Numerous cardio-metabolic risk factors influence screen-related behaviors in children and adolescents. Numerous studies with inconsistent results revealed a relationship between blood pressure and screen time in the children and adolescents. This systematic review and meta-analysis summarized the data regarding the relationship between screen time and hypertension (HTN) in children and adolescents. METHODS We examined three electronic databases, including Scopus, PubMed, and Embase to find the recent research on the relationship between screen time and HTN up to 19 July 2022. Twenty papers were included in the final two-class and dose-response meta-analysis. We conducted subgrouping to identify the source of heterogeneity. RESULTS The highest category of screen time increased the odds of HTN by 8% [odds ratio (OR): 1.15; 95% confidence interval (CI): 1.08, 1.23; P < 0.001; I2 = 83.20%] and 1.9 mmHg increase in systolic blood pressure [weighted mean difference (WMD): 1.89; 95% CI: 0.18-3.62; P = 0.030; I2 = 83.4]. However, there was no significant difference in diastolic blood pressure. Moreover, screen time in hypertensive children and adolescents was 0.79 h (47.4 min) higher than normotensive subjects (WMD: 0.79; 95% CI: 0.02, 1.56; P = 0.046; I2 = 92.8). A departure from linearity was observed between increased screen time [digital video discs, personal computers, and video games and HTN (Pnonlinearity = 0.049). CONCLUSION This systematic meta-analysis review is the first to demonstrate a positive correlation between screen time and HTN in children and adolescents.
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Affiliation(s)
| | - Elahe Fathi Azar
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Manzouri
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariborz Rashnoo
- Department of General and Minimally Invasive Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Shakarami
- Department of Cardiovascular Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
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Erdogan S, Sakha S, Shanmugaraj A, Prada C, Frank RM, Leroux T, Khan M. Comparing surgical outcomes of anterior capsular release vs circumferential release for persistent capsular stiffness. Shoulder Elbow 2023; 15:360-372. [PMID: 37538519 PMCID: PMC10395412 DOI: 10.1177/17585732221092016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 08/05/2023]
Abstract
Purpose To consolidate the existing literature evaluating anterior capsular release and circumferential capsular release in the treatment of adhesive capsulitis (AC) of the shoulder. Methods The electronic databases PUBMED, EMBASE, MEDLINE and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 8, 2020. Data are presented descriptively where appropriate. A meta-analysis was conducted for patient-reported outcomes. Results Overall, there were forty-six articles included. The majority of patients underwent circumferential release compared to anterior release (80.1% vs. 19.9%). Concomitant Manipulation Under Anesthesia (MUA) was employed in 25 studies, with a higher occurrence in the anterior compared to the circumferential release group (70% vs 60%). Both groups experienced significant improvements postoperatively in range of motion (ROM) and patient-reported outcomes. Complication rates were low for both anterior release (0.67%) and 360° release (0.44%). Conclusion Both anterior and circumferential release are effective techniques for treating AC with low complication rates. Future studies should improve documentation of patient demographics, surgical techniques and outcomes to determine an individualized treatment protocol for patients. Level of evidence Level IV, Systematic Review of Level I-IV studies.
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Affiliation(s)
- Safiya Erdogan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Seaher Sakha
- Faculty of Life Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Carlos Prada
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | | | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Gazzea E, Batáry P, Marini L. Global meta-analysis shows reduced quality of food crops under inadequate animal pollination. Nat Commun 2023; 14:4463. [PMID: 37491349 PMCID: PMC10368628 DOI: 10.1038/s41467-023-40231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Abstract
Animal pollination supports the production of a wide range of food crops fundamental to maintaining diverse and nutritionally balanced diets. Here, we present a global meta-analysis quantifying the contribution of pollination to multiple facets of crop quality, including both organoleptic and nutritional traits. In fruits and vegetables, pollinators strongly improve several commercially important attributes related to appearance and shelf life, whereas they have smaller effects on nutritional value. Pollination does not increase quality in stimulant crops, nuts, and spices. We report weak signals of a pollination deficit for organoleptic traits, which might indicate a potential service decline across agricultural landscapes. However, the deficit is small and non-significant at the α = 0.05 level, suggesting that pollen deposition from wild and/or managed pollinators is sufficient to maximise quality in most cases. As producing commercially suboptimal fruits can have multiple negative economic and environmental consequences, safeguarding pollination services is important to maintain food security.
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Affiliation(s)
- Elena Gazzea
- Department of Agronomy, Food, Natural resources, Animals and Environment (DAFNAE), University of Padua, Legnaro (Padua), Italy.
| | - Péter Batáry
- "Lendület" Landscape and Conservation Ecology, Institute of Ecology and Botany, Centre for Ecological Research, Vácrátót, Hungary
| | - Lorenzo Marini
- Department of Agronomy, Food, Natural resources, Animals and Environment (DAFNAE), University of Padua, Legnaro (Padua), Italy
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Ghasemirad M, Ketabi L, Fayyazishishavan E, Hojati A, Maleki ZH, Gerami MH, Moradzadeh M, Fernandez JHO, Akhavan-Sigari R. The association between screen use and central obesity among children and adolescents: a systematic review and meta-analysis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:51. [PMID: 37268998 DOI: 10.1186/s41043-023-00391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
Currently, there is no summative study evaluating the association between central obesity and screen time. This systematic review and meta-analysis aimed to summarize the results of studies evaluating the association between screen time and central obesity among children and adolescents. To this end, we performed a systematic search in three electronic databases, including Scopus, PubMed, and Embase to retrieve the related studies up to March 2021. Nine studies were eligible to be included in the meta-analysis. There was no association between odds of central obesity and screen time [odds ratio (OR) 1.136; 95% CI 0.965-1.337; P = 0.125]; however, waist circumference (WC) was 1.23 cm higher in those with highest screen time versus those in the lowest screen time category [weighted mean difference (WMD) = 1.23; 95% 95% CI 0.342-2.112; P = 0.007; Fig. 3]. Moreover, the possible sources of heterogeneity in the included studies were continent and sample size. No evidence of publication bias was reported. For the first time, the current systematic review and meta-analysis revealed that those with the highest screen time had higher WC compared with those with the lowest screen time. Although, there was no association between odds of central obesity and screen time. Due to the observational design of the included studies, it is impossible to infer the cause-effect relationship. Therefore, further interventional and longitudinal studies are warranted to better elucidate the causality of these associations.
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Affiliation(s)
- Mohammad Ghasemirad
- Department of Periodontics, Faculty of Dentistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Leyla Ketabi
- Department of Pediatrics, School of Medicine, Bouali Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ehsan Fayyazishishavan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas and Health Science Center at Houston (UTHealth), Houston, USA
| | - Ali Hojati
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Hosseinzadeh Maleki
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mohammad Hadi Gerami
- Bone and Joint Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mahdi Moradzadeh
- Department of Medical Sciences, Tabriz Branch of Islamic Azad University, Tabriz, Iran
| | | | - Reza Akhavan-Sigari
- Department of Neurosurgery, University Medical Center Tuebingen, Tuebingen, Germany
- Department of Health Care Management and Clinical Research, Collegium Humanum Warsaw Management University, Warsaw, Poland
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Rathbone J, Rackham M, Nielsen D, Lee SM, Hing W, Riar S, Scott-Young M. A systematic review of anterior lumbar interbody fusion (ALIF) versus posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), posterolateral lumbar fusion (PLF). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1911-1926. [PMID: 37071155 DOI: 10.1007/s00586-023-07567-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/15/2023] [Accepted: 01/25/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The rate of elective lumbar fusion has continued to increase over the past two decades. However, there remains to be a consensus on the optimal fusion technique. This study aims to compare stand-alone anterior lumbar interbody fusion (ALIF) with posterior fusion techniques in patients with spondylolisthesis and degenerative disc disease through a systematic review and meta-analysis of the available literature. METHODS A systematic review was performed by searching the Cochrane Register of Trials, MEDLINE, and EMBASE from inception to 2022. In the two-stage screening process, three reviewers independently reviewed titles and abstracts. The full-text reports of the remaining studies were then inspected for eligibility. Conflicts were resolved through consensus discussion. Two reviewers then extracted study data, assessed it for quality, and analysed it. RESULTS After the initial search and removal of duplicate records, 16,435 studies were screened. Twenty-one eligible studies (3686 patients) were ultimately included, which compared stand-alone ALIF with posterior approaches such as posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and posterolateral lumbar fusion (PLF). A meta-analysis showed surgical time and blood loss was significantly lower in ALIF than in TLIF/PLIF, but not in those who underwent PLF (p = 0.08). The length of hospital stay was significantly shorter in ALIF than in TLIF, but not in PLIF or PLF. Fusion rates were similar between the ALIF and posterior approaches. The Visual Analogue Scale (VAS) scores for back and leg pain were not significantly different between the ALIF and PLIF/TLIF groups. However, VAS back pain favoured ALIF over PLF at one year (n = 21, MD - 1.00, CI - 1.47, - 0.53), and at two years (2 studies, n = 67, MD - 1.39, CI - 1.67, - 1.11). The VAS leg pain scores (n = 46, MD 0.50, CI 0.12 to 0.88) at two years significantly favoured PLF. The Oswestry Disability Index (ODI) scores at one year were not significantly different between ALIF and the posterior approaches. At two years, ODI scores were also similar between the ALIF and the TLIF/PLIF. However, the ODI scores at two years (2 studies, n = 67, MD - 7.59, CI - 13.33, - 1.85) significantly favoured ALIF over PLF (I2 = 70%). The Japanese Orthopaedic Association Score (JOAS) for low back pain at one year (n = 21, MD - 0.50, CI - 0.78) and two years (two studies, n = 67, MD - 0.36, CI - 0.65, - 0.07) significantly favoured ALIF over PLF. No significant differences were found in leg pain at the 2-year follow-up. Adverse events displayed no significant differences between the ALIF and posterior approaches. CONCLUSIONS Stand-alone-ALIF demonstrated a shorter operative time and less blood loss than the PLIF/TLIF approach. Hospitalisation time is reduced with ALIF compared with TLIF. Patient-reported outcome measures were equivocal with PLIF or TLIF. VAS and JOAS, back pain, and ODI scores mainly favoured ALIF over PLF. Adverse events were equivocal between the ALIF and posterior fusion approaches.
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Affiliation(s)
- John Rathbone
- Faculty of Health Science & Medicine, Bond University, Gold Coast, Australia
| | - Matthew Rackham
- Gold Coast Spine, 27 Garden Street, Southport, Gold Coast, 4215, Australia
| | - David Nielsen
- Gold Coast Spine, 27 Garden Street, Southport, Gold Coast, 4215, Australia
| | - So Mang Lee
- Gold Coast Spine, 27 Garden Street, Southport, Gold Coast, 4215, Australia
| | - Wayne Hing
- Faculty of Health Science & Medicine, Bond University, Gold Coast, Australia
| | - Sukhman Riar
- Faculty of Health Science & Medicine, Bond University, Gold Coast, Australia
- Gold Coast Spine, 27 Garden Street, Southport, Gold Coast, 4215, Australia
| | - Matthew Scott-Young
- Faculty of Health Science & Medicine, Bond University, Gold Coast, Australia.
- Gold Coast Spine, 27 Garden Street, Southport, Gold Coast, 4215, Australia.
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Chang CH, Shih CA, Kuan FC, Hong CK, Su WR, Hsu KL. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop 2023; 10:58. [PMID: 37261559 DOI: 10.1186/s40634-023-00622-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE This study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques. METHOD This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. Studies were screened against predecided inclusion and exclusion criteria. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. The Methodological Index for Non-Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications. RESULTS A total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. Fourteen case-control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11-90). The follow-up period ranged from 6 to 300 months. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device; (2) tensile fixation device; (3) mixed device; and (4) extra-patella device. CONCLUSION Regarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The lowest functional score was also found in those using the patellotibial wire. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common.
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Affiliation(s)
- Chih-Hsun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C..
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan.
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Patient and Fetal Radiation-Induced Malignancy Risk From Imaging For Evaluation of Pulmonary Embolism in Pregnancy. J Emerg Med 2023; 64:295-303. [PMID: 36932003 DOI: 10.1016/j.jemermed.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/22/2022] [Accepted: 10/21/2022] [Indexed: 03/17/2023]
Abstract
BACKGROUND Imaging for diagnosis of suspected pulmonary embolism in pregnancy presents radiation concerns for patient and fetus. OBJECTIVES Estimate the risks of radiation-induced breast cancer and childhood leukemia from common imaging techniques for the evaluation of suspected pulmonary embolism in pregnancy. METHODS Breast and uterine absorbed doses for various imaging techniques were input into the National Cancer Institute Radiation Risk Assessment Tool to calculate risk of breast cancer for the patient and childhood leukemia for the fetus. Absorbed doses were obtained by synthesizing data from a recent systematic review and the International Commission on Radiological Protection. Primary outcomes were the estimated excess incidences of breast cancer and childhood leukemia per 100,000 exposures. RESULTS Baseline incidences of breast cancer for a 30-year-old woman and childhood leukemia for a male fetus were 13,341 and 939, respectively. Excess incidences of breast cancer were 0.003 and 0.275 for a single and two-view chest radiograph, respectively, 9.53 and 20.6 for low- and full-dose computed tomography pulmonary angiography (CTPA), respectively, 0.616 and 2.54 for low- and full-dose perfusion scan, respectively, and 0.732 and 2.66 for low- and full-dose ventilation perfusion scan, respectively. Excess incidences of childhood leukemia were 0.004 and 0.007 for a single and two-view chest radiograph, respectively, 0.069 and 0.490 for low- and full-dose CTPA, respectively, 0.359 and 1.47 for low- and full-dose perfusion scan, respectively, and 0.856 and 1.97 for low- and full-dose ventilation perfusion scan, respectively. CONCLUSION Excess cancer risks for all techniques were small relative to baseline cancer risks, with CTPA techniques carrying slightly higher risk of breast cancer for the patient and ventilation perfusion techniques a higher risk of childhood leukemia.
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Systematic review with meta-analysis: Current and emerging models of preoperative psychological preparation for individuals undergoing stoma surgery. J Psychosom Res 2023; 168:111211. [PMID: 36898315 DOI: 10.1016/j.jpsychores.2023.111211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Stoma surgery is a profoundly life changing event that can result in a range of negative psychological and mental health outcomes, often requiring significant postoperative adaption. While postoperative avenues of support to address these outcomes exist, there remains a lack of preoperative psychological preparation for surgical candidates in standard models of care. The present systematic review and meta-analysis aims to examine the current and emerging models of psychological preparation available to stoma surgery candidates during the preoperative period. METHODS A systematic search of PubMed, Embase, Emcare, PsycINFO, CINAHL, and SCOPUS was conducted. All studies examining the effects of preoperative psychological interventions targeting postoperative psychological adjustment and/or mental health outcomes for individuals planning to undergo or who had undergone stoma surgery were included. RESULTS Overall, 15 publications meeting inclusion criteria were identified, encompassing 1565 total participants. Intervention types ranged from psychoeducational, counselling, and practical based skills, examining the postoperative outcomes of anxiety, depression, quality of life, adjustment, self-efficacy, and systematic improvements to standard models of care. Five studies examining postoperative anxiety were included for meta-analysis, demonstrating an overall significant effect (SMD = -1.13, 95% CI -1.96 to -0.30, p = .008). Due to the high level of heterogeneity between remaining studies, articles examining postoperative outcomes other than anxiety were synthesised in narrative form. CONCLUSION Despite some promising advancements in the field, there remains insufficient evidence to judge the overall effectiveness of current and emerging models of preoperative psychological preparation on postoperative psychological outcomes for individuals facing stoma surgery.
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Laane CLE, Oude Nijhuis KD, Spil J, Sierevelt IN, Doornberg JN, Jaarsma RL, Verhofstad MHJ, Wijffels MME. What Surgical Technique to Perform for Isolated Ulnar Shortening Osteotomy After Distal Radius Malunion: A Systematic Review. Hand (N Y) 2023:15589447231152587. [PMID: 36794764 DOI: 10.1177/15589447231152587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Unstable fractures of the distal radius fractures (DRFs) may result in malunion, usually consisting of subsequent shortening and angular deviations. Ulnar shortening osteotomy (USO) is assumed to be a simpler procedure than radial correction osteotomy, resulting in fewer complications and comparable outcomes. The aim of this study was to identify the best surgical technique to perform USO to restore distal radioulnar joint congruency after DRF malunion. METHODS A systematic review of the literature is performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in February 2022 to identify studies reporting outcomes and surgical technique for isolated USO. The primary outcome was complication rates. Secondary outcomes included functional, radiologic, and patient-rated outcomes. The methodological index for nonrandomized studies criteria were used to assess the quality of evidence. RESULTS Included were 12 cohorts (185 participants). Due to substantial heterogeneity, a meta-analysis could not be performed. The overall complication rate was 33% (95% confidence interval, 16% to 51%). The most reported complication was implant irritation (22%), often requiring removal of the implant (13%). Only 3% nonunions were mentioned. Functional and patient-rated outcomes improved in most patients after USO. Quality of evidence of the papers was low to very low. Common methodological flaws were related to retrospective research. CONCLUSION No evident differences in complication rates and functional outcomes between the surgical techniques were observed. Based on this literature, most complications are related to implant irritation. Nonunion and infection rates were rare. Therefore, a surgical technique with a buried implant might be preferred. This hypothesis requires further investigation.
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Affiliation(s)
- Charlotte L E Laane
- Erasmus MC, Rotterdam, The Netherlands
- Massachusetts General Hospital, Boston, USA
| | | | | | - Inger N Sierevelt
- Xpert Clinics, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Job N Doornberg
- University of Groningen, The Netherlands
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | - Ruurd L Jaarsma
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
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Limb salvage versus primary amputation in Gustilo-Anderson IIIB and IIIC tibial fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04804-2. [PMID: 36781435 DOI: 10.1007/s00402-023-04804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION The last systematic review on this topic was published in 2008. With advances in surgical techniques, patients with mangled extremities may now be potentially salvageable with comparable outcomes. This review aims to evaluate the outcomes of limb salvage compared to primary amputation in patients with severe open tibial fractures. MATERIALS AND METHODS A comprehensive search on PubMed, MEDLINE, Embase, Web of Science, Scopus, CENTRAL and CINAHL was performed from inception to 19 January 2022. The primary outcome was to evaluate clinical and functional outcomes. Secondary outcomes were to evaluate pain, patient preference, quality of life, and patient preferences. Methodological quality was evaluated using the MINORS criteria. Pooled estimates of relative risk (RR) and mean difference (MD) with 95% confidence interval (CI) were used as a summary statistic for dichotomous variables and continuous variables, respectively. RESULTS Sixteen studies with 645 patients met inclusion criteria. The methodological quality was moderate based on the MINORS score. The majority were male. Mean age was 36.3 years. There was no significant differences in the length of hospitalization (n = 8), return to work rates (n = 9), return to sport rates (n = 4) and quality of life scores (n = 4). Patients with primary amputation had a significantly lower risk of total complications (RR 0.21, 95% CI 0.08-0.53, p = 0.001) (n = 10), infections (RR 0.46, 95% CI 0.25-0.85, p = 0.01) (n = 9), and number of surgeries (MD - 4.17, 95% CI - 6.49 to - 1.85, p = 0.0004) (n = 6). Patients with primary amputation were able to ambulate significantly earlier (MD - 4.06, 95% CI - 7.65 to - 0.46, p = 0.03) (n = 3). Three studies found a significantly higher cost of hospitalization in limb salvage patients. Functional outcomes were similar in both groups. CONCLUSION While patients with primary amputation had better clinical outcomes in the short-term, functional outcomes were not significantly different in both groups. Despite the heterogenicity of the results in this review, surgeons need to contextualize the decision making for their patients and incorporate these findings. LEVEL OF EVIDENCE III. TRIAL REGISTRATION PROSPERO CRD42022303357.
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Rutgers C, Verweij LPE, Schuit AA, Sierevelt IN, Jamaludin FS, van der Woude HJ, van den Bekerom MPJ. High resorption rates following glenoid augmentation procedures do not seem to lead to higher recurrence rates or worse clinical outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07267-x. [PMID: 36515733 DOI: 10.1007/s00167-022-07267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Bone augmentation techniques show a relatively high complication rate, which might be due to graft non-union and resorption. It is unclear which augmentation techniques demonstrate the highest amount of non-union and resorption and whether this leads to worse clinical or functional outcomes. Therefore, the aim of this review was (i) to compare non-union and resorption rates between surgical approaches, procedures, graft types, donor sites and fixation methods regarding clinical and functional outcomes and (ii) determine whether high non-union or resorption rates lead to less favorable clinical or functional outcomes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements were followed. PubMed, EMBASE (Ovid) and Cochrane Library were searched on December 15th 2021 for studies examining bone graft non-union or resorption using radiograph or CT following glenoid augmentation to treat anterior shoulder dislocation. RESULTS The search resulted in 103 inclusions, comprising 5,128 glenoid augmentations. When comparing pooled proportions of bony union, graft fracture rate, hardware failure rate, recurrence rate, return to sports and Rowe score, most results were similar between approaches, procedures, graft types, donor sites and fixation methods. High resorption rates were seen for allograft augmentation (74.3; 95% CI: 39.8-92.7) compared to autograft augmentation (15.5; 95% CI 10.1-23.2), but this was not associated with higher recurrence rates or worse clinical outcomes. Meta-analyses (8 studies; 494 patients) demonstrated no difference in incomplete and complete non-union rates between arthroscopic and open procedures; however, both analyses showed substantial heterogeneity. Higher partial resorption rates were observed on CT (48.0; 95% CI 43.3-52.7) compared to radiograph (14.1; 95% CI 10.9-18.1). Three studies comprising 267 shoulders demonstrated a higher rate of non-union and recurrence in smokers, whereas one study comprising 38 shoulders did not. CONCLUSION Non-union and resorption rates were similar among procedures, grafts and fixation methods. Higher resorption rates were observed in allografts, but this was not associated with higher recurrence rates or worse clinical outcomes. Pooling data demonstrated substantial heterogeneity and definitions varied among studies, warranting more standardized measuring. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cain Rutgers
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. .,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, The Netherlands.
| | - Lukas P E Verweij
- Amsterdam UMC, Location AMC, Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Musculoskeletal Health Program, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Jan Tooropstraat 164, Amsterdam, The Netherlands
| | - Alexander A Schuit
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, Laarderhoogtweg 12, Amsterdam, The Netherlands.,Orthopedic Department, Spaarnegasthuis Academy, Spaarnepoort 1, Hoofddorp, The Netherlands
| | - Faridi S Jamaludin
- Amsterdam UMC, Location AMC, Research Support, Medical Library AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henk-Jan van der Woude
- Shoulder and Elbow Unit, Joint Research, OLVG Hospital, Oosterpark 9, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.,Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Jan Tooropstraat 164, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, The Netherlands
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Pleural fluid interleukins for diagnosis of tuberculous pleural effusion: A systematic review and meta-analysis. Cytokine 2022; 159:156019. [DOI: 10.1016/j.cyto.2022.156019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
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Efficacy of the autogenous dentin graft for implant placement: a systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2022; 52:604-612. [PMID: 36328864 DOI: 10.1016/j.ijom.2022.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
The aim of this study was to determine whether the autogenous dentin graft (ADG) shows comparable results and similar clinical performance to other graft materials when utilized for implant placement. Four databases were searched, and controlled human studies that applied autogenous dentin for implant surgery, comparing it with other bone grafts, were included. Nine articles met the inclusion criteria, five of which were randomized controlled trials and were included in the meta-analysis. ADG showed equivalent primary and secondary implant stability when compared to Bio-Oss (primary: mean difference -0.74, 95% confidence interval (CI) - 3.36 to 1.88, P = 0.58; secondary: mean difference - 1.29, 95% CI - 5.69 to 3.11, P = 0.57). The standardized mean difference (SMD) of marginal bone loss at 6 months and at the final follow-up (18 months) showed the two grafts to be similar (6 months: SMD -0.26, 95% CI -0.64 to 0.12, P = 0.18; final follow-up: SMD -0.12, 95% CI -0.50 to 0.26, P = 0.53), and survival after immediate implant placement was the same in the two groups: 97.37% and 97.30%, respectively. Incidences of complications with the autogenous dentin particles or blocks were in line with those of Bio-Oss or autogenous bone blocks, respectively. This meta-analysis indicates that the autogenous dentin graft is an effective option for bone augmentation around dental implants, with acceptable implant stability, marginal bone loss, and incidences of complications and failure.
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Wang X, Bakhuis W, Veen KM, Bogers AJJC, Etnel JRG, van Der Ven CCEM, Roos-Hesselink JW, Andrinopoulou ER, Takkenberg JJM. Outcomes after right ventricular outflow tract reconstruction with valve substitutes: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:897946. [PMID: 36158811 PMCID: PMC9489846 DOI: 10.3389/fcvm.2022.897946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction This study aims to provide an overview of outcomes after right ventricular outflow tract (RVOT) reconstruction using different valve substitutes in different age groups for different indications. Methods The literature was systematically searched for articles published between January 2000 and June 2021 reporting on clinical and/or echocardiographic outcomes after RVOT reconstruction with valve substitutes. A random-effects meta-analysis was conducted for outcomes, and time-related outcomes were visualized by pooled Kaplan–Meier curves. Subgroup analyses were performed according to etiology, implanted valve substitute and patient age. Results Two hundred and seventeen articles were included, comprising 37,078 patients (age: 22.86 ± 11.29 years; 31.6% female) and 240,581 patient-years of follow-up. Aortic valve disease (Ross procedure, 46.6%) and Tetralogy of Fallot (TOF, 27.0%) were the two main underlying etiologies. Homograft and xenograft accounted for 83.7 and 32.6% of the overall valve substitutes, respectively. The early mortality, late mortality, reintervention and endocarditis rates were 3.36% (2.91–3.88), 0.72%/y (95% CI: 0.62–0.82), 2.62%/y (95% CI: 2.28–3.00), and 0.38%/y (95%CI: 0.31–0.47) for all patients. The early mortality for TOF and truncus arteriosus (TA) were 1.95% (1.31–2.90) and 10.67% (7.79–14.61). Pooled late mortality and reintervention rate were 0.59%/y (0.39–0.89), 1.41%/y (0.87–2.27), and 1.20%/y (0.74–1.94), 10.15%/y (7.42–13.90) for TOF and TA, respectively. Endocarditis rate was 0.21%/y (95% CI: 0.16–0.27) for a homograft substitute and 0.80%/y (95%CI: 0.60–1.09) for a xenograft substitute. Reintervention rate for infants, children and adults was 8.80%/y (95% CI: 6.49–11.95), 4.75%/y (95% CI: 3.67–6.14), and 0.72%/y (95% CI: 0.36–1.42), respectively. Conclusion This study shows RVOT reconstruction with valve substitutes can be performed with acceptable mortality and morbidity rates for most patients. Reinterventions after RVOT reconstruction with valve substitutes are inevitable for most patients in their life-time, emphasizing the necessity of life-long follow-up and multidisciplinary care. Follow-up protocols should be tailored to individual patients because patients with different etiologies, ages, and implanted valve substitutes have different rates of mortality and morbidity. Systematic review registration [www.crd.york.ac.uk/prospero], identifier [CRD42021271622].
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Affiliation(s)
- Xu Wang
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wouter Bakhuis
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Kevin M. Veen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ad J. J. C. Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jonathan R. G. Etnel
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Carlijn C. E. M. van Der Ven
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johanna J. M. Takkenberg
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: Johanna J. M. Takkenberg,
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Pleural fluid lysozyme as a diagnostic biomarker of pleural tuberculosis: A systematic review and meta-analysis. Lung India 2022; 39:428-436. [PMID: 36629203 PMCID: PMC9623869 DOI: 10.4103/lungindia.lungindia_738_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/12/2022] [Indexed: 01/14/2023] Open
Abstract
Objective Pleural fluid lysozyme (LP) and its ratio to serum lysozyme (LP/LS) have been proposed as potential biomarkers for diagnosing tuberculous pleural effusion (TPE). We assessed the diagnostic accuracy of LP and LP/LS for TPE and evaluated their ability to differentiate TPE from other effusions. Methods We queried the PubMed and Embase databases for studies indexed until October 2021. We included studies that (a) provided information regarding the sensitivity and specificity of LP or LP/LS for the diagnosis of TPE, or (b) compared LP or LP/LS between TPE and malignant or parapneumonic effusions. We used hierarchical summary receiver operating characteristic plots to model summary sensitivity and specificity. Random effects modeling was employed to pool standardized mean differences (SMD) across descriptive studies comparing TPE and other effusions. Results We included 11 publications in our review, most of which were small and of poor quality. The summary estimates for sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.94 (95% confidence interval [CI] 0.53-1.00), 0.89 (95% CI 0.63-0.97), and 129.88 (95% CI 6.26-2695), and 0.98 (95% CI 0.58-1.00), 0.91 (95% CI 0.84-0.96), and 708.47 (95% CI 11.42-43946), respectively, for LP and LP/LS. Mean LP and LP/LS in TPE were significantly higher than in malignant effusions (summary SMD 1.51 [95% CI 1.04-1.98] and 1.77 [95% CI 1.31-2.22], respectively), and parapneumonic effusions (summary SMD 0.86 [95% CI 0.51-1.22] and 1.15 [95% CI 0.64-1.66], respectively). Conclusion There is low-quality evidence of good diagnostic accuracy for both LP and LP/LS in identifying TPE, the latter being marginally superior.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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van Iersel TP, van Spanning SH, Verweij LPE, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up. J Shoulder Elbow Surg 2022; 31:1982-1991. [PMID: 35430365 DOI: 10.1016/j.jse.2022.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is uncertainty with regard to the optimal revision procedure after failed labral repair for anterior shoulder instability. An overview of outcomes of these procedures with quantitative analysis is not available in literature. The aim of this review is (1) to compare recurrence rates after revision labral repair (RLR) and revision bony reconstruction (RBR), both following failed labral repair. In addition, (2) recurrence rates after RBR following failed labral repair and primary bony reconstruction (PBR) are compared to determine if a previous failed labral repair influences the outcomes of the bony reconstruction. METHODS Randomized controlled trials and cohort studies with a minimum follow-up of 2 years and reporting recurrence rates of (1) RBR following failed labral repair and PBR and/or (2) RLR following failed labral repair and RBR following failed labral repair were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, and Web of Science/Clarivate Analytics. RESULTS Thirteen studies met the inclusion criteria and comprised 1319 shoulders. Meta-analyses showed that RBR has a significantly higher recurrence rate than PBR (risk ratio [RR] 0.51, P < .008) but found no significant difference in the recurrence rates for RLR and RBR (RR 1.40, P < .49). Also, no significant differences were found between PBR and RBR in return to sport (RR 1.07, P < .41), revision surgery (RR 0.8, P < .44), and complications (RR 0.84, P < .53). Lastly, no significant differences between RLR and RBR for revision surgery (RR 3.33, P < .19) were found. CONCLUSION The findings of this meta-analyses show that (1) RBR does not demonstrate a significant difference in recurrence rates compared with RLR and that (2) RBR has a significantly higher recurrence rate than PBR.
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Affiliation(s)
- Theodore P van Iersel
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.
| | - Sanne H van Spanning
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Lukas P E Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | | | - Derek F P van Deurzen
- Trauma Unit & Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Ramezani A, Ghaseminejad Raeini A, Sharafi A, Sheikhvatan M, Mortazavi SMJ, Shafiei SH. Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:392. [PMID: 35964047 PMCID: PMC9375332 DOI: 10.1186/s13018-022-03281-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Total hip arthroplasty is a common orthopedic surgery for treating primary or secondary hip osteoarthritis. Bilateral total hip replacement could be performed in a single stage or two separate stages. Each surgical procedure's reliability, safety, and complications have been reported controversially. This study aimed to review the current evidence regarding the outcomes of simultaneous and staged bilateral total hip arthroplasty. METHODS We conducted a meta-analysis using MEDLINE, EMBASE, Web of Science, and Scopus databases. Eligible studies compared complications and related outcomes between simultaneous and staged bilateral THA. Two reviewers independently screened initial search results, assessed methodological quality, and extracted data. We used the Mantel-Haenszel method to perform the meta-analysis. RESULTS In our study, we included 29,551 patients undergoing simBTHA and 74,600 patients undergoing stgBTHA. In favor of the simBTHA, a significant reduction in deep vein thrombosis (DVT) and systemic, local, and pulmonary complications was documented. However, we evidenced an increased pulmonary embolism (PE) and periprosthetic fracture risk in simBTHA. In the simBTHA, total blood loss, length of hospital stay, and total cost were lower. CONCLUSION This meta-analysis shows that simultaneous bilateral THA accompanies fewer complications and lower total cost. Well-designed randomized controlled trials are needed to provide robust evidence.
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Affiliation(s)
- Akam Ramezani
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Ghaseminejad Raeini
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Sharafi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Heidelberg Medical Hospital, Heidelberg, Germany
| | | | - Seyyed Hossein Shafiei
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Mo L, Li J, Wang Z, Huang F, Xin P, Zhou C, He W, Liu Y. Influence of less invasive hip preservation surgery on subsequent hip arthroplasty for osteonecrosis of the femoral head. J Hip Preserv Surg 2022; 9:197-205. [PMID: 35992024 PMCID: PMC9389913 DOI: 10.1093/jhps/hnac035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/19/2022] [Accepted: 07/27/2022] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) following less invasive hip-preserving procedures (LIHPs) and present a critical overview of the literature to aid in better result interpretation. The search time was from the establishment of the database to September 2021, and the outcome indicators were extracted and analyzed by Cochrane Collaboration Review Manager software (RevMan version 5.4). Finally, 10 articles were included in this meta-analysis by searching Chinese databases and English databases. Three of them were published in Chinese, and the remaining studies were published in English. LIHP was further divided into the tantalum rod implantation group and the non-tantalum rod implantation group. The results showed that prior tantalum rod implantation increased the difficulty of conversion to THA, which was reflected mainly in the longer operative time [weighted mean difference (WMD) = 24.50, 95% confidence interval (CI) = 14.09–34.91, P < 0.00001] and greater intraoperative blood loss (WMD = 114.74, 95% CI = 33.52–195.96, P = 0.006), while no significant difference was found between the non-tantalum rod implantation group and the control group. Simultaneously, easier intraoperative fracture [odds ratio (OR) = 5.88, 95% CI = 0.93–37.05, P = 0.06] and stem malalignment (OR = 4.17, 95% CI = 1.18–14.71, P = 0.03) in the LIHP group tended to be observed than in the control THA group. However, there was no significant difference in cup anteversion and inclination angle, ectopic ossification, postoperative Harris Hip Score and survivorship between the LIHP group and the control group. Although LIHP increased the difficulty of the conversion to THA, it does not detrimentally affect the clinical results of subsequent THA in the mid-term follow-up.
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Affiliation(s)
- Liang Mo
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Jianxiong Li
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Zhangzheng Wang
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Fayi Huang
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Pengfei Xin
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Chi Zhou
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Wei He
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
- Guangdong Research Institute for Traumatology & Orthopedics , Guangzhou, Guangdong Province 510378, China
| | - Yuhao Liu
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
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Sharma D, Bhaskar SMM. Prognostic Role of the Platelet-Lymphocyte Ratio in Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy: A Meta-Analysis. J Cent Nerv Syst Dis 2022; 14:11795735221110373. [PMID: 35860715 PMCID: PMC9290168 DOI: 10.1177/11795735221110373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Both inflammation and thrombotic/hemostatic mechanisms may play a role in acute ischemic stroke (AIS) pathogenesis, and a biomarker, such as the platelet-to-lymphocyte ratio (PLR), considering both mechanisms may be of clinical utility. Objectives This meta-analysis sought to examine the effect of PLR on functional outcomes, early neurological changes, bleeding complications, mortality, and adverse outcomes in AIS patients treated with reperfusion therapy (RT). Design Systematic Review and Meta-Analysis Data Sources and Methods Individual studies were retrieved from the PubMed/Medline, EMBASE and Cochrane databases. References thereof were also consulted. Data were extracted using a standardised data sheet, and systematic reviews and meta-analyses on the association of admission (pre-RT) or delayed (post-RT) PLR with defined clinical and safety outcomes were conducted. In the case of multiple delayed PLR timepoints, the timepoint closest to 24 hours was selected. Results Eighteen studies (n=4878) were identified for the systematic review, of which 14 (n=4413) were included in the meta-analyses. PLR collected at admission was significantly negatively associated with 90-day good functional outcomes (SMD=−.32; 95% CI = −.58 to −.05; P=.020; z=−2.328), as was PLR collected at delayed timepoints (SMD=−.43; 95% CI = −.54 to −.32; P<.0001; z=−7.454). PLR at delayed timepoints was also significantly negatively associated with ENI (SMD=−.18; 95% CI = −.29 to −.08; P=.001. Conversely, the study suggested that a higher PLR at delayed timepoints may be associated with radiological bleeding and mortality. The results varied based on the type of RT administered. Conclusions A higher PLR is associated with worse outcomes after stroke in terms of morbidity, mortality, and safety outcomes after stroke.
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Affiliation(s)
- Divyansh Sharma
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,University of New South Wales (UNSW), South Western Sydney Clinical School, Sydney, NSW, Australia
| | - Sonu M M Bhaskar
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,University of New South Wales (UNSW), South Western Sydney Clinical School, Sydney, NSW, Australia.,Department of Neurology & Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia.,NSW Brain Clot Bank, NSW Health Pathology, NSW, Sydney, Australia
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Balakrishnan N, Rychtář J, Taylor D, Walter SD. Unified approach to optimal estimation of mean and standard deviation from sample summaries. Stat Methods Med Res 2022; 31:2087-2103. [PMID: 35818759 DOI: 10.1177/09622802221111546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recently, various methods have been developed to estimate the sample mean and standard deviation when only the sample size, and other selected sample summaries are reported. In this paper, we provide a unified approach to optimal estimation that can be easily adopted when only some summary statistics are reported. We show that the proposed estimators have the lowest variance among linear unbiased estimators. We also show that in the most commonly reported cases, that is, when only a three-number or five-number summary is reported, the newly proposed estimators match the previously developed estimators. Finally, we demonstrate the performance of the estimators numerically.
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Affiliation(s)
| | - Jan Rychtář
- Department of Mathematics and Applied Mathematics, 6889Virginia Commonwealth University, Richmond, VA , USA
| | - Dewey Taylor
- Department of Mathematics and Applied Mathematics, 6889Virginia Commonwealth University, Richmond, VA , USA
| | - Stephen D Walter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Fewkes JJ, Kellow NJ, Cowan SF, Williamson G, Dordevic AL. A single, high-fat meal adversely affects postprandial endothelial function: a systematic review and meta-analysis. Am J Clin Nutr 2022; 116:699-729. [PMID: 35665799 PMCID: PMC9437993 DOI: 10.1093/ajcn/nqac153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/29/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Endothelial dysfunction is a predictive risk factor for the development of atherosclerosis and is assessed by flow-mediated dilation (FMD). Although it is known that NO-dependent endothelial dysfunction occurs after consuming a high-fat meal, the magnitude of the effect and the factors that affect the response are unquantified. OBJECTIVES We conducted a systematic review and meta-analysis exploring the quantitative effects of a single high-fat meal on endothelial function and determined the factors that modify the FMD response. METHODS Six databases were systematically searched for original research published up to January 2022. Eligible studies measured fasting and postprandial FMD following consumption of a high-fat meal. Meta-regression was used to analyze the effect of moderator variables. RESULTS There were 131 studies included, of which 90 were suitable for quantitative meta-analysis. A high-fat meal challenge transiently caused endothelial dysfunction, decreasing postprandial FMD at 2 hours [-1.02 percentage points (pp); 95% CI: -1.34 to -0.70 pp; P < 0.01; I2 = 93.3%], 3 hours [-1.04 pp; 95% CI: -1.48 to -0.59 pp; P < 0.001; I2 = 84.5%], and 4 hours [-1.19 pp; 95% CI: -1.53 to -0.84 pp; P < 0.01; I2 = 94.6%]. Younger, healthy-weight participants exhibited a greater postprandial reduction in the FMD percentage change than older, heavier, at-risk groups after a high-fat meal ( P < 0.05). The percentage of fat in the meals was inversely associated with the magnitude of postprandial changes in FMD at 3 hours (P < 0.01). CONCLUSIONS A single, high-fat meal adversely impacts endothelial function, with the magnitude of the impact on postprandial FMD moderated by the fasting FMD, participant age, BMI, and fat content of the meal. Recommendations are made to standardize the design of future postprandial FMD studies and optimize interpretation of results, as high-fat meals are commonly used in clinical studies as a challenge to assess endothelial function and therapeutics. This trial was registered at PROSPERO as CRD42020187244.
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Affiliation(s)
- Juanita J Fewkes
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Nicole J Kellow
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Stephanie F Cowan
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Aimee L Dordevic
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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Khosravaniardakani S, Bokov DO, Mahmudiono T, Hashemi SS, Nikrad N, Rabieemotmaen S, Abbasalizad-Farhangi M. Obesity Accelerates Leukocyte Telomere Length Shortening in Apparently Healthy Adults: A Meta-Analysis. Front Nutr 2022; 9:812846. [PMID: 35719148 PMCID: PMC9199514 DOI: 10.3389/fnut.2022.812846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/20/2022] [Indexed: 01/07/2023] Open
Abstract
Background Shorter telomere length is associated with numerous comorbidities. Several studies have investigated the role of obesity in telomere shortening. In the current systematic review and meta-analysis, we summarized the results of studies that evaluated the association between obesity and telomere length. Methods A systematic search from Scopus, PubMed, Embase, and ProQuest electronic databases up to 19 March 2021 without language restriction was performed and after data extraction and screening, 19 manuscripts were eligible to be included in the final meta-synthesis. Results The highest category of telomere length was associated with an approximate 0.75 kg/m2 reduction in body mass index (BMI; WMD = -0.75 kg/m2; CI = -1.19, -0.31; p < 0.001; I 2 = 99.4%). Moreover, overweight/obese individuals had 0.036 kbp shorter telomere length compared with non-overweight/obese adults (WMD = -0.036; CI = -0.05, -0.02; p = 0.030; I 2 = 100%). According to the results of subgroupings, continent, age, and sample size could be possible sources of heterogeneity. Conclusion From the results, it was clear that obesity was associated with shorter telomere length. Because of the observational design of included studies, the causality inference of results should be done with caution; thus, further longitudinal studies are warranted for better inference of causal association.
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Affiliation(s)
| | - Dmitry Olegovich Bokov
- Institute of Pharmacy, Sechenov First Moscow State Medical University, Moscow, Russia
- Laboratory of Food Chemistry, Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | - Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Seyedeh Sedigheh Hashemi
- Department of Nutrition, School of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Negin Nikrad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shadi Rabieemotmaen
- Department of Biology, East Tehran Branch, Islamic Azad University, Tehran, Iran
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Wu Y, Amirfakhraei A, Ebrahimzadeh F, Jahangiry L, Abbasalizad-Farhangi M. Screen Time and Body Mass Index Among Children and Adolescents: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:822108. [PMID: 35620148 PMCID: PMC9127358 DOI: 10.3389/fped.2022.822108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is no summative quantitative study that report the difference in BMI in high screen user children and adolescents or give a difference in screen time in children and adolescents with obesity vs. children and adolescents without obesity. In the current meta-analysis we systematically summarized the association between obesity and screen time and meta-analyzed the results. Methods A systematic search from Scopus, PubMed and Embase electronic databases. Studies that evaluated the association between screen time and obesity up to June 2021. Results Results revealed that those at the highest screen time category had 0.7 kg/m2 higher BMI (WMD = 0.703; CI = 0.128, 1.278; P < 0.016; I 2 = 95.8%). Moreover, children and adolescents with obesity had a mean value of 0.313 h higher screen time compared with children and adolescents without obesity (WMD: 0.313; OR = 0.219, 0.407; P < 0.001; I 2 = 96%). The results of subgrouping showed that study quality, continent and sample size could reduce the heterogeneity values. No evidence of publication bias was reported according to visual asymmetry of funnel plots and the results of Begg's and Egger's tests. Conclusion For the first time, the current systematic review and meta-analysis revealed a positive association between screen time and obesity among children and adolescents. Due to the cross-sectional design of the included studies, causal inference is impossible, therefore, further studies in separate analysis of both genders are suggested to better elucidate gender-specific results. Systematic Review Registration [www.ClinicalTrials.gov], identifier [CRD4202123 3899].
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Affiliation(s)
- Yiling Wu
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Azita Amirfakhraei
- Department of Psychology, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
| | - Farnoosh Ebrahimzadeh
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Jahangiry
- Department of Health Education and Health Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Sharma D, Spring KJ, Bhaskar SMM. Role of Neutrophil-Lymphocyte Ratio in the Prognosis of Acute Ischaemic Stroke After Reperfusion Therapy: A Systematic Review and Meta-analysis. J Cent Nerv Syst Dis 2022; 14:11795735221092518. [PMID: 35492740 PMCID: PMC9052237 DOI: 10.1177/11795735221092518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
Background Inflammation may mediate response to acute reperfusion therapy (RT) in acute
cerebral ischaemia. Neutrophil-lymphocyte ratio (NLR), an inflammatory
biomarker, may play an important role in acute ischaemic stroke (AIS)
prognostication. Objective This meta-analysis sought to examine the effect of NLR on functional
outcomes, mortality and adverse outcomes in AIS patients receiving RT. Methods Individual studies were retrieved from PubMed/Medline, EMBASE and Cochrane
databases. Data were extracted using a standardised data sheet and
meta-analysis on association of admission (pre-RT) or delayed (post-RT) NLR
with clinical/safety outcomes after RT was conducted. Results Thirty-five studies (n = 10 308) were identified for the systematic review
with 27 (n = 8537) included in the meta-analyses. Lower admission NLR was
associated with good functional outcomes (GFOs), defined as 3-month modified
Rankin scale (mRS) 0–2 (SMD = −.46; 95% CI = −.62 to −.29; P < .0001),
mRS 0–1 (SMD = −.44; 95% CI = −.66 to −.22; P < .0001) and early
neurological improvement (ENI) (SMD = −.55; 95 %CI = −.84 to −.25; P <
.0001). Lower delayed admission NLR was also associated with GFOs (SMD =
−.80; 95%CI = −.91 to −.68; P < .0001). Higher admission NLR was
significantly associated with mortality (SMD = .49; 95%CI = .12 to .85; P =
.009), intracerebral haemorrhage (ICH) (SMD = .34; 95% CI = .09 to .59; P =
.007), symptomatic ICH (sICH) (SMD = .48; 95% CI = .07 to .90; P = .022) and
stroke-associated infection or pneumonia (SMD = .85; 95% CI = .50, 1.19; P
< .0001). Higher delayed NLR was significantly associated with sICH (SMD
= 1.40; 95% CI = .60 to 2.19; P = .001), ICH (SMD = .94; 95% CI = .41 to
1.46; P < .0001) and mortality (SMD = 1.12; 95% CI = .57 to 1.67; P <
.0001). There were variations in outcomes across RT groups. Conclusion Higher admission or delayed NLR is significantly associated with worse
morbidity, mortality and safety outcomes in AIS patients receiving RT.
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Affiliation(s)
- Divyansh Sharma
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Kevin J. Spring
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Medical Oncology Group, Liverpool Clinical School, Western Sydney University and Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital and South-Western Sydney Local Health District, Comprehensive Stroke Center, Sydney, NSW, Australia
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Shigemura T, Murata Y, Yamamoto Y, Shiratani Y, Hamano H, Wada Y. Comparison between ilioinguinal approach and modified Stoppa approach for the treatment of acetabular fractures: An updated systematic review and meta-analysis. Orthop Traumatol Surg Res 2022; 108:103204. [PMID: 35066214 DOI: 10.1016/j.otsr.2022.103204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 05/15/2021] [Accepted: 07/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The modified Stoppa (MS) approach is an alternative to the ilioinguinal (IL) approach and three meta-analyses comparing these two approaches for the treatment of acetabular fractures were published previously. The aim of this study was to provide an updated systematic review and meta-analysis comparing the MS approach with the IL approach for the treatment of acetabular fractures and to answer the following question: are the results of the MS approach superior to those of the IL approach in terms of reduction quality, operative time, operative blood loss, complications, and clinical outcomes for treatment of acetabular fractures? PATIENTS AND METHODS An updated systematic literature review was conducted using relevant original studies from various databases (PubMed, Web of Science and the Cochrane Library). Pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value of<0.05 was considered to be significant. We calculated the mean differences (MDs) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed based on I2 using the standard Chi2 test. When I2>50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. RESULTS Six studies were included in this meta-analysis. The findings demonstrated that the rate of anatomical reduction was significantly higher in the MS approach than in the IL approach (I2=0%, OR=1.75, 95% CI: 1.13-2.69, p=0.01), the operative time was significantly shorter in the MS approach than in the IL approach (I2=88%, MD=-63.60, 95% CI: -93.01 - (-34.20), p<0.0001) and operative blood loss was significantly lower in the MS approach than in the IL approach (I2=75%, MD=-350.51, 95% CI: -523.45 - (-177.58), p<0.0001). There was no significant difference in the rate of nerve injury (I2=0%, OR=0.47, 95% CI: 0.16-1.39, p=0.17), the rate of vascular injury (I2=0%, OR=0.51, 95% CI: 0.17-1.49, p=0.22), the rate of infection (I2=0%, OR=0.53, 95% CI: 0.25-1.12, p=0.10), the rate of heterotopic ossification (I2=45%, OR=0.63, 95% CI: 0.22-1.85, p=0.40), and the rate of excellent or good clinical score (I2=21%, OR=1.15, 95% CI: 0.56-2.38, p=0.70) between the two approaches. DISCUSSION The MS approach provided better reduction quality, shorter operative time, lower operative blood loss, although there were no significant differences in the rate of complications, and excellent or good clinical score between the two approaches. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomonori Shigemura
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Chiba, Japan.
| | - Yasuaki Murata
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Chiba, Japan
| | - Yohei Yamamoto
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Chiba, Japan
| | - Yuki Shiratani
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Chiba, Japan
| | - Hiroyuki Hamano
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Chiba, Japan
| | - Yuichi Wada
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Chiba, Japan
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Bolia IK, Bougioukli S, Hill WJ, Trasolini NA, Petrigliano FA, Lieberman JR, Weber AE. Clinical Efficacy of Bone Marrow Aspirate Concentrate Versus Stromal Vascular Fraction Injection in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:1451-1461. [PMID: 34102078 DOI: 10.1177/03635465211014500] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knee injection using either bone marrow aspirate concentrate (BMAC) or stromal vascular fraction (SVF) from adipose tissue has been shown to result in symptomatic improvement in patients with knee osteoarthritis (OA). It is still unclear whether one of these therapies is superior over the other. PURPOSE To systematically report the clinical studies evaluating BMAC and SVF in the treatment of knee OA and to compare the clinical efficacy of these 2 injection therapies. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS This meta-analysis was performed per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Studies were included if they reported the clinical outcomes after a single BMAC or SVF injection in the knee joint of patients with OA. Studies evaluating preparations of culture-expanded stem cells were excluded. A random effects model was used; the clinical efficacy of BMAC or SVF injection was assessed using the standardized mean difference (SMD) and compared. Visual analog scale (VAS) scores for pain and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) knee index were the primary outcomes. The level of statistical significance was set at P < .05. RESULTS Ten studies and 472 patients with knee OA who received either BMAC (233 patients) or SVF (239 patients) were included. Patients who received an injection had improved VAS outcomes (mean ± SD): from 5.8 ± 1.3 to 2.6 ± 17 for BMAC and from 6.4 ± 1.4 to 3.4 ± 0.5 for SVF. They also experienced significantly reduced pain (SMD [VAS], 2.6 for BMAC and 3.4 for SVF) and improved function (SMD [WOMAC], 1.4 for BMAC and 1.2 for SVF). However, the SVF injection had a significantly greater effect on pain reduction than did the BMAC injection (P < .0001). Based on WOMAC, the clinical effect of BMAC versus SVF knee injection in patients with knee OA was equivalent (P = .626). Results were limited by the presence of publication bias as well as variability in the preparation methods utilized in the BMAC and SVF injection protocols. Complications were reported in 50% of the BMAC studies (knee stiffness, persistent knee swelling) and 67% of the SVF studies (knee swelling, knee pain, positive SVF cultures without symptoms of infection, and bleeding at the abdominal harvest site). CONCLUSION A single BMAC or SVF injection into the knee joint of patients with OA resulted in symptomatic improvement at short-term follow-up. However, SVF seemed to be more effective than did BMAC in the reduction of knee pain. There was significant variation in the BMAC and SVF injection preparation techniques used across the studies and a lack of stratification of outcomes based on the radiologic classification of OA. Therefore, these results should be taken with caution.
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Affiliation(s)
- Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Sofia Bougioukli
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - William J Hill
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Nicholas A Trasolini
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Jay R Lieberman
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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Mongelli F, Horvath Z, Marengo M, Volontè F, La Regina D, Peterli R, Garofalo F. Reoperative bariatric surgery after primary laparoscopic gastric plication for morbid obesity: a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:1839-1850. [PMID: 35233644 DOI: 10.1007/s00423-022-02485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopic gastric plication (LGP) often requires reoperative bariatric surgery (RBS) due to complications and insufficient weight loss. The aim of our study was to assess perioperative morbidity and weight loss during follow-up in patients undergoing RBS after primary LGP for morbid obesity. METHODS A search of PubMed, Web of Science, Cochrane Library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using ("conversion"OR "revision*""OR "reoperat*")AND("gastric"OR "curvatur*")AND "plication." Studies were deemed eligible if data on RBS after LGP were provided. For each study, data were extracted and analyzed. RESULTS In the literature review, 291 articles were screened and 7 included. The studies covered a total of 367 patients, of whom 119 received a sleeve gastrectomy (SG), 85 a Roux-en-y gastric bypass (RYGB), 75 a one anastomosis-gastric bypass (OAGB), 45 a re-LGP, and 25 a jejuno-ileal bypass. After RBS, excess weight loss was 50.8 ± 6.5% at 6 months, 71.0 ± 7.7% at 12 months, and 89.0 ± 7.8% at 24 months. Operative time was 101.3 ± 14.6 min. Postoperatively, 18/255 patients (7.1%) had a complication, and leakage and reoperations were reported in 6/255 (2.4%) and 5/255 (2.0%) patients, respectively. Length of hospital stay was 3.1 ± 2.4 days. The quality of evidence was rated as "very low." CONCLUSIONS Despite limitations, this systematic review and meta-analysis showed that RBS after LGP has an acceptable rate of complications and is effective in terms of excess weight loss during follow-up. No specific operation (e.g., SG, RYGB, OAGB) can be suggested over another due to the lack of evidence.
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Affiliation(s)
- Francesco Mongelli
- Department of Surgery, Lugano Regional Hospital, EOC, Via Tesserete, 6900, Lugano, Switzerland.
| | - Zsofia Horvath
- Department of Surgery, Lugano Regional Hospital, EOC, Via Tesserete, 6900, Lugano, Switzerland
| | - Michele Marengo
- Department of Surgery, Locarno Regional Hospital, EOC, Via Dell'Ospedale, 6600, Locarno, Switzerland
| | - Francesco Volontè
- Department of Surgery, Sant'Anna Clinic, Via Sant'Anna 1, 6924, Lugano, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis - University Center for Gastrointestinal and Liver Disesases, 4031, Basel, Switzerland
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, EOC, Via Tesserete, 6900, Lugano, Switzerland
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